Nurse practitioner offers practical advice for end-of-life care

April 5, 2015 | by City of Hope

“The dying, as a group, have been horribly underserved.” So says Bonnie Freeman, R.N., D.N.P., A.N.P.-B.C., A.C.H.P.N., a nurse practitioner in the Department of Supportive Care Medicine at City of Hope.


Bonnie Freeman End-of-life care: City of Hope's Bonnie Freeman developed the CARES tool to support caregivers of dying patients.


After nearly 25 years, primarily in critical care nursing, Freeman saw that the needs of the dying were often not being met, so she developed an innovative tool – in the form of an easy-to-carry booklet – to offer nurses clear and practical information to help provide a compassionate, loving experience for patients nearing the end of life.

The CARES (short for Comfort, Airway, Restlessness, Emotional support and Self-care) tool is small enough to fold up and put in your pocket and holds simple, straight-forward steps to address the symptoms of a dying patient. It’s a "Here’s what you’ll see; here’s what you can do" approach to pain management, ethics, feeding, breathing, family, music, room temperature and even lighting.

Death offers no second chances to get it right, not for the patient, the family or the caregiver. It’s a difficult experience for everyone, but Freeman has witnessed how every decision in end-of-life care has the power to make things better or make things worse.

“I once watched a mother try to touch her dying son through the gown and gloves they made her wear,” she said. But a call to the Infectious Diseases Department for new orders meant a mother’s last caresses didn’t include latex after all. It’s that individual approach that makes all the difference.


“We can’t change what’s going to happen,” Freeman says. Yet we still have the power to help the dying face their situation comfortably, peacefully and on their own terms.

The CARES tool, introduced in 2012, has already begun to influence the way City of Hope cares for patients near the end of their lives. But it’s also serving an audience far beyond the institution, through articles and downloads on multiple sites, including the CARES tool website.

Ultimately, Freeman says, everyone has to change how we think about death if we really want to change how we care for the dying.

“Death is not a sign that we have failed,” she says, but a summons to rise to the needs of the moment. “In the care of the dying, you will witness the most courageous, most loving acts you will ever see. And the greatest tool you possess is still your humanity. You should never­­­ be afraid to demonstrate that.”


Learn more about becoming a patient or getting a second opinion by visiting our website or by calling 800-826-HOPE (4673). You may also request a new patient appointment online. City of Hope staff will explain what's required for a consult at City of Hope and help you determine, before you come in, whether or not your insurance will pay for the appointment.

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