Within the first four months of working as a new bedside nurse, I’ve encountered two patients who were actively dying. I wasn’t sure what to do. After coming across this article from Medscape though (btw you need a free login to read this article), I finally understand what the palliative care nurse practitioners were doing.
The City of Hope came up with a tool called CARES to help the nurse take care of those who are dying.
C stands for comfort. You aim to alleviate pain and suffering for the patient. Additional testing and blood draws should be questioned, as the aim is to comfort, not treat.
C: ComfortA stands for airway. We used a scopolamine patch placed behind the ear. It’s used to help stop secretions from building up. While oxygen and oral secretion will not necessarily help, it may be comforting for the patient to have those things.
A: Airway
R stands for restlessness or delirium. It occurs in 25-85% of actively dying patients. It could be due to uncontrolled pain, a distended bladder, or it could be that the patient feels that there are unresolved issues with the family. Playing familiar music and providing a non-stimulating environment will help.
R: Restlessness or Delirium
E stands of emotional and spiritual support. Don’t underestimate a listening ear and providing clear and open communication. Whatever can be done to promote a comfortable and peaceful death should be considered.
E: Emotional and Spiritual Support
S stands for self-care. The nurse is often stressed and may need to debrief too.
S: Self Care