Patient Noncompliance and Causes In Nursing Education

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Causes of Patient Non Compliance In Nursing Education

Patient Noncompliance and Causes In Nursing Education

Impact of Illiteracy on Motivation and Compliance,Characters of Literary Disabled Person In Nursing Education,Educational Difficulties of Illiterate People In Nursing,Non Compliance Behavior and Instructions By Nursing Educator.

Impact of Illiteracy on Motivation and Compliance

    In addition to the fact that poor literacy skills affect the ability to read as well as to understand and interpret the meaning of written and verbal instructions, a person with illiteracy or low literacy struggles with other significant inter related limitations with communication that can negatively influence healthcare teaching (Doak et al., 1998; Kalichman, Ramachandran, & Catz, 1999; Vagvolgyi et al., 2016). The person's organization of thought, perception, vocabulary and language/fluency development, and problem solving skills are adversely affected, too (Giorgianni, 1998).

Characters of Literary Disabled Person In Nursing Education

    Fleener and Scholl (1992) investigated characteristics of persons who had identified themselves as literacy disabled. Vagvolgyi et al. (2016) conducted a comprehensive review of the literature to define what it means to be functionally illiterate and to uncover answers to questions about deficits in abilities, such as sensory, cognitive, and neurological, of those identified with one or more causes of illiteracy. These two groups of researchers found that among the functionally illiterate, the most common deficiencies found were in phonics, comprehension, and perception. 

    Difficulties in perception were evident in reversing letters and words, miscalling letters, and adding and omitting letters. Also, a major problem was comprehension that is, identification of words without knowing their meaning. Some individuals needed to read aloud to understand, and others read so slowly that they lost the meaning of a paragraph before they had finished it. Still other subjects perceived difficulty in remembering as a factor in their lack of reading skill. 

Educational Difficulties of Illiterate People In Nursing

    People with poor reading skills have difficulty analyzing instructions, assimilating and correlating new information, and formulating questions (Giorgianni, 1998). They may be reluctant to ask questions because of concerns that their inquiries will be regarded as incomprehensible or irrelevant. Frequently they do not even know what to ask, but they fear if they try, others will think of them as ignorant or lacking in intelligence. These individuals have great difficulty navigating the healthcare delivery system. 

    Which relies on written information and printed forms at every juncture. Studies have shown that Health Insurance Portability and Accountability Act (HIPAA) privacy notices, informed consent forms, drug warning labels, and insurance forms all present obstacles for individuals with poor reading skills (Davis et al., 2006; McCormack, Bann, Uhrig, Berkman, & Rudd, 2009; Sudore, Landefeld et al., 2006; Walfish & Ducey, 2007).

    Most nurses can recount a situation in which a patient failed to follow advice because he or she did not understand the instructions that were given. Hussey and Guilli land (1989) provide a poignant example, which remains as relevant today as it was then, of a young pregnant girl prescribed antiemetic suppositories to control her nausea. When she had no relief of symptoms, questioning by the nurse revealed that she was swallowing the medication. 

    Obviously, not only did she not understand how to take the medicine, but she also likely had never seen a suppository and was not even able to read or understand the word. She did not ask what it was, probably because she did not know what to ask in the first place, and she may have been reluctant to question the treatment out of fear that she would be regarded as ignorant.

    If their past experiences with learning have been less than positive, some people may prefer not knowing the answers to questions and may withdraw altogether to avoid awkward or embarrassing learning situations. Also, they may react to complicated, fast-paced instruction with discouragement, feelings of low self-esteem, and refusal to participate because their process of interpretation is so slow. Even when questioned about their understanding, persons with low literacy skills will most likely claim that they understood the information even when they did not (Doak et al., 1996).

    Another characteristic of illiterate individuals is that they have difficulty synthesizing information in a way that fits into their behavior patterns. If they are unable to understand a required behavior change or cannot understand why it is needed, they will disregard any health teaching (Vanderhoff, 2005; Weiss, 2007). 

    For example, patients recovering from fractured hips who are taught via demonstration and written instructions how to climb stairs and how to do strengthening exercises may fail to comply with this regimen because of lack of understanding of the information and ways to go about incorporating these changes into their lifestyle (Schultz, 2002).

    Persons with poor literacy skills may also think in only concrete, specific, and literal terms. An example of this limitation is the patient with diabetes whose glucose levels were out of control even when he insisted, he was taking his insulin as instructed injecting the orange and then eating the fruit (Hussey & Guilliland, 1989).

    The person with limited literacy also may experience difficulties handling large amounts of information and classifying it into categories. Particularly, older adults who need to take several different medications at various times and in different dosages may either become confused with the schedule or ignore the instruction. If asked to change their daily medication routine, a great deal of retraining may be needed to convince them of the benefits of the new regimen (Kessels, 2003).

Non Compliance Behavior and Instructions By Nursing Educator

    Another major factor in noncompliance is the lack of adequate and specific instructions about prescribed treatment regimens. Unfortunately, poor literacy skills are rarely assessed by healthcare personnel when, for example, teaching a patient about medications. Literacy problems tend to limit the patient's ability to understand the array of instructions regarding medication labels, dosage scheduling, adverse reactions, drug interactions, and complications (Davis et al., 2006; Elliot, 2007; Mauk, 2014; Williams et al., 2002; Wong, 2016). 

    No wonder those who lack the required vocabulary, organized thinking skills, and ability to formulate questions, and who also receive inadequate instruction, become confused and easily frustrated to the point of taking medications incorrectly or refusing to take them at all.

    Thus illiteracy, functional illiteracy, and low literacy significantly affect both motivation and compliance levels. What is often mistaken for noncompliance is, instead, the simple inability to comply. Although almost half of the adult population is functionally illiterate, this statistic is overlooked by many healthcare professionals as a major factor in noncompliance with prescribed regimens, follow-up appointments, and measures to prevent medical complications (Andrus & Roth, 2002; Doak et al ., 1996; Mc-Cray, 2005; Weiss, 2007; Williams et al., 2002).

    A significant number of studies have correlated literacy levels with noncompliance (Brown & Bussell, 2011; Doak et al., 1998; Jin. Sklar, Min Sen Oh, & Chuen Li, 2008; Kalichman et al., 1999; Weiss, 2007) . Individuals who have both poor literacy skills and inadequate language skills often have difficulty following instructions and providing accurate and complete health histories, which are vital to the delivery of good health care. The burden of illiteracy leads patients into noncompliance not because they do not want to comply but rather because they are unable to do so (Hayes, 2000; Williams,

    Counselman, & Caggiano, 1996). The impact of illiteracy is broader than just the inability to read; it alters the way a person organizes, interprets, analyses, and summarizes information (Giorgianni, 1998). Caregivers often overestimate an individual's ability to under-stand instructions and are quick to label someone as uncooperative and noncompliant. In reality. the underlying problem may be limited cognitive processing that impedes understanding and following written and oral communication.

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