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Nursing Actions Related to Medical Non-Adherence (Essay Sample)


In a 5-7 page written assessment, define the patient, family, or population health problem that will be the focus of your capstone project. Assess the problem from a leadership, collaboration, communication, change management, and policy perspective. Plan to spend approximately 2 direct practicum hours meeting with a patient, family, or group of your choice to explore the problem and, if desired, consulting with subject matter and industry experts. Document the time spent (your practicum hours) with these individuals or group in the Core Elms Volunteer Experience Form.
Nurses in all professional roles work to effect positive patient outcomes and improve organizational processes. Professional nurses are leaders in problem identification, planning, and strategy implementation—skills that directly affect patient care or organizational effectiveness.
Too often, change agents jump to a conclusion that an intervention will promote the envisioned improvement. Instead, the ideal approach is to determine which interventions are appropriate, based on an assessment and review of credible evidence. Interventions could be patient-facing or involve a change in policy and process. In this assessment, you’ll identify and make the case for your practicum focus area, then explore it in depth from a leadership, collaboration, communication, change management, and policy perspective.
This assessment lays the foundation for the work that will carry you through your capstone experience and guide the practicum hours needed to complete the work in this course. In addition, it will enable you to do the following:
Develop a problem statement for a patient, family, or population that’s relevant to your practice.
Begin building a body of evidence that will inform your approach to your practicum.
Focus on the influence of leadership, collaboration, communication, change management, and policy on the problem.
In this assessment, you’ll assess the patient, family, or population health problem that will be the focus of your capstone project. Plan to spend approximately 2 hours working with a patient, family, or group of your choice to explore the problem from a leadership, collaboration, communication, change management, and policy perspective. During this time, you may also choose to consult with subject matter and industry experts about the problem (for example, directors of quality or patient safety, nurse managers/directors, physicians, and epidemiologists).
To prepare for the assessment, complete the following:
Identify the patient, family, or group you want to work with during your practicum The patient you select can be a friend or a family member. You’ll work with this patient, family, or group throughout your capstone project, focusing on a specific health care problem.
Begin surveying the scholarly and professional literature to establish your evidence and research base, inform your assessment, and meet scholarly expectations for supporting evidence.
In addition, you may wish to complete the following:
Review the assessment instructions and scoring guide to ensure that you understand the work you’ll be asked to complete and how it will be assessed.
Review the Practicum Focus Sheet: Assessment 1 [PDF], which provides guidance for conducting this portion of your practicum.
Note: Remember that you can submit all, or a portion of, your draft assessment to Smarthinking Tutoring for feedback, before you submit the final version for this assessment. If you plan on using this free service, be mindful of the turnaround time of 24–48 hours for receiving feedback.
Complete this assessment in two parts.
Part 1
Define the patient, family, or population health problem that will be the focus of your capstone project. Assess the problem from a leadership, collaboration, communication, change management, and policy perspective and establish your evidence and research base to plan, implement, and share findings related to your project.
Part 2
Connect with the patient, family, or group you’ll work with during your practicum. During this portion of your practicum, plan to spend at least 2 hours meeting with the patient, family, or group and, if desired, consulting with subject matter and industry experts of your choice. The hours you spend meeting with them should take place outside of regular work hours. Use the Practicum Focus Sheet [PDF] provided for this assessment to guide your work and interpersonal interactions. Document the time spent (your practicum hours) with these individuals or group in the Core Elms Volunteer Experience Form.
difficult for them to focus on its substance.


Assessing the Problem: Leadership, Collaboration, Communication, Change Management, and Policy Considerations
Student name
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Assessing the Problem: Leadership, Collaboration, Communication, Change Management, and Policy Considerations
Medical non-adherence among the elderly
For my capstone project, I will focus on medical non-adherence by the elderly. Medication non-compliance is a fair problem among patients who suffer from chronic illness diseases. Non-adherence to medication is one of the significant causes of morbidity among patients. It is estimated that adult non-adherence to medication ranges between 26%- 59%. Medication adherence is essential for medication therapy success (Verloo et al., 2017). The elderly are prone to chronic diseases like diabetes, hypertension, and cancer, and as a general nurse, I have witnessed non-adherence patients having a prolonged stay in the hospital. Chronic diseases are the leading cause of death and disability among the elderly, and non-adherence to medication aggravates the condition. A systematic approach will be a significant focus as well as focusing on the numerous vital causes for medication adherence identified by existing literature. Due to its position as a barrier for many patients' lives, the cost of sustaining optimum health is a crucial source of worry for proper drug adherence.
Moreover, as a general nurse, I have witnessed discharged elderly patients re-admitted, and on assessing the factors, they did not comply with the medications given to them. Moreover, I have seen prolonged stays in hospitals of patients who did not comply with medications, and if they could follow the practice of medication accurately, the problem could have been alleviated. When I confront the hazards of medication non-compliance as a soon-to-be baccalaureate-prepared nurse, it is critical that the multidisciplinary team and my patients can rely on me to give them evidence-based information. In the hospital, as a general nurse, I was responsible for taking care of patients. In my line of duty, I witnessed ten elderly patients with chronic diseases die over a period of time. An exciting aspect of the patients is that they were all discharged, and within five days to a week, they were re-admitted, and it was established that the patients were nonadherent to the given medication.
Nursing actions related to medical non-adherence.
Adherence is a critical factor in medical therapy. Gast & Mathes define medication adherence is the extent to which the patients are able to take their medicines according to the description provided by the health providers (2019). The authors further note that patients with acute conditions are more likely to adhere to medication than patients with chronic conditions. The author’s assertion is correct, considering that most nonadherent patients in my hospital had chronic conditions. Poore adherence to medication has adverse clinical outcomes, like leading to mortality and worsening of the diseases. Moreover, Pasina et al. report that non-adherence is a significant public health concern in the US that costs the government $100 billion every year. The authors' claims are valid as from what I witnessed in the hospital. The chronic patients had problems with compliance with medication adherence. Pasina et al., data is reliable. He used a sample of elderly aged 65 and above patients from a hospital in Italy in 2012 and were followed up three months after discharge. In the study of 100 patients, non-adherence was reported 49 patients representing 55.1%, and after the second follow up the number reached 55, representing 69.6. the conclusion drawn from the study is that non-adherence is real. The above research reflects what I encountered in the hospital as a general nurse.
In addition, Alatawi et al. highlight the various barriers to implementing evidence-based practice (EBP) in the nursing profession. Alatawi et al. defines EBP as a "technique used in solving problems regarding patient care by integrating well-designed evidence with the patient preferences, patient assessments, and health professionals' expertise leading to lower health costs, better patient outcomes and safer care" (2020). Using this technique, health practitioners can solve the medical non-adherence problem. However, Alatawi et al., the barriers the health profession can encounter in implementing EBP on medical adherence include lack of support and supervision from the hospital administration. Another barrier is personal attitude and experience. Alatawi et al. highlight those nurses unwilling to try new ideas were 30.5%, this indicates that applying EBP on medical non-compliance by the elderly will subject the nurses to change something they are not willing to do to change and thirdly is the lack of awareness, knowledge, and skills in the implementation of EBP on non-compliant medical patients. The above-listed barriers hamper implementation of EBP on medical non-compliance by the elderly.
State board nursing practice standards/governmental policies and how they affect patient
Verloo et al. (2017) conducted a systemic review on nursing standards that can help improve medical adherence by the elderly. Participants included in the study were 2028, and results indicated that nursing intervention enhanced medical care. The standards of intervention that can be applied include collaborative nurse intervention, which involves routinely planed procedures between the nurse and the patient, and nurse-led intervention, which was used. The results of the patients who were applied with the method showed. The development of the intervention showed an improvement in the medical adherence of the patients.
Similarly, Easthall & Barnett (2017) suggest the “Health Coaching Theory” as an umbrella of the behavior change models. In “Health Coaching Theory," the patient is assisted in identifying a health-related objective and developing their own choices for resolving the problems that have been highlighted using methods drawn from psychology and performance coaching (Easthall & Barnett, 2017). Health coaching has been applied in several countries, including the UK hospitals pharmacy. The coaching method was essential in creating an integrated medications management service for healthcare workers in the Northwest London region has now been authorized. The structure for this model includes educating, empowering, exploring, and enabling (Easthall & Barnett, 2017). The pharmacist currently applies the model. It can also be incorporated by the nurses responsible for daily taking care and interacting with the non-adherence adults. However, more work is required in establishing the right method that can help to address medication non-adherence in elderly patients.
In addition, Muench et al. (2020) highlight the policy of “Expanding scope-of-Practice for Nurse Practitioners (NPs) on Medication Adherence." The policy can be both organized and at the state level. Despite the policy not being formulated for improving adherence, it can be put into practice to improve access to health care from qualified health providers (Muench et al., 2020). Nurses in practice can help improve medication adherence through the stages of medical adherence: initiation, implementation, and persistence. The first way they can help improve is that Nurses on Practice can help medical compliance in a stage as they are trained in communication and patient-centered care compared to the physicians. Another aspect which in turn, can affect the practices of prescription, patient trust, and educating patients on medication which are the critical factors of medical compliance (Muench et al., 2020)
Through policy work, nurses are well-positioned health care objectives. Policies are essential as they provide a framework through which standards of delivery service and care are done. Nurses can use policy work to improve the standards of practice and process to ensure quality care (Burke, 2016). Influencing of particular by nurses helps shape the care that is provided today and tomorrow (Burke, 2016). Nurses need to take leadership roles, which will help improve and strengthen healthcare policies and push forth their agenda. An example is collaborative policy work, in which health leaders across different nations can work together to improve healthcare. Through working in coloration, they can help prevent illness and reduce hospital stay.
Leadership strategies to improve patient outcomes
Leadership has been known as a critical factor for creating a high-quality corporate culture and delivering successful healthcare services. EBP is currently recognized as the tool for effective health care (Sfantou et al., 2017). Even in decentralized health systems, putting good leadership as a priority in health care units is predicted to improve a number of quantifiable indicators. In order to meet current societal, economic, and health problems and demands, structural changes are being undertaken by national and regional systems (Sfantou et al., 2017). Sfantou et al. assert that in order to establish an effective and meaningful priority-setting system in “health care, medical leadership in decision-making is essential." In this case of medical non-compliance, empowering leadership is critical in promoting patient outcomes as it encourages nursing expertise. Similarly, Transformational Leadership and Transactional Leadership can be used to help medical adherence of the patients.
In addition, communication is an essential component in equipping patients with necessary information. The communication strategies to improve medication adherence are patient reminders as they help reduce forgetfulness and ta...

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