Social boundaries are what I encounter on daily basis in my current practice. Working in a community heavily populated with minorities of poor socioeconomic status, low educational level, and language barriers, I am frequently faced with patients experiencing social boundaries. These boundaries oftentimes result in poor quality care or access to care for these patients. These patients present for surgery with a multitude of poorly managed health problems which include, hypertension, diabetes, end-stage renal disease, coronary artery disease, congestive heart disease, obstructive sleep apnea, chronic obstructive pulmonary disease, morbid obesity, hyperlipidemia, and so on. These co-morbidities constitute a high anesthetic risk for these patients which continually leads to cancellation of their surgical procedures, postponement of their cases, prolonged hospital stay, or post-operative complications. The frequent commonality among these patients is non-compliant with their care. They are often labeled as “non-compliant” in their charts.
However, as I interact with some of these patients, I’ve noticed that their medication non-compliance is multifactorial. For most patients, it’s the unaffordability of their medications, some are confused about the medication instructions due to poor education or language barriers and for some, they experience adverse drug reactions (ADRs) and stop taking the medications. According to Wood and Lightfoot (2018), 25% of patients who were non-compliant with their medications before surgery were confused about the medication instructions. Song et al., (2020) cite ADRs alone as a global clinical problem leading to increased morbidity and mortality. While medication costs and affordability were the most commonly mentioned barriers to medication adherence (Heidari et al., 2019). Poor compliance is very common among hypertensive patients constituting a worldwide problem (Ahmad & Shaheen, 2020).
As a leader, I must be an advocate for my patients. I’ve been able to advocate care for my patients by relating some of these concerns to my interprofessional teams. These include our leadership team, social workers, primary care physicians, and pharmacy. On the nursing level, we assess every patient for health literacy upon admission. We achieve this by communicating clearly, in simple and plain English. As we share information or instructions with patients or caregivers, we ask that they repeat to us their understanding of what was said and ask clarifying questions as necessary. Medical jargon is avoided as much as possible while communicating with patients. A video-assisted language line is provided to assist with communication for non-English speaking patients and social workers are involved with the care of patients with medication affordability concerns. The pharmacy helps find alternatives for medications with adverse effects or high costs.
To leverage resources to overcome these boundaries, we heavily advocate for family involvement in patients’ care and request that our non-English speaking patients come for their procedures with an English-speaking relative, and with their consent, instructions are given in the presence of caretaker in both their native language and English using a language line. Patients and or caretakers are asked to repeat instructions as given both pre-and postoperatively. A language line is provided in almost all languages and used on every non-English speaking patient. Reasons for non-compliance are addressed with resources provided as necessary and social worker consult is made on every patient having financial difficulties accessing medications or treatments. The facility has provided free walk trails for the members of the community. Patients and families are encouraged to use the trails.
References
Ahmad, I., & Shaheen, A. (2020). Status of medication compliance among patients with hypertension: A global challenge. Pakistan Heart Journal, 53(4), 210-212. https://doi.org/10.47144/ph.v53i4.1846
Heidari, P., Cross, W., Weller, C., Nazarinia, M., & Crawford, K. (2019). Medication adherence and cost‐related medication non‐adherence in patients with rheumatoid arthritis: A cross‐sectional study. International Journal of Rheumatic Diseases, 22(4), 555-566. https://doi.org/10.1111/1756-185X.13549
Song, Y., Zhang, W., Zhang, S., Wang, T., Jiang, Z., Meng, C., . . . Sun, Y. (2020). Factors influencing administration, recognition, and compliance of medicine among community residents from Jilin province, china: A questionnaire study. BioMed Research International, 1-13. https//doi.org/10.1155/2020/8730212
Wood, D., & Lightfoot, N. (2018). An audit of regular medication compliance prior to presentation for elective surgery. The New Zealand Medical Journal, 131(1480), 75-80. https://chamberlainuniversity.idm.oclc.org/login?url=https://search-ebscohost-com.chamberlainuniversity.idm.oclc.org/login.aspx?direct=true&db=mdc&AN=30116068&site=eds-live&scope=site
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