THE CARES TOOL (by Kathrynn Thompson)

THE CARES TOOL (Compassionate Person-Centered Care for the Dying) :


In my blogs for the past 2 months I have been talking about the CARES tool, an evidenced based practice tool developed to enhance the end of life care given by the bedside nurse. This month we will focus on A=AIRWAY. This portion of the tool focuses on dyspnea which occurs frequently during the active dying process. Metastatic cancer is one of the diseases commonly associated with dyspnea while dying according to the ELNEC curriculum (2016). It can be very frightening when respiratory failure occurs while the dying person is still alert and continues to be frightening for the family even when the dying person is not alert. . It is important to try to avoid any sense of suffocation. Management of this symptom can be challenging and requires education for the family.


  • Opioid and sedative use is standard medical management
  • Morphine is the most common medication used
  • Morphine’s sedative effects also help the patient relax and expend less energy
  • Reducing pain and anxiety also helps to decrease respiratory distress
  • Knowledge deficits and personal attitudes often lead to under-medicating the patient
  • Concern about double effect can be a barrier to care

Oral secretions:

  • Often a symptom of impending death
  • Glycopyrrolate, scopolamine patch, or atropine can reduce the amount of secretion production

Nursing interventions include:

  • Creating a calm and supportive environment
  • Using touch therapeutically
  • Placing a fan at a low setting to gently blow across the side of the patient’s face
  • Repositioning to a more upright position
  • Calming music, TV for distraction or reading to the patient may help to reduce anxiety
  • Providing aggressive oral care
  • Oral suctioning may give the family something to do and helps the family feel useful
  • Educate the family about the changes in breathing that occur as a normal part of the dying process
All content comes directly from: Freeman, B. (2015). Compassionate Person-Centered Care for the Dying: An Evidence-Based Palliative Care Guide for Nurses. New York, New York: Springer Publishing Company, LLC