I've been taking care of this 80 years old women for total of 4 or 5 shifts now. Diagnosis of ARDS, intubated on the vent, FiO2 from 70 to 100%, off sedation, alert, awake and somewhat appropriate, on tube feedings, with a chest tube, with a rectal bag on, having wrist restrains on. Very little chance of recovery. Finally made DNR by the family after weeks being like that, but family wants "everything" to be done. Family is very skeptical of her being uncomfortable, even when she is getting restless or nods "yes" when asked about pain, and objects when I try to medicate poor woman for pain. Night shift tells the same story. It got to the point that we try to medicate her when family is not around so you don't have to fight with them over 1 mg of Morphine every 6 hrs, but they are in the room almost 24 hours a day.
It looks like they are in denial of reality that it IS uncomfortable to be in a position she is now. We all try to educate them about pain control, but they still argue she does not need it. I even heard them discussing it with RT who came in to check on the vent.
What would you do? I want to be an advocate for the patient, who is not able to speak for herself, but I am running out of ideas what else to do, beside educating and emphasizing that pain issue is very real.