I work in a LTAC facility and the majority of my patients are on trach’s, have significant wounds, and are usually non-responsive. Nothing aggravates me more than to see that pain has not been addressed by the day shift. I know we are all very busy, but pain is a hindrance to healing and comfort. Just imagine what it would feel like to be unable to move or express what it is you are feeling. All the signs are there: restlessness, moaning, stiffness. At rounding, I assess this and give meds if they are ordered. If I see a patient has extensive wounds and nothing to ease the pain of wound care, I get an order. Especially if the patient doesn’t have a good prognosis. Our jib is to be an advocate for our patients (and their families). Dying is just as much a part of live as is being born. I consider it an honor to be there when a patient is passing. I also feel it is important to keep them comfortable and treat them with the respect everyone deserves. They can hear you! Many times I find the patient doesn’t respond simply because the have been ignored for so long. Keep in mind how you would want to be treated if you were the patient.