L2 · Not following the treatment plan
Actual Learning and self-management
Definition
The person does not take medicines, attend visits, or follow advice as agreed.- Side effects
- cost
- forgetfulness
- beliefs
- no symptoms
- complex plan
- Misses doses
- skips visits
- stops medicines
📋 Scenario
A patient with high blood pressure stops his pills when he feels well.
Subjective (S): "I feel fine so I stopped my pills."
Objective (O): Stopped blood pressure medicine; blood pressure 168/96; missed two appointments.
Assessment tools for this scenario: CP-LEARN Learning Readiness Check CP-SKIN Skin & Wound Score CP-BREATH Breathing & Circulation Check
Validated scales to consider: Teach-back, Braden Scale, TIME wound chart, NEWS2, SpO₂, ECG
**CarePath diagnosis:** Not following the treatment plan related to feeling well and not seeing the need for medicine, as evidenced by stopping blood pressure tablets, a blood pressure of 168/96, and two missed appointments.
**Interventions and rationale**
| Intervention | Rationale |
|---|---|
| Ask kindly why. | Asking without blame helps him say the real reason, such as feeling well, cost or side effects, which must be known to solve the problem. |
| Explain benefits. | High blood pressure often causes no symptoms, so explaining what the medicine prevents, such as stroke and heart disease, helps him see why he should keep taking it. |
| Simplify the plan. | A simpler plan, with fewer doses or tablets, is easier to follow and makes missed doses less likely. |
| Solve barriers. | Solving barriers such as cost, transport or side effects removes the actual reasons for stopping. |
| Involve family. | Family can remind and encourage him, and support makes it easier to keep up a long-term routine. |
| Use reminders. | Reminders such as alarms and pill boxes help with forgetfulness, which is a common cause of missed doses. |
**Expected outcomes**
- Takes medicines as prescribed.
- Keeps appointments.
- States why medicine is needed.
- Blood pressure improves.
**Linking the data to the diagnosis**
The patient says, "I feel fine so I stopped my pills." He stopped his blood pressure medicine, has a blood pressure of 168/96, and missed two appointments. These data show he is already not following the plan, so this actual diagnosis is right, and it fits better than a knowledge deficit because the problem is the behavior itself. The plan aims for him to take medicines as prescribed, keep appointments, state why the medicine is needed, and see his blood pressure improve.
CarePath diagnosis
Not following the treatment plan related to feeling well and not seeing the need for medicine, as evidenced by stopping blood pressure tablets, a blood pressure of 168/96, and two missed appointments.
Interventions and rationale
Listed in priority order.
| Intervention | Rationale |
|---|---|
| 1. Ask kindly why. | Asking without blame helps him say the real reason, such as feeling well, cost or side effects, which must be known to solve the problem. |
| 2. Explain benefits. | High blood pressure often causes no symptoms, so explaining what the medicine prevents, such as stroke and heart disease, helps him see why he should keep taking it. |
| 3. Simplify the plan. | A simpler plan, with fewer doses or tablets, is easier to follow and makes missed doses less likely. |
| 4. Solve barriers. | Solving barriers such as cost, transport or side effects removes the actual reasons for stopping. |
| 5. Involve family. | Family can remind and encourage him, and support makes it easier to keep up a long-term routine. |
| 6. Use reminders. | Reminders such as alarms and pill boxes help with forgetfulness, which is a common cause of missed doses. |
Expected outcomes
- Takes medicines as prescribed.
- Keeps appointments.
- States why medicine is needed.
- Blood pressure improves.
Linking the data to the diagnosis
The patient says, "I feel fine so I stopped my pills." He stopped his blood pressure medicine, has a blood pressure of 168/96, and missed two appointments. These data show he is already not following the plan, so this actual diagnosis is right, and it fits better than a knowledge deficit because the problem is the behavior itself. The plan aims for him to take medicines as prescribed, keep appointments, state why the medicine is needed, and see his blood pressure improve.