Page 45 - Encyclopedia of Nursing Research

12 n ADvANCE DiRECTivES

contribution to morbidity and mortality is information, such as electronic monitors,
high. Failures to quit smoking, to lose and PDAs, and other technologies.
A maintain weight, to exercise regularly, to Future research on adherence should
engage in safe sex practices, to avoid excess address strategies by which nurses can
alcohol, and to use seat belts contribute sig- improve adherence to treatment regimens
nificantly to declines in functional ability with attention directed toward various age
as well as to early mortality. Further data groups, clinical populations, and regimen
suggest that nonadherence to pharmacolog- behaviors across the range from decision to
ical as well as nonpharmacological thera- adopt to long-term maintenance. The research
pies contribute to excess hospitalization and would benefit from theoretical approaches
complication rates. to the problem of patient adherence and the
Poor adherence then is a significant design of intervention strategies. Effective
problem of direct relevance to nursing. strategies delivered by nurses have consider-
Nurse practitioners may prescribe or recom- able promise of a favorable impact on health
mend therapies. Home health and commu- outcomes and costs.
nity nurses provide education and assistance
in carrying out health care advice. Hospital, This paper was supported in part by the National
clinic, and office nurses provide education institute of Nursing Research (grant no. 5 P30
regarding treatment plans. There is a need NR03924) and the National Heart, Lung, and
for intervention studies that will guide prac- Blood institute (grant no. 1 Uo1HL48992).
tice as nurses prepare and support patients Jacqueline Dunbar-Jacob
in the conduct of treatment regimens.
Research on adherence has been focused
heavily on the determination of the extent of
the problem and on predictors or contribut-
ing factors. The 2010 report on medication AdvAnce directiveS
adherence by the Cochrane Collaboration
suggested that just 70 randomized con-
trolled studies have evaluated interventions Despite the advances in medicine and tech-
to improve medication adherence and exam- nology that have occurred over the past cen-
ine both adherence and clinical indicators tury, it remains imperative for all individuals
as outcomes. Thirty-six reported improve- to consider and plan end-of-life care. Since
ment in adherence, 25 in outcome. Most of the late 1960s, individuals have been encour-
these used general educational or behavioral aged to obtain greater control in the decisions
counseling interventions. improving con- that affect their future medical treatment
venience system-wide interventions have and assure advance directives are in place.
shown modest improvements with the use of Advance directives are legal documents that
case managers. Fewer studies have examined allow a patient to express their choice about
adherence to lifestyle behaviors. medical care or name another individual to
one problem in evaluating interventions make decisions regarding medical treatment
and identifying relevant predictors is that in the event that they are unable to make deci-
of measurement. Most clinical studies have sions themselves. As many more Americans
relied on self-report of adherence. There is with chronic medical conditions and poor
a growing body of evidence indicating that medical prognoses experience the suffering
individuals do not report accurately, and and costs associated with end-of-life care, the
those reports are biased toward an over- need for adults to maintain their autonomy
estimate of performance. Thus, alternative and their dignity at end of life has prompted
strategies are being used to obtain better health care providers and lawmakers to