How Can a Nurse Practitioner Improve Patient Compliance and Patient Education in a Perioperative Setting?

Jane C. Rothrock, DNSc, RN, CNOR, FAAN

Disclosures

January 07, 2008

Issues of Patient Compliance

Redman suggests that the use of the term "compliance" has largely been replaced with the term "adherence to prescribed regimens." [2] Compliance is too often associated with a paternalistic notion of obedience; a noncompliant patient is thought of as being disobedient. "Obedience" and "disobedience" connote inappropriate perspectives in many patient care situations. While adherence to a prescribed regimen for a surgical patient, either in the preoperative or postoperative phase of their care, is desirable, if not developed with the patient and family, the goals of the prescribed regimen may not be conducive to self-management. Jointly constructed regimens need to be convenient and reflect the patient's and family's understanding and acceptance of both benefits and burdens of the prescribed regimen.

Teaching and behavioral modification are 2 key methods used by APNs to enhance patient adherence to prescribed regimens, and there are many available resources pertaining to both methods. Behavioral strategies include modeling, demonstration, goal setting, self-monitoring, reinforcement, cueing, contracting, use of social support systems, and self-efficacy enhancement. All of these are adaptable to pre- and postoperative teaching.

Perceived self-efficacy is a person's judgment of his or her capabilities to organize and follow through a course of action required to achieve a designated level of performance. Perceived self-efficacy has to do with the person's belief that he or she is capable of accomplishing the goal rather than with his or her actual skill (efficacy expectancy), and that the goal will result in beneficial changes (outcome expectancy).[3] However, for any educational or behavioral strategy to be effective, the APN must consider the concept of health literacy.

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