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comfort, delirium, dying, dyspnea, emotional support, end of life, pain, palliative care, psychosocial support, restlessness, self-care, suffering, symptom management



  1. Freeman, Bonnie RN, MSN, ANP


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.