CHCPAL001 Deliver care services using a palliative approach

Sunita Mehmi ID: 10759

ASSESSMENT TASK 1 – QUESTIONING

Q1. i) Identify the types of matters which need to be addressed in holistically in relation to Palliative Care.
ii) Explain why each matter is important?

Types of matters Importance

 Emotional support Finding out the news of something like a terminal
illness can take an incredible emotional toll and
there need to be appropriate support services (e.g.
counselling) to help the patient deal with this
 Education They need to know the facts about their illness and
what their realistic expectations should be, with
regards to recovery.
 Work they need to know whether they can continue to
work, in order to help them plan the rest of their life
(if applicable)
 Recreation they should be encouraged to participate in
recreational activities to promote wellbeing and
happiness, and advised if any activities may be
unsuitable with their condition
 Health and mental health their physical and mental health should be
diagnosed and monitored over the period of care, to
ensure that they are receiving the most appropriate
treatment for their condition
 Finances They need to know about the monetary
implications of treating the disease and how it
might affect their income. They should be
encouraged to plan financially for all eventualities
 Accommodation/housing They need to have suitable accommodation so that
they can live with their condition safely and
comfortably. For example, if they have limited
mobility, can they get upstairs by themselves or will
home adaptations need to be made?
 Culture/religion There will need to be adaptations to care in some
cases where some options go against their
cultural/religious beliefs. Their opinions and right to
choose should be respected and they should not be
forced to do anything they don't want to
 Legal issues Client’s privacy should be maintained, if you breach
this as a carer, you may be liable for legal damages.
 Networks/community/family Who do they have in their life that they can rely on
to provide support and assistance in dealing with all
aspects of their condition?
(Reference: CHCPAL001– Learner Guide page no. 18, 19)
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 CHCPAL001 Deliver care services using a palliative approach
Sunita Mehmi ID: 10759

Q2. i) Explain, in your own words, why an elderly person may be reluctant to discuss their needs and
preferences with a care worker?

Elder people may be reluctant to discuss their needs and preferences with a care worker because they
might be not so comfortable about sharing their private life with others. Moreover they may be hesitating
or don’t feel like seen as pitiful object and don’t want to upset or stress out their near ones. They tend to
make false assumptions to avoid unhappiness.

ii) Highlight three (3) strategies that can be used to overcome communicative barriers.

Strategies which can be used to overcome Communicative barriers:

1. Maintaining clear body movements enhancing communication.

2. Maintaining proper eye to eye contact.
3. Listening carefully and allowing them to speak and question anything.
4. Try to use repetitions wherever necessary.

Q3. I) Name five (5) methods that can be used in the identification of pain and discomfort.

1. Short form McGill questionnaires

2. Brief pain inventories
3. Geriatric pain measures
4. Pain disability index
5. Numeric rating scale
6. Verbal descriptor scale
7. Pain thermometer
8. Visual analogue scale
9. Pictorial pain scale

(Reference: CHCPAL001– Learner Guide page no. 25, 26)

ii) Write a paragraph on the means of reporting pain and discomfort. Include details specific to your
organisation where appropriate.

You should compile reports on any assessments, treatments, and modifications that have been
recommended. Details of the current pain score and any descriptions provided by the elderly individual
should be also documented. Such reports may be consulted at a later date to gauge the effects of any
treatment. You should also ensure that all relevant care workers are aware of their responsibilities for
maintaining the condition of the elderly individual.

(Reference: CHCPAL001– Learner Guide page no.26)

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 CHCPAL001 Deliver care services using a palliative approach
Sunita Mehmi ID: 10759

Q4. i) Write a paragraph on the ways of involving and showing respect for family members during the care
process.

Family members are the closest ones to the client and they almost know everything about them which can
be utilised in outlining the care plan. There may be some activities which the family members want to do
on their own for the client. Take regular replies from family regarding care plan and any alteration if they
require. Visiting hours should be scheduled for family members to spend quality time with the client.
Family members must be aware of any care plan changes. Assure the family members if they have any sort
of doubt. Don’t deceive any information from family.

ii) List five (5) duties that family members may assume responsibility for in the care environment.

1. Organizing visits and tours.

2. Assisting them in bathing.
3. Making their surroundings livelier.
4. Taking them to church.
5. Assisting them in treatment sessions.
6. Organizing leisure activities.
7. Cooking for them.

Q5. i) Identify and list four (4) the external changes which might result in a change in condition of the
client?

1. Alteration in financial circumstances of client.

2. No support from loved ones.
3. Introduction of new circumstances.
4. Ageing.

ii) As a carer, note how you determine the client’s preferences for care?

 Having sound communication with the client.

 Knowing their choices in surroundings.
 Asking their religious and personal choices.
 Seeking cooperation from family and friends regarding the care.
 Consulting general practitioner about the medical conditions and risks.

iii) List five (5) types of information you need to find out when assisting a client in relation to care
preferences:

1. Household likings
2. Employment history
3. Leisure activities in past

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 CHCPAL001 Deliver care services using a palliative approach
Sunita Mehmi ID: 10759

4. Religious beliefs
5. Native places
6. Home nation

Q6. i) Identify eight (8) ways in which you can provide culturally appropriate palliative care?

1. Using interpretation services for matters that concern informed consent, such as the development
and review of care plans.
2. Establishing the openness with which the patient and family wish to discuss death (prior to
assessing them for palliative care needs).
3. Discussing with families and patient whether they wish for an open discussion of the diagnosis and
prognosis (consider legal issues of informed consent also).
4. Identifying and support the cultural, linguistic, and spiritual needs of care recipients and their
families, including rituals and practices around death and dying.
5. The appropriateness of certain treatments and medications with regards to religion and cultural
beliefs.
6. Differences in the definition of 'quality of life'.
7. The role of family members in decision-making (for care and treatment).
8. Culturally appropriate strategies that eliminate conflicts between carers, care recipients, and their
advocates.
9. Providing information in the preferred language of the care recipient.
10. Providing access to culturally appropriate spiritual and emotional support.
(Reference: CHCPAL001– Learner Guide page no.37)

ii) Identify the specific written requirements of documentation for a palliative care client.

Documentation should be completed as soon as possible after any event/incident. Progress notes are legal
documents. They must be filled out the following way:

 Using black ink and printed.

 No correction fluids (tip-ex, whiteout) to be used.
 Corrections must be indicated by a line drawn over the mistake. Initial the correction and re-write
the information.
 Draw a line to the end of the page where documenting information does not fill all the allocated
lines (as per a personal cheque).
 Date all notes and include the time of the incident.
 Sign all notes a print documenter's name and position/status.
(Reference: CHCPAL001– Learner Guide page no.38)

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 CHCPAL001 Deliver care services using a palliative approach
Sunita Mehmi ID: 10759

Q7. i) Comment where you would locate the details of staff members who may be referred to regarding
issues outside the scope of your role?

During few circumstances, the clients may require some facility which is not under our control or we are
not authorised to tackle them. The person must be aware of organisational policy procedures. Any carer
should not handle any sort of situation that they are not capable of dealing as this may worsen the
problem. Referring such issues makes sure good duty of care and overall wellbeing of client.

ii) Identify the staff members who you would contact about such issues?

Such situations must be referred to higher authorities like

 supervisor,
 manager or
 Other qualified person in age care.

Q8. i) List ten (10) effective communication skills required in palliative care?

Encouraging communication:

1. Make eye contact whenever you are communicating with them.

2. Make short simple statements.
3. Speak slowly and clearly.
4. Be patient with them for responses.
5. Don't interrupt them or try to finish their sentences.
6. Encourage them to join in conversations with others.
7. Don't speak on behalf of the person – especially during conversations about decision-making. This is
demeaning.
8. Don't patronise/ridicule them.
9. Don't dismiss what they say, even if it is irrelevant to the current conversation.
10. Keep choices and decisions as simple as possible.
(Reference: CHCPAL001– Learner Guide page no.44)

ii) Explain, in your own words, what empathetic/active listening is and how it plays a part in determining
the needs of the client?

Empathic/active listening:

Empathic/active listening is a type of communication in which the hearer confirms what you have told to
them by repeating it in their own understanding way. This sort of communication facilitates mutual
understanding between carer and client. It includes verbal and nonverbal methods of communication.
Clients sometimes are not comfortable in expressing their emotions and desires, in such cases
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 CHCPAL001 Deliver care services using a palliative approach
Sunita Mehmi ID: 10759

empathic/active listening is a good key of communication. It also depicts the respect towards the client
which results in maintaining dignity of their life.

Q9. i) Provide an explanation of what an Advanced Care Directive is?

Advanced care directive is a legal stipulation for the client having terminal disease to do things for them
when they are not able to make decisions on their own. It is tool of person centred practise and facilitates
the comfort and dignity of client. It includes official statements of what they want for future.

The directive provides chance to client to note their preferences for the care and therapy in the future
when they will not be conscious enough to do the judgement for themselves in any situation. This is why
advanced care directive is also called “living will”. It facilitates the client to choose where they want to live,
with whom they want to live and what treatment they want to opt.

ii) Identify what situations an ACD will used?

 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 patient's condition is 'terminal', 'incurable' or 'irreversible'.
 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.
 A nominated substitute decision-maker that the treating clinician may seek out to discuss
treatment decisions.
 Other non-medical aspects of care that are important to the person during their dying phase
 Relevant state and territory legislation or guidelines on advanced care directives.
(Reference: CHCPAL001– Learner Guide page no.51, 52)

iii) Describe how changing needs should and issues are reported and documented at the end of life?

There is chance of variety of demands and matters to be sorted out for the elderly person with terminal
illness prognostics when the death is near. Carer can notice the immense signs of degradation of body
systems. Extra assistance can be organised to maintain the comfort and glory of client. We can organise
particular planning after assessing their legal medical and spiritual state of affairs. When the aged person is
not able to express their desires the carer should approach the family. There may be arrangements made
to shift the client from hospice to their own homes when they are on their last legs. Other staff members
should also be informed about the modifications. Every amendment or modification must be written down
in the care plan of client.

Q10. i) Explain the impact the client's end-of-life needs may have on the carer?
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 CHCPAL001 Deliver care services using a palliative approach
Sunita Mehmi ID: 10759

Advanced care directive depicts the client’s desires regarding their end life, but health care workers
sometimes might not be fully comfortable with the details documented by client in it because it may leads
to temperament of the policy procedures of the palliative care facility. In such circumstances, healthcare
professionals should let the client or surrogate or power of attorney know about the situation and there
may be chance of shifting the client to other hospice or aged care facility. Advanced care directive must be
formally signed by the client and the copies of each should be provided to every concerned person.

ii) If a carer is experiencing stress, who should they be reported to?

 They can ask for Additional carers.

 They can choose counselling sessions.
 Assistive services (meal delivery, visiting nurses, adult day programs)
 Use carer support programs.
(Reference: CHCPAL001– Learner Guide page no.57)

iii) How can carers support elderly individuals to make choices about suitable end-of-life locations?

The end of life decisions of an elderly individual are meant to be decided by themselves whether it is about
the location they want to stay or the things they want to do. All the decisions should be taken when the
elderly client is feeling healthy and sound and not when they have excruciating pain.

Carers can consult the client and their trusted family member which is authorised by the client for decision
making on their behalf to choose the suitable location for them. All these provisions regarding the location
must be documented in the advanced care directive.

Elderly clients can choose to live in following organisations in their end of life:

 Client’s personal home

 Hospitals
 Aged Care homes
 Hospices

Elderly client must be aware of the quality of care and assistance provided in each of the above place so
that they can do possible modifications in their own concern.

Q11. Identify the palliative care team's role in observing and documenting pain and other symptoms in
clients?

The palliative team must observe the pain in elderly client by assessing the client:

 They can assess the location of pain like which body organ or part is in pain.
 The time when the client realised having pain.
 The effects of pain on activities.
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 CHCPAL001 Deliver care services using a palliative approach
Sunita Mehmi ID: 10759

After assessing such signs the palliative care team can recommend the required administration of
analgesics to be used by doctors and nurses for the client. The analgesics may include mild to strong
compounds like paracetamol or morphine respectively. All the symptoms and medication given must be
documented in the care plan. Undesirable effects of medication must if any, should also be mentioned in
care plan.

Other symptoms in clients may include:

 Feeling sick and tendency to vomit.

 Non frequent bowel habits.
 Colic pain
 Resistance in joint movements.

Q12. Identify the areas of comfort and briefly describe each one, which need to be accounted for in
palliative care?

 Physical comfort – pain, breathing problems, skin irritation, digestive problems, temperature
sensitivity, fatigue etc.
 Mental and emotional needs – fear of death, physical contact, depression, anxiety, loneliness
 Spiritual issues – finding meaning in life, ending conflicts and unresolved issues, sharing memories
 Practical tasks – reassurance that essential tasks will be done in their absence.
(Reference: CHCPAL001– Learner Guide page no.63)

Q13. i) Identify two (2) aims of continuous improvement.

1. Increase the value of care regarding their needs and preferences.

2. Enhance compliance with accreditation standards.
3. Identify opportunities for improvement in a systematic and planned manner.
(Reference: CHCPAL001– Learner Guide page no.67)

ii) List the five (5) steps of continuous improvement.

1. Identify the area or activity for improvement

2. Plan the process of creating the improvement

3. Make the improvement

4. Evaluate the improvement

5. Decide on future actions.

(Reference: CHCPAL001– Learner Guide page no.67)

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 CHCPAL001 Deliver care services using a palliative approach
Sunita Mehmi ID: 10759

iii) Comment how continuous improvement can be used to evaluate implemented strategies?

Carers must always aim on continuous improvement of the client. To achieve this they should always make
amendments wherever necessary in the organisational strategies. The key of the continuous improvement
is effective documentation to compare it with the previous experience or progress and also required in
evaluating implemented strategies.

Q14. Identify eight (8) misconceptions associated with approaches to pain relief and comfort, and provide
a statement to clear up the myths.

1. Pain can be determined by observation – patients are the only ones who can determine how much
pain they are in. They need to be asked to rate their pain on a scale of 1-10.
2. All patients with the same symptoms experience the same amount of pain – patients are
individuals and may react worse to certain types of illness and injury.
3. Medication is the best solution to pain – while it is commonly useful, consider psychosocial and
physical pain relievers e.g. counselling, massage, imagery training.
4. Patients will become addicted to opioids – as long as they are appropriately dosed, this shouldn't
be a problem.
5. Medication should always be started at the lowest level – pain medication should be matched to
the appropriate pain level.
6. Morphine will alleviate all pain symptoms – it is used as part of pain management and is not a
permanent solution for pain.
7. Opioids are the only medication required to control pain – there are other treatments available to
deal with all aspects of pain e.g. antidepressants for depression.
8. Opioids are associated with addiction, respiratory depression, tolerance, nausea, sedation and
cognitive impairment, constipation, and regulatory concerns – if dosage is matched appropriately
to pain, these symptoms should be minimal/non-apparent.
9. Patients should not be trusted with control of their medication – the patient is the only one who
knows how much pain they are in, so they can be trusted to increase or decrease the dose as
required.
(Reference: CHCPAL001– Learner Guide page no.69)

Q15.Briefly states why it is important to check the care plan for the duration that an elderly individual is
under your care?

Care plan should be looked after on regular basis during the stay of client in the palliative care unit to do
and check for modifications whenever necessary. By doing so, the client’s wishes are taken into
consideration which is duty of care. The client can do alteration in Advanced Care Directive and care plan,
but the carer should confirm with the organisational policies to before working on them. Also, the
alterations should also be discussed with other co-workers, healthcare professionals and other concerned
person.
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 CHCPAL001 Deliver care services using a palliative approach
Sunita Mehmi ID: 10759

Q16. Identify the support systems which are to be in place for clients, families, carer, and families during
end of life care.

 Aged Care Assessment Teams (ACATs) – they assess older people and help them and carers work
out effective care plans (residential or home care)
 Aged Care Information Line – general information line for matters about care access, respite fees,
bonds and charges
 Commonwealth Respite and Care link Centres (1800 059 059)– information on community care
programs and services to allow dementia sufferers to live at home
 Carer Advisory and Counselling Service – information and advice for carers on entitlements and
relevant services
 Doctors
 Local councils: City of Whitehorse
 Local community health centre: Nunawading community centre.
 Alzheimer's Australia (1800 100 500)
 Aged Care Assessment Services (1300 135 090)
 My Aged care (1800 200 422)
 Cognitive Dementia and Memory Service clinics (1300 135 090)
 Carers Victoria (1800 242 636)
 Dementia Behaviour Management Advisory Service (1800 699 79
(Reference: CHCPAL001– Learner Guide page no.77, 78)

Q17. Explain, in your own words, why hydration and nutrition requirements are an important part in the
end of life care of a patient.

During the end of life, client may not be so much dedicated to the hydration and nutrition requirements
and it may be a disagreeable subject. Both hydration and nutrition are two beneficial aspects of life. Some
Carers find it hard to cope with the situation and try to keep ongoing with the nutritional needs, while
some find it not so mandatory as in their belief it will elevate the toleration period of the disease.

When a patient in complete state of mind asks for liquids or solid eatable items, the carer cannot refuse to
give it to them. But if the patient is on his/her last legs and is few hours away from death, then the assisted
nutrition and hydration will adversely affect on their life, because during this phase organ systems are
gradually stopping their function and there will be no benefit of the assisted nutrition or hydration given to
patient.

Like other end of life decisions, elderly client do have the right of denying any fluid or food, whether it will
improve their health or not. This can also be mentioned in their advanced care directive by them
beforehand and that is client’s personal choice we cannot judge them.

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 CHCPAL001 Deliver care services using a palliative approach
Sunita Mehmi ID: 10759

Q18. Explain the term ‘dignity’ and list seven (7) ways it is to be maintained during end-of-life care and
immediately after death?

Dignity, in this respect, is defined by maintaining the best possible quality of life, remaining in control of
decisions and minimising suffering. During their end-of-life care and in the events that immediately follow
death, the client has a right to dignity.

Ways to maintain dignity include:

1. Give support to clients and allow them to have as much say in decisions as possible
2. Allow people to die when and where they want
3. Minimise pain and suffering
4. Allowing client's to talk to qualified staff about death and the related issues
5. Assist people to plan for after-death arrangements and say farewell to loved ones
6. Provide professional counselling and support
7. Encourage continuation of normal activities, as far as possible
8. Be aware of cultural, religious and individual preferences
9. Provide support for family and carers
10. Provide grief and bereavement support.
(Reference: CHCPAL001– Learner Guide page no.82)

Q19. List five (5) symptoms of deterioration and imminent death.

Symptoms of

Deterioration Imminent death

1. Loss of appetite 1. Difficulty breathing (long periods of apnoea)
2. Restlessness, agitation 2. Severe agitation of the client/hallucinations
3. Excessive fatigue/sleep 3. Inability to swallow
4. Extreme physical weakness 4. Patient states they are going to die
5. Mental confusion/disorientation 5. Fluid build-up in lungs
6. Difficulty breathing (short period of apnoea) 6. Coolness in toes and fingers (due to lack of
7. Clients report seeing people who are already circulation)
dead 7. Mottled veins (due to lack of circulation)
8. Social withdrawal, followed by brief, 8. Lack of consciousness
unexplained spurts of alertness and 9. Inability to speak
attention 10. Sudden drop in blood pressure
9. Swelling in ankles and feet (also sometimes 11. Numbness of patient's legs/feet
in hands, feet and face) 12. Rigidity of the body
10. Inability to heal from wounds and infections. 13. Cyanosis (bluish/purple hue to limbs)
14. Jaw drop (unable to be held together).
(Reference: CHCPAL001– Learner Guide page no.85, 86)

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 CHCPAL001 Deliver care services using a palliative approach
Sunita Mehmi ID: 10759

Q20. i) In your own words, explain what ‘debriefing’ is and who should run / manage the debriefing
session.

Debriefing is kind of a meeting which is held for family, friends and staff when a life ending situation
occurs. During this meeting feelings and emotions towards the demised person are shared by the
concerned or most affected person. This process facilitates the persons to go through their emotions which
act as a therapy for them.

The debriefing should be held by the person who is familiar with the process and is well qualified in doing
these sessions. The person can also analyse further emotional or therapeutic support for the traumatised
persons.

ii) Who should be debriefed and in what situation?

The people who are mostly affected by the death of the concerned person should be approached for
process of debriefing. But, the person should not be pressurized to avail the session, by practicing sound
conversation enlighten them with the service.

Some people instantly take advantage of the services while others ask for it after some time when they feel
like.

Q21. Identify your organisation's policies and procedures for managing emotional responses and ethical
issues?

When managing emotional responses and ethical issues, you must always follow your organisation's
policies and procedures.

 These will be specific to where you work and should guide you on the appropriate protocols to
follow in these cases.
 These policies and procedures should be available to all workers and they should be tested on their
knowledge of them, as well as having a reference copy for use in each individual situation where
they need to check what to do.
 As well as managing emotional responses and ethical issues, these policies and procedures should
cover all aspects of palliative care.
(Reference: CHCPAL001– Learner Guide page no.92)

Q22. i) Identify the emotional responses to death and dying which may exist.

It is emotionally challenging situation to watch somebody gradually degenerating in front of your eyes.
Also other circumstances like financial or restlessness can elevate the level of pressure making it harder to
deal with it. Person can experience frustration or even become aggressive by surviving these situations.

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 CHCPAL001 Deliver care services using a palliative approach
Sunita Mehmi ID: 10759

When a person stays by the side of a dying person throughout his/her journey by taking care of them, and
when the person demises, they feel deprived and see their life meaningless.

ii) List two (2) sources of loss and grief

Sources of loss and grief can be:

1. Past experience of someone demised in a professional’s life..

2. Multiple witnessing of deaths.
3. Type of response to loss and grief from colleagues.

iii) Identify five (5) symptoms and briefly describe each one in relation to the emotional responses to death
of a person / loved one.

1. Shock and disbelief –It usually happens in the period of time immediately following a loss. People
may refuse to accept what has happened and, if they have lost a loved one, they may hope/expect
them to show up.
2. Sadness – this is common and is expressed commonly through crying – people may feel loneliness,
despair and yearning.
3. Guilt – this may be guilt about 'things they should have done/said' regarding the person they have
lost. It may even be guilt about positive feelings, like relief about the death of someone after a long
illness, about the deceased. There may also be survivor's guilt – where the person feels they should
have done something to prevent the death or have died instead.
4. Anger –the person is looking to blame someone for the loss – themselves, doctors, God, or even
the deceased – even if it was no-one's fault.
5. Fear – this can manifest itself as helplessness, anxiety or insecurity. The person may face their own
mortality, worry about their responsibilities and life without their loved one. In severe cases, they
may suffer panic attacks.
(Reference: CHCPAL001– Learner Guide page no.96)

iv) Once grief in a person is identified, provide a list of five (5) support people etc, who may be able to
assist the person

1. Seniors.
2. Manager of the facility.
3. Co-workers.
4. Personal attendants.
5. Doctors, nurse etc.

Q23. List the and briefly explains the seven (7) ethical principles which will guide you in decision making?

1. Beneficence – carrying out all actions for the benefit of others.

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 CHCPAL001 Deliver care services using a palliative approach
Sunita Mehmi ID: 10759

2. Respect – you must always treat the patient with dignity and respect. This means respecting their
wishes and always treating them like an adult.
3. Self-determination – even if there is a difficult decision to make, you must have the will to make
the choice that is best for the patient.
4. Truth telling – you must never lie to a patient or their family. Even if the truth is bad news, you
must never deceive them or give inaccurate information.
5. Confidentiality – information about the patient should remain confidential and you should not tell
anyone outside of a professional requirement to do so.
6. Informed consent – before carrying out any treatment or procedure, you must get informed
consent, if possible. If they are not able to communicate this, then refer to the Advanced Care
Directive.
7. Justice and non-malfeasance – this means not providing any ineffective treatments or acting with
any malice. This can prove difficult as, some treatments will have harmful side effects – it is all
about judging whether the ends justify the means.
(Reference: CHCPAL001– Learner Guide page no.100)

Q24. i) Identify five (5) strategies that may be used to limit the impact of personal responses on self.

1. Participating in day to day tasks.

2. Going out with friends and family members.
3. Try to divert the mind from disturbing topics.
4. Promote healthy food habits.
5. Do meditation or yoga whichever is suitable.

ii) Name four (4) types of support available for home care staffs that are experiencing bereavement.

1. Cultural and religion related groups.

2. Some groups of people who come forward to help you.
3. Units that provide palliative care.
4. Healthcare organisations and community welfare branches.

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