Category: Noncompliance

Nursing Diagnosis – Code 00079 Noncompliance (1973, 1996, 1998 )

Domain 1. Health Promotion Class 2. Health Management

Noncompliance

Definition Behavior of person and/or caregiver that fails to coincide with a healthpromoting or therapeutic plan agreed on by the person (and/or family and/or community) and healthcare professional. In the presence of an agreed-upon, health-promoting, or therapeutic plan, the person’s or caregiver’s behavior is fully or partly nonadherent and may lead to clinically ineffective or partially effective outcomes.

Defining Characteristics

■ Development-related complication ■ Exacerbation of symptoms
■ Failure to meet outcomes ■ Missing of appointments ■ Nonadherence behavior

Related Factors

Health System ■ Difficulty in client–provider relationship ■ Inadequate access to care ■ Inconvenience of care ■ Ineffective communication skills of the provider ■ Insufficient follow-up with provider ■ Insufficient health insurance coverage
■ Insufficient provider reimbursement ■ Insufficient teaching skill of the provider ■ Low satisfaction with care ■ Perceived low credibility of provider ■ Provider discontinuity

Healthcare plan

■ Complex treatment regimen ■ Financial barriers ■ High-cost regimen
■ Intensity of regimen ■ Lengthy duration of regimen

Individual

■ Cultural incongruence ■ Expectations incongruent with developmental phase ■ Health beliefs incongruent with plan ■ Insufficient knowledge about the regimen
■ Insufficient motivation ■ Insufficient skills to perform regimen ■ Insufficient social support ■ Spiritual values incongruent with plan ■ Values incongruent with plan

Network

■ Insufficient involvement of members in plan ■ Low social value attributed to plan
■ Perception that beliefs of significant other differ from plan

Nursing diagnosis – NONCOMPLIANCE

NONCOMPLIANCE

DEFINITION

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 nonadherent and

may lead to clinically ineffective or partially ineffective outcomes

DEFINING CHARACTERISTICS

• Behavior indicative of failure to progress

• Complications or evidence of exacerbation of signs and symptoms

• Failure to keep appointments and adhere to treatment regimen

• Objective indications (e.g., laboratory tests, physiologic markers)

RELATED FACTORS

Health system

Individual

• Access to, convenience of care

• Cultural/spiritual values

• Client–provider relationships

• Developmental and personal

• Individual health coverage

abilities

• Provider communication skills,

• Health beliefs

credibility; continuity; teaching
skills; reimbursement

• Knowledge of regimen
• Motivational forces

Healthcare plan

Network

• Complexity, intensity

• Involvement of members in

• Cost, financial flexibility, and

health plan

duration of plan

• Social value regarding plan

ASSESSMENT FOCUS    (Refer  to  comprehensive  assessment  parameters.)

• Behavior

• Knowledge

• Beliefs/values

• Roles/responsibilities

• Coping

• Self-perception

• Emotional status

EXPECTED OUTCOMES

The patient will

• Identify factors that influence noncompliance.

• Demonstrate level of compliance that maintains safety.

• Contract to perform specific behaviors.

• Use support systems to modify noncompliant behaviors.

SUGGESTED NOC OUTCOMES

Acceptance: Health Status; Adherence Behavior; Compliance Behav-

ior; Symptom control; Treatment Behavior

INTERVENTIONS AND RATIONALES

Determine:  Assess patient’s perception of health problem, treatment

regimen and history of compliance, obstacles to compliance, financial

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resources, ethnicity, and religious influences. Assessment information

may help select appropriate interventions.

Perform:  Provide an environment that is nonjudgmental. This

demonstrates unconditional respect for the patient.

Contract with the patient to practice only nonthreatening behav-

iors. This involves the patient in a formal commitment and gives the

patient a sense of personal control.

Inform:  Teach self-healing techniques to both the patient and family

such as meditation, guided imagery, yoga, and prayer. These

techniques promote self-reliance.

Teach principles of good nutrition for patient’s specific condition.

Understanding importance of nutrition will encourage compliance.

Inform patient about diagnosis. Understanding essential informa-

tion needed to perform skills or give self-care increases compliance.

Demonstrate skills needed by patient to comply with treatment regi-

men to reinforce patient’s confidence in ability to replicate.

Attend:  Provide opportunities for the patient to discuss reasons for

noncompliance. The willingness of the nurse to listen allows the

patient the ability to listen to his or her own reasoning.

Help patient clarify his or her values about the importance of fol-

lowing a treatment plan to determine appropriate interventions.

Acknowledge patient’s right to choose not to comply with

prescribed regimen to respect autonomy. Control over patient’s

actions is legitimate only when dangerous to self or others. Offer

positive reinforcement.

Use support systems to reinforce negotiated behaviors. Support

from the family and friends help foster compliance.

Manage: When medically appropriate, support patient’s cultural

beliefs towards medical practices to demonstrate respect; and refer

to a member of the clergy or a spiritual counselor.

Refer family to community resources and support groups to pro-

mote compliance with modification of behavior. If patient’s situation

is complicated by lack of financial resources, contact agencies that

may offer help with costs of medical treatment.

SUGGESTED NIC INTERVENTIONS

Coping Enhancement; Counseling; Decision-Making Support; Health

Education; Patient Contracting; Self-Modification Assistance; Self-

Responsibility Facilitation

Reference

Riegel, B., et al. (2006, May–June). A motivational counseling approach to

improving heart failure self-care mechanisms of effectiveness. Journal of
Cardiovascular Nursing, 21(3), 232–241.