THE CARES TOOL (by Kathrynn Thompson)

December 28, 2017
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CARES TOOL (Compassionate Person-Centered Care for the Dying) :

C=COMFORT

Last month I introduced you to the CARES tool, an evidenced based practice tool to enhance the end of life care given by the bedside nurse. This month we focus on C=COMFORT. This focuses on comfort by addressing the physical needs of the dying patient. Pain management is discussed. As is the need to provide time for the patient and family to create final memories and deal with their grief. When providing comfort to the dying patient the nurse is often also acting as a patient advocate.

Pain Management:  Barriers to providing quality pain management include:

  • An inability to affectively assess or believe in the patient’s perception of pain
  • Limiting opioids out of fear of hastening death
  • Concern and the need to confirm that progressive unresponsiveness is caused by the dying process and not overmedication with pain medication
  • Lack of understanding of tolerance and addiction
  • Cultural/spiritual beliefs and a family’s desire to maintain the ability to communicate with the patient

Increasing direct interaction with the dying patient and their family/friends: The tool prompts the nurse to obtain orders to:

  • Stop or decrease vital signs and blood work, turn off alarms
  • Stop all nonessential medications
  • Clarify IV options
  • Stop or reduce tube feedings
  • Discontinue isolation if possible

Independent nursing comfort measures include:

  • Turning and positioning should be for comfort only or at family request
  • Adjust bathing schedule or stop if family requests
  • Only reinforce dressings if possible
  • Give oral care frequently
  • Teach patient/family the symptoms of dying such as mottling

Communication skills are a necessary competency for the bedside nurse that wants to provide quality end of life care and act as a patient advocate.

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