The document discusses several topics related to non-compliance in patients. It describes the top reasons for intentional non-compliance such as fear of side effects, cost of medication, and misunderstanding instructions. It provides tips for doctors and nurses to treat non-compliant patients, which include being empathetic, thoroughly educating patients, documenting all discussions, setting clear boundaries, and avoiding ultimatums. The document also discusses issues related to restraint and seclusion in psychiatric facilities as well as addressing food refusal in hospitalized psychiatric patients.

3. NON COMPLIANCE
 The term "non-compliant patient" generally refers to a patient
who intentionally refuses to take a prescribed medication or
does not follow the doctor's treatment recommendations.

4.  These are the top eight reasons for intentional non-compliance
which include:

 a. Fear: Patients may be frightened of potential side effects.
 b. Cost: A major barrier to adherence is often the cost of the
medicine prescribed to the patient.
 c. Misunderstanding
 d. Too many medications.
 e. Lack of symptoms.
 f. Mistrust. & Worry.
 h. Depression.

5. TIPS FOR TREATING NON-COMPLIANT PATIENTS
 Be understanding:
 Put yourself in the patient's shoes and make every effort to be
empathetic, thus recognizing the challenges they may
experience when trying to understand the requests.
 Educate:
 Patients may exhibit non-compliant behaviors because they
simply do not understand the diagnosis or instructions for
treatment. It is the responsibility of doctors and nurses to help
them. Ask them to repeat back what doctor or nurse said, or
take the time to describe the instructions in their own words or
words they fully comprehend.

6.  Document everything:
 It is important to maintain meticulous records when dealing
with non-compliant patients and documenting what has been
discussed with the patient, all diagnosis and treatment plans, and
any questions or concerns the patient or their visiting friends
and family may have.
 Set boundaries and enforce them:
 Sometimes a patient exhibits non-compliant behavior because
they are stubborn or have tendencies to test how far they can
push doctor or nurse. If doctor/ nurse impose limits and enforce
them with earnestness, doctor or nurse will ultimately help the
patient consider the very real consequences of their non-
compliance
 Avoid ultimatums:
 Don't threaten a non-compliant patient with empty ultimatums,
be objective when explaining the options to them .

8.  Restraints is not just about physically restraining people. It
includes the use of medication to subdue patients, and the use
of seclusion to confine and isolates someone on the ward.
 Restraints include the use of physical force, mechanical
devices, or chemicals to immobilize a person.
 Seclusion, a type of restraint, involves confining a person in a
room from which the person cannot exit freely.

9.  Failing to use restrain and seclusion in emergency situations c
also result in adverse outcomes to the individual himself or
others in the milieu.
 Minimum standards for the use of restrain and protect patients
basic constitutional rights, such as life and liberty,interests
and freedom from cruel and unusual punishment of
unnecessary bodily restraints, Violation of any of these rights
a be grounds for damages in a case involving restrain and
seclusion

10. ISSUES
 Death during restrain and seclusion often is due to asphyxiation,
aspiration, or cardiac events.
 Prone restraint increases the risk of suffocation and supine
restraint increases the risk of aspiration. The use of face towels
to prevent biting or spitting may also increase risk.
 Any type of technique that obstruct airways or impairs
breathing, any technique that obstructs vision, and restricts a
patient's ability to communicate should not be used under any
circumstances.
 Prolonged restraint can increase the risk of deep vein
thrombosis and pulmonary embolism, particularly in patients
already at risk for these conditions.

11.  Most facilities that have successfully reduced restrain and seclusion
related risk have implemented several different interventions based
on good clinical care, addressing leadership, examinations of
practice contexts, staff education and integration, treatment plan
improvement, increased staff-to-patient ratios, vigilant monitoring,
psychiatric emergency response teams, pharmacologic interventions,
involvement of patients as active participants in their treatment,
changes to milieu and facility policies, and addressing the needs of
clinical staff.
 For high-risk scenarios, policies should require the removal of
modifiable risk factors, particularly when restrain and seclusion
become necessary.
 The patient and room should be searched, and potentially harmful
objects should be held in a secure location until the crisis has abated.
 When a patient is in seclusion, the room should be free of any pipes
or other structures from which a patient could hang himself, as well
as objects that could be used for self-harm.

12.  Appropriate staff levels are necessary to maintain a safe
treatment environment.
 Vigilant monitoring is essential when a patient is in restraints
or seclusion.
 Staff and managers must take a proactive approach toward
communication within a treatment team.
 Communication and support are critical steps after an episode
of restraint or seclusion, particularly the process of debriefing.

13. Refuse to take food

14.  Food refusal is commonly seen in hospitalized patients with
mental illness resulting in muscle mass loss and death, if left
untreated.
 In acute conditions, it may lead to a medical emergency and
in chronic conditions, it can lead to ingrained behavior that is
difficult to change.
 Patients suffering from schizophrenia or other psy-chiatric
disorders having paranoid delusions involving food or
persecutory delusions, that food is contaminated or poisoned,
can be common reasons for food refusal.
 Auditory hallucinations and negative symptoms of
schizophrenia are associated with a reduced impulse to
restrict eating or binging.
 Eating problems might also result from social rein-forcement
such as coaxing, spoon-feeding, or persuading the patient,
wherein the patient seeks attention by refusing to eat.

15.  Capacity assessment should be done before adopting force-
feeding measures. Spoon feeding, tube feeding, and intravenous
feeding can be used to prevent starvation.
 Do not force someone to change their behavior as this could
make them feel even more anxious and fearful about food. It
could also make them withdraw from health care provider.
 Include patients in social activities. Arrange activities which do
not involve food.
 Keep meal times as stress-free as possible: Do not comment on
their food choices. Let them get on with eating the food they
feel like eating.
 Share stories from other people: It can be really helpful to read
stories and accounts by people with eating problems.
 Increase self-awareness, challenging dysfunctional beliefs, and
improving self-esteem and sense of control.