Unit of competency details

Descriptor 

This competency unit describes the skills and knowledge required for the Enrolled/Division 2 Nurse to perform nursing interventions to support the health care needs of the older person in both acute care settings and residential aged care environments

Application 

The knowledge and skills described in this competency unit are to be applied within jurisdictional nursing and midwifery regulatory authority legislative requirements

Enrolled/Division 2 nursing work is to be carried out in consultation/collaboration with Registered Nurses and under direct or indirect supervisory arrangements in line with jurisdictional regulatory requirements

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.

ELEMENT 

PERFORMANCE CRITERIA 

1. Respond to the special health requirements of the older adult

1.1 Work within the scope of practice for the Enrolled/Division 2 nurse with the aged care client within any health care setting

1.2 Work with an understanding of physical changes that take place as part of the ageing process, associated age -related adjustments  and transitions and psychosocial needs of the older persons and their families

1.3 Allow for the fact that drugs and medicines have different effects in the older person

1.4 Reflect an understanding of pathophysiological disorders and how they may affect older persons and their family

1.5 Communicate effectively with older person experiencing sensory loss

1.6 Perform preventive health checks  in consultation/collaboration with a registered nurse

1.7 Assist the older person to maintain health lifestyle practices

1.8 Work with an awareness of own values, attitudes and beliefs towards ageing and the aged person

1.9 Work with an awareness of common stereotypes associated with ageing and the influences they can have on the care of the older adult

1.10 In planning and implementing care for the older person, use work practices that reflect an understanding of theories of aging and best practice care guidelines

1.11 Take action to manage factors which may tend to segregate and disadvantage the older adult

2. Contribute to care plan development for the older person

2.1 Assess the older client to determine their health status in consultation/collaboration with registered nurse

2.2 Complete appropriate health assessment tools used specifically in the aged care environment

2.3 Assist the older client to identify self-care abilities and disabilities

2.4 Develop the nursing care plan within the context of the health care setting using organisation policies and procedures

2.5 Ensure client, family and/or significant other understand the implications of their admission to the health care setting

2.6 Discuss with older client or their family representative psychological, social and/or physical needs

2.7 Discuss with older person or their family representative the impact of the ageing process and/or pathophysiological disorders on the performance of activities of daily living 

2.8 Share information regarding older person's health status with other members of health care team

2.9 Implement care as per nursing care plan and monitor work allocated to others

2.10 Provide support, comfort for grieving family/client

2.11 Take into account the impact of complex issues involved in aged care on carer(s)

3. Assist to evaluate outcomes of planned nursing care of the older client

3.1 Document responses of older client to nursing actions

3.2 Report changes in older client response to nursing actions to registered nurse

3.3 Convey information clearly and accurately to appropriate staff member

3.4 Take in account complex and dual diagnosis issues in addressing aged care

3.5 Provide information on community services available to older person and their family

4. Practise within the aged care environment

4.1 Work with an understanding of the funding mechanisms impacting on aged care provision

4.2 Take into account the variety of areas of practice within the aged care environment

4.3 Take into account the changes and impacts of those changes to the delivery of health care for the older person

4.4 Work with an understanding of the changing demographics of the aging population

4.5 Work with an awareness of own values, attitudes and beliefs towards ageing and the aged person

4.6 Promote health maintenance for older person and their family

4.7 Provide information on community services available to older person and their family

4.8 Provide care of deceased person

4.9 Provide support, comfort for grieving family/client

4.10 Take into account the impact of complex issues involved in aged care on carer(s)

5. Address contemporary issues in aged care practice

5.1 Work with an awareness of the current legal and ethical issues  involved in aged care practice

5.2 Work with accurate knowledge of the role of guardianship, advanced health directives and legislation in aged care practice

5.3 Recognise and support the rights and responsibilities of the older person

5.4 Work with an awareness of elder abuse as a significant contemporary issue for older persons

5.5 Act as an advocate for the client and their family

5.6 Demonstrate respect for individual culture, spiritual and religious practice for the older person

5.7 Observe and respond appropriately to physical, emotional and mental signs of stress in the older adult

6. Use strategies which relate to the progressive and variable nature of dementia

6.1 Work with an awareness of dementia as a neurological condition

6.2 Provide activities appropriate for gender, culture and age reflecting likes and dislikes of the individual

6.3 Design activities that provide the client with opportunities for autonomy and risk-taking where they can maintain safety, dignity and comfort

6.4 Use a range of validation strategies to relieve distress and agitation in clients

7. Develop and implement strategies to minimise impact of challenging behaviours

7.1 Observe and document behaviours to determine triggers which may be related to: physical and emotional health; environment; tasks; and communication

7.2 Consider the potential impact of the behaviours on the person or other persons in determining an appropriate response

7.3 Consider a range of options when developing effective responses for inclusion in the person's care plan

7.4 Implement best practice strategies which minimise the impact of behaviours

7.5 Regularly review strategies that are implemented to ensure maximum effectiveness

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:

• Acute health problems with older person
• An understanding of the potential impacts of dual/multiple diagnosis on identifying and prioritising needs
• Basic knowledge of current research or dementia including relevant statistics
• Best practice guidelines to address complex and/or special needs
• Chronic health problems with older person
• Common indicators and symptoms of dementia
• Complex nursing interventions
• Confidentiality and privacy
• Continence management
• Counseling resources within environment and community
• Documentation principles
• Effective communication skills
• Environment policy and procedures
• Fundamental nursing interventions
• Infection control principles
• Legal frameworks/requirements e.g. RCS documentation, Aged Care Act.
• Limitations and legal ramifications of physical, chemical and psychological restraint
• Medication administration principles
• Nature of dementia as a neurological condition which is progressive
• Occupational health and safety
• Organisation protocols and policies related to own area of work
• Pain management
• Plan of care for the client
• Principles and practices of assessment of individuals with complex and/or special needs
• Range of appropriate strategies when working with people with dementia
• Relevant activities and communication in working with people with dementia
• Stereotypes and influences on ageing
• Support services available
• The importance of a physical, social and emotional environment for people with dementia
• The importance of a safe, physical environment for people with dementia
• Understanding of anatomy, physiology and pathophysiology
• Understanding of physiology of ageing process

Essential skills :

It is critical that the candidate demonstrate the ability 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:

• Apply problem solving skills, including use of tools and techniques to solve problems, analyse information and make decisions that require discretion and confidentiality
• Apply clinical skills related to activities of daily living:

• dressing
• elimination
• fluid intake
• grooming
• hygiene
• nutrition
• oral hygiene

• Apply professional standards of practice:

• ANMC code of conduct
• ANMC code of ethics
• ANMC national Enrolled/Division 2 nurse competency standards
• state/territory Nurse Regulatory Nurses Act
• state/territory Nursing and Midwifery Regulatory Authority standards of practice
• scope of nursing practice decision making framework

• Prioritise and address changing service needs of clients with complex and special care needs
• Undertake admission and discharge activities
• Use interpersonal skills, including working with others, empathising with client and relatives, using sensitivity when dealing with people and relating to persons from differing cultural, social and religious backgrounds
• Use oral communication skills (language competence) required to fulfil job roles as specified by the organisation/service. Advanced oral communication skills include interviewing techniques, asking questions, active listening, asking for clarification from client or other persons at the scene, negotiating solutions, acknowledging and responding to a range of views. The work may involve using interpreters
• Use written communication skills (literacy competence) required to fulfil job roles as specified by organisation/service. The level of skill may range from reading and understanding incident reports and case management materials to preparing handover reports for receiving agency staff
• Work effectively with older people, carers, colleagues and other health care providers

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 for assessment and evidence required to demonstrate this competency unit :

• The individual being assessed must provide evidence of specified essential knowledge as well as skills
• Observation of performance in a work context is essential for assessment of this unit
• Consistency of performance should be demonstrated over the required range of workplace situations and should occur on more than one occasion and be assessed by a registered nurse
• Observation must include:

• care of the older person in both acute care and residential aged care facility
• communication with older people, family and carers
• clinical performance
• assessment of the older person

Context of and specific resources for assessment :

• This unit is most appropriately assessed in the clinical workplace or in a simulated clinical work environment and under the normal range of clinical environment conditions
• Assessment should replicate workplace conditions as far as possible
• Where, for reasons of safety, access to equipment and resources and space, assessment takes place away from the workplace, simulations should be used to represent workplace conditions as closely as possible

Method of assessment 

• 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 - verbal and writing
• Role play/simulation

Access and equity considerations :

• All workers in the health industry should be aware of access and equity issues in relation to their own area of work
• All workers should develop their ability to work in a culturally diverse environment
• In recognition of particular health issues facing Aboriginal and Torres Strait Islander communities, workers should be aware of cultural, historical and current issues impacting on health of Aboriginal and Torres Strait Islander people
• Assessors and trainers must take into account relevant access and equity issues, in particular relating to factors impacting on health of Aboriginal and/or Torres Strait Islander clients and communities

Related units :

This unit is recommended to be assessed in conjunction with the following related units:

• HLTAP501B Analyse health information
• HLTEN509B Apply legal and ethical parameters to nursing practice

This competency unit incorporates the content of:

• HLTEN414B Deliver nursing care to older clients

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.

Theories of ageing could include :

• Biological theories
• Psychosocial theory
• Disengagement theory
• Social exchange theory
• Wear and tear theory
• Activity theory

Social attitudes and beliefs could include :

• Fear of ageing
• Definitions of aging
• Demographics of aging
• Changing attitudes
• Culture
• Religion

Normal ageing process 

• Normal physiological changes of aging
• Age related laboratory values
• Age related physical changes
• Age related psychosocial changes

Age -related adjustments could include :

• Role changes
• Retirement
• Multiple losses
• Loneliness
• Depression and suicide
• Fear of death
• Changes in body image

Preventative health care include :

• Health screenings
• Dental health
• Vision/hearing
• Cancer screenings
• Immunisations

Activities of daily living include :

• Maintaining a safe environment
• Communication
• Breathing
• Eating and drinking/eliminating
• Personal cleansing and dressing/grooming
• Controlling body temperature
• Mobilising/Working and playing
• Expressing sexuality
• Sleeping
• Dying
• Spiritual needs
• Expressing sexuality

Tools for functioning assessment may include :

• Katz Index
• Barthel Index and Scale
• Norton Scale
• Water Low Scale
• Functional health patterns
• Activities of daily living tool
• Geriatric Depression Scale

Special health problems may include :

• Common psychiatric problems
• Delirium
• Dementia
• Prevention of illness and injury
• Risk of falls
• Depression

Disease processes include :

• Alterations in sensory function
• Alterations in cardiac function
• Alterations in respiratory function
• Alterations in neurological function
• Alterations in musculoskeletal function
• Alterations in genitourinary function
• Alterations in endocrine function
• Alterations in renal function
• Oncological disorders
• Palliative care

Legal and ethical issues include :

• Rights and responsibilities of older persons
• Consent
• Power of attorney
• Advocacy
• Elder abuse
• Restraint
• Advanced care directives
• Legislation affecting older persons
• Research and the older person
• Ethical principles

Community services for the older person include :

• Advocacy services
• Meals on wheels
• Home help
• Hospice care
• Respite services
• Support groups and information (e.g. Council on the Ageing, Alzheimers Australia)

Strategies to respond to challenging behaviours include :

• Distraction, for example reminiscences, walking and music
• Behaviour modification
• Addressing physical triggers to behaviour including pain
• Complementary therapies

Ensuring safety and comfort  of aged person while addressing the risks associated with :

• Ability to find their own way
• Wandering or other behaviours relating to agitation
• Behaviours relating to psychotic experiences or mood disorders
• Ability to recognise dangers in their environment

Environmental strategies may include :

• Orientation to day, date, time of day, place, person, carer, family relationships, weather
• Adequate lighting to decrease risk of misinterpreting their environment
• Manipulate stimuli such as activity, noise, music, lighting, decor
• Provision of safe space (to pace, wander)
• Security

Validation strategies to relieve distress and agitation in clients may include :

• Acknowledgment
• Allowing expressions of distress
• Providing verbal and/or physical reassurance
• Use reminiscences routinely to connect with clients