CARES: An Acronym Organized Tool for the Care of the Dying

**NRSKarenRN, BSN, RN** · Jun 23, 2013

Found at Medscape nurses:

Bonnie Freeman, RN, MSN, ANP

Journal of Hospice and Palliative Nursing. 2013;15(3):147-153

Abstract

Providing symptom-based care during the last days or hours of life in a hospital setting requires a complex set of skills and interactions. Often, nurses are unaware of medications they can request and nursing orders they can write within their scope of practice. This deficit in knowledge can often result in unnecessary patient and family suffering.

The CARES tool, developed by this author as part of a doctor of nursing practice research project through Azusa Pacific University for the City of Hope National Medical Center, a 300-bed cancer research center in southern California, is an acronym organized educational tool that addresses the priority needs of comfort, airway, restlessness and delirium, emotional and spiritual support, and self-care. Prompts are provided for nurses on common symptom management needs of the dying based on 29 references cited in this article and the National Consensus Project for Palliative Care Clinical Practice Guidelines. The CARES acronym format was designed to help nurses stay focused and provide a method to inventory necessary tasks to address during the often chaotic and stressful last few days to hours of a patient's life.

Suggested Symptom Management

Sixty percent of all deaths occur in hospitals, and 80% to 90% of the deaths will be expected.^[1,3,6,9-12] Many hospitals do not have guidelines specific to the care of the dying. If a protocol or pathway is available, it is often initiated too late or not at all because of the unwillingness of the ordering provider to make the diagnosis of dying necessary to implement the protocol.^[3,10] This current system results in 50% of terminally ill patients dying in pain and 80% experiencing suboptimally treated dyspnea and terminal delirium before death.^[13] These dismal statistics can be attributed to the discomfort ordering clinicians have for the use of opioids, barbiturates, antipsychotics, and sedatives during the dying process.^{[1,4,7,9,12-14]}

C: Comfort

A: Airway

R: Restlessness and Delirium

E: Emotional and Spiritual Support

S: Self-care

Comfort:

Airway:

Restlessness and Delirium:

Emotional and Spiritual Support

Selfcare