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.

Using a palliative approach includes:
Identifying the client, family and carer as the unit of care
Participating in a team approach to address the needs of client, families and carers ensuring a palliative approach
Seeking advice from appropriate person eg supervisor or team leader or palliative care team
Maximising self-care and self-determination for the client
Assisting in the psychological and spiritual aspects of care for the client
Providing support for clients, family and carer using a palliative approach
Recognising symptoms of pain, discomfort and other symptoms
Recognising the signs that death may be imminent
Practice that 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

Sources of loss and grief may include:
Worker may have experienced a loss of their own and be grieving
Frequency and number of deaths experienced
Need to resolve some issues when a client dies
Different responses to loss and grief of co-workers

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

Misconceptions relating to use of pain relieving medication may include:
All members of staff should feel confident to ask questions and seek clarification about analgesia, addition and drowsiness as well as when hearing any of the following statements:
'Pain relief should only be given for pain that is currently present'
'Doctors and nurses are the best judge of a client's pain'
'Clients should not receive pain relief until cause is determined'
'Clients may become addicted'
'Strong analgesics may shorten life'
'Pain management alone is not palliative care'
'Client may become too drowsy to communicate with family'

Advanced care directive:
Sometimes called a 'living will' and describes one's future preferences for medical treatment
Contains instructions that consent to, or refuse, the future use of specified medical treatments
Becomes effective in situations where the patient no longer has capacity to make legal decisions

Advanced care directives may include:
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
Relevant state and territory legislation or guidelines on advanced care directives

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 promote comfort may include:
Regular observation, reporting and documentation of client's comfort
Provision of pain relieving measures by appropriate member of staff (see state/territory legislation regarding pain-relieving medications and organizational protocols)
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 workplace
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:
Relevant policies, protocols and practices of the organisation in relation to providing a palliative approach in own work role
Understanding the palliative approach to care of clients and family
Understanding complexity of carers' roles, needs and issues
Awareness of hydration and nutrition requirements during a palliative approach and at end-of-life
Misconceptions associated with approaches to pain relief and comfort
Role and function of team members
Scope of own responsibilities
Impact of loss and grief on clients, carers and workers
Understand advanced care directives and providing care in accordance with the care plan
Understand the goals of pain relief and comfort promotion
Awareness of diverse cultural aspects
Identify and access relevant resources
Awareness of the various signs of imminent death/deterioration
Principles and philosophy of a palliative approach

Essential skills must include ability to:
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
Use effective communication to ensure a palliative approach is undertaken
Understand and adhere to own work role/scope and responsibilities
Use observation skills re: the client's hydration and nutrition and respond in line with care plan
Identify own attitudes to a palliative approach and end-of-life care
Identify own beliefs on ageing, spirituality, relationships, sexuality, culture and intimacy
Identify cultural issues that may impact on a palliative approach
Work effectively with other team members to achieve principles of palliative approach
Follow appropriate protocols following death
Follow organisational policies, protocols and procedures
Liaise with and report appropriately to supervisor or other members of the team
Reflect on own performance and attitudes regarding a palliative approach
Develop and apply a non-judgmental approach
Informally and formally debrief with other team members and supervisors as necessary
Report and document observations of clients and their family using the appropriate forms
Provide care that reduces client's discomfort
Contribute to a supportive environment that enables clients and their families and other staff members to provide a palliative approach to palliative care
Use literacy and numeracy skills as required to fulfil work role in a safe manner and as specified by the organisation/service
Seek clarification and feedback from supervisors, clients and colleagues if unsure of work role
Use basic problem solving skills to resolve problems of limited difficulty within organisational protocols

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