Unit of competency details

Unit Descriptor 

This unit describes advanced skills and knowledge required to provide clients with specialist antenatal health care services

Application 

This unit is intended to build on clinical skills and knowledge developed at Certificate IV level in Aboriginal and/or Torres Strait Islander Primary Health Care (Practice)

Pre-requisites 

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

• HLTAHW401B Assess client's physical well being
• HLTAHW403B Plan and implement health care in a primary health care context

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. Deliver health care during pregnancy

1.1 Take and document general, social and obstetric health history

1.2 Identify symptoms of pregnancy and calculate expected date of delivery

1.3 Discuss with the pregnant woman an antenatal care plan based on standard protocols, instructions of medical staff and client requirements

1.4 Discuss information on healthy living and maternal health risks

1.5 Perform antenatal clinical assessments  in line with standard protocols and client requirements

1.6 Provide information  on birthing options, signs of labour, stages of labour, pain management techniques and family attendance at delivery

1.7 Identify from questioning minor disorders of pregnancy, provide advice and refer appropriately

1.8 Support women to obtain needed medicines and provide with appropriate information on use

1.9 Make appointments for specialist assessment, diagnostic imaging and other referred care according to medical orders and support women to attend as needed

1.10 Identify symptoms or signs suggesting potentially serious complications of pregnancy  and refer appropriately

1.11 Consult specialist obstetricians, allied health professionals and other members of the health care team and involve as appropriate

2. Organise and evaluate maternal health programs

2.1. Maintain registers of women undergoing antenatal care according to organisation policies and procedures

2.2. Keep schedules of participation in antenatal care and use to organise continuing care for women

2.3. Organise and/or provide reminders, transport and other assistance to attend care according to women's needs

2.4. Provide supervision of other staff participating in provision of antenatal care

2.5. Regularly update information on obstetric history and antenatal care assessment at the planned birthing facility according to organisation protocols

2.6. Maintain referral and communication networks with medical staff, specialist obstetricians, midwives, allied health staff, birthing facilities and female community elders

2.7. Keep statistics on attendance for antenatal care and birthing outcomes and use to evaluate maternal health programs

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
• Role of the Aboriginal Health Worker in counselling and health education
• Anatomy/physiology, pharmacology, pathology and basic microbiology relevant to pregnancy
• Knowledge of microbiology relevant to antenatal health and prevention of infection or cross infection
• Nutritional needs of pregnant women
• Health conditions, obstetric problems and associated issues related to pregnancy
• Strategies to:

• improve antenatal health in the community
• address clients presenting with antenatal problems
• coordinate provision of optimum level of maternal health service delivery

• Medical problems occurring in pregnancy requiring referral
• Relevant assessment methods and use of associated equipment, testing procedures
• Relevant treatments, medicines and associated care services available
• Risks and contraindications associated with relevant treatments and medication
• Realistic expectation of client condition during monitoring of progress
• Relevant evaluation criteria for monitoring effectiveness of specific antenatal health management program

Essential skills :

It is critical that the candidate demonstrate the ability to:

• Undertake comprehensive health checks related to antenatal health
• Provide information, guidance and support to clients and their families with antenatal health issues
• Monitor the outcomes of antenatal 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:

• Take and document a general, social and obstetric health history
• Perform an antenatal physical assessment
• Recognise situations requiring immediate or urgent action
• Work with other members of multi-disciplinary team to ensure actions determined in the client's care plan are carried out and documented
• Provide treatment, medicine and other health care services appropriate to antenatal health in a safe and effective manner and within guidelines
• Prepare and implement an antenatal plan
• Communicate effectively with client to obtain information and ensure understanding of information provided
• Liaise between service providers, individuals, families and community groups
• Holistically evaluate impact of treatment on client's physical, mental and emotional condition and behaviour
• Monitor outcomes of treatment / medication regimes
• Evaluate outcome of client's prescribed treatment/ care plan
• Evaluate overall effectiveness of care plan
• Make timely and appropriate referrals, providing accurate and relevant details to clients and referral agencies
• Manage community education on antenatal 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 should be assessed in conjunction with:

• HLTAHW517B Prepare for and manage childbirth
• HLTAHW518B Provide postnatal and infant health care

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

Potential impact of risk factors includes :

• Lifestyle and other risk factors identified from a health history
• Potential effects of risk factors on the foetus, including:

• alcohol consumption
• tobacco use
• nutrition
• prescription and non prescription drugs
• illegal drugs
• environmental hazards

• Potential impact of compliance or non-compliance with antenatal care plan
• Presence or absence of family, financial and social support systems
• Environmental and housing issues affecting pregnancy, child care and family health

Potentially serious complications of pregnancy requiring referral may include :

• Vaginal bleeding (painful and painless) - threatened miscarriage, incomplete miscarriage, placenta praevia, placental abruption
• Abdominal pain in early pregnancy -ectopic pregnancy
• Premature labour and premature rupture of membranes
• Proteinuria / hypertension - pregnancy-induced hypertension
• Signs and symptoms of gestational diabetes and pregnancy induced hypertension
• Other urinary abnormalities - UTI, glycosuria
• Reduced foetal movements and/or signs of poor foetal growth
• Symptoms such as:

• shortness of breath
• a rise in BP
• rapid weight gain
• poor weight gain
• oedema
• abnormal fundal heights for dates
• reduced or lack of foetal movement
• absence of foetal health sound
• abnormal urinalysis
• pain on micturition
• shortness of stature
• anaemia

Antenatal physical assessment includes :

• Abdominal palpation to identify foetal lie and presentation
• Measurement of fundal height and estimation of expected progression of pregnancy
• Perform venepuncture to collect blood for antenatal tests as per procedure manual
• Perform an antenatal assessment
• Identify all signs/evidence of pregnancy
• Documentation of findings from a physical assessment and follow up as per policy and procedures manual

Issues relating to nutrition may include :

• Nutrients required in pregnancy and their food sources
• Identifying women 'at risk' for nutritional problems in pregnancy
• Possible effects for the mother and foetus if diet is inadequate during pregnancy

Obstetric problems to be identified and managed include :

• Antepartum haemorrhage
• Vaginal discharges
• Importance of a 'show' before 38 weeks of pregnancy
• Fluid loss from the vagina
• Ruptured membranes (including onset of labour, prolapsed cord, infection)
• Abdominal pain in pregnancy (including braxton hicks contractions and labour contractions)
• Incompetent cervix

Information provided includes :

• Normal and abnormal vaginal discharge
• Care of the perineum
• Episiotomy or caesarean wound and breasts
• Resumption of sexual relations
• Obtaining baby clothes and nappies
• Sources of advice and support
• Welfare payments and other financial assistance