working with homeless pts

[matryoshka87]

hi guys, i am seeking advice on how to effectively deal with a pt (or i should say participant) who refuses medical care/attention. to give u guys a low down on the setting in which i work, it is a homeless outreach/homeless services facility.

anyhow, i came across this participant who was referred to me by my coworker who is a non medical professional. this participant had swollen legs, skin intact, no pain, but the left leg was larger than the right, and this person also stated he has a bone deformity on his left. he is also aaox3 but does have some paranoia/delusion about his leg. i wanted to help him out by suggesting to him that he go get seen in the ER as i was concerned it might be dvt, and we just dont know it. however, this person declined getting seen, and i know i just have to document, but what else could i have done besides that and pt education? i am getting pressure from my co workers for not having done enough but you cant just force someone to get medical attn if they dont want it right? especially if they do have the cognitive ability to know where and who they are. i really need some feedback on this, because i want to do the best i can to help those who need it the most. thanks in advance!

[Sour Lemon]

Sentences, please! This is very difficult to read.

[matryoshka87]

sorry sour lemon. my issue was that this participant in the facility i work in, refused to go to the ER after i suggested that he would benefit from additional testing that would rule out something serious like dvt. this participant, is also aaox3, but does have delusion about why his legs are so swollen. was there anything else that i could have done for him besides just documenting his refusal and noting i did as much pt education?

[12sonrisa, BSN]

I work in community dialysis where non-compliance is a big issue. A couple weeks ago I had a patient with very clear signs of a cvc line infection. The doctor wanted her to go to emerge directly after dialysis and she flat out refused. All you can do is educate and document. This particular patient speaks an entirely different language so I was actually using a translator by phone. As long as you have educated them on why they need ER Care/medication/procedure and the consequences to their health if they don't do it, and then document heavily on the education provided and their informed non-consent, that's all you can really do. I also ask why they don't want to go in case a little extra education or support is needed.

Their health care is up to them and how they view their quality of life with and without the treatment.

We have a few homeless patients as well and with them I go a step further and ensure it is not a lack of transportation, funding to take time off work, etc. And always get social work involved if needed to help support them.