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WORKING WITH NON-A Client Care Module:

COMPLIANT CLIENTS©1998-2012

May be copied for use within each physicallocation that purchases this inservice.

We hope you enjoy this

inservice, prepared by

registered nurses

especially

for nursing assistants

like you!

After finishing this inservice, you will be

able to:

Define compliance and adherence and discuss why

knowing the difference is important.

Describe at least three reasons clients may be non-compliant with their plan of care and how you can help.

Demonstrate the ability to read and understand the

Care Plan and state why it is important to do so.

List 4 things you can do to motivate clients to make

changes and comply with their plan of care.

List 3 things you can do to help clients comply with

diet, exercise and medication orders.

If you are studying the inservice on your own, please do the following:

Read through all the material. You may find it useful to have a highlighting marker nearby as you read. Highlight any information that is new to you or that you feel is especially important.

If you have questions about anything you read, please ask _________________________.

Take the quiz. Think about each statement and pick the best answer.

Check with your supervisor for the right answers. You need 8 correct to pass!

Print your name, write in the date, and then sign your name.

Keep the inservice information for yourself and turn in the quiz page to _____________________________ no later than _______________. Show your Inservice Club Membership Card to ___________________ so that it can be initialed.

Email In the Know at [email protected] with your comments and/or suggestions for improving this inservice.

THANK YOU!

Instructions for the Learner

A Client Care Module:

WORKING WITH NON-COMPLIANT CLIENTS

Developing Top-Notch CNAs, One Inservice at a Time

A Client Care Module: Working with Non-Compliant Clients

COMPLIANCE VS ADHERENCE

Inside This Inservice:

© 2012 In the Know, Inc. www.knowingmore.com

May be copied for use within each physical location that

purchases this inservice from In the Know. All other

copying or distribution is strictly prohibited.


When clients ignore medical advice, fail to follow doctors orders or refuse to participate in recommended health improvement activities, they are said to be non-compliant.

Although the term, "non-compliant" is still widely used, it is being replaced slowly by the term, "non-adherence."

The dictionary defines non-compliance as "the failure to obey." This term seems a little awkward for our modern society. Our goal is for clients to want to follow orders for their own well being . . . but they shouldn’t feel like they have to blindly obey in all circumstances!

Adherence, on the other hand, implies an agreement between the client and the medical team that the suggested treatments are valid, worthwhile and necessary for optimal health.

When you re-frame the problem of compliance into one of adherence, you will see that the solution lies in compromise, understanding and mutual agreement on a common goal.

However, until an agreement occurs, problems associated with adherence or non-compliance are

serious and can even lead to death. Here are some facts:

Nearly 70 percent of hospital admissions and 23 percent of nursing home admissions in the United States are the direct result of non-compliance. This makes non-compliance the largest and most expensive "disease category".

In Europe, non-compliance causes nearly 200,000 deaths each year.

One study found that “many people with chronic health conditions do not take their medications as often as prescribed − and that non-compliance may

cost as much as $300 billion per year to the healthcare system.”

Keep reading to learn about the many reasons clients have for refusing to adhere to a treatment plan.

You’ll get plenty of practical tips you can use to help your clients make the decision to adhere to a plan and improve their overall health!

What about Patient Rights?

Why are Clients Non-Compliant?

2

3-5

Understanding the Care Plan

6

The Cost of Non-Compliance

7

All about Motivation! 8

Tips for Encouraging Compliance

9-11

One of the most basic patient rights is the “right to participate”. This means that all patients/client/residents have the right to:

Make decisions about their own care.

Change their minds about health care treatments and services.

Refuse care (after being told what might happen if they do refuse).

Have an advance directive if they want one, including a living will and/or health care power of attorney.

Along with this right, patients have a responsibility to:

Ask for more information if they don't understand something.

Go to all scheduled doctor appointments.

Follow the plan of care that they help create.

Provide your workplace with a copy of their living will or other advance directive.

As you go about your daily care, it’s important to balance your client’s rights with your desire to comply with the plan of care. Here are some tips for doing just that:

Allow your clients to refuse care if they wish—but be sure to document the situation and/or let your supervisor know.

Keep in mind that a client’s medical insurance may have rules about paying for care that the client keeps refusing. For example, if you are a

WHAT ABOUT PATIENT RIGHTS?

A Client Care Module: Working with Non-Compliant Clients © 2012 In the Know, Inc. Page 2

home health aide for a client with Medicare insurance, Medicare may deny payment for your services if, day after day, the client refuses to allow you to assist with personal care.

Honor any advance directive. For example, if your client has a “Do Not Resuscitate” order, made sure you know what to do if he or she stops breathing during your care.

Make it a habit to explain what you are going to do with a client—before you do it. Your clients will be better prepared and more likely to comply if they know what’s going on. For example, explain to Mr. Wilson that you’re going to help him change position in bed—before you pull down his blanket and sheet!

Remember that all adults have the right to choose where and how they want to live—even if that environment seems unsafe or unhealthy to us. For example, Mr. Brown lives in a home with no

electricity. You might feel that Mr. Brown would be healthier if he could refrigerate his

foods, but he has lived in his home for twenty years and sees no reason to change now.

Never threaten your clients to get them to comply. For example, it’s wrong to say, “If

you don’t take a bath right now, you can’t watch TV this afternoon.”

Don’t force care on a client even if you know the client will be better off. For example, you can’t force a client to eat his lunch even if you are worried that he has been losing too much weight lately. (But be sure to document the fact that the client refuses to eat.)

Grab your favorite highlighter! As you read through this inservice, highlight five things you learn that you didn’t know before. Share this new information with your supervisor and co-workers!

There are many reasons your client may not follow a treatment plan. Sometimes it involves a combination of reasons. Over the next few pages, you will learn about some of the most common causes for clients not adhering to the plan of care.

INSTRUCTIONS ARE UNCLEAR OR TOO COMPLEX: Medical professionals speak their own language and can easily confuse non-medical people. Your client may not follow orders because the orders were not explained clearly or in a way that makes sense.

Example: Mrs. Jones was just discharged to her home with a new diagnosis of diabetes. She was given instructions to check her blood glucose level before each meal and at bedtime. She is supposed to write down her results and then self inject insulin on a sliding scale (based on the results). She was given a new diet to follow that is completely different from the way she has eaten her whole life, and she is supposed to get some exercise each day, eliminate alcohol, protect her feet, and lose weight.

When you arrive for your visit with her, you find she is only doing her finger sticks once a day, is not writing it down and can't recall how much insulin she has injected. In addition, you notice she is having a glazed donut for breakfast!

How you can help: Break down the steps into smaller, more manageable goals. With your supervisor’s okay, suggest Mrs. Jones spend the first week focusing on checking her blood sugar, documenting the results and getting comfortable with self-injecting insulin. Then, the following week you can work on helping her understand the diabetic diet. After that, you can add exercise, and so on.

Breaking the routine down into smaller, more manageable goals will give Mrs. Jones more time to focus on the individual tasks before putting it all together.

WHY ARE SOME CLIENTS NON-COMPLIANT?

A Client Care Module: Working with Non-Compliant Clients © 2012 In the Know, Inc. Page 3

PHYSICALLY UNABLE TO COMPLY: At times, a treatment may simply be physically impossible for your client. To make matters worse, some clients may not be willing to admit they can't perform a certain task.

Example: Mr. Hopkins recently fell and broke his hip. His surgery was successful but rehab is slow and he doesn't seem to be progressing. When you go to get him up for his ordered ambulation, he has many excuses to avoid the task. He tells you he wants to rest a few minutes . . . he is watching television . . . or, waiting for a visitor.

How you can help: Give him some time, but ask questions! You may learn that it is very painful for him to ambulate. Or, maybe he has another issue such as arthritis or a bad back that is troubling him. In this case, tell the nurse. Your client may be able to get some pain medication before he exercises.

DEPRESSION/HOPELESSNESS: There is a grieving process that occurs when a client is given a serious diagnosis. Sometimes this grief can cause the client to become depressed which can interfere with the ability to make rational decisions.

Example: Mrs. Smith was just diagnosed with advanced stage lung cancer. The doctor has recommended radiation and chemotherapy, which she refuses. She is placed on oxygen and told to

quit smoking. However, several times a day you find her outside the nursing facility without her

oxygen and smoking a cigarette.

How you can help: Discuss the issue with your supervisor. The nurse or social worker

can get a counselor or psychologist involved or recommend a peer support group.

Encourage family members to become involved. Monitor and report any signs of depression or suicidal thoughts to your supervisor immediately!

© 2012 In the Know, Inc. Page 4 A Client Care Module: Working with Non-Compliant Clients

COST OF TREATMENT: Even with insurance, the cost of some treatments and medications may be too high for your client.

Example: Mr. White takes many medications for various health problems. One day he tells you that in order to save money he takes a couple of the pills every other day, instead of every day as ordered.

Statistics show that about 125,000 Americans die each year because they do not take their medications properly.

How you can help: Make a list of which medications your client is taking incorrectly. Report the information to your supervisor immediately. There may be other options. Some generic medications are much cheaper than brand names and sometimes having the doctor choose an alternative medication that is covered under the client’s insurance plan can make all the difference.

PAST EXPERIENCES: A negative experience with a treatment or medication may lead a client to be non-compliant. In addition, a negative experience for a loved one can also influence a client to disregard or refuse medical advice.

Example: Mrs. Hart recently suffered a heart attack. The doctor prescribed a medication for high blood pressure. Mrs. Hart's husband previously had a severe allergic reaction to this same medication so she is afraid to take it. She confides to you that she spits it out after the nurse leaves.

How you can help: If you learn your client is not taking a prescribed medication out of fear, notify your supervisor immediately! This could be a life or death situation! Reassure your client that medications can react differently in different people. Then, tell her that her physician will be notified so that a solution (such as an alternate drug) can be found.

WHY ARE CLIENTS NON-COMPLIANT? - CONTINUED

LACK OF CONTROL: Needing to rely on others to complete life's basic tasks can leave your client feeling vulnerable and helpless. Combine that helpless feeling with doctors and nurses who don't always ask for the client's input on treatment. When clients feel they are not in control of their environment or treatment plan, they may not willingly participate.

Example: Mr. Johnson has never been sick a day in his life and he has never had to stay in a hospital. He is a strong, independent man who is accustomed to running his life on his own terms. Now, a serious illness has landed him in the hospital, separated from his work and family and surrounded by strangers.

The doctor has ordered coughing and deep breathing exercises every two hours to prevent pneumonia. Mr. Johnson has been taught how to do this and has demonstrated proper technique to the nurse. However, when you ask him about it, he says he only does it once a day and that's all he is going to do.

How you can help: If you feel your client is not following orders for fear of losing control, come up

with a way to get him to agree to do the exercises on his own terms. For instance, ask him how often he thinks he can do it and when he thinks are the best times.

See if you can get him to compromise on a plan that gets him to do the exercises at regular intervals throughout the day.

Stress the importance of preventing pneumonia but lead him to come up with the plan of doing the exercises on his own schedule. This will give him a sense of

control and increase the likelihood that he will actually do the deep

breathing!


UNDERSTANDING OF DISEASE: Doctors and nurses have an obligation to explain diseases and their treatments to clients in a way that meets each individual’s needs. However, the information is not always communicated effectively. Language, cultural differences, stress and education level can all interfere with the client's understanding of a disease process.

Example: Mrs. Sims has congestive heart failure. She is on many heart medications which she understands. But, she is also on a diuretic (water pill) which makes her urinate more frequently. Mrs. Sims thinks the water pill must be a mistake. When she gets tired of going to the bathroom so frequently, she stops taking the pill.

Without the diuretic, fluids builds up in Mrs. Sims’ body causing edema (swelling) and eventually backs up in the lungs causing her to be hospitalized.

How you can help: Encourage your clients to follow all medication and treatment instructions as ordered. If a client does not understand a particular medication or treatment, a call to the nurse, doctor or pharmacist can usually clear things up.

ALTERED MENTAL STATUS: Clients with altered mental status may appear, at times, to be non-compliant. But, this situation is different from all the others that have been discussed so far. This is not considered willful non-compliance. In other words, the client is not necessarily responsible for deciding not to comply. This means that simply explaining the situation to the client, or employing other tips you've read about so far, won't work!

Example: Mr. Bell has dementia. He is still fairly independent, can make decisions and participates in his own care. (He lives in an assisted living facility.) However, some days are worse than others and lately he has been forgetting to eat, bathe or change his clothes regularly.

How you can help: The best way to handle this type of situation is to create a simple but predictable routine. Although this type of non-compliance is unintentional, there can still be serious consequences.

Remember to EXPECT SETBACKS! Dementia, Alzheimer's and other diseases that cause altered mental status are usually progressive. In other words, they get worse over time.

How do you report a client’s non-compliance?

You may have daily client care forms to complete or you may give an oral report to your supervisor. Either way, it’s not enough to just say, “Client is non-compliant.”

Recall Mr. Johnson (p. 3). If Mr. Johnson develops pneumonia as a result of his non-compliance—but it’s not documented—the medical team could potentially get into legal trouble for failing to administer the treatment.

Here’s an example of what you could tell your supervisor:

“Mr. Johnson says he is doing breathing exercises once a day instead of every 2 hours as ordered. We talked about how the exercises help prevent pneumonia and he says he’ll begin doing them every 2 hours as ordered.”

Be sure to follow up with this client and report any improvement or continued non-compliance.

CHALLENGE! Look back at the examples on pages 2-4. Practice

reporting these scenarios according to your workplace policy.

Share your ideas with your supervisor and ask for

feedback to make sure it’s correct!

WHY ARE CLIENTS NON-COMPLIANT? - CONTINUED


If you are not already in the habit of reviewing client charts and/or plans of care, ask your supervisor if you can take a few minutes to look through and learn what you can about your client(s).

When you have a non-compliant client, knowing the reason for certain orders will help you help your client understand and agree to follow the treatment plan. You will find the rationale, or reason for orders in a client’s chart. Typically, here’s what you will find:

History of Present Illness: This section will be a detailed report of what brought the client to your facility or agency. These reports are usually easy to read and provide a good background about what your client has been through before coming to you.

Doctors’ Orders: This is where the doctors write their orders for the client. It can be difficult to read these, especially if they are hand written. The nurse usually reads the doctor’s orders and carries out the instructions.

CARE PLAN: This is the most important part for you! The Care Plan (sometimes called the MDS) is the plan of care, outlined by the nurse, that you and the nurse will carry out with the client.

The nurse writes the Care Plan based on a physical assessment, history of illness, goals for recovery and reports from you. It will contain information about how the client performs activities of daily living and will instruct you on how you can help your client meet specific goals for health improvement.

For example, a client who is recovering from a stroke may have the following orders in the care plan:

Monitor respiratory status (to assess changes in neurological status).

Assist client to sitting position, instruct to inhale deeply and cough (to expel secretions).

Encourage use of incentive spirometry (to prevent pneumonia).

Perform, assess and document ROM, transfer abilities, and positioning abilities (to assess current status and changes in ability to perform these functions—this will lead to changes in the care plan).

Maintain alignment with support pillows and footboard (to prevent contractures).

Encourage client to practice ROM independently (to promote sense of control).

Having a non-compliant client can be very frustrating for caregivers. It can leave you feeling like you are doing a lot of work for nothing!

The best way to deal with the frustration and stress of having a non-compliant client is to talk about it with co-workers.

Here are some conversation openers:

I have a client who would feel so much better, if only he/she would do what the doctor tells her . . .

Have you ever had a client who refuses to ____________? What do you do in these situations?

I completely understand why my client won’t ____________ but I need to find a way to get her to do it. Any suggestions?

REVIEW THE CHART: UNDERSTAND THE CARE PLAN

“If there were a cure for non-compliance…a pill that would make you take your other pills…it

would be a greater blessing to human health than any medication since

penicillin…”

Dr. Craig Saxton, former Head of Pfizer

©2012 In the Know, Inc. Page 7 A Client Care Module: Working with Non-Compliant Clients

THE COST OF NON-COMPLIANCE

Money, time, psychological stress, and the price of a human life are among the many costs associated with non-compliance.

Failure to comply with medical instructions causes up to one-fourth of all hospital and nursing home admissions and results in about 340 deaths per day.

Clients who ignore medical recommendations have 3 times as many doctor visits and pay $2000 per year in additional costs compared to those who follow their treatment plan

Medication-related hospital admissions in the US cost as much as 100 billion dollars every year!

While it is difficult to truly calculate the cost of non-compliance, most studies today have proven that adherence to treatment plans actually saves time, money, stress and can save lives.

Here is a scenario to show you how non-compliance can be costly:

Mrs. Jenkins goes to the doctor with a cough and fever. She is diagnosed with an upper respiratory infection and prescribed a 10 day course of an antibiotic.

She feels better after day 6 and stops taking the medication. Symptoms return one week later and Mrs. Jenkins goes back to the doctor where she fails to report that she didn't take the medication as ordered. The doctor assumes the medication didn't work and prescribes a stronger, more expensive antibiotic which has unpleasant side effects.

When Mrs. Jenkins can't take the medication because of the side effects, her condition worsens and she is taken to the emergency room where doctors admit her for IV antibiotics.

Now, what could have been solved with one trip to the doctor and one prescription for an antibiotic has turned into a very expensive hospital stay. Additionally, Mrs. Jenkins is away from her home and family and at risk of developing additional infections just by being in the hospital.

In the past, the medical community felt that patients who were non-compliant just didn’t understand the instructions or the reason for the instructions . . .

As a result, long explanations about diseases, medications, and other therapies were given to clients. But, they still didn’t comply!

Today, research has shown that people only change when:

Their values support it,

They think the change will be worth it,

They believe they can and should change,

They are ready for it, and

They have a good plan with plenty of support.

1. Think about a non-compliant client you have cared for. Why do you think this client is/was non-compliant?

2. Based on the above information, what do you think can be done to get this client to follow orders?

3. Share your ideas with your co-workers and ask them how they handle these situations.

You, the doctor, the nurse, family members and friends can explain the benefits of adhering to the medical plan to your client until you are all blue in the face . . . but none of the effort will matter unless your client is MOTIVATED to change!

So how do you motivate someone to change?

Remember, research has shown that people change because:

Their values support it,

They think the change will be worth it,

They believe they can and should change,

They are ready for it, and

They have a good plan with plenty of support.

Lack of motivation is the main reason clients fail to change bad habits in order to improve health.

Instead of preaching, harping, nagging and threatening, try these tactics:

PLAY THE “GOOD COP” ROLE: Establish a relaxed and easy relationship. Let your clients know you are on their side and only want what’s best. Say, “It’s not easy making these big changes.” Then, follow up with, “But, you did say you felt better when you quit smoking in the past.”

SUPPORT INDEPENDENCE AND CONTROL: Let your clients know that no one can force any treatment on them. Reassure them that they are in control. Follow up by encouraging them to explore all the options and talk to the doctor about a plan that better fits their goals and lifestyle.

PRAISE EVEN THE SMALLEST EFFORTS: Giving support and encouragement can have a huge impact on a client’s willingness to participate in and continue treatment. Let your client know you are proud of every accomplishment.

AGREE ON A PLAN: Getting the client to come up with and agree on a plan increases the likelihood that it will actually get done! So, instead of just telling your clients to get some exercise every day, ask what time of day is best, what type of exercise they find most fun, and get a list of some alternatives in case the weather is bad or they get bored.

©2012 In the Know, Inc. Page 8 A Client Care Module: Working with Non-Compliant Clients

ITS ALL ABOUT MOTIVATION!

Think about a client you are caring for right now who is not adhering to the plan of care.

Meet with the nurse to discuss the issue. Make sure you know exactly what needs to be done and why.

Try to understand why your client may not be compliant.

Sit down with the nurse and the client and see if you can get the client to come up with a workable plan.

Here are your guidelines:

Let your client know you only want what’s best,

Reassure your client that you won’t force anything,

Support whatever decision is made, and

Remember to follow up with praise for even the smallest efforts!

“It's kind of fun to do the impossible.”

~ Walt Disney


FOCUS ON DIET & NUTRITION

Just about every disease process you encounter will require your clients to make changes in the way they eat. But, this is the hardest medical advice to follow!

No one wants to give up favorite foods . . . So, encourage your clients to try healthier versions of their favorite foods. For example, they may enjoy mac and cheese made with whole wheat pasta and low fat cheese or a hamburger made from ground turkey instead of beef...and so on.

Keep cravings under control by occasionally allowing small bits of "forbidden" foods (like 5-6 M&M's or 1 fun size candy bar).

Sometimes eating healthy is hard because clients just don't know what to eat. Introduce one or two healthy items to your client each week. Have fun with it. You may find a new favorite for yourself, too!

Relate better eating habits to achieving health goals. For example, show your client how healthy eating results in better blood sugar results or lower blood pressure.

FOCUS ON EXERCISE AND ACTIVITY

Exercise builds strength, coordination and endurance. It can lift a depressed mood and actually give clients more energy. The problem is that it's hard work! Motivation is the key factor here!

Start by developing a plan. Allow your clients to participate in the planning stage. But, be sure to follow up and hold them

accountable for following through with the plan.

Begin any new routine slowly to avoid pain or injury. Reassure your client that the activity will

stop if there is any pain at all.

Have your client set a goal like "lose 10 pounds, or "be able to walk to the corner (or down the hall) and

back." Decide on a realistic reward for when the goal is reached.

Praise every effort and be sure to point out progress like weight loss, increased strength or increased endurance.

TIPS FOR ENCOURAGING COMPLIANCE / ADHERENCE

Working with clients in the home often requires coming up with creative solutions to uncommon problems.

THE PROBLEM: You are caring for a 65 year old man who has diabetes. Two months ago he developed a sore on his foot that has failed to heal. The wound has become gangrenous and the doctor has recommended amputation, which your client does not want to do.

To make matters worse, your client continues to eat a high fat, high carbohydrate diet, does not exercise and has poor control of his blood sugar levels.

WHAT YOU KNOW: You know that without the surgery, your client’s life is in danger. You also know that without making necessary lifestyle changes, your client is going to continue to have serious problems related to his diabetes.

GET CREATIVE: Think of 3 creative solutions you might try with your client right now to get him to agree to the surgery and make the necessary changes to improve his overall health.

TALK ABOUT IT: Share your ideas with your co-workers and supervisor and find out how they would solve the problem.


FOCUS ON REST

We spend a lifetime complaining about how busy we are. There is never enough time to rest! Then as soon as someone tells us we have to rest . . . we can think of ten thousand things that need to be done right away!

Help your client comply with orders to rest by encouraging delegation! Tell your client to share the load. Pass the work around! Rally friends and family members to help, if possible.

If the work your client is requesting you to do seems unimportant, have her make a list of all the things she wants done, then ask her to prioritize the top three and work on those.

Be sure your client has easy access to everything she needs within arm's reach like the telephone, newspaper, books, a glass of water, the TV remote, laptop computer, pen and paper, glasses, or whatever else she seems to need to get through the day.

FOCUS ON KEEPING APPOINTMENTS

Missed appointments can be costly and can delay treatment that may be critical to your client's health.

Develop a system with your client for keeping track of appointments. This can be a calendar, appointment book, dry erase board, or any other system the client feels comfortable using.

Go through appointment cards and put all the dates, times, and who the appointment is with on the calendar.

Get your client into the habit of looking at the week ahead to plan in advance for appointments. Arrange transportation at least one week in advance.

Encourage your clients to request appointment times when they know they will

have the most energy. For example, if your client feels best just after lunch,

recommend she schedule her appointments for this time of day.

Stress the importance of cancelling and re-scheduling if your client is unable to make it to the scheduled appointment.

TIPS FOR ENCOURAGING COMPLIANCE – CONTINUED

1. No one wants to be ordered around, or told what to do! Involving clients in the care plan will increase the likelihood of it actually getting done!

2. All clients have rights. These include the right to be involved in their own care and the right to refuse treatment.

3. Change is hard! It’s not enough to just tell clients they have to make a change . . . They must be motivated to make the change in their own time, and on their own terms.

4. Give clients a running start by removing barriers to compliance, such as cost, access and physical ability to comply.

5. Providing emotional support, praising every effort, and working on mutually agreed upon goals will give your client the strength and confidence necessary to achieve optimal health!


FOCUS ON MEDICATIONS (GREAT FOR HOME CARE!)

Whether you work in home care or help get clients healthy enough to go home, these tips may be helpful. Keep in mind: the sheer volume of pills that some clients must take each day can be confusing and difficult to schedule and remember.

Unless your client tells you there is a problem with a medication, you may not know until it's too late. Ask questions! Ask your clients if they are taking all their medications or if they are having any trouble with side effects.

Alert the nurse immediately if your client tells you he is not taking a particular medication or has unpleasant side effects.

Recommend your client make a list of all current medications, doses and frequencies. Write out a daily schedule with the medications listed at the appropriate times throughout the day (see medication worksheet included in handouts for this lesson).

Recommend using a medication reminder aid, such as daily pill organizers. Your client can sit down once a week and sort the pills into small boxes marked for each day of the week. That way, if a dose is missed, it will be easy to recognize because it will still be in the pill sorter.

If your client is having trouble remembering to take a certain medication, try to attach a routine to it. For example, Ms. Smith is supposed to take one pill at bedtime. However, she goes to bed at different times, and sometimes she falls asleep in front of the TV in the living room. Suggest Ms. Smith take the pill when she sits down to watch a certain program, or take the pill when the brushes her teeth in the evening. The routine itself can be anything that fits her lifestyle. The important part is that she remembers to take it and that she takes it about the same time each night.

If side effects are a problem, recommend the client call the doctor or pharmacist for guidance. There is usually a solution, such as taking with certain foods, or at certain times of the day.

Speak to the nurse or social worker if your client tells you she is unable to afford her medications. Often, prescriptions can be changed to a generic or something more affordable. You may also recommend your client visit the Partnership for Prescription Assistance at www.pparx.org if access to the internet is available.

TIPS FOR ENCOURAGING COMPLIANCE – CONTINUED

Now that you‘ve read this inservice on non-compliant clients, take a moment

to jot down a couple of things you learned that you didn’t know before.

Are you “In the Know” about non-compliant clients? Circle the best choice or fill in your answer. Then check your answers with your supervisor!

1. True or False The only reason that clients are non-compliant is because they just don’t understand the nurse’s or doctor’s instructions.

2. True or False Cost of medications and treatment can be a barrier to compliance.

3. True or False When a client is non-compliant, you should document, “client non-compliant” in the chart.

4. True or False The Care Plan is the plan of care, outlined by the nurse, that you and the nurse will carry out with the client.

5. Your client has nausea and diarrhea from a new medication he is taking, you should: A. Recommend he take half the dose. B. Tell him to stop taking the medication. C. Crush up the medication and mix it in milk. D. Call the doctor or pharmacist for guidance.

6. True or False If your client is physically unable to comply with orders, you should force them to do it anyway. If the doctor ordered it, it has to be done.

7. True or False A client who is not following an ordered diet may not know what to eat.

8. True or False Lack of motivation is the main reason clients fail to follow orders.

9. True or False The goal with clients should be to get them to obey doctor’s orders without question.

10. Fill in the Blanks When a client with altered mental status is non-compliant it is not considered

_______________ non-compliance, in other words, it is not a conscious decision.

Inservice Credit:

Self Study 1 hour

Group Study 1 hour

File completed test in employee’s personnel file.

EMPLOYEE NAME (Please print):

________________________

DATE: __________________

I understand the information presented in this inservice.

I have completed this inservice and answered at least eight of the test questions correctly.

EMPLOYEE SIGNATURE:

________________________

SUPERVISOR SIGNATURE:

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A Client Care Module: Working with Non-Compliant Clients


working with non- compliant clientstraining.firstchoiceohio.com/wp-content/uploads/2014/04/... ·...

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