CHCPAL001 Deliver care services using a palliative approach

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CHC33015 Certificate III in Individual Support (Ageing)
Advance College
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This Student Assessment Booklet includes all your tasks for assessment of CHCPAL001 Deliver care services using a palliative approach.

ABOUT YOUR ASSESSMENTS

This unit requires that you complete 4 assessment tasks. You are required to complete all tasks to demonstrate competency in this unit.

Assessment Task	About this task
Assessment Task 1: Written questions	You must correctly answer all 9 questions to show that you understand the knowledge required of this unit.
Assessment Task 2: Case study	You are to read the case study and complete the questions that follow.
Assessment Task 3: Role play	You are undertake a role play relating to pain management for a client in late stages of stomach cancer. You will also need to answer a set of verbal questions.
Assessment Task 4: Role play	You are undertake a role play relating to the development of an advance care plan.

What is palliative care?

What are the aims of palliative care?

What are three of the principles of palliative care?

Principle 1:
Principle 2:
Principle 3:

What is the difference between a ‘curative’ and a ‘palliative’ approach?

Working in palliative care can be very stressful. List three emotions that workers would feel while caring for terminally ill clients.

1:
2:
3:

b) What are four things that you can do to help your colleagues deal with their emotions?

1:
2:
3:
4:

List three types of nutrition and hydration advice you would give to a client and their family during the early stages of palliative care.

1:
2:
3:

b) In the final stages of life, appetite and thirst may decrease significantly. Family members may feel that they should try to feed the person. What would you advise the family members?

List two common misconceptions about pain relief.

1:
2:

b) Choose one of the misconceptions from a) above. In one paragraph describe why it is a misconception and what the truth is around this statement.

QUESTION 5

Shamus’s family come to talk to you about their his care.

They want to speak to you because they trust you as someone who has worked very closely with Shamus as a palliative care worker for the last two months.

They are very distressed about a report they have received from the doctor, who has told them that Shamus has only days to live.

His family ask you to refer them to a different doctor – there must be something that can be done to preserve his life. They aren’t ready to lose him yet!

Shamus has an advanced care directive. It states he does not want any further medical treatment to keep him alive.

His family are aware of this directive.

You feel that people have the right to get a second opinion. Should you refer Shamus’s family to a good doctor that you know? Explain your answer.

What other action could you take to support Shamus’s family?

QUESTION 6

Shamus has died.

His wife, Katherine, comes to see you and thanks you for looking after him so well.

She gives you a hug and you both feel a bit sad.

Katherine tells you that she seems to be living in a daze. She can’t even remember what she did this morning. She is usually so well organised but just can’t seem to concentrate at the minute – what if something goes wrong at the funeral because she forgets to do something?

‘I haven’t even cried yet!’ she exclaims.

Why is Katherine experiencing this type of reaction so soon after her husband’s death?

What would you say to Katherine to reduce her fear of something going wrong at the funeral?

What are the five stages of grief according to the Kübler-Ross Grief Cycle?

QUESTION 7

Constipation is a common problem in palliative care clients. Laxatives may be prescribed by the doctor to assist with this.

Apart from medication, what are two supports that a personal care worker can give to a client suffering from constipation?

1.
2.

QUESTION 8

A client’s family is looking for some information on palliative care. They have received the information provided by the HACC team but they are looking for more.

Research the Internet and find a reputable source of information that they can access to find out more. Write down the source of this information (ie the website address).

QUESTION 9

Describe each of the following terms – give an example of each.

Bessie has severe dementia.

Before she got dementia, she had written out an advanced care directive that said that she wanted to be resuscitated by CPR if she collapsed under any circumstances.

As far as Bessie was concerned, life was more important than anything else – even if she wouldn’t be able to make her own decisions as her dementia progressed.

Bessie’s son has not been to visit her for months. One day he appears at Bessie’s side. ‘I’m the only next of kin,’ he says. ‘Mum isn’t here anymore, she’s just a vegetable now. I don’t want her to be resuscitated if she collapses again. Just let the old lady die.’

You are aware that Bessie is a very rich woman. From the look of her son, he could do with some money.

What are the ethical issues involved in this scenario and what action should the care worker take?

Describe three legal and ethical issues that may arise with advanced care directives and suggest to deal with these.

Bessie’s son begins to ask a lot of questions about his mother:

§ ‘What is the matter with her?’

§ ‘How sick is she?’

§ ‘Does she know who anyone is anymore?’ § ‘Where is all her bank paperwork?’

Bessie’s son assures you that he has a power of attorney for Bessie – but he does not show you a copy.

Bessie’s last surviving relative is her son. Considering he says he has power of attorney, do you think you can give him any of the information he has asked for? Explain your answer.

What do I need to hand in for this task?	Have I completed this?
Your answers to each question	o

ASSESSMENT TASK 2: CASE STUDY

TASK SUMMARY:

You are to read the case study and complete the questions that follow.

WHAT DO I NEED IN ORDER TO COMPLETE THIS ASSESSMENT?

Access to textbooks and other learning materials
Access to a computer and the Internet (if you prefer to type your responses).

WHEN DO I DO THIS TASK?

You will do this task in your own time.
Write in the due date as advised by your assessor: _______________

WHAT DO I NEED TO DO IF I GET SOMETHING WRONG?

If your assessor marks any of your answers as incorrect, they will talk to you about resubmission. You will need to do one of the following:

Answer the questions that were incorrect in writing.
Answer the questions that were incorrect verbally.

CASE STUDY:THORDRIE

Thordrie is English. He came to Australia in his 60s to be with his family.

Thordrie and his family are very private people. They tend to keep their feelings to themselves – perhaps this is because of their English culture.

Thordrie has late stages of a terminal disease. He has made it clear in his advance care directive that he:

§ does not wish to be resuscitated

§ wants to be kept comfortable

§ would like his immediate family to be with him when he dies (if possible) § would like the Anglican priest to be called to perform the last rites.

Thordrie’s health has deteriorated significantly. He has been sleeping for the last 24 hours and today he has been very restless.

The doctor has told you that he is not expected to live more than a few hours.

You and your colleague, Jasmin, will be caring for Thordrie today.

It is likely that he will die on your shift.

You have been well aware of Thordrie’s end-of-life wishes for some time. Is there any need for you to check them again? Explain your answer.

What are the indicators that death is imminent for Thordrie?

List four other common signs that indicate death is imminent.

1.
2.
3.
4.

List three types of care that you and Jasmin can give Thordrie at this stage.

1.
2.
3.

What can you do to respect Thordrie’s dignity at this time?

Who should you talk to if you don’t know what to do during this end-of-life stage?

Given his end-of-life wishes, who should be contacted about Thordrie’s imminent death?

What support can you give to Thordrie’s family?

What can you do to support Thordrie and his family with their cultural and spiritual needs?

The buzzer goes off in Thordrie’s room.

The family tell you that Thordrie has passed on. They tell you it was peaceful – he just took a last breath and it was all over. He is on his way to heaven now – flying with the angels.

The family says the Lord’s Prayer.

You observe the body. Thordrie’s eyes are half open and his mouth is open. He is not wearing his dentures.

You and Jasmin may have cultural practices and religious beliefs that are very different to those of Thordrie’s family. How should you deal with this situation?

What signs will you check to confirm that Thordrie has died?

What will you and Jasmin do to care for Thordrie’s body after death? List the steps you need to take.

Where would you find guidance on how to care for a body after death?

You are a new personal care worker and have not previously prepared a body after death. You are feeling uneasy but are prepared to get the job done.

What can you do to look after yourself – now and during the next few days?

What support can you give Thordrie’s family after death?

What documentation must be completed after Thordrie’s death?

What do I need to hand in for this task?	Have I completed this?
Your answers to this case study	o

ASSESSMENT TASK 3: ROLE PLAY

TASK SUMMARY:

You are undertake a role play about pain management for a client in late stages of stomach cancer. After the role play you will need to answer a set of verbal questions.

WHAT DO I NEED IN ORDER TO COMPLETE THIS ASSESSMENT?

Access to a workplace environment (your assessor will organise this with your supervisor) A blanket
A jug of water and a glass
Palliative Care Management plan (provided) Pain and Symptom Management form (provided).

WHEN DO I DO THIS ASSESSMENT?

You will do this task in during your assessor’s workplace visit.
Write in the date of your assessor’s workplace visit:

WHAT DO I NEED TO DO IF I GET SOMETHING WRONG?

If your assessor sees that you have not shown appropriate skills or knowledge, they will give you some feedback and you will need to do the role play again or answer the verbal questions again.

INSTRUCTIONS:

ROLE PLAY:PAIN MANAGEMENT

You are a care worker who is working with a client called John. He has terminal stomach cancer and is receiving palliative care.

John’s care plan provides you with the following information:

§ He is in the late stages of stomach cancer.

§ Pain medication is morphine taken orally. It has been successful in reducing pain and discomfort.

§ John needs to be reminded to take regular sips of water to remain hydrated.

Today John has received his morphine as usual – his last dose was one hour ago.

Your assessor will play the role of John. You will need to show that you can respond to his needs and support him appropriately. You will document your observations on the Pain and Symptom Management form provided

Following this part of the role play, your assessor will play the role of the supervisor of John’s care team. Discuss your observations with your supervisor.

The table below gives further information about what you need to show during the role play.

John’s Palliative Care Management Plan can be found over the page.

After the role play you will need to answer a set of verbal questions.

Your assessor will be looking to see that you can:

§ Follow John’s Palliative Care Plan (see over the page).

§ Observe John and identify his pain or any other symptoms.

§ Document John’s pain and other symptoms using the Pain and Symptom Management Form provided.

§ Communicate appropriately in relation to John’s quality of life, pain, comfort and wishes. For example, you should listen carefully to John, consider your body language, show respect, be empathetic, use clarifying statements, confirm understanding, etc

§ Create an emotionally supportive environment in which John can share information about his condition and his current symptoms.

For example, by developing trust, asking sensitive and appropriate questions, etc

§ Use strategies to manage John’s pain and make him more comfortable

For example, ensuring he is in a position that is comfortable; considering his hydration; asking if he is hot/cold and making sure you address his needs

§ Show that you respect and support John’s end-of-life wishes.

§ Review and document if John’s pain management has been effective.

§ Accurately report your observations to the supervisor of John’s care team

VERBAL QUESTIONS

At the completion of the role play, your assessor will ask you a set of verbal questions about John and his care.

What do I need to hand in for this task?	Have I completed this?
Palliative Care Management Plan	o

Palliative Care Management Plan

Name:

John Smith

Date:

12/05/2015

DOB:

01/07/1942

Address:

286 High Street, Kerrytown VIC 3878

Diagnosis of illness:

Terminal stomach cancer

Current medical treatment:

Morphine 10mg 4 hourly

Laxative as required

Liquid food only

Client’s prognosis

John has advanced stage stomach cancer.

He has had surgery and one round of both chemotherapy and radiotherapy. However, the cancer has spread to the bowel region.

John has made the decision to refuse any further surgery or chemo/radio therapy and is now receiving palliative care.

John’s condition is terminal – John’s doctor has indicated that he may have 3–5 months left.

Palliative care planning

Physical needs:

§ Needs assistance for all activities of daily living

§ Pain is severe but well controlled with medication

§ Requires assistance with feeding (liquid diet) and drinking

§ Can walk short distances with support

§ Requires laxatives for constipation

Emotional/psychological:

§ John has accepted his condition

§ John has a very supportive family who visit often

§ He may sometimes be teary, but is generally in

good spirits

Family:

§ John’s wife, Catherine, is next of kin. Catherine is supportive and has accepted his condition; however, she feels helpless to care for him.

§ Catherine and John have agreed that he will remain at the hospice until he is in last stages, then he will return home to Catherine’s care.

§ John has two sons, Jeremy and Peter.

Spiritual/religious:

§ John is Catholic (non-practicing)

Future care needs:

§ Palliative care only – no further surgery, chemotherapy or radiation therapy at John’s request.

§ Maintain pain control.

§ Maintain hydration.

§ Feed liquids orally only – no feeding tubes at John’s request.

Communication

§ John is able to communicate himself with no

trouble.

	Client Care Plan
Symptoms	Objectives	Intervention
Pain	Reduce pain to a manageable level	Morphine orally 10mg every 4 hours
Nutrition	Prevent malnutrition; enjoy food Prevent choking, nausea	Liquid food only by mouth – no feeding tubes
Hydration	Maintain adequate level of hydration Prevent dry mouth and mouth conditions	Provide sips of water frequently
Temperature maintenance	Provide adequate body and ambient temperature	Monitor body temperature Provide blankets, warm drinks if cold Control ambient room temperature
Nausea	To prevent distressing symptoms	Maxolon as required

Pain and Symptom Management Form
Client’s name:						Student’s name:
Date:						Time:
Medication: § Morphine orally 10mg 4-hourly § Laxative twice daily
Pain level:
No Pain 0	1	2	3	4	5		6	7	8	9	Worst Pain 10
Pain location: Locate on the diagram the location of client’s pain.

Source: http://www.wps.ac.nz

What makes the pain less?

What makes the pain worse?

What type of pain is it? (For example, stabbing, throbbing, dull ache.)
Is it constant or does it come and go?
Is the pain relief you are currently receiving enough to make a real difference to your life?
Adverse Events Is the client experiencing any of the following symptoms?
	None	Mild	Moderate	Severe
Nausea	¨	¨	¨	¨
Vomiting	¨	¨	¨	¨
Constipation (When were bowels last open?)	¨	¨	¨	¨
Itching	¨	¨	¨	¨
Mental cloudiness	¨	¨	¨	¨
Sweating	¨	¨	¨	¨
Fatigue	¨	¨	¨	¨
Drowsiness	¨	¨	¨	¨
Other (insert details):	¨	¨	¨	¨
Other (insert details):	¨	¨	¨	¨
Comments:

Action to be taken:

ASSESSMENT TASK 4: ROLE PLAY

TASK SUMMARY:

You are undertake a role play relating to the development of an advance care plan.

WHAT DO I NEED IN ORDER TO COMPLETE THIS ASSESSMENT?

Advance Care Plan, NSW Health, Hunter New England Local Health District (provided as a separate document) An extra participant to play the role of Thelma (your assessor will organise).

WHEN DO I DO THIS TASK?

You will do this task in during your assessor’s workplace visit.
Write in the date of your assessor’s workplace visit:

WHAT DO I NEED TO DO IF I GET SOMETHING WRONG?

If your assessor sees that you have not shown appropriate skills or knowledge, they will give you some feedback and you will need to do the role play again. If you have not completed all parts of the template correctly, you will need to fix and resubmit.

INSTRUCTIONS:

ROLE PLAY:ADVANCE CARE PLAN

You are a care worker who is working in a palliative care unit.

Jim is a 72-year-old man with Stage 4 Pancreatic cancer.

Jim has had chemotherapy, which initially looked like it would be successful, but last week Jim was told by the oncologist that the chemo was no longer effective.

Jim and his wife, Thelma, talked it over and they both decided that they would like Jim to remain at home for as long as possible – hopefully being able to die peacefully and with dignity in his home.

Jim has been referred to the community palliative care team.

You work with this team and you are meeting with Jim and Thelma today to put together an advance care plan.

Your assessor will play the role of Jim. You will need to show that you can support him in developing his advance care plan.

Your assessor will give you a copy of an advance care pan template before you start the role play.

The table below gives further information about what you need to show during the role play.

Your assessor will be looking to see that you can: § Identify that Jim’s needs will vary from now until his death. For example, his support needs will change as his health status deteriorates; Jim should understand that his plans can be changed at any time. § Support Jim and Thelma to talk about their needs, including physical, cultural and spiritual needs. Use the advance care plan template to guide your discussion. § Communicate with Jim and Thelma appropriately. For example, you should be respectful, empathetic and supportive, avoid passing judgment on his requests, consider your body language, observe their body language and cues, use clarifying statements, confirm understanding, etc
	Respect Thelma’s role as an integral part of Jim’s care team. For example, speaking to Thelma as well as Jim, displaying empathy for Thelma’s concerns, asking for her opinion on some matters, encouraging Jim and Thelma to discuss issues together
	Identify any needs and issues that may be outside of your own boundaries and refer to appropriate person for advice For example student’s supervisor or client’s medical practitioner
	Respect Jim’s dignity of risk.
	Accurately record all information in the advance care plan template.
	Report your observations to the supervisor of John’s care team.

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