Wednesday, October 30, 2013

Lack of Resources Makes for Distractions and Non-Compliance

By E’Louise Ondash, RN

Non-compliant patients are the bane of the health care provider’s existence.

My nurse colleagues complain about them all the time.

“Why don’t they just do what they are supposed to do?” they chant. “It would make things so much easier and they would be so much healthier.”

I agree; in a perfect world, all patients would do exactly as they are told and it would be a whole lot easier on us.

I thought about the non-compliance problem after reading a feature written by Ivan Semeniuk, a science reporter for The Globe and Mail in Toronto. He interviewed Eldar Shafir, a professor of psychology and public affairs at Princeton University. Shafir’s most recent work looks at why the poor seem to make bad decisions which usually have negative impacts on their lives.

What Shafir found was that “those who are living on meager incomes are often frantically juggling resources – money, time and health – in a high-stakes game where the consequences of making an error can be severe.”

Such juggling of time and money requires a lot of energy and can be exhausting. It leaves few mental resources for dealing with tough decisions.

“Scarcity focuses our attention to the exclusion of all else,” Shafir explained. “Scarcity…tends to block out competing demands.”

Nurses need to think about this when working with low-income patients, and even with those who may be financially stable but have a scarcity of time and rest because of the demands of job and family. In my experience, though, higher-income patients are generally better educated about their health and the health care system; feel more empowered; and tend to be more compliant than low-income patients. When the chips are down, they at least, unlike the poor, have more resources (people and money) to call into play.

The poor and those who are losing ground in the middle class face many obstacles when it comes to obtaining health care: fewer and more confusing options for insurance coverage; unreliable transportation to appointments; the high cost of medication and good food; lack of support networks; the challenge of caretaking; and potential job loss or underemployment. Financial struggles are a huge distraction, so these hurdles usually appear higher on their priority list than compliance.

But without compliance, health problems only intensify.

If you work with lower-income and/or struggling middle-class populations, have you encountered problems of non-compliance?

If so, have you been able to help solve any of their “distracting” problems?

Tell us about it.

1 comment:

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Interesting perspective. This question emphasizes to idea of a two-speed medical care and the gap between treatments for whealty and poor people.