IDI FAITH A BNS 4Y1-1B

CONNECTING WITH CHRONICALLY ILL

PATIENTS TO IMPROVE TREATMENT
ADHERENCE
Giovana G. Silva MSN, RN, AGNP-C
Martha K. Swartz PhD, RN, CPNP, FAAN
Sheila L. Molony PhD, RN, GNP-BC
The Nurse Prac!!"#er$ The A%er!ca# &"ur#a' "(
Pr!%ar) Hea'h Care
Septe!er "#$%
&ol'e () N'!er )
Pa*e+ %" - %,
*e)+"r,s$ atta-hent theory, -hroni- illne++, patient-pra-titioner relation+hip, therape'ti-
allian-e, treatent a.heren-e
A-srac
A!+tra-t/ 0hi+ +t'.y pre+ent+ an inte*rative review o1 the literat're a++e++in* the relation+hip+ aon* a
patient2+ +tyle in -opin* with a lon*-ter health -on.ition, the patient-pra-titioner therape'ti- allian-e,
an. treatent a.heren-e aon* -hroni-ally ill a.'lt+. 3vi.en-e-!a+e. re-oen.ation+ to iprove n'r+e
pra-titioner-patient therape'ti- allian-e an. treatent a.heren-e are +'**e+te..
Chroni- .i+ea+e+ have !e-oe in-rea+in*ly prevalent on an international +-ale.$ Fort'nately, priary -are
n'r+e pra-titioner+ 4NP+5 are 'ni6'ely poi+e. to 1or e11e-tive, lon*-ter -lini-al relation+hip+ with
-hroni-ally ill patient+ an. their 1ailie+ while a++i+tin* the thro'*h the .i+ea+e pro-e++. 0he 6'ality o1
the patient-pra-titioner relation+hip 4or therape'ti- allian-e5 i+ parti-'larly iportant when -arin* 1or
-hroni-ally ill patient+ !e-a'+e it i+ a .eterinant o1 treatent a.heren-e."-% Non a.heren-e to a e.i-al
re*ien 41or e7aple, a patient2+ !ehavior not at-hin* a*ree. re-oen.ation+ 1ro the -lini-ian5 i+
e+tiate. to a11e-t appro7iately (#8 to 9#8 o1 patient+ with -hroni- -on.ition+ an. *enerate+ ne*ative
o't-oe+, in-l'.in* in-rea+e. e.i-al -o+t+ an. rate+ o1 ho+pitalization.9,:
;hen a patient i+ -on1ronte. with a .e!ilitatin* .i+ea+e, hi+ or her +tyle o1 -opin* with +tre++ ay
-ontri!'te to a non-pro.'-tive -lini-al relation+hip with the health-are pra-titioner. Pra-titioner+ ay 1eel
1r'+trate. an. -on1'+e. !y patient+ who are 'n.er or over -on-erne. a!o't their health +tat'+ a+ well a+
tho+e who are over .epen.ent on the pra-titioner2+ opinion.<,, A+ a re+'lt o1 thi+ pattern, e++ential an.
po+itive patient-pra-titioner relation+hip+ are not 1ore., whi-h ay lea. to poor 6'ality o1 -are.
0hi+ arti-le pre+ent+ an inte*rative review o1 the literat're that a++e++e+ the relation+hip+ o--'rrin* aon*
the 1ollowin* varia!le+/ the patient2+ +tyle in -opin* with a lon*-ter health -on.ition= the patient-
pra-titioner therape'ti- allian-e= an. treatent a.heren-e aon* -hroni-ally ill a.'lt+ in priary -are
+ettin*+. 0he review o1 epiri-al an. theoreti-al +t'.ie+ will !e *ro'n.e. in Bowl!y2+ atta-hent theory
an. will re+'lt in evi.en-e-!a+e. re-oen.ation+ 1or tailore. +trate*ie+ aie. to iprove therape'ti-
allian-e an. treatent a.heren-e.
R3AC0>?N
;ith in-rea+in* level+ o1 +ophi+ti-ation in e.i-al te-hnolo*y, -hroni-ally ill patient+ ay !e a!le to live
lon*er live+ an. hen-e, the i++'e o1 6'ality o1 li1e 4@?L5. @?L en-opa++e+ % .i+tin-t area+, that -over
the patientA+ total e7perien-e o1 illne++, naely phy+i-al health an. +yptoatolo*y, 1'n-tional +tat'+ an.
a-tivitie+ o1 .aily livin*, ental well - !ein* an. +o-ial role 1'n-tionin* an. +o-ial +'pport.
So when n'r+in* -onne-t+ an. '+e epathy with a -hroni-ally ill patient it will Provi.e patient+ with an
'n.er+tan.in* o1 the e.i-al a++e++ent an. e7plain pro-e.'re+ !e-a'+e Me.i-al pro-e.'re+ -an -a'+e
1ear, an7iety, -on1'+ion, irritation an. a ho+t o1 other ne*ative 1eelin*+. >n1oration a!o't +'-h
pro-e.'re+ -an help a5 re.'-e -on1'+ion an. an7iety on the part o1 the patient !5 *et the patient ore
involve. in the treatent pro-e++, ri*ht 1ro the very !e*innin*.
>t will al+o help patient+ han.le the .ia*no+i+. For e7aple Dia*no+i+ o1 a -hroni- Bi.ney .i+ea+e ay
eli-it a n'!er o1 eotional rea-tion+ whi-h are ani1e+te. in any way+ an. whi-h -an have a.ver+e
e11e-t+. >t i+ iportant to note that the+e rea-tion+, e+pe-ially an7iety an. .epre++ion, are o1ten 'n.er
.ia*no+e., -on1'+e. with +ypto+ o1 the .i+ea+e or treatent or pre+'e. to !e noral an. there1ore
not worthy o1 inve+ti*ation. A++e++in* an7iety an. .epre++ion an. onitorin* the +ae thro'*ho't the
.i+ea+e are th'+ iportant.
>t will al+o 3nhan-e patient a.heren-e to treatent i1 Mental health pro1e++ional+ +ho'l. Provi.e
Bnowle.*e to the patient+ a!o't the .i+ea+e an. the treatent re-oen.ation+.