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The nurse-patient relationship will prove key to effective medication adherence

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Compare and contrast the following statements: ‘Non-adherence [to medication] should not be considered the patient’s problem’; and ‘You [the patient] should follow the course of treatment which you have agreed.’

The two are not mutually exclusive but they reflect a tension at the heart of modern health care and, therefore, nursing practice.

The first is from the latest NICE guidance on medicines adherence, the second from the newly minted NHS Constitution.

Both documents promote ‘patient-centred care’ – in which treatment must be responsive to the needs of the individual. Both set their face against the ‘doctor (or nurse) knows best’ approach of the past.

However, the NHS Constitution makes a point of balancing patients’ rights with their responsibilities, whereas the NICE guidance talks exclusively about what the service must do for the patient. It recommends ‘an open, no-blame approach to patients to discuss any doubts or concerns about treatment’.

This is the crux of the matter. Can you equate ‘blaming’ a patient with reminding them of a ‘responsibility’ to follow a
course of prescribed medication? Well, of course, that depends on how it is done.

Both the NICE guidance and the NHS Constitution stress the importance of good communication between healthcare professionals and patients. Chief Nursing Officer for England Dame Christine Beasley often speaks of nurses learning to become good ‘junior partners’ with patients in the planning and delivery of care.

A nurse who has built a good relationship with a patient by informing and empowering them will be in a strong position to have a non-judgemental conversation with them about the importance of adherence.

It should be the responsibility of a patient to comply with prescribed medication regimens – it is part of the deal the government has struck with the public in providing free health care. Non-adherence is a drain on resources the NHS can ill afford. However, that responsibility only has meaning if the NHS has done its part in delivering care which works with an individual’s needs.

Between the paternalistic poles of ‘be thankful for what you get’ and ‘we can’t expect the poor dears to remember to take their pills’ lies a path to patient-centred care which nurses can help blaze.

Alastair McLellan editor, Nursing Times

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