A hospice agency I recently worked for struggled with the idea of holding families accountable for compassionate care. Because I thought we should hold families accountable, I was looked at as narrow-minded. For example, I cared for a dementia patient who was a holocaust survivor, who me, suffered night terrors. Seroquel actually helped, but his family stopped giving it to him, because he was too sedated, and they were not willing to try any other meds as they feared side effects. The social worker on the case identified that this family's preference was lucidity vs comfort. The IDG ssaid we can't impose our values on the families. So his night terrors continued for the couple of months he was in our care, until he developed what appeared to be an acute incarcerated hernia, after which he died 3 days later. With the hernia, he was moaning, and saying "it hurts". The family fought me on medicating him, even after I told them his prognosis if he did indeed have an incarcerated hernia. I finally told the family it wouldn't be right to keep him at home with an incarcerated hernia without medicating him, and they let me give him a dose of Morphine. A nurse went out the next 2 days, to reinforce pain management. My manager called me into her office, wanting to know why I thought I had the right to "impose my own values" on this family. (The family complained to the social worker, and the social worker complained to my nurse manager, again saying this family valued lucidity). The MD thought the patient should be medicated every 4 hours, but says we are powerless to hold families accountable for managing symptoms. It was a difficult work environment, because the same sort of situations came up repeatedly with my 1-1/2 years with this company. There was no team approach to overcoming barriers to symptom management, because the team did not accept as it's responsibility, overcoming barriers to symptom management. I'm afraid to go back into hospice nursing, without knowing what I can do in this kind of a situation? Has anyone had similar experiences, and if so, what can be done about it?