Unit of competency details

Descriptor 

This competency unit describes the skills and knowledge required to implement principles of aged care nursing, enabling the Enrolled/Division 2 nurse to provide holistic nursing care to aged clients at an advanced level

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. Address the health care needs of the older adult in the Australian health care environment

1.1 Work with an understanding of the physical and psychological effects of aging on the human body

1.2 Work with an understanding of the significance of physical and psychosocial assessment in evaluating the health of older clients

1.3 Apply an understanding of funding arrangements for aged care and extended care environment

1.4 Address documentation requirements to assist the funding that impacts on aged care  provision

1.5 Recognise crisis situations and implement emergency management as required

1.6 Provide a physically and psychologically safe environment for the older client

1.7 Communicate effectively with older person experiencing sensory loss

2. Assess health care needs of older clients

2.1 Perform a holistic assessment of the client in consultation/collaboration with the registered nurse

2.2 Incorporate an in-depth understanding of anatomy, physiology and pathophysiology into nursing practice as applied to the various manifestations of the ageing process and clinical manifestations of ageing

2.3 Discuss with the client the physical and psychosocial impact of ageing on their activities of daily living

2.4 Identify common problems and complications the client may encounter

2.5 Communicate effectively with clients, family and health team members

3. Contribute to planning appropriate care for the older client

3.1 Use contemporary assessment tools accurately

3.2 Establish a database of resource personnel to assist in decision making for the older client

3.3 Use a problem-solving framework to plan appropriate nursing management strategies in consultation/collaboration with the registered nurse

3.4 Develop an individualised plan of care for the older client in consultation/collaboration with the client and the health care team

3.5 Ensure care plan reflects client's current nursing needs and nursing actions designed to maximise the older client's function and minimise potential complications

3.6 Apply an understanding of risk management principles in planning client care

3.7 Ensure planned care and therapeutic interventions aim to assist client/s to achieve optimal health outcomes

3.8 Regularly review plan of care and modify to reflect changes in condition of older client

3.9 Identify aged care client needs requiring research to improve nursing practice

3.10 Implement evidence based practice to care of older clients

4. Assist to perform clinical nursing skills appropriate to the management of the older client

4.1 Prioritise nursing interventions  according to client needs

4.2 Modify nursing interventions using critical thinking and problem solving approaches, to reflect changes in client's condition

4.3 Update nursing interventions to assist client, and identified significant others to meet expected outcomes, including health promotion and/or education

4.4 Monitor nursing interventions, review those that fail to address client needs and revise in consultation/collaboration with health care team

4.5 Ensure appropriate pre-, intra- and post-diagnostic procedures are undertaken in line with organisation policies and procedures

4.6 Ensure medication administration is based on sound knowledge of principles of drug actions and side effects in accordance with health unit policies and procedures

4.7 Ensure rehabilitation principles underpin appropriate nursing interventions for the older client as required

5. Assess the needs of clients experiencing loss and grief

5.1 Work with an understanding of the effects of grief on the physical, emotional, cognitive, behavioural, social and spiritual domains of a person's experience

5.2 Review client knowledge of their condition, self management and therapies

5.3 Recognise determinants impacting or potentially impacting on the client's experience of grief and on identified significant other/s

5.4 Recognise the potential or actual manifestation of a complicated grief reaction

5.5 Review the significant other's knowledge of the client's condition, management and therapies

5.6 Use counselling skills to encourage clients and/or significant other/s to verbalise grief experience

5.7 Support client and/or significant others experiencing loss and grief

5.8 Use effective communication skills to break adverse news or assist a health care team member to break adverse news to a client and/or significant other/s

6. Provide support for peers and colleagues

6.1 Recognise the symptoms of stress and professional carer burnout in peers and colleagues

6.2 Implement appropriate support and safety and welfare measures for peers and colleagues

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:

• Admission and transfer to acute care environments
• Client rights and responsibilities
• Critical thinking and problem solving
• Cultural and spiritual beliefs and practices
• Culturally appropriate health promotion activities for clients with respiratory problems
• Diagnostic tests and their meanings
• Emergency and first aid management
• Evidence based practice
• Factors influencing growth and development
• Factors influencing self esteem
• Health - illness continuum
• Legislation related to aged care and extended care practice, including:

• Aged Care Act and criteria for admission to aged care facilities
• occupational health and safety legislation

• Legal standards for practice
• Medical terminology
• Organisation policy and procedure
• Participating as a member of the health care team
• Participating as a member of the health care team
• Philosophy of loss and grief
• Philosophy underpinning aged care and extended care management
• Principles of health assessment
• Reflective practice
• Research strategies and methodologies
• Specialised in-depth knowledge of anatomy, physiology and pathophysiology of chronic disease
• Specialised knowledge and execution relating to emergency care of older clients
• Specialised knowledge of clinical manifestations of chronic disease states

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 clinical nursing skills, including:

• acute care of aged care client
• addressing pain management needs
• addressing pressure area care needs
• chest pain assessment and management
• emergency medications
• fundamental and complex nursing interventions
• medication administration as per jurisdictional and legal requirements
• neurological function
• physical assessment
• specimen collection

• 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

• Assessment, observation and documentation of

• blood glucose monitoring
• neurovascular observations
• nutritional status and hydration
• pain scale or analogue observations
• respiratory function
• skin integrity

• Apply principles of documentation to document planned nursing interventions
• Apply principles of rehabilitation
• Demonstrate accountability for personal outputs and broad client group outcomes
• Maintain effective symptom management
• Maintain evidence based practice in line with current literature and work of professional bodies associated with aged care clients
• Recognise and address

• needs of client and significant others in relation to grief and loss
• religious and cultural needs of client and significant others

continued  ...

Essential skills  (contd ):

• Use appropriate communication skills (non-verbal, openness, sensitivity, non-judgmental attitudes):

• oral communication skills (language competence) required to fulfil job roles as specified by the organisation/service, including interviewing techniques, asking questions, active listening, asking for clarification
• written communication skills (literacy competence) required to fulfil job roles as specified by organisation/service, ranging from reading and understanding client documentation to completion of written reports

• Use interpersonal skills to work with others, use sensitivity when dealing with people and relate to persons from differing cultural, social and religious backgrounds

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

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 prior to assessment in the workplace
• 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 work place
• 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

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.

Multidisciplinary health care team members could include :

• Aged care client and their significant others
• Medical and nursing staff
• Social workers
• Physiotherapists
• Occupational therapists
• Speech pathologists
• Dietitian
• Podiatrists
• Community services
• Transitional rehabilitation services

Health care settings could include :

• Residential aged care facilities
• Extended care settings
• Hospital - private or public
• Short stay centres
• Respite centres
• Community
• Day Centres

Assessment of impact of ageing process may include :

• Performance of activities of daily living
• Loss or limitation to physical function
• Impact on sexuality, relationships, self image, body image
• Grief and loss
• Coping mechanisms
• Personal and community support mechanisms
• Level of communication
• Maintenance/improvement of quality of life
• Maintenance/improvement of lifestyle
• Impact of secondary disease processes

Age related adjustments and transitions could include :

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

Disease processes include :

• Alterations in sensory function
• Alterations in cardiac function
• Alterations in respiratory function
• Alterations in neurological function
• Alterations in musculoskeletal function
• Alteration in genitourinary function
• Alteration in endocrine Function
• Alteration in renal function
• Oncological disorders
• Pressure ulcers

Plans of care may include :

• Nursing care plans
• Clinical pathways
• Treatment plans
• Medical notes
• Community referrals
• Admission and transfer
• Rehabilitation plans

Legal and ethical issues include :

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

Specific nursing interventions /clinical skills could include :

• Foundation nursing interventions
• Complex nursing interventions
• Management of elimination (urinary and bowel) needs including - insertion of indwelling catheters, irrigation of indwelling catheters
• Management of permanent and temporary mechanical ventilation including suctioning and bagging
• Wound care
• Skin care including - assessment and management of skin care
• Health teaching in relation to client care needs
• Pain management
• Manual handling
• Co ordination of clinical care
• Assessment of oxygen saturation levels
• Rehabilitative care practices

Evaluation of planned care includes :

• Level of independence in performance of activities of daily living
• Participation in rehabilitation programs
• Self management of symptoms