THE CARES TOOL (by Kathrynn Thompson)
THE CARES TOOL (Compassionate Person-Centered Care for the Dying):
R=RESTLESSNESS and DELIRIUM
This blog series continues to explore the CARES tool, an evidenced based practice tool developed to enhance the end of life care given by the bedside nurse. The focus this month is on restlessness and delirium. Delirium, a neuropsychiatric disorder, occurs in 25-85% of actively dying patients (Brajtman, 2005). Risk factors can include: advanced age, pre-existing cognitive impairment, severity of illness, depression, vision or hearing impairment and functional impairment. We need to protect the dying patient from injury and the family needs to be supported in their decisions about how to treat the delirium.
Interventions for care of terminal delirium:
- Trial dose of opioids to rule out pain. Pain can lead to restlessness and delirium. Monitor mental status
- Assess for bladder distention, if distended may need to insert indwelling catheter
- Assess for impaction if appropriate. When a patient is actively dying. This step can usually be omitted
- Consider use of antipsychotics or benzodiazepines which can reduce restlessness and improve rest. Some meaningful interactions may then be possible.
- Maintain a calm environment
- Use non-pharmacological treatments like aromatherapy, playing music softly, speaking quietly to the patient saying “I am with you, You are safe”, and using touch and presence can be very helpful
The overall goal is to make delirium peaceful so patients and their families can experience a peaceful and loving death. We, as health care providers, play an important role in educating the family and guiding them through the transition from life to death. Encourage families to be involved and help them emphasize to the patient that they are safe and loved. Help the family focus on celebrating the patient’s life and fully experience their time together.
End of life care provides the perfect opportunity for nurses to practice the “art of nursing”. Our calm presence, communication skills and ability to bear witness are necessary nursing skills during 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