Application
The unit involves application of specialised skills and 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. |
Prerequisites
Pre-requisites | This unit must be assessed after successful achievement of the following related units of competency: HLTRNL601C Support the client with chronic kidney disease HLTRNL602C Provide support and management of the client undergoing peritoneal dialysis therapy AND one of the following units: HLTEN519C Administer and monitor intravenous medication in the nursing environment OR HLTAHW606B Manage medicines in Aboriginal and/or Torres Strait Islander health care |
Elements and Performance Criteria
ELEMENT | PERFORMANCE CRITERIA |
1. Establish therapeutic relationship with client and their significant others | 1.1 Provide the client and significant others with the opportunity to ask questions and discuss areas of concern 1.2 Ask the client questions clearly and in an appropriate manner, level and pace, and in a way that encourages the client to provide full answers 1.3 Provide accurate feedback and education, appropriate to the client's, and their significant others', needs and concerns, within scope of role and responsibilities 1.4 Encourage client independence according to their level of capability |
2. Assist the client with Stage 5 chronic kidney disease (CKD) to assess their health status | 2.1 Complete a health assessment of the client through observation and interview and report to other members of the health care team as required within scope of work role and organisation guidelines 2.2 Review pathology results, identify significant variations and refer to other health care team members according to organisation policies and procedures 2.3 Identify any significant physical health status issues in relation to current renal replacement therapy 2.4 Assist the client to determine if changes to current renal replacement therapy are required and report to other members of the health care team as required within scope of work role and organisation guidelines 2.5 Document client assessment and refer actual and potential problems in accordance with organisation policies and procedures 2.6 Recognise and refer actual and potential problems that vary from the client's normal health status to other members of the health care team as required within scope of work role and organisation guidelines 2.7 Provide feedback to the client on physical health assessment in order to maintain optimal health status |
3. Support the client to self-manage their renal replacement therapy | 3.1 Encourage the client to voice concerns, respond within scope of work role and organisation guidelines and report to other members of the health care team as required 3.2 Assist the client adhere to self-care principles 3.3 Observe the client manage their renal replacement therapy and provide effective education as required 3.4 Assist and empower the client to self-manage the dialysis equipment and consumables 3.5 Recognise and respond appropriately to actual and potential problems of renal replacement therapy and report to other members of the health care team as required within scope of work role in consultation with registered nurse and organisation guidelines 3.6 Document and report outcomes to the appropriate members of the health care team 3.7 Identify situations when the client is not coping with the renal replacement therapy and report to other members of the health care team in consultation with registered nurse 3.8 Incorporate referral to community services into advanced care planning strategies in consultation/collaboration with registered nurse and other members of the health care team |
Required Skills
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: Application of infection control principles to the management of clients who undergo renal replacement therapies including: importance of good hygiene and adequate nutrition in prevention of infection maintaining cleanliness of exit site or fistula arm monitoring and maintaining integrity of skin to prevent infection no touch technique Common pathology tests to diagnose and monitor CKD and their interpretation Fluid, electrolyte and acid base balance Health status monitoring Immunity and the importance of vaccinations Knowledge of disinfection procedures for dialysis equipment and machine according to organisation policies and procedures and infection control guidelines Management principles for different types of renal replacement therapy including: haemodialysis kidney transplant peritoneal dialysis Medicines in common use in management of clients with Stage 5 CKD including basic mechanism of action, precautions and side effects Organisation policies, procedures and protocols relating to renal replacement therapy Pathophysiology of Stage 5 CKD Primary health care assessment and its interpretation Reportable limits for patients vital signs and biochemical and haematological results for clients undergoing renal replacement therapy Resources available to support the client Self-care principles, and commitment required and the potential impact of Stage 5 CKD and renal replacement therapy has on quality of life and self-esteem Signs and symptoms of actual and potential problems of renal replacement therapy and the appropriate response Structure and function of the urinary, cardiovascular, lymphatic and immune systems 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 interpersonal skills, including working with others, using sensitivity when dealing with people and relating to persons from differing cultural, social and religious backgrounds Assess patency of vascular access Deliver effective education Demonstrate accountability for personal outputs and client group outcomes Demonstrate an understanding of self-care principles, education resources and long term commitment required to support the client to achieve self-care In consultation with the health care team, contribute to effective plans of care to meet the needs of the client undergoing renal replacement therapy Monitor the client in the preparation of dialysis equipment Monitor the client's ability to assess the effectiveness of their current renal replacement therapy Perform a health status assessment within scope of practice to monitor the health status of the client undergoing renal replacement therapy Recognise actual and potential problems of renal replacement therapy and respond appropriately Take into account opportunities to address waste minimisation, environmental responsibility and sustainable practice issues, including appropriate practices to ensure efficient use of resources Use appropriate communication skills (non-verbal, openness, sensitivity, non-judgemental attitudes) Use 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 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 Required
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 are limited to: | Adolescent Adult |
Significant others may include: | Family Carer Friend |
Assessment of health status mayinclude: | Blood pressure, pulse and respiration Weight Evidence of uraemia and electrolyte imbalance e.g. lethargy, anorexia, confusion, nausea and vomiting Signs of fluid overload e.g. dyspnoea, tachypnoea, ankle oedema, weight gain over a short period of time and high blood pressure readings Signs of dehydration e.g. dry mouth, dizzy, postural drop in blood pressure, low blood pressure and weight loss over short period of time Pathology results from routine testing for dialysis clients Peritoneal dialysis exit site and/or fistula |
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 |
Scope of work role refers to: | Enrolled/Division 2 nurses Aboriginal or Torres Strait Islander health workers |
Pathology resultsmay include: | Haematological tests haemoglobin iron studies Biochemical tests urea creatinine calcium phosphate Dialysis adequacy tests Kt/Vs urea reduction ratio fraction reduction urea |
Renal replacement therapy includes: | Peritoneal dialysis Haemodialysis Kidney transplant |
Actual and potential problemsmay include: | Hypertension/hypotension Hyperglycaemia/hypoglycaemia Cardiovascular abnormalities Fluid imbalance Electrolyte imbalance Malnutrition Haemodialysis problems haemolysis vascular access problems infection clotted or stenosed vascular access prolonged bleeding Peritoneal dialysis problems infection peritonitis exit site infection blocked or split Tenckhoff catheter accidental break in sterile pathway hernia leak obesity Psychosocial issues Dietary management |
Self-care principles include: | Fluid balance management Nutritional management Prevention of infection Care of dialysis access Care of transplanted kidney Administration of medications and identification of their side effects |
Provide effective education include: | Develop lesson plan Time management of education session Evaluating education session Evaluating client learning Recognising teachable moments Assessing teaching and learning resources |
Management ofdialysis equipment and consumables may include: | Stock management principles stocktake ordering cycle count stock on hand ordering supplies method of ordering check expiry dates Delivery mode Timeframes Storage requirements Requirement to rotate stock Check equipment |
Documentation may include: | Record of test procedures Complete and sign request form Medical record notation Labelling specimens and documentation Data entry on paper and electronically |
Sectors
Not Applicable
Employability Skills
This unit contains employability skills |
Licensing Information
Not Applicable