University of Miami/Jackson Memorial Medical Center restructures its health care system for the 21st century.

Change, challenge, and commitment motivate staff at the University of Miami/Jackson Memorial Medical Center in Miami, Florida, to prepare its health care system for the 21st century. Doctors, nurses, environmental workers, pharmacists, cashiers, nursing assistants, laboratory technologists, and many others are participating on a variety of teams to bring about the changes needed for our delivery system to be competitive.

Compliance redefined and implications for home care.

In home care, clients' behaviors are of primary concern. Behavioral change toward health maintenance and health promotion is influenced by the role of the nurse and the client in the process of change. The proposed definition of compliance is consistent with the philosophy of nursing and, in particular, with that of home care. The theoretical definitions reviewed were inconsistent in defining the health care provider's and the client's roles in compliance. The proposed definition of compliance clarified these roles. The operational definitions, although suggesting client behavior, do not explicate client participation in the therapeutic regimen. The definitions imply that clients could be labeled noncompliant if they did not follow exact protocols or were uncooperative with treatment. The validity of operational definitions and measurement techniques has been questioned. Perhaps if the instruments measured factors affecting health-related behavior from the client's perspective, nurses could target interventions more effectively. Several implications of the proposed definition for home care nursing were described to clarify the need for comprehensive assessment and intervention targeted at the cause of client compliance issues. Analysis of the definitions of compliance assists home care nurses to clarify the meaning of compliance in their practice. The time has come to end the ongoing debate about the words used, recognize the richness of the compliance literature, and come to a consensus on the meaning of this concept.