Contents. Before you begin

Contents Contents Before you begin i What you will learn i Competency standard ii What is expected of a Certificate III learner v Assessm...
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Contents

Contents Before you begin

i

What you will learn

i

Competency standard

ii

What is expected of a Certificate III learner

v

Assessment 

v

Employability skills

vi

How to work through this unit

viii

Resources 

ix

Introduction: Deliver care services using a palliative approach

1

Chapter 1: Applying a palliative approach

5

1.1 Differentiating between curative and palliative approaches

6

1.2 Applying the principles and aims of a palliative care approach 

10

1.3 Using an approach that reflects the client’s needs

15

Discussion topics

19

Chapter summary

19

Checklist for Chapter 1

20

Assessment activity 1: Applying a palliative approach

21

Record your employability skills

22

Chapter 2: Respecting client preferences for quality-of-life choices

23

2.1 Encouraging clients, carers, family members and/or significant others to share information

24

2.2 Respecting the client’s lifestyle, social activities and spiritual needs

30

2.3 Respecting cultural choices

37

2.4 Supporting people’s rights to discuss spiritual and cultural issues

41

2.5 Referring needs and issues when necessary

43

2.6 Using effective communication skills to provide emotional support

45

2.7 Demonstrating respect for the relationship between the client and carer

49

Discussion topics

49

Chapter summary

50

Checklist for Chapter 2

50

Assessment activity 2: Respecting client preferences for quality-of-life choices

51

Record your employability skills

52

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CHCPA301B Deliver care services using a palliative approach

Chapter 3: Following the client’s advanced care directives in the care plan 3.1 3.2 3.3 3.4 3.5 3.6

Following legal and ethical regulations Following advanced care directives in the care plan Complying with end-of-life decisions Reporting clients’ end-of-life needs and issues to appropriate personnel Recognising the impact of clients’ end-of-life issues on carers Delivering services to support the client’s right to choose the location of  their end-of-life care Discussion topics Chapter summary Checklist for Chapter 3 Assessment activity 3: Following the client’s advanced care directives in the care plan Record your employability skills

Chapter 4: Following end-of-life care strategies 4.1 4.2 4.3 4.4 4.5 4.6

Regularly checking the care plan Providing a supportive environment to all those involved in the client’s care Considering the client’s preferences and culture  Maintaining the dignity of the client Recognising and reporting signs of imminent death Recognising and supporting the emotional needs of those affected by the death of a client Discussion topics Chapter summary Checklist for Chapter 4 Assessment activity 4: Following end-of-life care strategies Record your employability skills

53 54 58 61 63 64 66 67 67 67 68 71

73 74 75 79 81 83 85 88 89 89 89 91

Chapter 5: Responding to signs of pain and other symptoms

93

5.1 Observing the client to identify pain and other symptoms 5.2 Documenting and reporting observations of pain and other symptoms 5.3 Implementing strategies to promote comfort 5.4 Regularly evaluating and documenting the effectiveness of strategies 5.5 Referring misconceptions about pain-relieving medication Discussion topics Chapter summary Checklist for Chapter 5 Assessment activity 5: Responding to signs of pain and other symptoms Record your employability skills

94 97 100 105 108 110 110 111 112 114

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Contents

Chapter 6: Managing your own emotional responses and ethical issues

115

6.1 Identifying and reflecting on your own emotional response to death and dying

116

6.2 Recognising and dealing with the potential impact of your personal responses on others

118

6.3 Accepting the need for bereavement care and support

120

6.4 Reflecting on and discussing ethical issues

123

6.5 Following organisational policy and procedures when managing emotional responses and ethical issues

127

Discussion topics

130

Chapter summary

130

Checklist for Chapter 6

131

Assessment activity 6: Managing your own emotional responses and ethical issues 132 Record your employability skills

134

Final assessment: CHCPA301B Deliver care services using a  palliative approach

135

Employability skills

143

Glossary

145

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Chapter 1: Applying a palliative approach

Chapter 1 Applying a palliative approach Palliative care is an area of health care that specifically addresses the needs of clients who have life-limiting illnesses or are in the final stages of their life. Health care providers and health care professionals have a responsibility to ensure all clients experience the best-possible quality of life until their death. Standards for providing palliative care have been developed by Palliative Care Australia, the national peak body for palliative care. These standards must be applied appropriately and sensitively at all times when dealing with palliative care clients, their families and carers. In this chapter you will learn about: 1.1 Differentiating between curative and palliative approaches 1.2 Applying the principles and aims of a palliative care approach 1.3 Using an approach that reflects the client’s needs

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Chapter 1: Applying a palliative approach

Palliative care standards Palliative Care Australia’s Standards for providing quality palliative care for all Australians detail the responsibilities of those who provide specialist palliative care to ensure clients’ comfort and dignity are maintained. The standards cover the physical, spiritual, psychological, social and cultural support required to achieve this.

Practice task 1 You can access the standards for providing quality palliative care for all Australians at Palliative Care Australia’s website: www.palliativecare.org.au/Portals/46/resources/StandardsPalliativeCare.pdf. Read to page 13, which outlines the core values for the standards and includes eight bullet points on how care workers provide quality end-of-life care. Look up any words you are unfamiliar with and discuss them with your trainer.

A palliative care approach embraces the following philosophies: ƒƒ

Palliative care enhances the client’s quality of life and may also positively influence the course of illness by treating pain and physical, psychological, social and spiritual problems in a holistic manner.

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Palliative care uses a team approach to address the needs of clients’ families and carers facing problems associated with a life-limiting illness, including providing information, emotional support and bereavement counselling.

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Palliative care ensures that care of an individual client is not delayed until the end stages of their illness. Instead, it focuses on active comfort-focused care and a positive approach to reducing suffering and promoting an understanding of loss and bereavement.

ƒƒ

Palliative care incorporates a positive and open attitude towards dying and death by the palliative care team.

For clients, a palliative approach begins when there is a change in the goals of their care from curative (symptom control and supportive care) to end-of-life care due to a lifelimiting illness. For many clients with life-limiting illnesses, the transition from curative treatment to palliative care is gradual. As a palliative care team member, you should understand when a client is moving from curative care to a palliative approach. Recognising this change in the type of care required by the client is very important, as it gives you an opportunity to provide tailored support for them, their family and carers. You must also ensure all stakeholders fully understand the shift in treatment from curative care to palliative care and the impact this may have.

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CHCPA301B Deliver care services using a palliative approach

A palliative philosophy Understand the needs of clients approaching the end of their lives

Applying a palliative care approach This means: ‚‚ understanding that clients need to maintain their quality of life for as long as possible ‚‚ understanding that clients need to retain their dignity ‚‚ understanding that clients need to be provided with information so they are able to make their own choices ‚‚ being familiar with each client’s care plan ‚‚ understanding the client’s physical, social, psychological, spiritual and cultural needs ‚‚ discussing with clients their hopes, fears and wishes so you can plan ahead for the client, their family and carers.

Identify the client, family and carer as the unit of care

This means: ‚‚ ensuring you know each member of the client’s unit of care, including:

–– –– –– –– –– –– –– Provide support for clients, their families and carers using a palliative approach

biological relations such as siblings and parents spouses partners friends carers advocates guardians.

This means: ‚‚ explaining to the client, their family and carers what a palliative approach means ‚‚ ensuring decisions are made with the client, their family and carers ‚‚ ensuring all communication is open and clear so everyone understands what is involved and effective decisions can be made – this avoids conflict and confusion about palliative care goals ‚‚ letting everyone know about their rights and responsibilities regarding decision-making, which is often the responsibility of family members.

Participate in a team approach to address the needs of clients, families and carers

This means: ‚‚ understanding the roles of each team member ‚‚ establishing an effective, professional relationship with team members ‚‚ building respectful and trusting relationships with clients, families and carers ‚‚ following organisational policies and procedures.

Seek advice from appropriate people when necessary

This means:

‚‚ always asking for advice or information from your supervisor, manager or palliative care team members when necessary.

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Chapter 1: Applying a palliative approach

1.3 Using an approach that reflects the client’s needs The aim of a palliative approach to care is to provide high-quality end-of-life care by: ƒƒ

providing the desired physical comfort and emotional support

ƒƒ

promoting shared decision-making

ƒƒ

respecting the dying client

ƒƒ

respecting the client’s cultural and social beliefs and values

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providing information and emotional support to family members and carers

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helping the client maintain quality of life and independence for as long as possible.

The pattern of care may differ for every individual faced with a life-limiting illness or who is at the end of their lifespan. Factors that influence a person’s pattern of care include where the person lives, the services in their area, their specific needs, beliefs, values, spirituality and culture and the needs and desires of their family members and friends. These factors must all be taken into account and a care program implemented and maintained as soon as a person is admitted to palliative care – not just when death is imminent. This involves the development of a care plan to ensure the client’s needs, as well as those of their family and carers, are acknowledged in line with their wishes. The following example shows how a client’s wishes and needs are documented when they are in the early stages of needing palliative care.

Example Bernard lives alone and has a chronic, degenerative condition, requiring hospital visits and frequent overnight stays. When he is no longer able to care for himself at home Bernard is admitted to a high-care facility. He makes his wishes quite clear: ‘If I’m ever in the position where I can’t answer for myself, please take me to St Mary’s Hospital. They have a huge file on me there and know me well. They’ll say “Here comes Bernie again” as I come through the door. If it ever gets to the stage where they can’t do anything for me, they can send me back here to my second home.’ This request is recorded and the form signed by Bernard. Two weeks later Bernard suffers a brain stroke and is immediately transferred to St Mary’s hospital for diagnosis. A comprehensive advanced care plan outlines his needs and preferences; however, it is anticipated that Bernard will not regain consciousness. Through consultation with the hospital it is agreed that Bernard should return to the high-care facility for a palliative approach. Bernard dies one week later surrounded by his family. His preferences were respected and the changed goals for care achieved.

Care plans Care plans are written documents developed by the palliative care team, the client, their family and carers that outline the care needs of the client. A clear and comprehensive care plan ensures that care planning is holistic and meets the client’s physical, spiritual, psychological and cultural needs as well as the wishes, needs and expectations of the family.

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Chapter 2: Respecting client preferences for quality-of-life choices

Practice task 7 Read each of the following statements. In the second column, indicate whether each statement is true or false. Statement

True or false

Only parents, sisters, brothers, aunts and uncles are referred to as the client’s family. Family members must let members of the health care team know as soon as there is a change in the client’s needs or condition. It is important to support carers and family members as well as the client. Family members aren’t health care professionals. They can’t give you any information about changes in a client’s condition. Family members are always too emotional to be able to provide accurate information.

4. Significant others There are other people who can provide information about a client, including: ƒƒ

enduring powers of attorney

ƒƒ

guardians

ƒƒ

advocates.

Enduring powers of attorney When a person is appointed an enduring power of attorney, the client gives them the power to make decisions on their behalf regarding financial, medical treatment or guardianship matters. The term enduring means the power continues even when the client is no longer able to make decisions on their own behalf. A client can only appoint an attorney if they are over 18 years of age and able to demonstrate capacity to make the appointment. In Australia, medical service cannot be provided without the consent of the person concerned. Consent is considered informed consent when the person agrees to a treatment: ƒƒ

without duress

ƒƒ

voluntarily provides their consent after a reasonable time

ƒƒ

has been provided with adequate information to give consent.

The only exception is when the person’s capacity to consent is impaired; for example, by a serious illness. If a family member has been granted a legal right to make decisions for the client, then the legal document stating this must be sighted by a member of the palliative care team and its powers and limitations noted on the client’s record. The palliative care team is then directed by this document. As legislation regarding the

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Final assessment: CHCPA301B Deliver care services using a palliative approach

Final assessment CHCPA301B Deliver care services using a palliative approach To be assessed as competent in CHCPA301B Deliver care services using a palliative approach, you must provide evidence of the specified essential knowledge and skills. Details of the essential knowledge and skills can be found in the ‘Before you begin’ section of this workbook.

Assessment mapping The following table maps this final assessment activity against the elements and performance criteria of CHCPA301B Deliver care services using a palliative approach. Part

Element

Performance criteria

A

All

All

B

All

All

C

All

All

Detailed mapping of this workbook against the methods of assessment, the elements, the performance criteria and essential skills and knowledge is available in the Aspire Trainer’s resource and assessment tools for this unit. The following activity forms part of your assessment of competence. You may also need to provide various workplace documents or third-party reports. Your trainer will give you guidance in this area. The following activity has been designed for all learners to complete.

Part A: Essential skills Your trainer needs to observe you demonstrating the following essential skills in your workplace or in a simulated environment. Essential skills

Example

Demonstrate how you: ‚‚ communicate effectively with clients, their families and other team members using effective listening, sensitive clarification and questioning, recognition of non-verbal cues, and provision of information within level of responsibility

Show your trainer/assessor how you interact with your clients on a daily basis.

continued ...

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Glossary

Glossary Activities of daily living (ADLs): Activities of daily living are the tasks people do every day such as cook a meal, look after pets, shop and clean. Advocate: An advocate helps their client make decisions about their care. An advocate may attend discussions about their client’s support and care. They make sure their client receives the service they want and need. Alternative therapies: Alternative therapies are treatments used in addition to those prescribed by your doctor such as naturopathy, iridology or massage. (See also complementary therapy.) Alzheimer’s disease: Alzheimer’s disease is a progressive and degenerative brain disease that affects memory, thinking and behaviour. Anti-thrombotic: Anti-thrombotic therapy is designed to prevent the formation of blood clots. Autopsy: Autopsy is when the body is inspected and dissected to determine the cause of death. Bereavement counselling: Bereavement counselling is provided to people who have experienced the death of someone close to them. Body language: Body language is a way of communicating by using body movements, gestures or facial expressions to give more meaning to verbal communication. People can communicate how they feel using body language and without saying a word. Care plan: A care plan describes the care needs of a client. It explains what care is needed and how and when the care should be provided. Catheter: A catheter is a small, flexible tube inserted into the body to inject or remove fluids. Chemotherapy: Chemotherapy is a form of treatment using chemicals. It is often used in cancer treatment. Communication book: A communication book is used by workers and family members to write information for each other about what is happening with a client. This includes information about the client’s health, what work has been done with them during the day and any changes that have taken place. Complementary therapies: Complementary therapies describe a range of services that complement traditional medical practice. (See also alternative therapies.) Cremation: Cremation is when a body is burnt after death. De facto: A de facto relationship is one where the partners have not been officially married. Dementia: Dementia is a term used to describe a group of illnesses that cause progressive loss of memory and thinking skills. It is a term that describes loss of memory, intellect, reason, social skills and normal emotion. The illness gets worse over time.

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