Family denies that patient is in pain

[bananorama, LPN]

I work as a homecare overnight nurse caring for palliative patients. I am a new nurse, but I have had quite a bit of clinical palliative experience and have worked with this agency for 4 months now. Most of my clients and their families want comfort care and are receptive to EOL teaching. I have one client who is from the middle east and doesn't speak English. She lives with her daughter, no other family is around. I have been with this client for over a week and I clearly see non verbal signs of pain/agitation at times- moaning/grunting, SOB, pulling at sheets, calling out. I have tried to provide teaching to the daughter but she denies that the client is in pain and doesn't want to give her medication. She has HM and Midazolam in the home. When I have given PRN doses of HM she has gotten upset, not wanting the client to be sedated. She tells me "this grunting is normal for her," "she just needs water," "she is just praying" and she wants to be consulted before any PRN's are given. She gets defensive almost when I talk to her about it. I try to explain all while being culturally sensitive that there are clear signs of pain and discomfort, but she is not receptive to teaching AT ALL. She says that in her culture a person's death is preset. Her MD knows that she is reluctant to give pain medications and is supportive of that. But I see a woman who is clearly in the last days of her life and suffering. I do the best I can to reposition her, give mouthcare, hold her hand, but I feel like this isn't always enough. My question is what would you do in this situation? What is the nest way for me to be an advocate in this situation?

[beckysue920]

Jana, is it at all possible to get a translator? Perhaps this would provide some insight for the daughter. This may help to allow the patient to be more at rest and die peacefully.

[RN_2012, BSN, RN]

I would see if the doctor would schedule her medications. Maybe her daughter would allow meds given regular if the doctor ordered them that way.

[bananorama, LPN]

Becky, yes I think she holds strong to her spiritual beliefs and although I have been sensitive to this, maybe someone who speaks her language would be more relatable? Maybe she has some trust issues with those who don't share the same faith. I'll talk to the MD about this.

The doctor scheduled her HM BID but then the daughter asked to have it changed to PRN. The doctor has asked the nurses to just keep encouraging her to use them.

On my last shift I became more assertive with her because the client was clearly in distress and she agreed to give a dose of HM, but then today she blamed me for sedating her. I feel like at this point she is not receptive to any teaching. I guess with some clients you just have to accept that?