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Hi all,
I am seeking input on the understanding and use of the terms adherence and compliance by nurses. Are they seen the same or different? If different, how would you define the two?
Thank you.
I agree that there is only a slight difference in the meaning of compliance and adherence. They mean almost the same thing but not quite. Complying to an order, is slightly different from adhering to it. From a patient perspective, speaking to a patient, I would prefer using adherence.
I do not believe that there is only a slight difference in meaning between these two terms – and I've tried to provide a view that is held by many nurses outside of our group of language and informatics experts:
____________________________________________
I think we are missing an important fact in our discussion – that is there is no one concept or term in any of our standardized languages that has created more controversy than “noncompliance”. As nursing leaders who are to represent the global nursing community to SNOMED we have an obligation to consider the views of ALL nurses, just simply our own ideas.
I’ve be an active member of the holistic/integrative nursing community for more than 3 decades and I also represent many nursing faculty/scholars who find the term ‘noncompliance’ completely outside the domain of professional nursing. Why? That’s because compliance suggests that an individual is not following directions, orders or advice given by another. When used in a health care setting, the term refers to any situation where the nurse (or health care provider) tells a patient/client what to do and the patient/client chooses not to comply with that order. Many nurses reason our patients/clients can not be denied their right to self-determination and autonomy. When we make a decision that these patients/clients have a problem we need to correct because they do not choose the treatment plan we’ve ‘ordered’ for them, we are are violating our nursing ethical codes. Further, these nurses also reason that when we observe behaviours that indicate noncompliance, we likely have devised a treatment plan that disregards the patient/client’s social circumstances or cultural beliefs.
I worry that these concerns have driven literally thousands of nurses away from use of any standardized language and has resulted in many faculty in my country not teaching or researching this content. We have many nurses who are skeptical about anyone’s ability to capture nursing activities in computerized health records, in some locations these are the majority of nurses.
One thing we have the power to do here is at least provide these colleagues of ours an alternative term to document those situations where a patient/client as agreed to a treatment plan and requests our help/guidance in following the regimen. That term is “adherence” and its use in practice is “non-adherence to the agreed-upon treatment plan” (with emphasis here on the notion of ‘agreed-upon). *
I urge us to act on behalf of nurses who are not within our ranks as informaticians and developers of standardized terms as well as acting on behalf of those who are. For the future of our profession, we need to address ALL so that nursing as a discipline and profession may (hopefully) stand as a more unified group than we are today.
*Please also note that the NANDA-I taxonomony retired the use of noncompliance in 2018, citing the lack of the term’s use in the then current nursing literature, and among other concerns, the conflicts of its use and the Affordable Care Act (ACA) in the US that protects patient rights.
A more patient focussed term is 'concordance' which is semantically slightly different different again but reflects the direction of clinical practice being more patient directed rather than a more paternalistic approach. Medicines concordance and adherence: involving adults and ...
Thank you all for your input. This topic has been discussed internally with the the decision the compliance and adherence are seen as synonymous. Concepts will be created with Compliance in the FSN. Adherence to <x> will added as a synonym. The latter can be used as preferred term in extensions where that option is preferred.
Great to see the start-up of the Nursing SIG-meetings! Just noticed it two weeks ago.
Thank you Cathy Richardson for your question in the first place. Very interesting topic!
I read in the comments that participants agree on that compliance and adherence are not a synonym. I can confirm this.
I don't want to redo the discussion, if this was a topic in your latest meeting of Nursing SIG (March 9, 2021), because there is no recording uploaded yet. If so, you can ignore this comment.
On the other hand, I see that both terms are already stated as synonym, back in 2019 or even earlier. In the current Snomed CT I read:
258143003 P Non-compliant (qualifier value) - synonym: Non-compliance - Non adherence
Beside that, I could find other terms (like adherence) in this Snomed CT-list:
P Device adherence Device adherence (disorder) S Adherence behavior Self-initiated health seeking behavior (observable entity) S Religious adherence Religiousness (observable entity) S Medication adherence Medication compliance (observable entity) S Promoting medication adherence Promotion of adherence to medication (procedure) S Verbalizes medication adherence Verbalizes medication compliance (finding) P Healthy diet adherence behavior Healthy diet adherence behavior (observable entity) P Medication regimen adherence education Medication regimen compliance education (procedure) S Non-adherence to antiretroviral medication Noncompliance with antiretroviral medication regimen (finding) P Adherence to rules and boundaries Adherence to rules and boundaries (observable entity) P Assessment of barriers to adherence Assessment of barriers to adherence (procedure) S Develop home medication adherence plan Development of home medication compliance regimen (procedure) S Promoting adherence to exercise regime Promotion of adherence to exercise regime (procedure) P Self reported nutrition adherence score Self reported nutrition adherence score (observable entity) P Monitoring adherence to medication regime Monitoring adherence to medication regime (regime/therapy) S Promoting medication adherence using pillbox Promotion of adherence to medication using pill dose dispenser (procedure) P Suspected non-adherence of medication therapy Suspected non-compliance of drug therapy (situation) P Medication adherence telemetric monitoring system Medication adherence telemetric monitoring system (physical object) P History of partial adherence to treatment History of partial adherence to treatment (situation) P Assessment of adherence to immunization regime Assessment of adherence to immunization regime (procedure) S Reported adherence to nutrition self management Reported adherence to nutrition self management (observable entity) P Reinforcement of adherence to treatment regimen Reinforcement of adherence to treatment regimen (procedure) P Medication adherence telemetric monitoring system transmitter Medication adherence telemetric monitoring system transmitter (physical object) P Medication adherence telemetric monitoring system, pre-ingestion Medication adherence telemetric monitoring system, pre-ingestion (physical object) P Adherence to rules and boundaries - finding Finding of adherence to rules and boundaries (finding) P Reinforcement of adherence to physical therapy regimen Reinforcement of adherence to physical therapy regimen (procedure) S Verbalizes plan for reduction of medication adherence barriers Verbalizes plan for reduction of medication compliance barriers (finding) S Reported adherence to nutrition self monitoring at agreed upon rate Reported adherence to nutrition self monitoring at agreed upon rate (observable entity)
I have lot's of questions.
What impact does the decision from your internally group have? What suggestions can we make, as thé Nursing SIG-group?
What is the consequence of the other terms (with adherence in it)? Can terms be adjusted or retired? Can we change the terms to adherence as the preferred term, and compliance as a synonym?
Maybe we can put this on the agenda next meeting?
It a very interesting way on how to deal with, and how to handle the right terms for nursing and nurses.
I will be participating next Tuesday 13th of April.
Firstly, I am not sure if you are aware but twice a year we hold business meetings- in April and October. The April meetings are being held next week and given this the Nursing CRG will be meeting as part of those instead of its normal time slot. The meeting will be held on Tuesday 20th April 2000UTC and run for an hour and a half. The agenda will be posted very shortly. You can register (for free)for this and the other meetings we have via:https://snomed.eventsair.com/snomed-international-april-2021-business-meetings This helps us with planning. There is a session for clinicians which Ian Green or Jane Millar could provide more details on.
Adherence and Compliance:
In this discussion we were focusing on a patient's adherence or compliance not that of a device. The question had been raised given the ICNP - SNOMED work currently underway and input had been gathered from nursing SME's amongst other sources to support the decision. The internal group I mentioned is predominately made up of Terminologists in the Internal Content Team plus a small number of SMEs. It includes our Head of Terminology.
When we make content decisions we need to consider the international aspect as well as the fact these concepts may be used by different clinical domains. At this point in time the information we have did not support creating different concepts for these terms at the international level. We are aware that some do see them as different in meaning.
Provision of input from SME's such as yourself is welcomed. You will also find some other topics in the discussion area on this site that are currently open for comment.
At present the focus is on completing the ICNP - SNOMED work for the upcoming release. I am aware the adherence - compliance issue is broader than this and will be looking to set up a content issue to record the additional work required. I can post that link here when it is created. You would also be welcome to watch and comment on that issue.
8 Comments
Kathy Molstad
I agree that there is only a slight difference in the meaning of compliance and adherence. They mean almost the same thing but not quite. Complying to an order, is slightly different from adhering to it. From a patient perspective, speaking to a patient, I would prefer using adherence.
Noreen Frisch
I do not believe that there is only a slight difference in meaning between these two terms – and I've tried to provide a view that is held by many nurses outside of our group of language and informatics experts:
____________________________________________
I think we are missing an important fact in our discussion – that is there is no one concept or term in any of our standardized languages that has created more controversy than “noncompliance”. As nursing leaders who are to represent the global nursing community to SNOMED we have an obligation to consider the views of ALL nurses, just simply our own ideas.
I’ve be an active member of the holistic/integrative nursing community for more than 3 decades and I also represent many nursing faculty/scholars who find the term ‘noncompliance’ completely outside the domain of professional nursing. Why? That’s because compliance suggests that an individual is not following directions, orders or advice given by another. When used in a health care setting, the term refers to any situation where the nurse (or health care provider) tells a patient/client what to do and the patient/client chooses not to comply with that order. Many nurses reason our patients/clients can not be denied their right to self-determination and autonomy. When we make a decision that these patients/clients have a problem we need to correct because they do not choose the treatment plan we’ve ‘ordered’ for them, we are are violating our nursing ethical codes. Further, these nurses also reason that when we observe behaviours that indicate noncompliance, we likely have devised a treatment plan that disregards the patient/client’s social circumstances or cultural beliefs.
I worry that these concerns have driven literally thousands of nurses away from use of any standardized language and has resulted in many faculty in my country not teaching or researching this content. We have many nurses who are skeptical about anyone’s ability to capture nursing activities in computerized health records, in some locations these are the majority of nurses.
One thing we have the power to do here is at least provide these colleagues of ours an alternative term to document those situations where a patient/client as agreed to a treatment plan and requests our help/guidance in following the regimen. That term is “adherence” and its use in practice is “non-adherence to the agreed-upon treatment plan” (with emphasis here on the notion of ‘agreed-upon). *
I urge us to act on behalf of nurses who are not within our ranks as informaticians and developers of standardized terms as well as acting on behalf of those who are. For the future of our profession, we need to address ALL so that nursing as a discipline and profession may (hopefully) stand as a more unified group than we are today.
*Please also note that the NANDA-I taxonomony retired the use of noncompliance in 2018, citing the lack of the term’s use in the then current nursing literature, and among other concerns, the conflicts of its use and the Affordable Care Act (ACA) in the US that protects patient rights.
Zac Whitewood-Moores
A more patient focussed term is 'concordance' which is semantically slightly different different again but reflects the direction of clinical practice being more patient directed rather than a more paternalistic approach. Medicines concordance and adherence: involving adults and ...
Asta Thoroddsen
I agree with Noreen. Compliance has a negative meaning by nurses, a paternalistic meaning. Adherence is the concept we should use.
Cathy Richardson
Thank you all for your input. This topic has been discussed internally with the the decision the compliance and adherence are seen as synonymous. Concepts will be created with Compliance in the FSN. Adherence to <x> will added as a synonym. The latter can be used as preferred term in extensions where that option is preferred.
Noreen Frisch
this is a very disappointing decision.
Friso Raemaekers
Great to see the start-up of the Nursing SIG-meetings! Just noticed it two weeks ago.
Thank you Cathy Richardson for your question in the first place. Very interesting topic!
I read in the comments that participants agree on that compliance and adherence are not a synonym. I can confirm this.
I don't want to redo the discussion, if this was a topic in your latest meeting of Nursing SIG (March 9, 2021), because there is no recording uploaded yet. If so, you can ignore this comment.
On the other hand, I see that both terms are already stated as synonym, back in 2019 or even earlier. In the current Snomed CT I read:
Beside that, I could find other terms (like adherence) in this Snomed CT-list:
I have lot's of questions.
What impact does the decision from your internally group have? What suggestions can we make, as thé Nursing SIG-group?
What is the consequence of the other terms (with adherence in it)? Can terms be adjusted or retired? Can we change the terms to adherence as the preferred term, and compliance as a synonym?
Maybe we can put this on the agenda next meeting?
It a very interesting way on how to deal with, and how to handle the right terms for nursing and nurses.
I will be participating next Tuesday 13th of April.
Cathy Richardson
Hi Friso Raemaekers,
Firstly, I am not sure if you are aware but twice a year we hold business meetings- in April and October. The April meetings are being held next week and given this the Nursing CRG will be meeting as part of those instead of its normal time slot. The meeting will be held on Tuesday 20th April 2000UTC and run for an hour and a half. The agenda will be posted very shortly. You can register (for free)for this and the other meetings we have via:https://snomed.eventsair.com/snomed-international-april-2021-business-meetings This helps us with planning. There is a session for clinicians which Ian Green or Jane Millar could provide more details on.
Adherence and Compliance:
In this discussion we were focusing on a patient's adherence or compliance not that of a device. The question had been raised given the ICNP - SNOMED work currently underway and input had been gathered from nursing SME's amongst other sources to support the decision. The internal group I mentioned is predominately made up of Terminologists in the Internal Content Team plus a small number of SMEs. It includes our Head of Terminology.
When we make content decisions we need to consider the international aspect as well as the fact these concepts may be used by different clinical domains. At this point in time the information we have did not support creating different concepts for these terms at the international level. We are aware that some do see them as different in meaning.
Provision of input from SME's such as yourself is welcomed. You will also find some other topics in the discussion area on this site that are currently open for comment.
At present the focus is on completing the ICNP - SNOMED work for the upcoming release. I am aware the adherence - compliance issue is broader than this and will be looking to set up a content issue to record the additional work required. I can post that link here when it is created. You would also be welcome to watch and comment on that issue.
Kind regards,
Cathy