Abstract and Introduction
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.
The CARES tool is a pocket-size, card reference that provides acronym organized prompts to address the most common symptom management needs of the dying identified in literature as c omfort, a irway management, r estlessness and delirium, e motional and spiritual support, and s elf-care.[1–5] Prompts are provided for the nurse to consider regarding orders to obtain or nursing actions to implement for symptom management, possible resources for support, communication opportunities, suggestions on education needs for the dying patient and his/her family, and recommendations for methods to address compassion fatigue and professional grieving for the health care provider. Nurse's independent actions remain governed by individual comfort levels and by state and country scope of practice. The CARES tool does not provide specific drug dosages because of the wide variety of provider preference, and it is intended to be nurse driven. Many of the suggestions can be initiated at any time during the course of caring for a terminally ill patient and his/her family.
The CARES tool was designed to complement and build upon previous education obtained from professional organizations such as the Hospice and Palliative Care Nurse Association, certification examinations, and the End of Life Nursing Education Consortium programs. It is intended to be a bridge between current evidence-based knowledge and application of the knowledge to bedside nursing care.
The intentional use of an acronym format was utilized to encourage parallels to be drawn to other treatment acronym-based formats such as American Heart Association's ACLS (Advanced Cardiac Life Support) and BCLS (Basic Cardiac Life Support) in an effort to elevate the importance and respect for the unique skills required to effectively care for the dying and their family. Care of the dying may not require the same technical skills, but the communication and associated supportive skills qualify care of the dying an acute event.[6–8]
The CARES tool debuted as a poster presentation at the 19th International Congress on Palliative Care in Montreal, Quebec, Canada, in October 2012, and received a 98% (n = 125) positive approval rating from expert palliative care providers when asked to formally evaluate the tool. Reviewers felt the CARES tool (a) could assist in the education of health care staff, (b) could be easily implemented, and (c) effectively prompts the obtaining of orders and supportive measures for the dying patient and his/her family.
Journal of Hospice and Palliative Nursing. 2013;15(3):147-153. © 2013 Lippincott Williams & Wilkins