Since Hippocrates, Galen, and countless healers, physicians, and surgeons, getting patients to follow their care plans has been the Diogenes of adherence. People do not follow their care plans. Which patients are most at risk? How do you identify them? How will that risk determine where they are most at risk? Our Adherence Improvement Plans answer these questions and protect nurses and medical practices from negligence in care lawsuits.
The dirty secret of patient education is that > more than 80% of all patients will stop following their care plan, and nurses will share the lame Teachbrisk risk, a 30-plus-year-old tool that sounds great in theory but fails terribly in practice. If that were not so, why is patient nonadherence at the same levels today as when Teachback started three decades ago?
Come with us on our behavioral journey. We develop evidence-based tools and training to improve defense. Built into the process is documented evidence that patients choose not to follow their adherence improvement plans. Nurses should not be held accountable for patient choice. However, we all know that if you didn't document it, you did it. From identifying at-risk patients to developing and teaching the Adherence Improvement Plan, nurses and other patient educators can demonstrate that patients and their families understand the importance of positive reinforcement in moving towards aanereference Care plans, from a clinician's perspective, are a go-hing Patients agree Why else would we not do the very thing that increases the quality and quantity of their most important set Their life.
For the last several years, as a nursing professor, I have taught my students that, along with everything else they must learn to be safe clinicians, they must focus on two areas: curiosity and Consequences. The scope of nursing practice grows daily.
Every patient brings something new. There are words, diseases, diagnoses, and treatments. Where words are unfamiliar, be curious. What are the patient and their physician telling us about their physical, spiritual, and personal needs? Nurses are predominantly consequence managers. Patient behaviors and genetics have resulted in a disease process. Nurses must identify the consequences of these behaviors. Physicians and a dozen or more health service providers write orders, document care, and project new consequences due to their behaviors. Medications, treatments, diseases, cognition, family interactions, the environment, and dozens of setting events all end up on the nurse's care plan. NANDA diagnoses are not diagnoses of things that are. They are a projection of harm that could result if each potential consequence is not defined and managed. Training nurses in consequence identification and management is essential to 21st-century nursing.
Throughout nursing, leadership is the distinct difference between success and failure. The Measure of a Leader is found in the consistency and willingness to work among the followers. There are only five consequences for every human behavior: Positive Reinforcement, Negative Reinforcement, Extinction, Penalty, and Punishment. Too many leaders rely on penalties and Punishments or ignore excellent performance (extinction). Only Positive Reinforcement consistently delivers the performance management wants and needs. Why, then, do so many leaders rely on Penalty and Punishment? Join us in your journey to becoming the best leader you can be.
The basis of all human behavior is a single word: consequences. Applied behavior focuses on what people do. Four of the five consequence categories will assure us of non-adherence. Regarding following care plans, the medical team wants more of some behaviors (adherence) and less of others (non-adherence). On the other hand, patients look at a lifetime of habits and the punishing aspects of following their care plan. Let us show you how to identify your at-risk patients on admission so you can evaluate the consequences of your care plan on their behavior before they go home, and 8.5 out of 10 choose non-compliance. Let us teach you how to identify the punishers and penalties in your care plans. I believe we can improve the adherence ratio. Are you willing to try something else? It is evidence-based and a lot more effective than hope.
Patients stop taking medications because of the consequences. We created a three-word mnemonic (ICE IF SAD) to understand why most patients quit taking their medications. Care plans are Inconvenient, Confusing, and Expensive (ICE). In addition, the Illness itself may have no symptoms. "If I don't feel bad, why must I take these pills?" Forgetful is the "get out of jail free" card. In the absence of organic brain disease, look at the other reasons. (IF). Side effects: What is the typical response if patients don't feel bad until they take their medications? Nonadherence. Acceptance: Many patients find peace in accepting the consequences of their disease process. They may need additional education to understand how the acceptance of their disease can be effectively managed. Distrust: Patients have unlimited access to the internet and a thousand contradicting articles about the best way to manage their condition. Nurses are best positioned to guide patients and work through their concerns (SAD).
There is a 50/50 chance a patient will become non-adherent to their care plan within 30 days of discharge. The question is, which one? We have created a simple evidence-based matrix that can be administered on admission to help nurses identify patients needing additional attention with their patient education program. The Wright Patient Adherence Assessment Scale is a Green, Yellow, Orange, and Red format that provides nurses with a quick risk assessment tool.
Once identified as at-risk, a further assessment can assist clinicians in targeting physical issues that can contribute to non-adherence. This is, once again, an easily administered evidence-based scale resulting in a Green, Yellow, Orange, and Red assessment of physical risk factors the care team will need to address.