Elements and Performance Criteria

Aim of a palliative approach adapted from Guidelines for a Palliative Approach in Residential Aged Care (2004) is:
An approach linked to palliative care that is used by primary care services and practitioners to improve the quality of life for individuals with a life limiting illness, their caregivers and family.
The palliative approach incorporates a concern for the holistic needs of patients and carers that is reflected in assessment and in the primary treatment of pain and physical, psychological, social and spiritual problems.
Application of the palliative approach to the care of an individual patient is not delayed until the end stages of their illness. Instead, it provides a focus on active comfort-focused care and a positive approach to reducing suffering and promoting understanding of loss and bereavement in the wider community.
Underlying the philosophy of a palliative approach is a positive and open attitude towards dying and death.

Palliative approach services include:
Identifying the client, family and carer as the unit of care
Participating in a team approach to address the needs of clients, families and carers ensuring a palliative approach
Seeking advice from appropriate person eg supervisor, team leader or palliative care team
Maximising self-care and self-determination for the client
Assisting in the psychological, cultural and spiritual aspects of care for the client
Providing support for clients, family, worker and carer using a palliative approach
Recognising symptoms of pain, discomfort and other symptoms and the clients need for pain relief
Recognising the signs that death may be imminent
Practice that reflects an understanding of the aims of a palliative approach
Practice reflects an understanding of the impact of a palliative approach in an organisation
Maintaining the client's dignity
Understanding the needs of clients approaching end-of-life

Issues of loss and grief may include:
Experiences of the worker of their own loss and grief
Ability of worker to address loss and grief when a client dies
Frequency and number of deaths experienced
Acknowledge the need to resolve some issues when a client dies
Support of co-workers in their response to loss and grief

Worker emotional responses may include:
A range of emotions that may be demonstrated or displayed as a response to the process of loss and grief, for example:
Crying and feelings of sadness
Poor concentration
Fear, anger, silence which may appear singularly or together and prolong the worker's own grief

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
As per state and territory legislation or guidelines on advanced care planning

Advanced care directives:
Are sometimes called a ' living will' and describe one's future preferences for medical treatment
Contain instructions that consent to, or refuse, the future use of specified medical treatments
Become effective in situations where the patient no longer has capacity to make legal decisions
Are to be in alignment with state and territory legislation or guidelines on advanced care planning
Are to be completed as one component of the broader advanced 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 advanced 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 patient'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
A nominated substitute decision maker that the treating clinician may seek out to discuss treatment decisions
Other non-medical aspects of care that are important to the person during their dying phase

Legal implications of advanced care directives:
As per 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, Palliative Care Australia, November 2005)

Strategies to relieve pain may include:
Regular assessment and effectiveness of strategies are documented
Comfort measures using a range of therapies as requested by the client, carer and/or family
Environmental aspects such as room heating and cooling
Pain relieving medication to be administered by a Registered Nurse or endorsed Enrolled Nurse in line with state/territory legislation
Pain relieving therapies other than medication to be administered by appropriate staff member
Psychological, cultural and spiritual activities
Other measures to promote comfort and relieve pain - massage, relaxation, distraction, aromatherapy

Carers include:
Carers are usually family members who provide support to children or adults who have a disability, mental illness, chronic condition or who are frail aged
Carers can be parents, partners, brothers, sisters, friends or children. Some carers are eligible for government benefits while others are employed or have a private income (Carers Australia, 2004)

Impact on carers may include:
Changing nature of carer's role
Grief due to multiple losses

Guardian:
A person appointed to make personal and lifestyle decisions for an adult with an impaired capacity. A guardian can make decisions about an adult's lifestyle and/or health care
Role to be interpreted in line with individual state and territory legislation or guidelines on definition of guardian

Client:
May also refer to resident or patient 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

Critical aspects of assessment:

Evidence of competence must be demonstrated through a minimum of three (3) different assessment methods, which may include:

Observation in the work place
Written assignments/projects
Case study and scenario as a basis for discussion of issues and strategies to contribute to best practice.
Questioning
Role play/simulation

Essential knowledge:
Awareness of relevant policies, protocols and practices of the organisation in relation to the provision of both a palliative approach and palliative care
Identifying and accessing relevant resources
Understanding the palliative approach to care of clients and their family
Awareness of diverse cultural aspects
Understanding the complexity of carer's needs and potential issues
Understanding of own role and responsibilities, and those of other team members involved in delivering a palliative approach and care
Impact of loss and grief on clients, carers and workers
State and Territory legislation on advanced care planning and advanced care directives
Ethical and legal issues related to a palliative care approach
Basic information about the use of pain relieving medication for staff, client and their family and within level of responsibility
Awareness of hydration and nutrition requirements during a palliative approach and at end-of-life
Awareness of the various signs of imminent death/deterioration

Essential skills must include ability to:
Communicate effectively with clients, their families, carers and other team members using effective listening, sensitive clarification and questioning, recognition of non-verbal cues, and provision of information within level of responsibility
Share knowledge and information with other team members regarding the palliative approach
Contribute to the provision of an environment that supports clients and their families and ensures other staff members are able to provide a palliative approach to palliative care
Understand and adhere to own responsibilities and ensure other staff are aware of their roles and responsibilities
Document clearly advanced care directive and end-of-life needs on care plan and report to appropriate person
Intervene appropriately in accordance with care plan in the care of clients with pain relief and other symptom and comfort promotion
Assess effectiveness of pain relief and comfort strategies
Identify and reflect on own performance and attitudes regarding a palliative approach and end-of-life care
Identify and document cultural and spiritual issues that may impact on a palliative approach
Be supportive of team members to undertake informal and formal debriefing as necessary
Contribute to and initiate problem solving processes to resolve issues as necessary
Use literacy and numeracy skills as required to fulfil work role in a safe manner and as specified by the organisation

Resource implications:
Access to appropriate workplace where assessment can take place
Access to equipment and resources normally used in the workplace

Consistency in performance:
Assessment will be conducted or evidence gathered over a period of time and cover the normal range of workplace situations and settings
Consistency of performance should be demonstrated over the required range of situations relevant to the workrole

Context of assessment:
This competency unit will be most appropriately assessed in a simulated workplace and/or in the workplace and under the normal range of workplace conditions