Elements and Performance Criteria

RANGE STATEMENT

The Range Statement relates to the unit of competency as a whole. It allows for different work environments and situations that may affect performance. Add any essential operating conditions that may be present with training and assessment depending on the work situation, needs of the candidate, accessibility of the item, and local industry and regional contexts.

Palliative approach aims to:
Improve the quality of life for individuals with a life-limiting illness and their families, by reducing their suffering through early identification, assessment and treatment of pain, physical, psychological, social, and spiritual problems. A palliative approach is not delayed until the end stages of an illness. Instead a palliative approach provides a focus on active comfort care and a positive approach to reducing an individual's symptoms and distress, which facilitates residents and their families understanding that they are being actively supported through this process. Underlying the philosophy of a palliative approach is a positive and open attitude towards death and dying.
(Standards for Providing Quality Palliative Care to all Australians. PCA 2005).


Palliative care means
An approach that improves the quality of life of clients and their families facing the problem associated with a life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychological and spiritual (WHO 2002)


Advanced care planning refers to:
The process of preparing for likely scenarios near end of life and usually includes assessment of, and dialogue about a person's understanding of their medical history and condition, values, preferences and personal and family resources. Advanced care planning elements are the written directive and an appointment of a substitute decision maker
Access through state and territory legislation or guidelines on advanced care planning
Advanced care directive:
Is sometimes called a 'living will' and describes one's future preferences for medical treatment. It contains instructions that consent to, or refuse, the future use of specified medical treatments. It becomes effective in situations where the client no longer has capacity to make legal decisions
Access through state and territory legislation or guidelines on advanced care planning
Completion of an advance care directive should be one component of the broader advance care planning process. Documenting advanced care directives is not compulsory as the person may choose to verbally communicate their wishes to the doctor or family, or appoint a substitute decision maker to make decisions on their behalf. Examples of advance care directives are:
medical treatment preference, including those influenced by religious or other values and beliefs'.
particular conditions or states that the person would find unacceptable should these be the likely result of applying life-sustaining treatment, for example severe brain injury with no capacity to communicate or self-care.
how far treatment should go when the client's condition is 'terminal', 'incurable' or 'irreversible' (depending on terminology used in specific forms).
the wishes of someone without relatives to act as their 'person responsible' in the event they became incompetent or where there is no one that person would want to make such decisions on their behalf.


Legal implications of advanced care directive:
A nominated substitute decision maker that the treating clinician may seek out to discuss treatment decisions
Other non-medical aspects of care that is important to the person during their dying phase
Although the content of an ACD usually stipulates treatment limitation preferences, this should never be assumed as some individuals may indicate they want full measures to prolong their life
Access through state and territory legislation or guidelines on advanced care directives


End-of-life ethical decisions may include:
Ongoing discussion with the client, family, doctor, guardian and organisation to ensure that the client's and/or family's wishes are up-to-date


Client's lifestyle choices may include:
Personal supports and relationships
Social activities
Emotional supports
Cultural and spiritual supports
Sexuality and Intimacy supports


Life limiting illness describes
Illnesses where it is expected that death will be a direct consequence of the specified illness. This definition is inclusive of both a malignant and non-malignant illness. Life limiting illnesses might be expected to shorten an individual's life expectancy (Standards for Providing Quality Palliative Care to all Australians. PCA 2005).


Client:
May also refer to resident or client throughout this document.


Ethical issues may include:
Decisions regarding medical treatment
Conflict that may occur in relation to personal values and decisions made by or for the client


Health promotion strategies may include:
School topics personal and sexual health, nutrition drugs, mental health
Community outreach breast feeding mothers
Mass media advertising campaigns
Social marketing
Immunisation
Public education
Genetic counselling
Screening


Client education strategies may include:
Discussions about relevant issues regarding health
One-on-one guidance/supervision
Small groups
Demonstrations
Referrals to appropriate health professional
Contact with self-help group


Risk factors may include:
Alcohol and substance abuse
Drug abuse
Stress
High blood pressure
Smoking
Obesity
Poor nutrition
Elimination problems
Lack of exercise
Interpersonal conflict
Loneliness
Poor sleep

EVIDENCE GUIDE

The evidence guide provides advice on assessment and must be read in conjunction with the Performance Criteria, Required Skills and Knowledge, the Range Statement and the Assessment Guidelines for this Training Package.

Critical aspects for assessment and evidence required to demonstrate this competency unit:
The individual being assessed must provide evidence of specified essential knowledge as well as skills
Observation of performance in a work context is essential for assessment of this unit
Consistency of performance should be demonstrated over the required range of workplace situations and should occur on more than one occasion and be assessed by a registered nurse


Context of and specific resources for assessment:
This unit is most appropriately assessed in the clinical workplace or in a simulated clinical work environment and under the normal range of clinical environment conditions
Where, for reasons of safety, access to equipment and resources and space, assessment takes place away from the workplace, simulations should be used to represent workplace conditions as closely as possible, prior to assessment in the workplace


Method of assessment
Observation in the workplace
Written assignments/projects
Case study and scenario as a basis for discussion of issues and strategies to contribute to best practice
Questioning - verbal or written
Role play/simulation


Access and equity considerations:
All workers in the health industry should be aware of access and equity issues in relation to their own area of work
All workers should develop their ability to work in a culturally diverse environment
In recognition of particular health issues facing Aboriginal and Torres Strait Islander communities, workers should be aware of cultural, historical and current issues impacting on health of Aboriginal and Torres Strait Islander people
Assessors and trainers must take into account relevant access and equity issues, in particular relating to factors impacting on health of Aboriginal and/or Torres Strait Islander clients and communities