The Challenge of Patient Adherence

Abstract

The scope of practice for the bariatric nurse includes more than just providing care and education; it also involves supporting patients in making the best decisions for their health. The most critical decision that a bariatric patient makes is to change behaviors that will lead to improvement of their health and quality of life. This is a difficult choice and even more difficult to maintain.

As a nurse working with bariatric patients, I am interested in effective strategies that promote adherence to recommended behavior changes. Can you please describe some techniques that I can use to encourage patients and keep them motivated?

Promoting positive change can be a difficult task. Patients who struggle with their weight may have other problems that compound or influence their ability to maintain new behaviors. This becomes a challenge for the bariatric nurse. Patients may have multiple issues that overlap and impact their ability to maintain positive changes, such as financial problems, marital problems, or other interpersonal issues. Extensive research has been done in the process of change, the stages of change, and the use of models of change. Irrespective of the theory used, the starting point should be to develop a relationship that fosters trust and understanding. The nurse should understand that assisting patients in moving toward improved health requires acceptance of patients as individuals who may have very different values. Patients must understand and agree to their role in their treatment plan for change, and feel ready for change. The nurse and patient must mutually agree upon a treatment plan that fits within the medical parameters leading to a positive outcome.

Starting Point

In developing a trusting relationship with patients, the nurse must start with a collaborative approach. Traditionally nurses have had a controlling, formal, expert manner in providing care; using approaches that empower patients have proven to be more effective. Using an approach that concentrates on patients' beliefs, values, and skills enhances self-efficacy and will improve adherence. When patients are told what to do, they do not have ownership of the plan and feel that their care is out of their control. It is essential that patients see that they are in control of their care. Respecting and valuing patients as the experts in their own lives is important, but this can be very difficult for the nurse and it involves suspending judgments. The nurse must keenly listen to patients explain their health problems in their own terms and show empathy for the difficulty these problems have created. Encouraging patients to recognize their problems and express their feelings about the problems will promote a trusting relationship with the nurse.

What To Do and What To Avoid

Empathy is critically important, but if not genuine it can polarize the professional relationship. Patients want to know and hear that the nurse is truly concerned and eager to provide support. Never use empty phrases such as “I'm so sorry”; instead ask how the patient is managing their problem. Never pretend to listen to patients; keep patients on track when they drift into a lengthy story that contains information that is not vital for their care. When patients share details of their life that are highly emotional, acknowledge their emotion and permit them to express their feelings. Patients may have negative opinions and display negative self-talk; redirect them to the positive aspects of their life and always be encouraging. Everyone wants to hear good news, so deliver the good first and the not so good later. When providing not so good news, do it with a team approach: “Let's look at this together and see what our options are.”

Summary

Working with bariatric patients presents challenges beyond those that typically fall within the scope of fundamental nursing. Keeping bariatric patients motivated and on task with their treatment plan requires emotional intelligence on the part of the nurse. A trusting professional relationship is of paramount importance for bariatric patients to feel secure and confident in their lifestyle changes; bariatric nurses are at the foundation of this change.

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