ENHANCING PATIENT MOTIVATION TO CHANGE

Ann Russell Dernbach

DQ1

In the past few decades there has been a paradigm shift in healthcare from an authoritarian type of delivery, where the healthcare provider makes all the decisions and the patient is required to follow them, to a patient-centered style, where the provider and patient are partners and collaborate to make decisions. I believe this is important to point out when answering this question. Instead of ensuring compliance the nurse should strive to ensure adherence to the mutually agreed on plan. Adherence denotes collaboration, compliance insinuates a power relationship and leads to better patient outcomes (Flavo, 2010). 

Since medical nonadherence has many consequences, including monetary, health, psychosocial and even death, it is important that the nurses address any obvious or potential areas for nonadherence. The first step in developing a plan for Alma will be to assess the cognitive function of Alma and her knowledge base of the procedure and post-procedure needs. Asking simple direct questions will yield the answer necessary to formulate more specific open-ended questions. It should be discovered if Alma has access to resources and accommodations needed to be adherent to the plan. Next the nurse should develop a plan in collaboration with Alma. After the plan is collaboratively agreed upon the nurse should work with Alma to put the plan in place. Lastly, the nurse should ensure adherence by following-up with Alma to determine if she is following the mutually agreed upon plan. If Alma is nonadherent then the nurse will have to engage Alma to discover where the shortcoming is and together, they should reformulate the plan. 

In the case of Alma, it will be imperative that she feel a sense of respect is being given to her. I say this based upon the fact that she insisted that her name be pronounced correctly before she would partake in any part of treatment. It will be difficult to gain a level of trust with Alma since she already feels disrespected by the staff. To gain her trust the nurse should apologize and show clear collaboration throughout the entire encounter and after care. After trust established it should be discovered what accommodations she will need and how to incorporate them into her current lifestyle. For example, if she currently is adherent to her medication regimen it should be discovered why. Does someone set her pills out for her? Does she prefer to take her pills at a specific time of day? Will she need some sort of reminder to take her pills? The detrimental effects of medication nonadherence should be explained to Alma. And proper agreed upon interventions should be put in place so that negative effects do not happen (Barber, 2002). 

Reference

Barber, N. (2002). Should we consider non-compliance a medical error? Quality & Safety in Health Care, 11(1), 81.  http://dx.doi.org/10.1136/qhc.11.1.81

Falvo, D. (2010). Effective patient education (4th ed.). Jones & Bartlett Learning.

DQ2

Ann Russell Dernbach

Interdisciplinary collaboration involves using a multifaceted approach to caring for the patient in a holistic manner. The interdisciplinary team (IDT) in health care generally incorporates a group of professionals such as nurses, providers, dieticians, respiratory therapists, occupational therapists, physical therapists and social workers or combination therein. The goal of the IDT is to provide care that encompasses a patient’s whole self, not just a diagnosis or specific need (Green & Johnson, 2015). When health care professionals collaborate on a patient case, they are more likely to provide more help through interventions than they would be able to achieve alone which results in enhanced quality patient outcomes. 

As humans age the body goes through natural physiological changes which complicate care. Examples would be decrease visual acuity from common disease processes such as glaucoma and cataracts, muscle atrophy, decreased bone density, and slowed peristalsis to name a few. The IDT is needed to meet this population due the increased acuity of these patients. Not only can the health care IDT prove to be beneficial for quality care of the patient, external stakeholders, such as the Aging and Disability Resource Center (ADRC), serve as valuable community partners. 

In the case of Alma, it would be imperative to conduct a thorough needs assessment to determine what resources she already uses, which resources would currently be beneficial, and what anticipated resources will be needed in the future. I would instill the help of the social worker from the IDT for referrals to community programs, such as meals on wheels. Also, the social worker could help place Alma in a physical therapy program should she need rehabilitation after the procedure. It will be important to evaluate the support system Alma has in place. Support such as local friends or families who aid in Alma’s care. No matter what collaboration takes place Alma should be the centric figure and any decisions should be mutually agreed upon by her and the stakeholders in her care. When patients feel engaged and in control they are likely to adhere to the plan of care. 

Reference

Green, B. N., & Johnson, C. D. (2015). Interprofessional collaboration in research, education, and clinical practice: working together for a better future. The Journal of chiropractic education, 29(1), 1–10. https://doi.org/10.7899/JCE-14-36