The nursing diagnosis Noncompliance is defined as the behavior of a person and/or caregiver that fails to coincide with a health-promoting or therapeutic plan agreed on by the person (and/or family and/or community) and health care professional. In the presence of an agreed-on health-promoting or therapeutic plan, a person’s or caregiver’s behavior is fully or partially nonadherent and may lead to clinically ineffective outcomes.
Learn about the nursing interventions, care plan goals, assessment, and related factors for Noncompliance with nursing diagnosis.
NOTE: As of 2018, the nursing diagnosis Noncompliance is retired from the current taxonomy. According to the NANDA-I, the diagnosis “was quite old with the last revision in 1998. It is no longer consistent with the majority of current research in the area, which has its focus on the concept of adherence rather than compliance.”
Compliance is defined as the extent to which a person’s behavior (in terms of taking medications, following specific regimens, or dealing with lifestyle modification) coincides with medical or health advice. Whereas noncompliance is literally defined as the patient’s failure to comply with the prescribed treatment regimen for his/her full recovery from such illness or disease.
Patient education has been determined to actually improve compliance with medication across a broad range of conditions and the extent of diseases. However, patient knowledge alone does not guarantee compliance. A patient must be well prepared and well informed about the management of their condition, instructions from their physician, and potential side effects of any treatments. The more clearly a disease is apprehended, the more likely it is that an individual will be complacent with their care and comply with necessary treatment regimens.
Factors associated with noncompliance include past history of noncompliance, stressful lifestyles and environment, socioeconomic status, contrary cultural or religious beliefs and values, lack of social support, lack of financial resources, and compromised emotional state. Lack of compliance is linked with unsatisfactory clinical outcomes, increased hospitalizations, lower quality of life, and higher overall healthcare costs.
Nursing Assessment and Rationales
Nursing assessment tips and cues for noncompliance:
1. Examine the actual therapeutic effect with the expected effect.
These data give baseline information on compliance.
2. Request the patient to bring prescription drugs to appointments; count remaining pills.
This approach provides objective evidence of compliance. This evidence is very useful in research protocols.
3. Evaluate serum or urine drug levels.
This data is useful in distinguishing if the patient is not using the recommended treatment and those not responding to a prescribed treatment.
4. Assess the patient’s understanding of his or her current condition and the importance of health care.
Views on maintenance vary for each patient. Some may base it on religious beliefs and refuse medical treatments. Others may consider natural remedies. This approach will provide a basis for planning future care.
5. Assess the patient’s viewpoint and interest in complying with the treatment regimen.
According to the Health Belief Model, a patient’s perceived susceptibility to and perceived seriousness and the threat of disease, along with perceived benefits from adhering to the treatment plan, affect compliance. Some patients may not be able to apprehend the severity of their disease or their ability to manage some of the ongoing symptoms.
6. Assess the factors that the patient thinks interfere with compliance.
Each piece of information is unique to each patient and it allows for individualizing the corrective plan.
7. Evaluate the patient’s insight about the treatment regimen.
Understanding and considering each patient’s worries and misconceptions about the treatment plan help in future interventions.
8. Assess the patient’s religious beliefs and practices that affect health and disease management.
People of other cultures may have different views and approaches to certain illnesses. Many people believe that a disease can be healed through divine intervention or spirituality.
Nursing Interventions and Rationales
The following are the therapeutic nursing interventions for Noncompliance nursing diagnosis:
1. Create a plot of the pattern regarding hospitalizations and clinic appointments.
These data provide objective information regarding follow-up but do not necessarily mean that the patient is not complying with other prescribed therapies.
2. Develop a therapeutic relationship between and among the patient and significant others.
This allows the patient to gain the trust of the nurse and will boost confidence in the completion of the treatment.
3. Involve the patient in planning the proper treatment for him or her.
Patients who are included in the planning have a greater stake in achieving a positive outcome.
4. Eliminate disincentives to compliance.
Decreasing waiting time in clinics, recommending lower levels of activity, and suggesting medications with fewer side effects can increase compliance.
5. Provide therapy that is short and simple. Eliminate unnecessary medication.
Compliance increases when therapy is short and easy to understand.
6. Discourage any unnecessary clinic visits.
Physical demands of traveling to an appointment cause patients to avoid upcoming follow-ups.
7. Adjust the therapy to the patient’s lifestyle.
A “one-size fits all” approach is usually ineffective.
8. Explain that side effects can be controlled or eliminated.
Side effects of medications are usually a commonly reported problem.
9. Supervise the patient until compliance improves.
Home health nurses, telephone monitoring, and frequent return visits or appointments can provide increased supervision as needed that can be tapered as appropriate.
10. Create a behavioral contact.
This approach can aid the patient to accept his or her role in the entire treatment regimen.
11. Create with the patient a system of rewards that follow successful compliance.
Rewards provide positive reinforcement for compliant behavior.
12. Educate the patient and the family members on the treatment regimen that the patient will undergo.
This increases awareness about the importance of completing the prescribed treatment. It provides increased compliance with such treatment.
13. Provide specific instructions as indicated.
The information allows the patient to better take control in selecting and implementing required changes in behavior.
14. Explore available community resources.
Churches, social clubs, and community groups can play a dominant role in some cultures.
15. Provide social support through the patient’s family and self-help groups.
Such groups may help the patient in gaining a greater understanding of the benefits of treatment compliance.
Recommended Resources
Recommended nursing diagnosis and nursing care plan books and resources.
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Ackley and Ladwig’s Nursing Diagnosis Handbook: An Evidence-Based Guide to Planning Care
We love this book because of its evidence-based approach to nursing interventions. This care plan handbook uses an easy, three-step system to guide you through client assessment, nursing diagnosis, and care planning. Includes step-by-step instructions showing how to implement care and evaluate outcomes, and help you build skills in diagnostic reasoning and critical thinking.
Nursing Care Plans – Nursing Diagnosis & Intervention (10th Edition)
Includes over two hundred care plans that reflect the most recent evidence-based guidelines. New to this edition are ICNP diagnoses, care plans on LGBTQ health issues and on electrolytes and acid-base balance.
NANDA International Nursing Diagnoses: Definitions & Classification, 2021-2023
The definitive guide to nursing diagnoses is reviewed and approved by the NANDA International. In this new version of a pioneering text, all introductory chapters have been rewritten to provide nurses with the essential information they need to comprehend assessment, its relationship to diagnosis and clinical reasoning, and the purpose and application of taxonomic organization at the bedside. A total of 46 new nursing diagnoses and 67 amended nursing diagnostics are presented.
Nurse’s Pocket Guide: Diagnoses, Prioritized Interventions, and Rationales
Quick-reference tool includes all you need to identify the correct diagnoses for efficient patient care planning. The sixteenth edition includes the most recent nursing diagnoses and interventions from NANDA-I 2021-2023 and an alphabetized listing of nursing diagnoses covering more than 400 disorders.
Nursing Diagnosis Manual: Planning, Individualizing, and Documenting Client Care
Identify interventions to plan, individualize, and document care for more than 800 diseases and disorders. Only in the Nursing Diagnosis Manual will you find for each diagnosis…. subjectively and objectively – sample clinical applications, prioritized action/interventions with rationales – a documentation section, and much more!
All-in-One Nursing Care Planning Resource – E-Book: Medical-Surgical, Pediatric, Maternity, and Psychiatric-Mental Health
Includes over 100 care plans for medical-surgical, maternity/OB, pediatrics, and psychiatric and mental health. Interprofessional “patient problems” focus familiarizes you with how to speak to patients.
See also
Other recommended site resources for this nursing care plan:
- Nursing Care Plans (NCP): Ultimate Guide and Database MUST READ!
Over 150+ nursing care plans for different diseases and conditions. Includes our easy-to-follow guide on how to create nursing care plans from scratch. - Nursing Diagnosis Guide and List: All You Need to Know to Master Diagnosing
Our comprehensive guide on how to create and write diagnostic labels. Includes detailed nursing care plan guides for common nursing diagnostic labels.
References and Sources
The following are the recommended sources for Noncompliance nursing diagnosis:
- Ackley, B. J., Ladwig, G. B., Msn, R. N., Makic, M. B. F., Martinez-Kratz, M., & Zanotti, M. (2019). Nursing Diagnosis Handbook E-Book: An Evidence-Based Guide to Planning Care. Mosby. [Link]
- Carpenito-Moyet, L. J. (2006). Handbook of nursing diagnosis. Lippincott Williams & Wilkins. [Link]
- Falvo, D. R. (2004). Effective patient education: A guide to increased compliance. Jones & Bartlett Learning.
- Seltzer, A., Roncari, I., & Garfinkel, P. (1980). Effect of patient education on medication compliance. The Canadian Journal of Psychiatry, 25(8), 638-645.
- Vincent, P. (1971). Factors influencing patient noncompliance: a theoretical approach. Nursing Research.
Good Morning Gil,
Congratulations on your publication. Your article is well written and focused. While I agree with your nursing assessments and interventions, I would like to reflect on the word “compliance”
The word “compliance” means to act in accordance with a wish or command. In itself the word is paternalistic although well-meaning. The implication of the word is that the patient is willfully disobeying an order.
I prefer the term “adherence” to “compliance”. The definition of adherence is to commit to a cause or belief, which is less paternalistic and more patient centered. We, as nurses, strive to assist the patient with the goal of independent self-care. You can see that adherence is a word that assumes the patient’s participation in that mutually agreed upon goal.
I believe the word change also changes our view of the patient as one who “won’t listen” to our advice, to one where we partner with the patient to solve the reasons behind their inability to adhere to their plan.
Thank you for your investment in the nursing profession.
Best Regards,
Cynthia
Cynthia Moore MSN, RN, M.Ed.
Hi Cynthia,
I agree. The current taxonomy states that noncompliance is no longer consistent with the current research about it and thus retired as of the 11th edition of the NANDA-I nursing diagnosis taxonomy. We’ll try to update this accordingly. Thank you!