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 may be assessed independently or in conjunction with other units with associated workplace application

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:

Statistical incidence of diabetes, heart disease and kidney failure in Aboriginal populations compared to the non-Aboriginal population

In relation to cardiovascular diseases:

the concept of 'cardiovascular risk factors', the significance of an individual having multiple risk factors and the concept of 'high absolute risk'

the importance of reduction of saturated fats and sugar-sweetened soft drinks, increased physical activity and smoking cessation in reducing the risk of heart and kidney disease in Aboriginal population

In relation to diabetes mellitus:

basic pathophysiology of type II contrasted with type I diabetes mellitus

complications of diabetes (including heart disease and stroke; renal failure; retinal damage and blindness; nerve damage and infection resulting in amputation; impotence)

the main elements of the 'diabetes checkup'

the procedure for taking retinal photographs

basic anatomical features and abnormalities on a retinal photograph

the content of client education for diabetes covering diet, physical activity, foot-care, and use of diabetes medicines

In relation to chronic renal disease:

basic pathophysiology of chronic renal failure (causes, body systems affected, natural history)

factors, which may worsen or accelerate renal failure (including: high blood pressure, anti-inflammatory drugs, poor diabetes control, dehydration, high protein diet)

clinical features of advanced renal failure

the importance of early detection of renal disease in efforts to defer or prevent end-stage renal failure

options for treatment of end-stage renal failure (haemodialysis, chronic ambulatory peritoneal dialysis, transplant).

The dilemmas and difficulties faced by Aboriginal people and their families who need to relocate to distant centres in order to access dialysis treatment

Familiarity with a range of other common chronic conditions in Aboriginal populations:

chronic liver disease - causes, clinical features and principles of management (including hepatitis B, hepatitis C, alcoholic liver disease and cirrhosis)

chronic obstructive lung disease, relationship to smoking and principles of management

major types of chronic disability (psychiatric, physical and mental)

continued ...

Essential knowledge (continued):

Agencies able to provide support and assistance to Aboriginal and/or Torres Strait Islander people with chronic disabilities

Strategies that can assist Aboriginal and/or Torres Strait Islander people with disabilities to live fulfilling and productive life in the community

Methods of organising the care of clients with chronic diseases (eg: disease registers, care plan schedules in medical files, tagging files, computerised client information and recall systems)

The value of the opportunistic approach to chronic disease surveillance (comprehensive check-ups as people come to the clinic)

The use of computerised client information and recall systems to follow-up clients

Ways of evaluating a chronic disease program

Methods of providing feedback to health service management and community on the effectiveness of a chronic disease program

Essential skills:

It is critical that the candidate demonstrate the ability to:

Communicate effectively in a group and one-on-one environment to promote healthy practices and discuss health issues

Provide accurate and relevant information and guidance about chronic disease care in line with identified individual and community needs

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:

Explain and describe procedures and illnesses/ disorders in clear, simple language to clients

Work with groups in the community to seek input and feedback on health services

Read and write reports, interpret statistics, charts and test results, write letters, keep client documentation

Use computers for client records, report writing, letters and use client information and recall systems

Observe clients

Negotiation with clients, colleagues, community members and other agencies

Work with a team to deliver effective health promotion and education for Aboriginal and/or Torres Strait Islander communities and clients using appropriate facilitation, problem solving and instructional practices

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

Support for clients with common chronic diseases may include but is not limited to:

Support for clients with Type II Diabetes Mellitus information on:

diet

medication

physical activity

foot-care

the importance of regular blood tests, urine tests and medical review

Regular offer of a diabetes check for:

glycaemic control

development of diabetes complications

presence of other cardiovascular risk factors

Support for clients with impaired renal function and chronic renal failure [and their families], with advice regarding:

the natural history of the disease

the importance of blood pressure control

control of diabetes

regular monitoring to maintain renal function

Information about options for management of end-stage renal failure (ESRF)

Support for clients with coronary heart disease:

education about their condition

information about risk factors and use of medication to reduce risk

cardiovascular risk status determined on the basis of age, sex and presence of risk factors

Support for clients with asthma and chronic obstructive pulmonary disease:

education on their condition including the appropriate use of symptom-relieving and suppressant medication

Support for clients with chronic disabilities (physical, psychiatric, and cognitive) and their families:

referral

liaison with other agencies

Support offered to all clients with chronic disease as per NH&MRC guidelines:

arrangement for immunisation against pneumococcal disease and influenza

Support for clients re acute rheumatic fever and rheumatic heart disease, including:

referral for diagnosis

education about their condition

regular follow up with monthly injections (secondary prevention strategy)

Social and environmental factors that impact on chronic disease may include but are not limited to:

Access to good food

Structured physical activity programs/initiatives, through, for example:

sport and recreation opportunities

active recreation

supportive environments for active transport

Medication supply

Dietary information includes:

Assessment of usual dietary patterns, particularly sources of dietary fat

Promotion of low-fat foods and food preparation techniques that are consistent with individual and families dietary habits

Promotion of foods high in fibre, vitamins and minerals

Physical activity information includes:

Assessment of adult, children and adolescent physical activity patterns

Promotion of incidental physical activity, such as walking to school

Promotion of supportive environments for physical activity

Cardiovascular risk factors include:

Tobacco smoking

Obesity

Central obesity

Hypertension

Diabetes mellitus

Family history of ischaemic heart disease

Hyperlipidaemia

Proteinuria