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?