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Improving Knowledge, Comfort, and Confidence of Nurses Providing End-of-Life Care in the Hospital Setting Through Use of the CARES Tools

Stacy, Alison, DNP, RN, AGACNP-BC; Magdic, Kathy, DNP, ACNP-BC, FAANP; Rosenzweig, Margaret, PhD, FNP-C, AOCNP, FAAN; Freeman, Bonnie, DNP, RN, ANP-BC, ACHPN; Verosky, Denise, MSN, RN, CNS

Journal of Hospice & Palliative Nursing: June 2019 - Volume 21 - Issue 3 - p 200–206
doi: 10.1097/NJH.0000000000000510
Feature Articles

Although most individuals prefer to die at home, approximately 60% of Americans die in the hospital setting. Nurses are inadequately prepared to provide end-of-life (EOL) care because of cure-focused education. Friends and family of dying patients report poor quality of death largely as a result of inadequate communication from health care professionals about the dying process. The purpose of this project was to improve nursing knowledge and comfort related to EOL care through use of the CARES tool and to improve the EOL experience of families of dying patients in the hospital setting through use of Final Journey. These acronym organized tools were developed based upon the common symptom management needs of the dying including Comfort, Airway, Restlessness and delirium, Emotional and spiritual support, and Self-care. The CARES tool for nurses improved nursing knowledge and comfort related to EOL care and common symptom management needs of the dying and also enhanced nurses' confidence in communicating about the dying process with friends and family. Final Journey, the friends and family version of the CARES tool, reinforced EOL information for friends and family, helped nurses answer difficult questions, and promoted and enhanced communication between health care professionals and friends and family of the dying.

Alison Stacy, DNP, RN, AGACNP-BC, nurse practitioner, Division of Pulmonary, Critical Care, and Sleep Medicine, Butler Memorial Hospital, Butler, Pennsylvania.

Kathy Magdic, DNP, ACNP-BC, FAANP, assistant professor and coordinator, Adult-Gerontology Acute Care Nurse Practitioner Program, University of Pittsburgh, Pennsylvania.

Margaret Rosenzweig, PhD, FNP-C, AOCNP, FAAN, professor, Vice Chair of Research, Acute & Tertiary Care Program, University of Pittsburgh, Pennsylvania.

Bonnie Freeman, DNP, RN, ANP-BC, ACHPN, nurse practitioner, Department of Supportive Care Medicine, City of Hope National Medical Center, Duarte, California†.

Denise Verosky, MSN, RN, CNS, director of Supportive and Palliative Care, University of Pittsburgh Medical Center (UPMC) Mercy, Pennsylvania.

Address correspondence to Alison Stacy, DNP, RN, AGACNP-BC, One Hospital Way, Butler, PA 16001 (

The authors have no conflicts of interest to disclose.

†Died April 2018.

© 2019 by The Hospice and Palliative Nurses Association.