CHCPA301B: Deliver care services using a palliative approach

Assessor is to use this cover sheet to record the results of all the assessments in this unit.

Assessment Tasks Outcome

Unit:	CHCPA301B: Deliver care services using a palliative approach
Student ID:
Student’s Name:

Assessor’s Feedback

Assessors: Please return this cover sheet to the student, along with the assessment results and feedback. A copy must be supplied to the office and kept in the student’s file with the evidence. Please complete the table above.

Tasks included in this submission:

Assessment Tasks	Title	Satisfactory/ Not yet satisfactory	Re-submission Satisfactory/ Not yet satisfactory
Short Questions	Assessment 1
True/False Questions 1	Assessment 2
Case study 1	Assessment 3
Case study 2	Assessment 3
Case study 3	Assessment 3
Case study 4	Assessment 3
Case study 5	Assessment 3
Assessor’s Feedback
Assessor’s name & signature: ………………………………………………………………………………………………..

Assessments

To achieve a competent result for these units you must satisfactorily complete all the assessments requirements listed below. Your trainer/assessor will give you the timelines when these assessments need to be submitted.

Assessments for these units are as follows:

Assessment Number	Type of Assessment	Description and location
Assessment 1	Short Questions	These are found in this booklet. Answer all them to a satisfactory level.
Assessment 2	True/false Quiz	Read the statements given and choose the correct one.
Assessment 3	Case study	There are five case studies in this booklet. You are required to answer the questions that follow each case study.
Assessment 4	Personal journal	Each student is to keep a journal of their daily activities while on clinical placements.
Assessment 5	Workplace observation	Each student will be expected to cover some aspects of this course at the workplace. Your assessor will give you more details.
Assessment 6	Third-party observation	Each student will be expected to cover some aspects of this course at the workplace and to get a report from the supervisor.

Assessment 1 – Short questions

Instructions to the student:

Please read all the information given to you before answering. If you do not understand any of the questions, please ask your trainer/assessor for assistance.

You must answer ALL the questions in your own words.

Based on the resources and PowerPoint slides provided on delivering care services using a palliative approach, answer the following questions:

1. Explain what advanced care planning and advanced care directives are.

2. Briefly explain where you can access advanced care directives of the client.

3. Explain briefly how you develop an advanced care plan.

4. Explain why advanced care planning is important.

5. Give one main principle of Advanced Care Planning within a Palliative Approach.

6. Explain what the resident’s rights to consent or refuse care are.

7. Give four responsibilities of the palliative care team in advanced care planning.

8. Briefly explain how you would you implement advanced care planning for a CALD client and family who have limited English.

9. Briefly explain why it is important to report the client’s needs/issues in relation to end of life to the appropriate team member.

10. Give two examples of life-limiting illness.

11. Part of our carer work role and function is to maintain sustainability in the workplace, which includes environmental, economic, workforce and social sustainability. Based on the reading resources and PowerPoint slides, answer the following questions:

a. Give two examples of workforce sustainability.

b. List four forms of social sustainability.

c. List two ways to achieve economic sustainability.

d. Name four practices in achieving environmental sustainability.

12. How would you define ‘pain’?

13. Briefly explain the differences between acute and chronic pain for the client.

14. Explain the major aim of palliative care that is related to pain.

15. Explain briefly the main method of treating pain and if it is possible to always totally relieve pain.

16. As a carer, briefly explain your role in pain management in palliative care.

17. The following pain scale may be used with people with dementia or who are confused or any client who might find it easier to interpret than a numerical scale. Each face indicates a level of pain. Name these levels.

Indications of pain:

18. Describe two additional methods that can be used to assess levels of pain in clients and why they are needed.

19. What are the main painkillers used in palliative care for different levels of pain and when are they best given to maintain the client in a pain-free state?

20. There are varying attitudes to pain control according to culture and beliefs.

a) What different attitudes might you meet when dealing with CALD clients?

b) What misconceptions tend to exist about pain control?

21. In moderate to severe pain, opioids are recognised as probably the most effective treatment but are often rejected. Why?

22. Pain observations and actions must be documented. If you observe signs of increasing pain levels in your client, who would you report it to and how and where will you document them?

23. Palliative Care Australia identifies three forms of palliative care. Explain your understanding of each in the table below:

Form of palliative care	Description
A palliative approach
Specialised palliative service provision
End-of-life (terminal) care

www.palliativecare.org.au

24. Fill in the following table to compare differences between curative and palliative care.

Palliative care	Curative care
1. Aims to:	1. Aims to:
2. Focuses on:	2. Focuses on:
3. The client’s role is:	3. The client’s role is:
4. Sets treatment boundary around:	4. Sets treatment boundary around:
5. Methods used include:	5. Methods used include:
6. Place of treatment:	6. Place of treatment:

25. What is ‘legal guardian’?

26. Care of a resident at the end of life is a distinct and important part of residential care. It is important to communicate well to maintain the comfort and dignity of clients and support their families and loved ones. Reading the resources and PowerPoint slides in relation to end-of-life care issues, answer the following questions.

a. Briefly explain what part of care ‘end-of-life care’ refers to.

b. Briefly explain the carer’s role in identifying the terminal phase of illness.

c. List three care worker’s roles to consider during client’s end-of-life phase.

d. Give at least four signs and symptoms you might observe as death approaches.

e. What is the main goal of the carer?

27. You have been feeling very stressed from a number of deaths of clients you were very fond of occurring quite close together. You have not found support within your facility very useful. How might you identify and access help outside the home and what forms of help might you look for?

Assessment 1 – True-False Questions

It is very important to be aware of symptom management techniques in palliative and end-of-life care. Based on the resources and PowerPoint slides provided, select the correct answer: True or False (For online students, retain the correct option and delete unwanted option.)

It is important for a carer to have good communications skills so that they can effectively address clients’ emotional needs.	True/False
It is not important to demonstrate respect for the relationship between the client and the carer.	True/False
All elderly people have constipation.	True/False
A history of bowel habits can help carers in delivering care.	True/False
Ongoing bowel assessments are not necessary in palliative care.	True/False
Opioids are often used in palliative care.	True/False
Opioids are a significant cause of constipation.	True/False
When treating constipation, it is important to maintain the dignity of the client.	True/False
Elderly people do not really bother about bowel movements as they eat less.	True/False
Codeine is a painkiller that does not contribute to constipation.	True/False
Constipation can cause feelings of nausea.	True/False
Stomach pain does not accompany constipation.	True/False
Rectal pain often accompanies constipation.	True/False
Laxatives should be prescribed with opioids.	True/False
A laxative with a softening agent and stimulant is often appropriate for those on opioid pain relief.	True/False
Suppositories are never used in palliative care clients.	True/False
Good fluid intake can help relief constipation.	True/False
Fibre in diet assists in preventing constipation.	True/False
Oral nutrition rather than nasogastric enteral feeds is preferable.	True/False
It is not part of a carer’s duty to assist with feeding.	True/False
Interest in food and drink decreases towards the end of life.	True/False
Clients should be forced to eat and drink to keep up their strength.	True/False
The provision of artificial nutrition and hydration may be detrimental to a dying person.	True/False
Artificial hydration at the end of life may cause fluid build-up.	True/False
A resident’s best interests and expressed preferences should guide nutrition and hydration.	True/False
Resident’s preferences need not be followed if family are against them.	True/False
Oral care is not needed in end-of-life care.	True/False
Artificial saliva can be used if required.	True/False
Nausea and vomiting can be caused by physical anxiety.	True/False
During the service delivery process, a carer must not always seek advice from supervisor, team leader or a member of the palliative care team as per organisational policy and procedure.	True/False
A carer should encourage client, carers, family members and significant others to share information regarding client’s changing needs and preferences.	True/False
It is unlawful to discriminate carers based on his/her sexual identify and sexual preference.	True/False
It is not important to document a client’s lifestyle choice, social context and spiritual needs in the care plan.	True/False
Carers must always demonstrate respect for client’s cultural choices and encourage and support client, carer, family and/or significant others to discuss spiritual and cultural issues in an open and non-judgemental ways within the scope of their own responsibilities and skills.	True/False
Respecting client’s cultural choices is not important in the palliative care process.	True/False
In line with the organisation’s protocols, it is important to refer clients’ needs and issues to appropriate member of the palliative care team.	True/False
Holistic approach takes into consideration a client’s physical, emotional and spiritual needs and not just the end of life.	True/False
When you recognise the impact of your client’s end-of-life needs/issues on carers, it is advisable to refer the carer directly to a member of the palliative care team in line with organisation’s policy and procedure.	True/False
Palliative care approach also includes participating in a team approach to address the needs of clients, families and carers.	True/False
It is a waste of time on a carer’s part to try to promote independence and self-determination in a client who is on palliative care.	True/False
Advanced care directive is a legal binding document as per state and territory legalisation.	True/False
A legal guardian is a person who does not have the power to make personal and lifestyles decision for an adult with an impaired capacity.	True/False

Assessment 3 – Case Study

Case Study 1

Stress and grieving

CHCPA301B Deliver care services using a palliative approach

6. Manage own emotional responses and ethical issues

Kim had been feeling very stressed since the death of George Murphy, whom he had been particularly close to and had cared for over the last two years. The two had a lot in common, and despite George’s severe physical impairments, they had talked a lot about sport, watched games together on TV and laughed and joked and shared rivalry over their different teams. George had a large and argumentative family who were constantly around, and Kim liked them too.

Since George’s death, Kim felt tired and low. He had a lot of headaches and did not want to go to work but just to stay in bed. His wife was impatient with him and did not like him to talk about work – or deaths. Kim confided his problems to his mother who suggested he go to a counsellor who specialised in grief, as she thought Kim was grieving for George. Kim decided to take her advice.

He told the counsellor that George had died when he was on a week’s leave and he had not seen him or been told of the funeral. He felt hurt and excluded by the staff at the home and George’s family who all knew of their closeness. George had deteriorated very suddenly following a fall and died within 48 hours. The family had not conveyed George’s wishes not to be resuscitated when he was moved to the hospital, although these were clearly recorded in the care notes. Kim felt this was negligent. The family had made every attempt to keep George alive, including resuscitation following a heart attack. Although this was not successful and George passed away, Kim resented the fact it was not the peaceful death in a familiar place with a known and loved team around him.

Kim kept going to counselling for nearly three months, talking through the issues and at last finding some peace. He contacted the family and felt able to express his sadness to them without feeling bitter and he visited George’s grave where he felt a sense of closure.

1. What do you think are the factors involved in Kim’s grief?

2. What are the indications of stress?

3. What did Kim need to help him get over these problems?

4. Have you ever felt this way? Note any symptoms you may have had following the death of a loved one and how you got over them.

Group-based task – CHCPA301B

Appropriate responses to clients

CHCPA301B Deliver care services using a palliative approach

1. Apply a palliative approach

2. Respect client preferences for quality of life choices

3. Follow the client’s advanced care directives in the care plan

4. Follow end-of-life care strategies

5. Respond to signs of pain and other symptoms/discomfort

Discuss in your training group what you feel the most appropriate response is to the following situations.

Case Study 2

The care plan states that Jenny is to have a shower every day at the family’s request. You are helping her get out of bed when she states, “I don’t think I can shower today”. You also note that she is very short of breath.

What is the appropriate response to this situation?

Case Study 3

You are part of a palliative care team caring for a client who is in the last stages of a life-limiting illness. The client’s advanced care plan states that there is to be no other medical intervention except medication for pain relief. The client has provided a written advanced directive for this request with the doctors and the care team. While you are caring for the client, she lapses into a state of unconsciousness and you observe that the client’s breathing pattern has altered. A family member arrives and insists that you call an ambulance and start CPR.

What is the appropriate response to this situation?

Case Study 4

You have a Japanese client in care and she is obviously in considerable pain. You report your observations to your supervisor who assesses her and organises medication; however, the client refuses it. The care team is not sure if the problem is language or with the painkillers.

What is the appropriate response to this situation?

Case Study 5

You have an Iranian client who has entered aged care. Your supervisor calls a family meeting to discuss care and cultural needs at the time of death. The family says they do not want to discuss their father’s death as they feel it is not yet his time. Your supervisor asks you to find out the customs your clients may wish to follow during the dying period and after death so that you can provide appropriate care. You know that your client is a Muslim.

What is the appropriate response to this situation?