Patient Compliance in Nursing: Concept Analysis and Practice

Introduction to Patient Compliance

Patient compliance is not always easy to obtain, and it is frustrating when patients fail to follow recommendations and instructions. Nurses and physicians tend to expect compliance, yet there is substantial evidence from clinical studies suggesting that compliance should not be taken for granted. This paper examines and analyzes the issue of patient compliance (Stone et al., 1998). Lamb (n.d.) 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, which is equally serious."

Stone et al. (1998) assert 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." The difference, Stone et al. (1998) emphasize, "is not just semantic; it goes right to the heart of our relationship with our patients. We need to influence our patients to become — or remain — adherents of good self-care." According to one source, experts have estimated 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).

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." Renzi et al. (2001) are reported to have correlated "poor patient satisfaction with poor adherence to prescribed medical regimens and consequently poor health outcomes" (cited in Agnosta, 2005). Additionally, Vuckovich (n.d.) reports that Graham (2002) found that "affective support, health information received, decisional control, and technical competence all positively influenced client satisfaction with care."

Another aspect of patient compliance involves the individual personality of the patient. As Falvo (2004) observes, "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 further notes that the individual who fails to adhere to a prescribed regimen often has identifiable reasons for that failure, including economic ones. Therefore, the nurse or physician should assess the reasons for noncompliance so that those barriers can be mitigated or alternative care options can be presented to the patient (Falvo, 2004).

Purpose of Concept Analysis

The purpose of this 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 to examine and define in order to eliminate any ambiguity surrounding its meaning in clinical contexts. 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 and maintaining patient compliance is a critical one. Vuckovich (n.d.) states that "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 (1999, p. 31) captured the essence of nurses' influence on patient compliance:

"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."

The work of Ingram (2009) states that formal definitions of compliance "suggest a need for its reconceptualization in the nursing profession. As defined throughout the 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."

Conclusion

This study has reviewed the literature relating to patient compliance with prescribed treatment regimens and individualized health care plans, finding that the conception of compliance needs analysis not only in terms of its meaning but also in terms of the application of nursing principles and methods geared toward gaining and maintaining patient compliance. It is important that patients adhere to prescribed health care and medications so as to enhance not only the length but also the quality of their lives. Statistics show that many lives as well as billions 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, and that poor satisfaction has been highly correlated with failure to adhere to health care plans and prescribed medications.

The role the nurse plays in gaining patient compliance is a critical one. The nurse can influence compliance through developing a relationship characterized by interaction, transaction, and partnership — one that enables the client to make responsible choices, follow through with prescribed behavior, and ultimately adhere to the collaboratively agreed-upon health care plan. This work has noted Ingram's (2009) call for a reconceptualization within the nursing profession of precisely what compliance means, what it demands of today's nursing professionals, and the many opportunities nurses have to foster it. While compliance may be referred to by many names, it ultimately means keeping the agreement that the nurse and patient have formulated collaboratively — an agreement geared toward best-practice health care in view of the patient's condition, treatment options, personal preferences, and desired health outcomes.