The nurse is caring for a patient in his home.After several visits and review of the plan of care,the nurse notices the patient will not follow the diet and exercise regimen.What is the most appropriate action by the nurse?

A) Discharge the patient from home care because he is not following the medical regimen
B) Continue to teach and reinforce the importance of the diet and exercise regimen
C) Notify the primary care provider of the patient's refusal to follow the diet and exercise regimen
D) Identify why the patient is not following the plan and revise the plan in collaboration with the patient

Patients may fail to comply with proposed medical regimens or a plan of care if the plan has no cultural or personal relevance for the patient (or family).The nurse must consider the patient's understanding of the plan,knowledge level,and feasibility in terms of available support,time,energy,and finances.Noncompliance often occurs because the effort,inconvenience,or pain involved with the plan is too much for them to handle.People probably do not refuse to carry out a plan of care simply out of stubbornness,hostility toward healthcare providers,or wanton disregard for their own welfare.The challenge and best action by the nurse is to develop an individualized plan of care in collaboration with the patient,based on mutual goals and respect.If after assessing the problem and revising the plan,the patient continues to refuse to follow the plan,then the physician can be notified and the patient possibly discharged.However,these are not the first and most appropriate actions by the nurse.