Unit of competency details

HLT07 Version 4

HLT07 Version 5

Comments

HLTRNL601B Support the client with chronic kidney disease

HLTRNL601C - Support the client with chronic kidney disease

Unit updated in V5.

ISC upgrade changes to remove references to old OHS legislation and replace with references to new WHS legislation. No change to competency outcome.

Descriptor 

This unit of competency describes the knowledge and skills required to support the client undergoing the physical and psychosocial influences and stages as chronic kidney disease (CKD) progresses

Application 

The unit involves application of specialised knowledge by Enrolled/Division 2 nurses or Aboriginal and/or Torres Strait Islander health workers, for clinical assessment and follow up of client care plans under direct or indirect supervisory arrangements in line with jurisdictional and regulatory requirements.

For Enrolled/Division 2 nurses the knowledge and skills described in this unit of competency are to be applied within jurisdictional nursing and midwifery regulatory authority legislative requirements.

Enrolled 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.

For Aboriginal and/or Torres Strait Islander health workers, this unit of competency addresses the delivery of renal health care services in Aboriginal and/or Torres Strait Islander communities.

Work performed by Aboriginal and/or Torres Strait Islander health workers is to be carried out in consultation/collaboration with registered nurses and/or medical practitioners under direct or indirect supervisory arrangements in line with jurisdictional regulatory requirements.

Pre-requisite units :

This unit must be assessed after successful achievement of one of the following related units of competency:

• HLTEN519C Administer and monitor intravenous medication in the nursing environment

OR 

• HLTAHW606B Work with medicines

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. Assess the educational needs of the client in regards to the impact of CKD

1.1 Work with a knowledge of the various clinical manifestations of CKD and associated pathophysiology of each manifestation

1.2 Identify and discuss with the client common problems and complications associated with CKD, focusing on the client's specific contributing factors

1.3 Discuss with the client the psychosocial impact of CKD on their activities of daily living

1.4 Ascertain and respect client needs in relation to lifestyle, social context, emotional and spiritual choices

1.5 Communicate effectively with the client, their significant others and other members of the health care team

1.6 Clarify the educational needs of the client with CKD in terms of the CKD stages, required care and the client's self-management strategies

1.7 Support the client and significant others to ensure their freedom to discuss spiritual and cultural issues in an open and non-judgemental way within scope of work role and responsibilities

2. Contribute to providing education to the client with CKD

2.1 Provide information and resources to the client and their significant others on the aetiology and pathophysiology of the stages of CKD within scope of work role and responsibilities

2.2 Provide the client with relevant information to assist in maintaining their health status and slowing disease progression

2.3 Provide information and support to the client to assist them establish and maintain an appropriate diet

2.4 Provide the client with access to appropriate health education resources on CKD and renal replacement therapy

2.5 Support the client to access information about treatment options, so that they can make an informed treatment choice

2.6 Communicate effectively with the client, their significant others and health care team members to clarify the needs of the client in terms of the stages of the disease, including end of life discussion, and the care required, and refer to other members of the health care team to meet those needs

2.7 In consultation with the health care team contribute to advanced care planning to identify and meet the changing needs of the client

2.8 Monitor changes to advanced care directives as they are reviewed regularly by appropriate staff members and support implementation of these changes

3. Contribute to determining the health status of the client with CKD

3.1 Perform a holistic primary health care assessment of the client in consultation/collaboration with the registered nurse

3.2 Monitor health status of the client to identify disease progression, report changes, and where appropriate, refer in accordance with scope of work role and organisation guidelines

3.3 Identify psychosocial impacts of common conditions and complications experienced by a client with a kidney condition, discuss with the client and refer, if required, for counselling or assistance in accordance with scope of work role and organisation guidelines

3.4 Work with an awareness of the psychosocial impact of palliative care on a client's family and significant others

3.5 In consultation with the health care team contribute to effective plans of care for clients with CKD

4. Assist the client to develop self-management strategies

4.1 Assist the client to self-manage the various clinical manifestations and common problems associated with CKD

4.2 Assist the client to maintain optimal health status

4.3 Assist the client to adhere to care management strategies and medical management regime of CKD

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:

• Basic principles of client education
• Changing educational needs of the client as CKD progresses
• Common pathology tests to diagnose and monitor CKD and their interpretation
• Diverse cultural, religious and spiritual factors underpinning client choices at end of life
• Factors that can slow the progression of CKD
• Fluid, electrolyte and acid base balance
• Health status monitoring
• Immunity and the importance of vaccinations
• Interventional and investigational procedures used in the diagnosis and the management of CKD
• Management principles for various clinical manifestations of CKD and associated co-morbidities
• Meaning and interpretation of health check results for clients with CKD
• Medicines in common use in management of clients with CKD including basic mechanism of action, precautions, contraindications and side effects
• Nutritional considerations for clients with CKD
• Pathophysiology of Stages 1 to 5
• Primary health care assessment and its interpretation
• Principles of self-management for the client with CKD
• Relevant policies, protocols and practices of the organisation in relation to the provision of palliative care
• Risk factors for CKD
• Signs and symptoms of uraemia and fluid retention
• Structure and function of the urinary, cardiovascular, lymphatic and immune systems
• Treatment options for clients with CKD including renal replacement therapies e.g. peritoneal dialysis (PD) and haemodialysis (HD), including theory, terminology, procedures, risks and benefits at a basic level
• Underlying environmental and social factors contributing to CKD in the general population in Australia and to the higher rates experienced within Aboriginal and/or Torres Strait Islander communities
• Understanding of own role and responsibilities and those of other health care team members in the delivery of care to clients with CKD

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 care plans for clients with CKD in consultation/collaboration with registered nurse
• Apply interpersonal skills, including working with others, using sensitivity when dealing with people and relating to persons from differing cultural, social and religious backgrounds
• Deliver effective client education
• Demonstrate a professional approach to health education, knowledge of health systems and disease processes
• Demonstrate accountability for personal outputs and client group outcomes
• In consultation with the health care team contribute to effective plans of care to meet the educational needs of the client with CKD
• Monitor health status of a client with CKD
• Perform a primary health care assessment
• Select effective communication strategies
• Use appropriate communication skills (non-verbal, openness, sensitivity, non-judgemental attitudes)
• Use written communication skills (literacy competence) required to fulfil job roles as specified by organisation/service at a level of skill that may range from reading and understanding client documentation to completion of written reports

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 competency in this unit

• Candidates must demonstrate their ability to apply essential knowledge identified for this unit of competency before undertaking workplace application
• Observation of performance in a work context is essential for assessment of this unit of competency
• Consistency of performance should be demonstrated over the required range of workplace situations and should occur on more than one occasion

Context of and specific resources for assessment

• This unit of competency is most appropriately assessed in the clinical workplace and under the normal range of clinical environment conditions

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 written
• Role play

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/or Torres Strait Islander communities, workers should be aware of cultural, historical and current issues impacting on health of Aboriginal and/or 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.

Clients may include:

• Adolescent
• Adult

CKD conditions may include:

• Diabetic nephropathy
• Glomerulonephritis
• Hypertensive nephropathy
• Polycystic kidney disease
• Reflux nephropathy
• Kidney stones

Clinical manifestations of CKD may include:

• Hypertension
• Anaemia
• Bone disease
• Cardiovascular disease
• Impaired immunity
• Electrolyte imbalance
• Fluid imbalance

Common problems and complications associated with CKD may include:

• Uraemic breath
• Unusual or metallic taste
• Anorexia
• Nausea and vomiting
• Lethargy
• Change in urination
• Confusion
• Pain
• Increase in depression
• Stages in grief and loss
• Sexual dysfunction
• General malaise
• Cardiovascular events
• Infections
• Uraemic frost
• Pruritus
• Restless leg syndrome

Significant others may include:

• Family
• Carer
• Friend

Members of the health care team may include:

• Enrolled/Division 2 nurse
• Registered nurse
• Nurse practitioner
• General practitioner
• Renal physician
• Chronic disease management team
• Dietitian
• Social worker
• Pharmacist
• Podiatrist
• Aboriginal and/or Torres Strait Islander health worker

Client's self-management strategies include:

• The knowledge and life long commitment to:

• healthy life style
• exercise
• renal diet
• fluid requirements
• medication regime
• care of dialysis access
• recognising progressive symptoms of CKD
• vaccination regime
• diabetes care
• cardiovascular disease care
• dental care
• optometry care
• skin care

Information may include:

• Normal structure and function of the urinary and cardiovascular systems.
• Causes of CKD
• Need for ongoing routine health assessments by health professionals
• Explanation of interventional and investigational procedures

• blood tests
• x-rays
• abdominal ultrasounds

• Early and late physical symptoms of CKD
• CKD treatment options
• The importance of vaccinations
• Factors that can slow the progression of CKD

Scope of work role refers to:

• Enrolled/Division 2 nurses
• Aboriginal and/or Torres Strait Islander health workers

Advanced care planning refers to:

• The process of preparing for likely scenarios near end of life and usually includes assessment of, and dialogue about, a person's understanding of their medical history and condition, values, preferences and personal and family resources. Advanced care planning elements are the written directive and an appointment of a substitute decision maker
• Access through state and territory legislation or guidelines on advanced care planning

Advanced care directive refers to:

• Sometimes called a 'living will', an advanced care directive describes one's future preferences for medical treatment and becomes effective in situations where the client no longer has capacity to make legal decisions
  Specifically, it contains instructions that consent to, or refuse, the future use of specified medical treatments.
• Access through state and territory legislation or guidelines on advanced care planning
• One component of the broader advanced care planning process
  Documenting advanced care directives is not compulsory as the person may choose to verbally communicate their wishes to the doctor or family, or appoint a substitute decision maker to make decisions on their behalf

Examples of advanced care directives are:

• Medical treatment preference, including those influenced by religious or other values and beliefs
• Particular conditions or states that the person would find unacceptable should these be the likely result of applying life-sustaining treatment, for example, severe brain injury with no capacity to communicate or self-care
• How far treatment should go when the client's condition is 'terminal', 'incurable' or 'irreversible' (depending on terminology used in specific forms)
• The wishes of someone without relatives to act as their 'person responsible' in the event they became incompetent or where there is no-one that person would want to make such decisions on their behalf

Holistic primary health care assessment may include:

• Physical health status:

• blood pressure, pulse, respirations
• urinalysis
• protein creatinine ratio
• girth measurement
• weight

• Social needs:

• sickness benefits
• family support
• transport to appointments
• accommodation

• Psychological and cultural needs

Monitor health status may include:

• Urinalysis
• Blood pressure, pulse and respirations
• Review pathology results from routine blood tests
• Identifying changes in client's weight
• Identifying signs and symptoms that may indicate changes in health status

Psychosocial impacts may include:

• Depression
• Stages of grief and loss
• Lethargy
• Sexual dysfunction
• Sleep disorders
• Changes to relationships within the family unit