In a hospital context, providing symptom-based care in the final days or hours of life necessitates a comprehensive set of skills and interactions. Nurses are frequently uninformed of the drugs and nursing orders that are available to them within their area of practice. This knowledge gap can lead to unnecessarily painful experiences for patients and their families.
The CARES tool is a pocket-size card reference with acronym-organized prompts for the most common symptom management needs of the dying.
The acronym spells;
- Comfort;
- Airway management;
- Restlessness and delirium;
- Emotional and spiritual support; and
- Self-care
Components of cares tool
C: Comfort: The CARES tool tackles the subject of comfort in general. A major focus is on pain management. Because of the wide range of drugs available and physicians’ individual preferences, the CARES tool avoids specific opioids and dosing.
Hospice professionals act as an advocate for patients at all times to control their pain and discomfort. Pain control is essential in the management of a dying patient, and thus we do all we can to make sure that patients are as comfortable as possible.
A: Airway: The CARES tool’s airway component explores the management of dyspnea. (Or difficulty in breathing) in dying patients. A fundamental grasp of the physiologic changes that occur during the dying process is critical and will have a significant impact on the effectiveness of the education given to the patient and family. Hospice professionals are trained on the airway management methods to reduce the discomfort of patients as much as possible. Understanding the fears of loved ones when patients gasp for air, it is essential that oxygen supply is made ready at all times. There are cases where patients lose the ability to swallow or control airway secretions. Hospice professionals are trained in the necessary steps to be taken. Understanding the airway management section of care tools allows supplementary management to be effectively delivered to the patient.
R: Restlessness and Delirium: In broad range of anywhere between 25 percent to 85 percent of actively dying patients, terminal or restless delirium often develops. Agitation, restlessness, disorientation, nightmares, and hallucinations are some of the most common symptoms. Uncontrolled pain, especially in the elderly, can lead to delirium and confusion. Effective pain management can help the patient to keep their mind clear.
The family may seek aid in determining the source of the patient’s restlessness, which could include unsolved disputes, a desire to visit a specific dear one again, or a fear of leaving their family. We often encourage the family to reassure their loved one and assist where possible to resolve any “unfinished business.”
E: Emotional and Spiritual Support: We can care for the soul by providing emotional, psychological, spiritual, and cultural assistance to the patient and family. This is the cornerstone of providing care for a dying patient.
When reviewing the spiritual and emotional needs of the patient and loved ones, we look at the necessary things that need to be done to ensure a comfortable and peaceful death. We also take additional measures to support the family.
S: Self-care: For a health care practitioner, caring for the dying and their families can be extremely stressful. Moral discomfort can arise if personal fundamental values and futility perceptions are not addressed. Hospice care professionals do the following to provide care for the patients and patient’s families:
- Examining what went successfully and what obstacles need to be overcome.
- Sharing the bereaved family’s thoughts.
- Taking care of moral distress.
- Identifying and seeking support for death anxiety.
- Exploring how the care provided made a difference to the grieving family.
The CARES tool is intended to remind the healthcare professional to debrief and, if necessary, seek professional and peer help. Accepting the normal human urge to grieve as well as recognizing the emotional, spiritual, and psychological harm that can result when grieving is denied is essential in providing essential care to patients.
References
Compassionate Person-Centered Care for the Dying.
Retrieved from: https://connect.springerpub.com/content/book/978-0-8261-2248-3/part/part1/chapter/ch01
CARES; an Acronym Organized Tool for the Care of the Dying. Freeman, Bonnie.
Retrieved from: https://journals.lww.com/jhpn/Fulltext/2013/05000/CARES__An_Acronym_Organized_Tool_for_the_Care_of.5.aspx?WT.mc_id=HPxADx20100319xMP
