Unit of competency details

Unit Descriptor 

This unit describes advanced skills and knowledge required to provide clients with health care services in addition to general health care and specific to sexual and reproductive health

Application 

This unit is intended to address additional skills and knowledge required by those working with Aboriginal or Torres Strait Islander communities to deliver specific health care services and is available only within the context of qualifications at Certificate IV level or higher in Aboriginal and/or Torres Strait Islander Primary Health Care

It is imperative that cultural issues, including gender and kinship issues, are respected in the delivery, assessment and application of this competency unit

Whilst the practical application of skills for this competency unit may be limited to clients of the same gender, knowledge should apply to both genders

Pre-requisites 

This unit must be assessed after successful achievement of pre-requisites:

• HLTAHW401B Assess client's physical well being
• HLTAHW402B Assess and support client's social and emotional well being
• HLTAHW403B Plan and implement health care in a primary health care context
• HLTAHW404B Monitor health care

Employability Skills 

This unit contains Employability Skills

Elements define the essential outcomes of a unit of competency.

The Performance Criteria specify the level of performance required to demonstrate achievement of the Element. Terms in italics are elaborated in the Range Statement.

ELEMENT 

PERFORMANCE CRITERIA 

1. Check sexual and reproductive health

1.1 Undertake tests, observations and other screening procedures in line with protocols and client requirements

1.2 Review client records to determine priorities and potential areas of risk for each client

1.3 Question client appropriately to identify and/or clarify any sexual and /or reproductive health issues  and/or significant variations from normal

1.4 Use medical equipment effectively and maintain in accordance with organisation policies

1.5 Consult relevant allied professionals and available documentation in relation to the sexual and/or reproductive health of the client

1.6 Obtain informed consent for all examinations and tests and undertake appropriate pre-test discussion before testing for HIV or other blood-borne viruses

2. Provide care to clients with sexual health problems

2.1 Respect Aboriginal and/or Torres Strait Islander community values, beliefs and gender taboos in assessing and managing sexual health problems

2.2 Engage clients in holistic STI risk assessment and take an appropriate sexual health history  for each client presenting or identified with a sexual health problem

2.3 Assess common sexual health problems according to clinical presentation and treat/refer/support in line with standard protocols and organisation guidelines

2.4 Obtain history of sexual contacts where an STI is identified, negotiate contact tracing and follow up contacts for testing and treatment in line with standard protocols

2.5 Develop holistic health care plan for each client with sexual health problems

2.6 Support and counsel clients with STIs to assist in treatment and prevention of infection

2.7 Ensure records of STI management and contact tracing are kept confidential and secure

2.8 Maintain current, complete, accurate and relevant records for each client interaction

3. Provide information on sexual and reproductive health care

3.1 Promote safe sex practices or other STI risk reduction strategies and distribute condoms as appropriate

3.2 Discuss common methods of birth control with clients, explaining the methods, their advantages and disadvantages

3.3 Discuss transmission of STIs  and complications with the client as appropriate

3.4 Discuss symptoms of pregnancy with clients and identify as appropriate

3.5 Provide information on healthy lifestyle and risks during  pregnancy

3.6 Provide clients with information which is age and culturally appropriate and aligned with their specific needs

3.7 Employ a range of interpersonal techniques to ensure own values are not imposed on clients and information is provided in a non-judgmental way

3.8 Provide referral where own personal and professional abilities do not match client needs

4. Evaluate effectiveness of sexual and reproductive health care

4.1 Monitor sexual and reproductive health in line with schedule and criteria incorporated in care plan for each client

4.2 Evaluate intervention/ongoing sexual and/or reproductive health care against standing order/written care protocols and client level of comfort and compliance with health care practices

4.3 Ascertain degree of improvement of client's holistic health and compare with expectations under the health care plan

4.4 Undertake clinical re-assessment and/or review of treatment/medication regime as required where client fails to progress in accordance with expectation

4.5 Provide client with clear information about their level of improvement in relation to the health care plan and their level of compliance

4.6 Encourage clients to maintain sexual and reproductive health by active involvement with the care plan

REQUIRED SKILLS AND KNOWLEDGE 

This describes the essential skills and knowledge and their level required for this unit.

Essential knowledge :

The candidate must be able to demonstrate essential knowledge required to effectively do the task outlined in elements and performance criteria of this unit, manage the task and manage contingencies in the context of the identified work role

This includes knowledge of:

• Organisation policies and procedures relating to client confidentiality
• Anatomy/physiology, pharmacology, pathology and basic microbiology relevant to sexual and/or reproductive development stages and health
• Knowledge of microbiology relevant to sexual and/or reproductive health and prevention of infection or cross infection
• Health conditions and associated issues related to sexual and/or reproductive health
• Nature, history, pathology and transmission of sexually transmitted infections and relevant interventions
• Understanding of oppression and discrimination as related to sexuality
• Assessment methods, equipment and testing procedures associated with sexual and reproductive health and STIs
• Methods of birth control and their advantages and disadvantages

Essential skills :

It is critical that the candidate demonstrate the ability to:

• Undertake comprehensive health checks related to sexual and reproductive health
• Provide information, guidance and support to clients and their families with sexual and/or reproductive health issues
• Monitor the outcomes of sexual and reproductive health care services and make any required revisions to services, care plans or information provided

In addition, the candidate must be able to effectively do the task outlined in elements and performance criteria of this unit, manage the task and manage contingencies in the context of the identified work role

This includes the ability to:

• Conduct an accurate sexual and/or reproductive health assessment, including requesting pathology tests
• Recognise situations requiring immediate or urgent action
• Provide treatment, medicine and advice/ information appropriate to sexual and/or reproductive health in a safe and effective manner and within guidelines
• Communicate effectively with client to obtain information and ensure understanding of information provided
• Holistically evaluate impact of treatment on client's physical, mental and emotional condition and behaviour
• Make timely and appropriate referrals, providing accurate and relevant details to clients and referral agencies
• Reflect on own and others' values in relation to sexual behaviour and health
• Reflect on and improve own level and application of skills and knowledge to achieve desirable outcomes and maintain own capabilities

EVIDENCE GUIDE 

The evidence guide provides advice on assessment and must be read in conjunction with the Performance Criteria, Required Skills and Knowledge, the Range Statement and the Assessment Guidelines for this Training Package.

Critical aspects of assessment :

• The individual being assessed must provide evidence of specified essential knowledge as well as skills
• Consistency of performance should be demonstrated over the required range of situations relevant to the workplace
• Where, for reasons of safety, space, or access to equipment and resources, assessment takes place away from the workplace, the assessment environment should represent workplace conditions as closely as possible

Conditions of assessment :

This unit includes skills and knowledge specific to Aboriginal and/or Torres Strait Islander culture

Assessment must therefore be undertaken by a workplace assessor who has expertise in the unit of competency or who has the current qualification being assessed and who is:

• Aboriginal or Torres Strait Islander him/herself

or:

• accompanied and advised by an Aboriginal or Torres Strait Islander person who is a recognised member of the community with experience in primary health care

Context of assessment :

Competence should be demonstrated working individually, under supervision or as part of a primary health care team working with Aboriginal and/or Torres Strait Islander clients

Assessment should replicate workplace conditions as far as possible

Related units :

This unit may be assessed independently or in conjunction with other units with associated workplace application.

RANGE STATEMENT 

The Range Statement relates to the unit of competency as a whole. It allows for different work environments and situations that may affect performance. Add any essential operating conditions that may be present with training and assessment depending on the work situation, needs of the candidate, accessibility of the item, and local industry and regional contexts.

Cultural respect 

This competency standard supports the recognition, protection and continued advancement of the inherent rights, cultures and traditions of Aboriginal and Torres Strait Islander peoples

It recognises that the improvement of the health status of Aboriginal and Torres Strait Islander people must include attention to physical, spiritual, cultural, emotional and social well being, community capacity and governance

Its application must be culturally sensitive and supportive of traditional healing and health, knowledge and practices

Community control 

Community participation and control in decision-making is essential to all aspects of health work, and the role of the health worker is to support the community in this process

Supervision 

Supervision must be conducted in accordance with prevailing state/territory and organisation legislative and regulatory requirements

References to supervision may include either direct or indirect supervision of work by more experienced workers, supervisors, managers or other health professionals

A person at this level should only  be required to make decisions about clients within the organisation's standard treatment protocols and associated guidelines

Legislative requirements 

Federal, state or territory legislation may impact on workers' practices and responsibilities. Implementation of the competency standards should reflect the legislative framework in which a health worker operates. It is recognised that this may sometimes reduce the application of the Range of Variables in practice. However, assessment in the workplace or through simulation should address all essential skills and knowledge across the Range of Variables

Aboriginal and/or Torres Strait Islander Health Workers may be required to operate in situations that do not constitute 'usual practice' due to lack of resources, remote locations and community needs. As a result, they may need to possess more competencies than described by 'usual practice circumstances'

Under all circumstances, the employer must enable the worker to function within the prevailing legislative framework

Sexual health check refers to :

• A sexual and reproductive health consultation that incorporates assessment (with the client) of:

• STI risk factors
• promotion of good sexual health and safe sex practices
• examination/testing based on risk status, best available evidence and consideration of local circumstances.

Obtaining a client sexual health history involves :

• Ensuring confidentiality
• Building trust
• Providing explanations for seeking information
• Obtaining history of current complaint and genital symptoms
• Sensitive questioning on sexual practices and risk behaviours
• Eliciting details of sexual contacts

Common sexual health problems include :

• Male urethral syndrome (gonorrhoea, chlamydia)
• Impotence (psychological, medication related, microvascular disease)
• Inguino-scrotal swellings (hydrocele, hernia, varicocele, testicular tumour)
• Acute painful testicle (torsion, epididymo-orchitis)
• Penile disorders (phimosis, balanitis, circumcision complications)
• Prostatism (benign prostatic hypertrophy, prostatic carcinoma)
• Vaginal discharge (gonorrhoea, chlamydia, bacterial vaginosis, candidiasis, trichomoniasis)
• Female pelvic pain (gonorrhoea, chlamydia, and non-infectious causes such as ovarian complications and ectopic pregnancy)
• Ulcerative genital disease (herpes simplex virus, syphilis, Donovanosis)
• Genital lumps (wart virus)
• Asymptomatic (most of above, plus HIV and Hepatitis B)

Sexual health issues may include :

• Rape and sexual assault
• Family and domestic violence
• Child sexual abuse
• Relationships
• Sexual identities
• Homophobia
• Gender, including transgender issues
• Power and discrimination
• Menopause
• Unplanned pregnancy
• Sexually transmitted infections
• Sexual behaviours
• Contraception
• Management of menstruation, including menstrual problems and pre-menstrual syndrome
• Sexual coercion
• Sexual health check ups
• Impotence
• Impotence
• Circumcision complications
• Puberty
• Cervical and breast screening

Issues relating to pregnancy may include :

• Consideration of options in relation to unwanted pregnancy
• Provision of information about pregnancy
• Difficulties associated with pregnancy

Examination /testing of client may include :

• Routine examinations for sexual and/or reproductive health problems.
• More invasive examinations such as:

• pap smears
• STI specimen collection

Risk factors for sexually transmitted infection include :

• Number of sexual partners
• Unsafe sex practices
• Past history of sexually transmissible infections
• Alcohol or substance misuse
• Local disease prevalence
• Frequency of being named as sexual contact of an index case

Screening for STI may include :

• Genital inspection for ulceration, pubic lice and discharge
• Taking genital swabs for gonorrhoea and chlamydia
• Taking blood for syphilis, HIV and Hepatitis B serology
• Obtaining a first-pass urine specimen for gonorrhoea and chlamydia PCR testing
• Acquiring a client-obtained vaginal specimen (tampon or low-vaginal swab) for gonorrhoea and chlamydia PCR testing

Common methods of birth control  (and their advantages and disadvantages ) include :

• Oral contraceptive pill (reliable, safe, need to take daily)
• Condoms (reduced STI transmission, shared responsibility, high failure rate)
• Withdrawal (male responsibility, high failure rate)
• Breast-feeding (high failure rate)
• Injectable or implantable hormonal contraception (highly reliable, low effort, delayed return of fertility, irregular menses)
• Post coital ('morning after') pill (nausea)
• Tubal ligation
• Vasectomy (reliable)

Ethical , legal and religious issues involved in reproductive choices may include :

• Restrictions on termination of pregnancy
• Access to pharmaceutical supplies
• Church teachings

Factors that influence reproductive choices for Aboriginal and /or Torres Strait Islander women may include :

• Age of consent
• Educational attainment
• Informed decision making
• Cultural norms for maternal age and numbers of children
• Coercion

Local beliefs and traditional practices regarding pregnancy and childbirth may include :

• Food restrictions in pregnancy
• Role of traditional midwives
• Birthing in traditional country