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CONNECTING WITH CHRONICALLY ILL

PATIENTS TO IMPROVE TREATMENT


ADHERENCE
Giovana G. Silva MSN, RN, AGNP-C

The Nurse Practitioner: The American Journal of

Martha K. Swartz PhD, RN, CPNP, FAAN Primary Health Care


Sheila L. Molony PhD, RN, GNP-BC

September 2014
Volume 39 Number 9
Pages 42 - 48

Keywords: attachment theory, chronic illness, patient-practitioner relationship, therapeutic


alliance, treatment adherence

Abstract
Abstract: This study presents an integrative review of the literature assessing the relationships among a
patient's style in coping with a long-term health condition, the patient-practitioner therapeutic alliance,
and treatment adherence among chronically ill adults. Evidence-based recommendations to improve nurse
practitioner-patient therapeutic alliance and treatment adherence are suggested.
Chronic diseases have become increasingly prevalent on an international scale.1 Fortunately, primary care
nurse practitioners (NPs) are uniquely poised to form effective, long-term clinical relationships with
chronically ill patients and their families while assisting them through the disease process. The quality of
the patient-practitioner relationship (or therapeutic alliance) is particularly important when caring for
chronically ill patients because it is a determinant of treatment adherence.2-4 Non adherence to a medical
regimen (for example, a patient's behavior not matching agreed recommendations from the clinician) is
estimated to affect approximately 30% to 50% of patients with chronic conditions and generates negative
outcomes, including increased medical costs and rates of hospitalization.5,6
When a patient is confronted with a debilitating disease, his or her style of coping with stress may
contribute to a non-productive clinical relationship with the healthcare practitioner. Practitioners may feel
frustrated and confused by patients who are under or over concerned about their health status as well as
those who are over dependent on the practitioner's opinion.7,8 As a result of this pattern, essential and
positive patient-practitioner relationships are not formed, which may lead to poor quality of care.

This article presents an integrative review of the literature that assesses the relationships occurring among
the following variables: the patient's style in coping with a long-term health condition; the patientpractitioner therapeutic alliance; and treatment adherence among chronically ill adults in primary care
settings. The review of empirical and theoretical studies will be grounded in Bowlby's attachment theory
and will result in evidence-based recommendations for tailored strategies aimed to improve therapeutic
alliance and treatment adherence.

REACTION
With increasing levels of sophistication in medical technology, chronically ill patients may be able to live
longer lives and hence, the issue of quality of life (QOL). QOL encompasses 4 distinct areas, that cover
the patients total experience of illness, namely physical health and symptomatology, functional status and
activities of daily living, mental well - being and social role functioning and social support.
So when nursing connects and use empathy with a chronically ill patient it will Provide patients with an
understanding of the medical assessment and explain procedures because Medical procedures can cause
fear, anxiety, confusion, irritation and a host of other negative feelings. Information about such
procedures can help a) reduce confusion and anxiety on the part of the patient b) get the patient more
involved in the treatment process, right from the very beginning.
It will also help patients handle the diagnosis. For example Diagnosis of a chronic kidney disease may
elicit a number of emotional reactions which are manifested in many ways and which can have adverse
effects. It is important to note that these reactions, especially anxiety and depression, are often under
diagnosed, confused with symptoms of the disease or treatment or presumed to be normal and therefore
not worthy of investigation. Assessing anxiety and depression and monitoring the same throughout the
disease are thus important.
It will also Enhance patient adherence to treatment if Mental health professionals should Provide
knowledge to the patients about the disease and the treatment recommendations.

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