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Nurses and ‘difficult’ patients: negotiating non-compliance


Sarah Russell, 86 Clarke St, Northcote, Victoria 3070, Australia. E-mail:


Background.  There is a large body of nursing literature on patient non-compliance. While some articles address non-compliance as a patient problem to be resolved by nursing interventions, there is also a growing number that critique this approach. This reflects the discomfort many nurses feel about the practice of labelling patients as non-compliant.

Aim.  The aim of this discussion paper is to build on the critical nursing literature to offer an alternative to the interventions commonly directed at patients who do not follow health care advice. This alternative approach locates patients within their social context and focuses on those who adapt health care advice to fit with their beliefs, life situation and circumstances. The aim is to encourage nurses to learn about how health care treatments affect patients’lives, and not merely their health.

Method.  Specific nursing articles were reviewed to demonstrate the ways in which the concept of compliance is used within the nursing literature. These articles were then used to support an argument that promotes a patient-centred approach to health care.

Conclusion.  A patient-centred approach involves transferring power and authority away from health care professionals and towards patients. We encourage nurses to take a leadership role by changing the way in which health care is delivered towards a focus on patients’lives. Learning about patients’ lives may assist nurses to offer health information to patients that is more relevant and, therefore, useful.