¶ … Compliance Patient compliance is not always easy to obtain and it is frustrating when patients fail to follow recommendations and instructions. In addition, nurses and physicians tend to expect compliance while there is plenty of evidence derived from clinical studies that compliance should not be expected. This work intends to examine and analyze the issue of patient compliance. (Stone, et al., 1998) Lamb (nd ) reports that for products marketed in the United States "poor compliance with treatment regimens is estimated to cost the health care system around $100 billion each year. More than 100,000 patient deaths and one million hospital admissions each year, in addition to increased antibiotic resistance, are believed to be due to poor patient compliance in clinical trials is equally serious."

Stone et al. (1998) states that in the era of the empowered patient "it is time to think about compliance in a different way. Compliance implies an involuntary act of submission to authority, whereas adherence refers to a voluntary act of subscribing to a point-of-view." In fact, Stone et al. (1998) states that the difference "is not just semantic; it goes right to the heart of our relationship with our patients. We need to influence out patients to become -- or remain -- adherents of good self-care." According to one source it has been estimated by experts that "non-adherence costs the pharmaceutical industry in excess of $30 billion a year - not to mention, the chance at a fuller, healthier life for countless patients." (Eye For Pharma, 2010)

The work of Agnosta (2005) states that patient satisfaction with care received " is an essential criterion by which patients assess quality of medical care received. Positive satisfaction with health care is further viewed as a determinant of patient compliance and subsequent health status outcome." In fact the work of Renzi et al. (2001) is reported to have correlated "poor patient satisfaction with poor adherence to prescribed medical regimes and consequently poor health outcomes." (cited in Agnosta, 2005) In addition it is reported by Vuckovich that Graham (2002) states findings that "affective support, health information received, decisional control and technical competence all positively influenced client satisfaction with care." (nd)

Another aspect of patient compliance is the individual personality of the patient as according to Falvo (2004) "Patients differ remarkably in their perceptions of and reactions to what may appear to be similar medical conditions. Obviously, a variety of psychosocial factors determine individuals' reactions to illness, and, consequently, their reactions to the recommendations and advice given." (Falvo, 2004) Falvo relates that the individual who fails to adhere to a prescribed regimen oftentimes has reasons for this failure including economic reasons. Therefore, the nurse or physician should assess the reasons for failure to comply so that those reasons can be mitigated or alternative care options presented to the patient. (2004, paraphrased)

Purpose of Concept Analysis

The purpose of the concept analysis is to develop a conceptual definition of precisely what compliance means for the patient in terms of abiding by or adhering to their medical treatment plan. The concept of compliance is important for examination and definition in order to do away with any ambiguity concerning the concept and meaning of patient compliance. The work of Evangelista (1999) states that nurses "are challenged to embrace an interactive, transactional process in order to form a partnership with clients that enables and allows for client choice and control in decision-making about carrying out the prescribed behavior."

Why the Concept of Compliance is of Interest to Nursing

The role of the nurse in gaining the compliance of patients and maintaining the patient's compliance is a critical one. The work of Vuckovich (nd) states "Nursing ethical codes (ANA, 2001; Fowler, 2008; ISN, 2006) and standards of care (ANA, 2004) call for nurses to develop partnership models and empower patients." Hagenow wrote, of the influence of nurses on patient compliance stating:

"In its' positive sense power means to influence; influence means to get people to do something we want them to do because they want to. If we tell people what to do they'll comply. But if we get them to go there because they want to we have commitment" (1999, p.31)

The work of Ingram (2009) states that formal definitions of compliance:

"suggests a need for its reconceptualization in the nursing profession. As defined throughout literature, the term compliance suggests that patients are merely passive recipients of health care. Affording patients the opportunity to maintain autonomy by formulating care plans as a collaborative effort has proven highly effective in facilitating compliance."

Uses and Definitions of Compliance in Literature

1. Therapeutic alliance - a collaborative model in which the client's and family's voices are heard and their concerns addressed...

Concordance - an agreement between the patient and the treatment team on the goals and the means of treatment.
3. Compliance means deference and obedience, elevating the authority of medical expertise. (Encyclopedia of Mental Disorders, 2010)

4. Non-Compliance - 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, person's or caregiver's behavior is fully or partially non-adherent and may lead to clinically ineffective or partially ineffective outcomes. (Nursing Diagnosis, Noncompliance, 2010)

Critical Attributes of Compliance

The critical attributes of patient compliance can be gained from reviewing the defining characteristics of patient non-compliance which are stated to include: (1) Behavior indicating failure to adhere; (2) objective tests including improper pill counts and missed prescription refills as well as analysis of body fluids being inconsistent with compliance; (3) evidence of development of complications; (4) worsening symptoms; (5) increases in admission to hospital; (6) missed appointments; and (7) therapeutic effect not achieved or maintained. (Nursing Diagnosis: Noncompliance, 2010)

Therefore it can be understood that patient compliance is evidenced in behavior indicating adherence including objective tests, proper and timely refill of prescriptions, body fluid analysis indicating compliance, no development of complications, no worsening of symptoms, no increases in hospital admissions, no missed appointments and the therapeutic effect being achieved and maintained.

Value of Concept to Nursing and Nursing Knowledge

It has been shown in the literature reviewed that the nurse must gain the trust of the patient. Pfister-Minogue (2007) reports that studies have demonstrated that an interactive patient education approach, incorporating many of the factors that influence compliance, is successful in influencing patients to follow health care advice." This approach is one that is stated to require "a consistent, concerned, nonjudgmental, supportive relationship with the patient…" (Pfister-Minogue, 2007) Pfister-Minogue (2007) states that increased compliance has the potential to "…save health care dollars, and nurses facilitating this are a valuable asset. Hospital nurses, home health nurses, clinic nurses, and nurses practicing in advanced practice -- such as clinical specialists and nurse practitioners -- would be ideal to facilitate long-term follow-up.

Application of Concept of Compliance in Practice

Nursing expertise in the provision of specific individualized information along with a detailed plan and then backed up with plenty of reinforcement and support is critical for gaining the acceptance and adherence of patients to the health care plan for the patient. In addition, long-term nursing follow-up is also critical for gaining and maintaining the compliance of patients. Pfister-Minogue (2007) states that nurses can make some impact on patient compliance no matter what the setting. Studies have shown that when patients are involved in the decision-making concerning their health care plan and health treatment that the patients are much more likely to be complaint to the specified regimen of treatment. (Wilson, et al., 2009)

Conclusion

This study has reviewed the literature relating to patient compliance to prescribed treatment regimen and individualized health care plans and has found that the conception of compliance is one that needs analysis not only in terms of its meaning but in terms of application of nursing principles and methods geared towards gaining and maintaining patient compliance. It is important that patients adhere to prescribed health care and mediations so as to further not only the length but as well the quality of their life. Statistics show that many lives as well as millions of dollars are lost each year due to patient noncompliance. This study has shown that patient satisfaction with health care service provision is a determinant of patient compliance and the resulting health status outcome of patients. This work has shown that lack of satisfaction of patients with health care service provision has been highly correlated with failure of patient to adhere to health care plan and prescribed medications.

The role that the nurse plays in gaining the compliance of patients is a critical one and that the nurse can influence patient compliance through development of a relationship that is characterized by interaction, transaction and partnership which enables the client to make responsible choices and to follow through with the prescribed behavior and…