CHCPA402B Plan for and provide care services using a palliative ...

ContentsContentsBefore you beginWhat you will learnCompetency standardWhat is expected of a Certificate IV learnerAssessment Employability skillsHow to work through this unitResourcesviiviiviiixixixiixivxvIntroduction: Planning for and providing care services 1using a palliative approachChapter 1: Planning a palliative approach to client care 31.1 Understanding the difference between curative and palliative approaches 4in client care planning1.2 Addressing client needs holistically in their care plan over time 91.3 Applying the principles and aims of a palliative approach when 13developing a care planDiscussion topics 17Chapter summary 17Checklist for Chapter 1 18Assessment activity 1: Planning a palliative approach to client care 19Record your employability skills 19Chapter 2: Supporting clients to identify their preferences 21for quality-of-life choices2.1 Consulting with stakeholders to identify and share information 22about the client’s changing needs and preferences2.2 Respecting the client’s lifestyle, social context and spiritual needs 312.3 Respecting cultural choices 402.4 Supporting the freedom of the client, their family members, carers 43and significant others to discuss spiritual and cultural issues2.5 Demonstrating respect for the roles of the client and carer in 45planning and delivering care2.6 Addressing client issues or referring them appropriately 472.7 Using effective communication skills to provide emotional support 50© Aspire Training & Consultingiii

Before you beginAssessment activity 4: Contributing to the development and implementation 98of end-of-life care strategiesRecord your employability skills 98Chapter 5: Taking action to alleviate pain and other 99end-of-life symptoms5.1 Collaborating with others to plan and document strategies to 100promote comfort5.2 Assessing and reporting the client’s need for pain relief and other 105symptom relief5.3 Providing pain relief in line with relevant legislation, organisational 112policies and the care plan5.4 Providing information about the use of pain-relieving medication 114and other treatments to staff, clients and their family members5.5 Observing, reporting and documenting the effectiveness of 117interventions for symptom relief5.6 Communicating and documenting the ineffectiveness of interventions 119Discussion topics 120Chapter summary 120Checklist for Chapter 5 120Assessment activity 5: Taking action to alleviate pain and other 121end-of-life symptomsRecord your employability skills 124Chapter 6: Identifying and managing emotional 125responses in yourself and others6.1 Identifying and reflecting on your own emotional responses to 126death and dying6.2 Reflecting on the impact of your responses on yourself and others 1286.3 Informing others about available support systems 1316.4 Following organisational policies and procedures in relation to 133emotional welfare6.5 Assisting colleagues to debrief and discuss bereavement care 1366.6 Identifying other strategies and resources available for debriefing 1396.7 Evaluating the effectiveness of emotional response strategies 141Discussion topics 143Chapter summary 143Checklist for Chapter 6 144Assessment activity 6: Identifying and managing emotional responses 145in yourself and othersRecord your employability skills 146© Aspire Training & Consultingv

CHCPA402B Plan for and provide care services using a palliative approachFinal assessment: CHCPA402B Plan for and provide 147care services using a palliative approachEmployability skills 153Glossary 155© Aspire Training & Consultingvi

Before you beginBefore you beginWhat you will learnThis unit is based on CHCPA402B Plan for and provide care services using a palliativeapproach from the CHC08 Community Services Training Package.Knowledge and skills requiredThe following is a list of the knowledge and skills required of a worker in contributingto the development, implementation, evaluation and communication of a care plan forclients with life-limiting illness and/or normal ageing process in a team environmentusing a palliative approach.KnowledgeLearners should understand:• relevant policies, protocols and practices of the organisation in relation to theprovision of both a palliative approach and palliative care• how to identify and access relevant resources• the palliative approach to care of clients and their family• diverse cultural aspects• the complexity of carers’ needs and potential issues• their own role and responsibilities, and those of other team members involved indelivering a palliative approach and care• the impact of loss and grief on clients, carers and workers• state and territory legislation on advanced care planning and advanced caredirectives• ethical and legal issues related to a palliative care approach• basic information about the use of pain relieving medication for staff, clients andtheir family and within level of responsibility• hydration and nutrition requirements during a palliative approach and at end of life• the various signs of imminent death/deterioration.SkillsLearners should have the ability to:• communicate effectively with clients, their families, carers and other team membersusing effective listening, sensitive clarification and questioning, recognition ofnonverbal cues, and provision of information within level of responsibility• share knowledge and information with other team members regarding the palliativeapproach• contribute to the provision of an environment that supports clients and theirfamilies and ensures other staff members are able to provide a palliative approachto palliative care© Aspire Training & Consultingvii

CHCPA402B Plan for and provide care services using a palliative approachThe following example describes a client’s lifestyle, social and spiritual needs.ExampleAn elderly woman, Rose, requires abdominal surgery. Following surgery she is unable to beweaned from the ventilator. She has a history of severe cardiac disease and recovery canonly be achieved by having a heart transplant. Her elderly husband has Alzheimer’s disease,her daughter has an intellectual handicap and her son lives a considerable distance from thehospital.The worker speaks to Rose about her feelings, beliefs, values and goals in life. Rose clearlyunderstands the condition of her heart and is clear about her wishes if her heart stops: she doesnot want to be resuscitated. As the conversation continues Rose explains what is important toher at this time. She comes up with the following list, which is documented in her care plan. Shewants to:• always be kept clean and for a little bit of make-up to be applied• be dressed in her favourite casual clothes• have pictures in her room of her family and dog• have the Bible and rosary beads her husband gave her before he became ill, and have herfavourite Catholic priest visit her weekly• be able to speak to her family on a regular basis and therefore asks for a phone to beplaced in her room• have relaxing music to help her sleep at night• keep on the ventilator• have pain medications when she requires them• have an enduring power of attorney (medical treatment) appointed so her husband is notbothered.A conference is called to discuss the impact of Rose’s wishes and to update her care plan.Documenting observationsThe Guidelines for a palliative approach in residential aged care recommend that all stepsregarding a client’s preferences about their care or treatment must be documented. Thesepreferences should be regularly assessed to ensure they remain current. For example,a client may no longer want to participate in a social activity or decide that they dowant to undergo a specific treatment after all, even though it contravenes their religiousbeliefs.Care plans should be reviewed in accordance with the organisation’s policy or when:• the client experiences a change in their health condition; for example, an acuteepisode of illness or a change to their chronic condition• the family and/or carers request a case conference to review the client’s care plan• there is a change in the client’s situation, such as the death of a spouse• the client is transferred either into or from the palliative care environment.© Aspire Training & Consulting38

CHCPA402B Plan for and provide care services using a palliative approachTips••••••••••Speak clearly, use plain English and avoid using jargon.Tailor the information you are communicating to the individual needs of the client, theirfamily members and carers. Pace information to client circumstances. Seek to understand,not to convince.Listen carefully so you know what someone is saying; never interrupt someone before theyfinish speaking. Do not anticipate what the client might say; listen instead.Ask questions to clarify what someone is saying if you don’t understand them; encourageothers to do the same. Open questions encourage conversation; for example, ‘How doesthat make you feel?’Repeating what a client has said lets them know you understand them and that youacknowledge their thoughts. If you are unsure whether you understand the client, askthem to clarify their thoughts for you.Be prepared to repeat explanations, check people’s understanding of what has beendiscussed and make sure the information provided meets the client’s, family’s and carers’needs.Show empathy and sensitivity; never try to laugh off anything that is said.Use body language to convey appropriate feelings, such as nodding your head inunderstanding, leaning forwards, maintaining eye contact and touching the person lightly(if this is appropriate).Recognise nonverbal cues from others, such as frowning, shaking their head or closingtheir eyes.Don’t give advice unless it is asked for. If you do give advice, offer it with humility.Practice task 151. Re-read the list of tips for communicating and tick those you feel confident you can do. Puta mark against the ones you feel you need to improve.2. How can you plan to work on those communication skills you need to improve?Using effective communication strategiesEfficient communication with clients and other members of the palliative care teamis essential. The palliative care team should conduct regular meetings to maintainawareness of the client’s current situation and the care being provided. These meetingsshould also involve the client, their family and carers, where possible, allow them toreceive current information about the client’s status and give them an opportunity tovoice their concerns.The following communication strategies may help you develop effective communicationskills.• Ask the client who they want involved in their care and at what level they would likethem involved. Be sensitive to who is considered to be immediate family and theperson responsible as friends may play the role of relatives for some clients.• Clarify who the decision-makers are in the family and who you should shareinformation with; for example, the client, family members, or a communityrepresentative such as a community elder or religious leader.© Aspire Training & Consulting52

CHCPA402B Plan for and provide care services using a palliative approachAssessment activity 2Supporting clients to identify their preferences forquality-of-life choicesThe following table maps the assessment activity for this chapter against the elementand performance criteria of Element 2 in CHCPA402B Plan for and provide care servicesusing a palliative approach. The activity has been designed for all learners to complete.Part Element Performance criteriaA 2 2.1, 2.4, 2.6B 2 AllC 2 2.1, 2.4, 2.5, 2.7Part A1. Prepare a bulleted list of suggestions for how you could encourage family membersand carers to be involved in the care planning process and end-of-life care of a lovedone.2. Complete a table similar to the following of contacts for client referrals in your localarea.Support service Contact details Referral proceduresMedical practiceCommunity nursing servicesHospiceLegal servicesCentrelink servicesSupport groups/associationsfor specific conditionsFuneral servicesPhysiotherapyBereavement counselling© Aspire Training & Consulting56

Employability skillsEmployability skillsIn the table below, describe the activities you have undertaken that demonstrate howyou developed the following employability skills as you worked through this unit. Keepcopies of material you have prepared as further evidence of your skills.Alternatively, prepare a table similar to the following table.Employability skillsCommunicationThe activities undertaken todevelop the employability skillTeamworkPlanning andorganisingInitiative andenterpriseProblem-solvingSelf-managementTechnologyLearning© Aspire Training & Consulting153