The nursing diagnosis Noncompliance is defined as behavior of 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 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 a 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 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 to 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.
Related Factors for Noncompliance
Here are some factors that may be related to the nursing diagnosis Noncompliance:
- Conflicting health values
- Health beliefs
- Cultural beliefs
- Religious beliefs
- Spiritual values
- Nurse-patient relationships
- Complexity of therapeutic regimen
- Financial limitations
- Lack of support groups
- Deficient knowledge on the benefits of compliance to such treatment
- Health care system barriers
Defining Characteristics of Noncompliance
The following are the assessment cues or inferences manifested by the Noncompliance nursing diagnosis:
- Behavior suggestive of failure to comply to a therapeutic recommendation
- Objective tests: inaccurate pill counts or missed prescription refills
- Evidence of development of complications
- Evidence of exacerbation of symptoms
- “Revolving-door” hospital admissions
- Missed checkups and consultations
- Therapeutic effect not achieved or maintained
Goals and Outcomes for Noncompliance
The following are the common goals and expected outcomes for Noncompliance nursing diagnosis:
- Patient/significant other reports compliance with the therapeutic plan.
- Patient verbalizes the benefits and importance of complying to such treatment.
- Patient complies with therapeutic plan as evidenced by proper intake of medicines following the prescribed dosage and duration, appropriate pill count, maintained medical appointments, and fewer hospital admissions.
- Patient displays gradual health restoration with minimal or no complications developed.
Nursing Assessment for Noncompliance
Nursing assessment tips and cues for Noncompliance nursing diagnosis.
|Examine the actual therapeutic effect with the expected effect.||These data gives baseline information on compliance.|
|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.|
|Evaluate serum or urine drug levels.||This data is useful in distinguishing if patient is not using recommended treatment and those not responding to a prescribed treatment.|
|Assess the patient’s understanding about his or her current condition and the importance of health care.||Views on maintenance vary from each patient. Some may base it on religious beliefs and refuse medical treatments. Other may consider natural remedies. This approach will provide a basis for planning future care.|
|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 threat of disease, alonf with perceived benefits from adhering to treatment plan, affect comliance. Some patients may not be able to apprehend the severity of their disease or their ability to manage some of the ongoing symptoms.|
|Assess the factors that the patient thinks interfere with compliance.||Each information is unique to each patient and it allows individualizing the corrective plan.|
|Create a plot of 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.|
|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.|
|Assess the patient’s religious beliefs and practices that affect health and disease management.||People of other cultures may have different views and approach to certain illness. Many people believe that a disease can be healed through divine intervention or spiritually.|
Nursing Interventions for Noncompliance
The following are the therapeutic nursing interventions for Noncompliance nursing diagnosis:
|Develop a therapeutic relationship between and among the patient and significant others.||This allows the patient to gain trust from the nurse and will boost confidence in the completion of the treatment.|
|Involve the patient in planning the proper treatment for him or her.||Patients who are included in the planning have greater stake in achieving a positive outcome.|
|Eliminate disincentives to compliance.||Decreasing waiting time in clinics, recommending lower levels of activity, and suggesting medications with fewer side effects can increase compliance.|
|Provide therapy that is short ans simple. Eliminate unnecessary medication.||Compliance increases when therapy is short and easy to understand.|
|Drop any unnecessary clinic visits.||Physical demands of traveling to an appointment cause patient to avoid upcoming follow-ups.|
|Adjust the therapy to the patient’s lifestyle.||A “one-size fits all” approach is usually ineffective.|
|Explain that side effects can be controlled or eliminated.||Side effects of medications is usually a commonly reported problem.|
|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.|
|Create a behavioral contact.||This approach can aid the patient accept his or her role in the entire treatment regimen.|
|Create with the patient a system of rewards that follow succesful compliance.||Rewards provides positive reinforcemnets for compliant behavior.|
|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 to such treatment.|
|Provice specific instructions as indicated.||Information allows the patient to better take control in slecting and implementing required changes in behavior.|
|Explore available community resources.||Churches, social clubs, and community groups can play a dominant role in some cultures.|
|Provide social support through the patient’s family and self-help groups.||Such groups may help the patient in gaining greater understanding of the benefits of treatment compliance.|
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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.