A milestone resource for palliative care nurses that facilitates evidence-based compassionate and humanistic care of the dying

A valuable contribution to the evolving field of palliative nursing care. It is authored by a model for this field, Bonnie Freeman, and brings to the bedside what her practice embodies--evidence-based clinically expert care...The CARES tool is a long-needed resource and we are all grateful to the author for moving her passion to paper. It will touch the lives and deaths of patients, families, and the nurses who care for them.

--Betty Ferrell, PhD, RN, MA, FAAN, FCPN, CHPN

Professor and Director, Division of Nursing Research and Education

City of Hope National Medical Center

From the Foreword

This groundbreaking reference for palliative care nurses is the first to provide realistic and achievable evidence-based methods for incorporating compassionate and humanistic care of the dying into current standards of practice. It builds on the author's research-based CARES tool; a reference that synthesizes five key elements demonstrated to enable a peaceful death, as free from suffering as possible: comfort, airway management, management of restlessness and delirium, emotional and spiritual support, and selfcare for nurses. The book describes, step by step, how nurses can easily implement the basic tenets of the CARES tool into their end-of-life practice. It provides a clearly defined plan that can be individualized for each patient and tailored to specific family needs, and facilitates caring for the dying in the most respectful and humane way possible.

The book identifies the most common symptom management needs in dying patients and describes, in detail, the five components of the CARES paradigm and how to implement them to enable a peaceful death and minimize suffering. It includes palliative care prompts founded on 29 evidence-based recommendations and the National Consensus Project for Palliative Care Clinical Practice Guidelines. The resource also addresses the importance of the nurse to act as a patient advocate, how to achieve compassionate communication with the patient and family, and barriers and challenges to compassionate care. Case studies emphasize the importance of compassionate nursing care of the dying and how it can be effectively achieved.

Key Features:

• Provides nurses with a clear understanding of the most common needs of the dying and supplies practical applications to facilitate and improve care
• Clarifies the current and often complex literature on care of the dying
• Includes case studies illustrating the most common needs of dying patients and how these are addressed effectively by the CARES tool
• Based on extensive evidence as well as on the National Consensus Project for Palliative Care Clinical Practice Guidelines

Bonnie Freeman, DNP, ANP, RN, ACHPN, is an adult nurse practitioner in the Department of Supportive Care Medicine at the City of Hope National Medical Center in Duarte, California. She is involved with treating the symptom management needs of many chronically and terminally ill individuals diagnosed with various forms of cancer. Dr. Freeman trained at such excellent facilities as the in-patient units at San Diego Hospice and the Institute of Palliative Medicine in San Diego, California, and the home care hospice program in Owensboro, Kentucky. While in Kentucky, she completed her advanced practice clinical training for adult nurse practitioners with a specialty focus on palliative care through Vanderbilt University in Nashville, Tennessee. This program exposed Dr. Freeman to current concepts in caring for the dying, and enhanced her already significant clinical experience caring for dying individuals acquired from over 30 years working in critical care. Dr. Freeman obtained her MSN from Indiana Wesleyan University, and her DNP from Azusa Pacific University in Azusa, California.

Contributors

Tracey Das Gupta, MN, RN, CON, is director of Interprofessional Practice at Sunnybrook Health Sciences Centre in Toronto, Ontario, Canada. She is also the colead of the Quality Dying Initiative with Dr. Jeff Myers. Tracey has been passionate about health care, quality of life, and leadership since becoming a nurse in 1991. Her decision to become a nurse was influenced by her father who lived with muscular dystrophy. Ms. Das Gupta has fulfilled various frontline nursing roles along the continuum of care and has had the opportunity to continue to grow in leadership roles such as educator, professional practice leader, and director of nursing practice. In her current role, she also provides leadership for the development and implementation of Sunnybrook's interprofessional care (IPC) strategy.

Margaret Fitch, PhD, MScN, is a nurse researcher and holds an appointment at the Bloomberg Faculty of Nursing and School of Graduate Studies at the University of Toronto. She also serves as expert lead for cancer survivorship and patient experience for the Person-Centered Perspective Portfolio of the Canadian Partnership Against Cancer. She is also editor-in-chief for the Canadian Oncology Nursing Journal. Dr. Fitch has an extensive publication record based on her many years of research regarding patient perspectives, coping and adaptation with illness, and screening for psychosocial distress. She has particular expertise in measurement and evaluation, qualitative methods, and knowledge integration. During her career, she has held clinical and administrative positions and has maintained an ongoing role in education of both undergraduate and graduate students and health professionals in practice.