Nurse Practitioners and Patient Care

This research examines the relevance and importance of relationship-centered care to the work of nurse practitioners. The research will set forth a working definition of the term, in the context of emerging health-care-delivery praxis, and then discuss ways in which relationship-centered care can be used as the primary blueprint and guide for fostering improved patient adherence/compliance.

The term relationship-centered care has evolved in recent years to describe a modality of health-care-delivery protocols that focus on the psychological and social as well as medical needs, wants, concerns, and priorities of patients and their families rather than structuring health-care delivery around the priorities of the physician in charge of a case. Also called patient-centered care, in recent years the term of preference for the structure of health care being described appears to have changed for two reasons. First of all, use of the word patient in the term can have the effect of failing to include the idea that families as well as the individual under treatment may have a stake in patient outcomes. Secondly, there appears to have been some concern in the physician community that the "patient-centered" idea could be misconstrued as a medical-treatment protocol that relinquishes primary responsibility or control for core medical decisions to patients or families when control of a case actually is meant to remain firmly lodged with doctors (Williams & Others, 2000).

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is evidence that patient compliance or adherence to a medical regimen, whether related to ancillary treatments, exercise, diet management, follow-up appointments, substance abuse, or medication schedules, can be problematic for a variety of ailments and personalities. To be sure, if patients are overwhelmingly concerned with being able to pay for multiple clinical visits or prescription drugs, they may resist compliance with doctor orders. But a number of studies have found that financial concerns are less positively associated with failures of compliance than psychological and communication concerns. Melnikow (2000) tracked follow-up family-planning clinical visits of women with problematic pap smears and found that among both insured and uninsured women, those who were provided with multiple reminders were likely to receive follow-up tests. The absence of reminders was associated with failure to adhere to test recommendations. Patient compliance with doctors' instructions is a persistent theme of the literature, a phenomenon noted, tracked, and scored even when not analyzed in depth (e.g., Chervinsky & Other, 1999). While Bayliss, et al., found that simplified instructions for administering dosages tended to improve as improvin

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