Concepts are the building block for the theoretical development. The concept analysis will provides a clear definition of the concept selected, including concept uses, other close concepts, defining attributes, and its uses to the selected discipline (Walker &Avant, 1995).
Compliance has studied in a wide range of scientific perspectives including nursing discipline, medicine, economics, and psychology. Especially, anyone who administers treatment, advice or support understands the value of compliance. The response to the ambiguity over the compliance term has been to suggest and use alternative concept like adherence, mutuality, cooperation, and therapeutic alliance.
Through healthcare providers, ‘compliance’ is a term with competing meanings. Although the negative connotations of this term have been specified and discussed for years, compliance continues to be used to characterize patients and their behavior. In the last 20 years, healthcare literature regarding to compliance has raised, while its usage infiltrate the slang of healthcare givers. One reason for the increased concern is the suggestion that healthcare regimens are worthless if the patient chooses not to comply (Dracup & Meleis, 1982). Compliance research and anecdotal reports are also many in the general health-related literature.
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According to (Norries, 1982) one of the main problems with the nursing science is that its concepts are terms that lack the elements of the system that are important for a scientific discipline (e.g. rules and categories). For that, the researcher will show a concept analysis of compliance which will identify and inspect its characteristics, attributes, antecedents, consequences and the usage of the concept in nursing discipline. Usually an analysis of the concept is done to explain its meaning and to display the relations of its elements in different area. In this analysis paper the concept of compliance will be studied in the scope of nursing to clarify its meaning to develop a nursing knowledge base and to exhibit its significance in nursing profession.
In an attempt to answer the question, ‘How does nursing utilize the term compliance?’ nursing literature was checked and a critical analysis of this concept was conduct. Including an inspection of how nursing was existed in relation to the historical argument surrounding the word compliance. The important of this analysis expands beyond semantics when we take in mind the implications of its application to patient care.
The majority of compliance research which published between 1970 and 1980 was undertaken by physicians or behavioral scientists, with no input from nursing or reference to a theoretical framework from which to operationalize compliance (Sackett & Haynes 1976(.
Nursing became involved in the argument over compliance as a measurable behavior through the work of Marston (1970). She was one of the first nursing authors to enter the compliance filed, and increased the concerns about the several definitions of compliance used in the literature as well as the lack of objective measures for compliance behavior. Marston said that nursing should exhibit its experience and understanding of patient compliance because research was dominated by physicians and behavioral scientists in the 1970s (S.ackett.& H.aynes 19[76). Marston motivates nurses to participate in compliance discussion because she believed that healthcare professionals need to understand the term compliance from a more holistic nurse patient perspective. In 1973, the First North American Nursing Diagnosis Association (NANDA) listed non-compliance as a nursing diagnosis, the diagnosis being based on the medical literature (Kim 1982).
More definitions of compliance in the literature include the paternalistic connotation, such as defined by (Festa et al., 1992) “the extent to which a patient’s behavior coincides with advice and therapy prescribed by the medical provider” (as sited in Ingram, T. L. 2009), and “following directions or following a prescribed regimen” (Evangelista, 1999, p. 7), as well as those with an aspect of participation and reciprocity, such as “the extent to which an individual chooses behaviors that coincide with a clinical prescription” (Dracup &.Meleis, 1982, p. 31), and “the patient’s active, intentional, and responsible process of self-care, in which the patient works to maintain his or her health in close collaboration with healthcare staff” (Kyngas, H.,&Hentinen , M.,1997).
Without operational definition, it is very difficult to develop objective measurement tools and analyze compliance across and among disciplines. This part will examine the concept of compliance across different fields of study in attempt to develop an operational definition of compliance as it relates to healthcare and specifically, nursing.
In the widest sense, compliance is defined by the Oxford English Dictionary as “obedience to a command, rule or request” and “the tendency to agree, to do what others want.” And defined in other dictionaries as in Webster’s New World Dictionary (Agnes, 2001) as “act of complying; acquiescence; a tendency to give in readily to others; a disposition or tendency to yield to the will of others; flexible” (p. 136). Using this as a foundation, many disciplines such as psychology, education, business, engineering and healthcare have redefined the general definition to give a more specific description of compliance individualized to their area of study. While this has resulted in a broad array of definitions, further inspection of literature detects several common features.
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A lot of definitions for compliance can be found in other discipline’s dictionaries and through its literature. The definition of compliance is attached to the discipline and the context which it is use in. When used in engineering discipline, it defines compliance as “the displacement of a linear mechanical system under a unit force” (McGraw- Hill Dictionary of Engineering, 2003, p. 116), and according to the psychology, compliance is “a form of yielding to a group” (Statt, 1998, p. 29). Other discipline which is physiology, define compliance as “a measurement of distensibility or the ease by which a tissue can be stretched” (Bulllock &Henze, 2000, p. 526), Educators define the concept as “an agreement to conform to a request presented, whether or not there may be some degree of coercion involved” (Spafford, Pessce, & Grosser, 1998 , p. 56).
For the purpose of concept analysis, the concept of compliance will be examined as it is used in nursing and health care. As defined by the World Health Organization (2003), compliance is “the extent to which a person’s behavior-taking medication, following a diet, and/or executing lifestyle changes-corresponds with agreed recommendations from a healthcare provider” (p. 3). The term compliance carries a negative connotation in the healthcare setting, as it implies some degree of “submission” to the provider (Vermeire, Hearnshaw,Van Royen, & Denekens, 2001). Failure to comply with a specified treatment course can be viewed as “disobedience” of the patient, further supporting the negativity associated with the concept (Vermeire et al.). In clinical practice, the exact meaning of compliance varies from individual to another, even among healthcare providers (Tebbi, 1993). Haynes, Taylor, and Sackett (1979) defined compliance as “the extent to which the patient’s behavior coincides with medical or health advice”. The lack of a gold standard to measure the concept has created a barrier to establishing a unified definition of compliance in the healthcare setting (Vermeire et al., 2001).
Antecedents are those event or incidents that must occur prior to the occurrence of the concept (walker & Avant 1988), and as (Chinn & Kramer, 2008 (said Experiences that must occur prior to a concept are known as antecedents. Control by an external source and a capability to yield, adapt and conform must be exciting for compliance to happen in any discipline. For more explanation let’s take an example from other of health care like lung compliance, as seen by the physiologist, and the displacement of a structure under force, as estimated by those in the engineering profession. Considering the previous examples, the driving force is in control of a particular function or situation, while an ability to yield, conform, and adapt is demonstrated by that which was placed under the driving force. The same principle holds true in nursing and medicine by way of human interactions. Treatment plans are given to patients who are expected to yield, adapt, conform, and demonstrate elasticity to obey completely as specified. In nursing without a patient who is willing to collaborate and follow the orders as prescribed, compliance cannot occur.
Characteristics, which describe the concept, are known as its defining attributes (Walker & Avant, 1988), Evangelista (1999) described the five defining attributes of compliance as the “ability to complete or perform what is due, flexibility, adaptability, malleability, and subordinate behaviors” (p. 7).
First defining attributes the ability to complete or perform, which described as an act of obedience with a request or demand of other one. The second attribute is flexibility, which means being capable of repeated bending. Another thing need for compliance is ability to adapt to new, different or changing requirement in term of adaptability. Other attribute is malleability which refers to the capability of being controlled by outside forces. The last one of compliance attributes, which is subordinate behaviors, which can be attached to human relationship.
Consequences refer to result, products or outcomes of compliance, which defined by (Chinn & Kramer 2008) as Events or incidences that occur as a result of the concept. Loss of control, powerlessness, obedience, conformity, and adaptation all occur as consequences of compliance. In the educational filed, when a student is compliant with the requests or instructions given by the instructor, he has been obedient by conforming and adapting, while losing some degree of power and control over the situation. Likewise, patients lose power and control if they are obedient by conforming and adapting to the treatment plans inventive by healthcare givers. Compliance often implies that the healthcare provider holds the power in the patient-provider relationship, resulting in the lack of an alliance or partnership (Sackett, Haynes, & Gibson, 1975). Most patients need an active part in their health care, while they often understand themselves as passive recipients of care when adhering to a plan as prescribed by their provider.
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