Page 44 - Encyclopedia of Nursing Research

ADHERENCE/CoMPLiANCE n 11

addiction comprehensively. Research that literature was published in Nursing Research
links theory, education, and practice will be in 1970 by Marston. Since that time, there has
needed that focuses on diverse populations, been a profusion of research from a variety of A
directs the development of curriculums, disciplines. The majority of the research has
establishes priorities for workforce develop- been focused on patient adherence, although
ment, and influences the direction of policy there is a smaller body of literature on the
decisions. All nurses regardless of specialty adherence of research staff to clinical proto-
can participate by reading and sharing cols and a growing body of literature on pro-
applicable research within their own spe- vider adherence to treatment guidelines.
cialty area that increases their own exper- Studies on adherence have focused pri-
tise and improves patient care (Kronenfeld marily at the stage of maintaining a pre-
et al., 2007; LoBiondo-Wood & Haber, 2006; scribed and adopted treatment regimen.
McCarty, 2010). Nurses practicing in the spe- Adherence, however, is important from the
cialty areas of addiction and mental health time of regimen advice to the acquisition of
can participate in, conduct, or collect data the medication, food, exercise equipment,
for a variety of research improving quality and so forth, required to carry out that
of addiction care and increasing knowledge advice for the initiation of care, design and
about the disease. accurate management of the regimen, and
contribution over the short and long term.
Carolyn Baird These preceding stages have not been well
studied.
one of the issues that continue to arise
in discussions of patient adherence is patient
autonomy. is nonadherence a patient right or
Adherence/comPliAnce is adherence a patient responsibility? This
argument presumes that the patient is aware
of his or her own behavior and has con-
Adherence is defined as the degree to which sciously decided not to follow a treatment
behavior corresponds to a recommended regimen. The literature suggests that less
therapeutic regimen (Haynes, Taylor, & than 20% of patients with medication regi-
Sackett, 1979). Numerous terms have been mens consciously decide not to engage in a
used to describe this behavior, including treatment program. Those patients who have
compliance, therapeutic alliance, and patient decided to follow the regimen but do not
cooperation. Although the literature is filled carry it out are unaware of episodic lapses in
with discussion of the acceptability of these behavior or have difficulty in integration of
terms and the differences between them, the health care regimen into their lives. The
most investigators view the terms as synon- most common reasons given by patients for
ymous and independent of the decision to lapses in adherence are forgetting and being
engage in a particular therapeutic regimen. too busy. This group comprises on average
The most complete literature can be obtained 40% to 50% or more of patients in a treatment
from structured databases with the term regimen.
patient compliance. The problem of nonadherence is costly
Adherence to health care regimens has in terms of dollars and lives. The national
been discussed in the literature since the pharmacy council estimates that nonad-
days of Plato. However, little systematic herence to pharmacological therapies costs
attention was given to this phenomenon until $100 to $300 billion annually. Although the
the 1970s, when there was a proliferation cost of nonadherence to nonpharmacologi-
of research. one of the first reviews of the cal therapies has not been estimated, the