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CARES: An Acronym Organized Tool for the Care of the Dying

Freeman, Bonnie RN, MSN, ANP

Journal of Hospice & Palliative Nursing: May 2013 - Volume 15 - Issue 3 - p 147–153
doi: 10.1097/NJH.0b013e318287c782
Symptom Management Series

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.

Bonnie Freeman, RN, MSN, ANP, is Pain and Palliative Care Medicine Nurse Practitioner, Department of Supportive Care Medicine, City of Hope, Duarte, California.

Address correspondence to Bonnie Freeman, RN, MSN, ANP, Department of Supportive Care Medicine, City of Hope, 1500 Duarte Rd, Duarte, CA 91010 (;

The author has no conflicts of interest to disclose.

Permission is granted for the use of the CARES tool for research studies and further trials with the request a copy of all study results referencing the CARES tool be forwarded to

© 2013 The Hospice and Palliative Nurses Association