Adherence vs. Compliance

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:

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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.

I agree with Noreen. Compliance has a negative meaning by nurses, a paternalistic meaning. Adherence is the concept we should use.

this is a very disappointing decision. 

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