Kristina Paola De Rueda CHCPAL001

10244 Deliver care services using a palliative approach

Assessment Task 1- Questioning

Q1.
i., ii
➢ Emotional support – you need to ensure that they are able to be emotionally stable and can
still function. 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. Often, understanding why something
is happening makes it easier to accept
➢ 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?
➢ 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?
➢ 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 – there needs to be consideration for client privacy and confidentiality – if you
breach this as a carer, you may be liable for legal damages. You should also ensure that you
are fully qualified to provide holistic care and that you comply with duty of care requirements
and organisation policies, procedures, and protocols.

Q2.
i. They wanted to maintain their independence and doesn’t want to burden others.
You still don’t have a trusting relationship

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ii.
 Eye contact
 Open body language
 Facial expressions
 Ask open ended questions
 Empathy
 Be patient

Q3.
i.
➢ Short form Macgill questionnaires
➢ Brief pain inventories
➢ Geriatric pain measures
➢ Pain disability index
➢ Numeric rating scale
➢ Verbal descriptor scale
➢ Pain thermometer
➢ Visual analogue scale
➢ Pictorial pain scale
ii. 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.

Q4.
i. Family members may have established relationships with the elderly people in your
care. They are likely to have a good understanding of the individual’s preferences
and characteristics. You may harness such knowledge to organise individualised
support. However, you shouldn’t make any presumptions about the level of input
desired by family members. Some may have already dedicated substantial amounts
of time to the provision of care for the individual. They may welcome the break and
be willing to trust the specialist carers. Other people may want a fair degree of
control over the care process. You should establish the desired level of input during
the initial stages of consultation with the elderly person and any family members.
Ask whether there are any tasks and duties that the family member would like to
carry out independently of the support team. Account for any feedback provided by
the family members and make adjustments to the level of care. Respect their
intimate knowledge of the elderly person’s needs. You should respect the family
member’s requests to spend time exclusively with the elderly person. They may
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want to discuss personal matters and share quality time. You may schedule visiting
times and designate areas of the care home for private meetings. It might also be
necessary to provide information about any treatments that are being administered
or discontinued. You should address any concerns and set the minds of family
members at rest. Facts about the elderly person’s level of health should be provided
in an honest and sensitive manner. There should be regular communication and
updates on the condition of the elderly individual. Family members should be
prepared for when the time comes.
ii.
Family members may assume the following responsibilities:
➢ Arranging trips
➢ Washing the elderly person
➢ Cleaning and maintaining the living environment
➢ Arranging spiritual services
➢ Attending counselling and therapy sessions
➢ Arranging entertainments
➢ Helping the elderly individual with mobility issues
➢ Preparing food and drink

Q5.
i.
Changing needs can be down to:
➢ Changes in condition
➢ Change in financial position
➢ Loss of support (e.g. family/friends/significant others)
➢ New conditions arising
➢ Age.
ii.
Changing needs and preferences
When trying to find out the background of a client, you will need to use all available
resources.
These include:
➢ The client themselves
➢ Carers
➢ Family members
➢ Significant others.
You need to create a supportive environment where all parties can openly share their views
and information about the needs of the client – the needs will usually not be stagnant and
require monitoring.
iii.
The types of information you need to find out are:

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➢ Previous jobs
➢ Domestic interests
➢ Recreational pastimes
➢ Religious views
➢ Family members
➢ Family history
➢ Homes and neighbourhoods
➢ Nationality and countries of residence.

Q6.
i.
To provide culturally appropriate palliative care, consider the
following:
➢ Using interpretation services for matters that concern informed
consent, such as the development and review of care plans
➢ Establishing the openness with which the patient and family wish to
discuss death (prior to assessing them for palliative care needs)
➢ Discussing with families and patient whether they wish for an open discussion of the
diagnosis and prognosis (consider legal issues of informed consent also)
➢ Identifying and support the cultural, linguistic, and spiritual needs of care recipients
and their families, including rituals and practices around death and dying
➢ The appropriateness of certain treatments and medications with regards to religion
and cultural beliefs
➢ Differences in the definition of 'quality of life'
➢ The role of family members in decision-making (for care and treatment)
➢ Culturally appropriate strategies that eliminate conflicts between carers, care
recipients, and their advocates
➢ Providing information in the preferred language of the care recipient
➢ Providing access to culturally appropriate spiritual and emotional support
ii.
Ensure progress notes are written in the active voice rather than the passive, as this gets the
message across more directly, and helps with concise writing. Written documents can
include progress reports, case notes, and incident reports.
Documents should be:
Concise
➢ Objective
➢ By exception
➢ Appropriate in language (no slang, unless recording direct speech)
➢ Include only necessary information.

Q7.

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i.
 Supervisor
 User manual
 Policies and procedures
 Organisation protocols
ii.
 Supervisor
 Manager
 Nurse

Q8.
i.
Encouraging communication
Tips for encouraging communication may include:
➢ Make eye contact whenever you are communicating with them
➢ Make short simple statements
➢ Speak slowly and clearly
➢ Be patient with them for responses
➢ Don't interrupt them or try to finish their sentences
➢ Encourage them to join in conversations with others
➢ Don't speak on behalf of the person – especially during conversations about decision
making. This is demeaning
➢ Don't patronise/ridicule them
➢ Don't dismiss what they say, even if it is irrelevant to the current conversation
➢ Keep choices and decisions as simple as possible
➢ If they don't appear to understand you, rephrase what you say or utilise different
communication strategies e.g. visual communication.
ii.
Empathic/active listening
Empathic/active listening is a form of communicating that requires the listener to clarify
what they hear, by way of restating or paraphrasing what they have heard in their own
words. This helps both the carer and client understand and confirm what is being
communicated. Empathic/active listening is the most effective form of communication
between carer and client – it is functional, mechanical, and leaves little room for
assumptions/interpretation. Feedback shows understanding and involves both verbal and
nonverbal communication. When a carer is listening to the words being spoken by the
client, they are also taking note of the way the words are being spoken. Often, clients can

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find it difficult to express their feelings in words and nonverbal cues can express a client’s
feelings more effectively. When a carer communicates through active listening, it shows
respect for the client and validates their worth. This enhances the client's self-esteem
which, in turn, enables the client to relax and means they are less likely to put up defensive
barriers. OARS skills (open ended questions, affirmations, reflections, summaries) are one
example of empathic listening skills because they are all about listening in a heartfelt
manner without trying to change or push the individual. These OARS skills come from a
therapy called Motivational Interviewing, developed by Professor William R Miller.

Q9.
i.
It is a legal means of instruction for someone else to carry out their wishes on
their behalf. They are not clinical care or treatment plans but can inform the
previous two things. They form part of Advanced Care Planning – the process
of reflecting, discussing and communicating about the future
medical/palliative treatment of a patient. It is part of person-centred care and
aims to reduce suffering and promote dignity.
ii.
The list of situations and preferences that an Advanced Care Directive may cover
includes:
➢ 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' (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
➢ 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.
iii.
Reporting changing needs and issues

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There are likely to be a wide range of needs and issues that need to be dealt with as the elderly
person nears the end of their lives. If the individual is suffering from a terminal illness or other
condition then you may identify serious signs of deterioration. Additional support may be
arranged to ensure the dignity and comfort of the aged person. You may have to make specific
arrangements, depending on the spiritual, legal and medical circumstances. The focus may
change to the provision of palliative care and relief of pain and emotional trauma. If the elderly
person is unable to communicate their wishesthen you are advised to consult a family member.
It might be appropriate to move the elderly person back to their own homes for the final days
of life. Alternatively you may provide the opportunity for quality time in the care home. You
should make sure that relevant staff members are aware of the changing circumstances. Details
of any decisions should be documented in the care plan.

Q10.
i.
As well as caring for patients, you also need to monitor your own health – one of the main
factors related to working with people with in end-of-life care is stress – this is because of the
high demands, in terms of time, the burden of caring for someone and the financial (if informal
care) and social impacts of caring for someone.
Signs of stress
There are ten signs of stress in caregivers:
1. Denial – refusing to accept the reality of the disease and inevitable effects on the person with
the illness
2. Anger – at the person diagnosed, that no cure exists or the reactions of other people
3. Depression – giving in to the inevitability of the situation and seeing no point in doing
anything
4. Anxiety – worrying about what will happen in the future
5. Social withdrawal – becoming reclusive from activities and friends you used to do/see
6. Sleeplessness – due to worrying and inability to relax e.g. going over possibilities in your head
while lying in bed
7. Exhaustion – leading to a lack of desire to complete everyday tasks – they tend to stop taking
care of themselves
8. Irritability – triggering negative responses and moodiness
9. Health problems – susceptibility to illnesses due to the mental and physical burden
10. Trouble concentrating – making it difficult to function and perform tasks that were once
second nature.
If you feel yourself getting stressed, you should utilise the help and resources available.
ii.

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They should report to their supervisor or any superiors available.

iii.
Decisions regarding the location of end-of-life care will ideally be made when the elderly
individual is in a good state of mind. Carers and support workers may consult with the
individual and any family members to decide the best location. The elderly person should
also designate a trusted family member with authority for making decisions if circumstances
change. Such details should be included in the advanced care directive. The aged individual
and any close associates should be given details of care organisations, so that they can carry
out research for when the time comes.
Elderly people may decide to live their last days in:
➢ Their own domestic residences
➢ Hospitals
➢ Care homes
➢ Hospices
It is important to provide information about the types of care that will be provided in each
of these settings. The old person might want special arrangements to be made, so that they
are better able to cope.

Q11.
The palliative care team can advise doctors and nurses, who can then administer pain
relieving drugs, if necessary. These include non-opioid painkillers e.g. paracetamol, mild
ones e.g. codeine and strong opioids e.g. morphine. You should refer and document these
symptoms in the care plan, along with any treatments being administered for the pain. Also,
note any side effects of the treatment, so that these are not mistaken for symptoms of an
underlying cause.

Q12.

➢ 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.

Q13.

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i.
The aims of continuous improvement should be to:
➢ Increase the value of care regarding their needs and preferences
➢ Enhance compliance with accreditation standards
➢ Identify opportunities for improvement in a systematic and planned manner.
ii.
The steps of continuous improvement are as follows:
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.
iii.
It should be ongoing and be fully integrated into the daily practices and documentation
procedures – so that improvements are ever-ongoing and progress doesn't stagnate

Q14.
Misconceptions associated with approaches to pain relief and comfort
With pain medication, some patients (and even carers) will have misconceptions and pre-
determined attitudes about its effects.
The following are some common beliefs, along with the reality of the situation:
➢ 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
➢ 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
➢ Medication is the best solution to pain – while it is commonly useful, consider psychosocial
and physical pain relievers e.g. counselling, massage, imagery training
➢ Patients will become addicted to opioids – as long as they are appropriately dosed, this
shouldn't be a problem
➢ Medication should always be started at the lowest level – pain medication should be
matched to the appropriate pain level
➢ Morphine will alleviate all pain symptoms – it is used as part of pain management and is not
a permanent solution for pain
➢ 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

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➢ 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
➢ 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
➢ If patients are intolerant to one type of pain medication, they will be intolerant to all
painkillers – the only issue that exists is providing the correct conversion dosage from one
opioid dosage to another, as there is no maximum dosage (more opioids equal more pain
relief).
Q15.
Reviewing the care plan
It is important to regularly check the care plan throughout the duration that a patient is under
your care– this is because they may choose to change it. If you are still following their old plan,
you may not be providing care according to their agreed wishes. They have the right to make
changes to their care plan and Advanced Care Directive (ACD) – make sure these are authorised
changes before carrying them out; if not, assist them in making their changes official. They
should have consulted with a medical professional when making the aforementioned changes
to the plan. These changes should have already been discussed in the regular reviews of the
care plan held between care providers, medical professional, patients and their surrogates.

Q16.
Resources/support systems
There are a number of support symptoms for those working with people in care.
They include:
➢ 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 Carelink 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
➢ Local community health centre
➢ Alzheimer's Australia (1800 100 500)

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➢ 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 699 799).

Q17.
One of the few important things for end-of-life care is that of nutrition and hydration – some
medical professionals believe it as important to continue providing it to the patient, whereas
others see it as unnecessary and allowing natural dehydration will not cause any distress to the
patient and quicken their death (rather than prolonging the suffering). One thing is certain – if a
conscious patient requests fluids or food, this should not be denied. However, if they are
slipping in and out of consciousness and the healthcare team agrees that death is imminent,
artificial nutrition and hydration will only decrease their quality of life, as the body is naturally
shutting down and the kidneys and digestive system will not be able to process the intake.
Remember that the patient has the right to refuse hydration or nutrition, even if it would be
beneficial to their condition. This request can be made verbally, if they are conscious and
competent or, if they are incompetent or unconscious, through and Advance Care Directive.
The reasons for refusal may down to cultural, religious or individual beliefs. Refusing artificial
hydration and nutrition at the end of life is not considered intent to end life and has little effect
on controlling symptoms or survival.

Q18.
Maintaining the dignity of the client
During their end-of-life care and in the events that immediately follow death, the client has a
right to dignity. Dignity, in this respect, is defined by maintaining the best possible quality of
life, remaining in control of decisions and minimising suffering.
Ways to maintain dignity include:
➢ Give support to client's and allow them to have as much say in decisions as possible
➢ Allow people to die when and where they want
➢ Minimise pain and suffering
➢ Allowing client's to talk to qualified staff about death and the related issues
➢ Assist people to plan for after-death arrangements and say farewell to loved ones
➢ Provide professional counselling and support
➢ Encourage continuation of normal activities, as far as possible
➢ Be aware of cultural, religious and individual preferences
➢ Provide support for family and carers

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➢ Provide grief and bereavement support.

Q19.
Some of the symptoms of deterioration include:
➢ Loss of appetite
➢ Restlessness, agitation
➢ Excessive fatigue/sleep
➢ Extreme physical weakness
➢ Mental confusion/disorientation
➢ Difficulty breathing (short period of apnoea)
➢ Clients report seeing people who are already dead
➢ Social withdrawal, followed by brief, unexplained spurts of alertness and attention
➢ Swelling in ankles and feet (also sometimes in hands, feet and face)
➢ Inability to heal from wounds and infections.
Some of the symptoms of imminent death include:
➢ Difficulty breathing (long periods of apnoea)
➢ Severe agitation of the client/hallucinations
➢ Severe incontinence/concentrated urine (that was not present before)
➢ Inability to swallow
➢ Patient states they are going to die
➢ Fluid build-up in lungs
➢ Coolness in toes and fingers (due to lack of circulation)
➢ Mottled veins (due to lack of circulation)
➢ Lack of consciousness
➢ Inability to speak
➢ Sudden drop in blood pressure
➢ Systolic blood pressure below 70, diastolic blood pressure below 50
➢ Numbness of patient's legs/feet
➢ Rigidity of the body
➢ Cyanosis (bluish/purple hue to limbs)
➢ Jaw drop (unable to be held together).

Q20.
i.
It is a session where all the information about death will be shared by those who are
affected which not only with the family members but also to staff members. It’s therapeutic

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and helps everyone to cope with the recent happenings that surround death. The said
session can be run by someone eligible and with experience like the supervisor, counselor
and registered nurse.
ii.
Staff, clients, and families should be debriefed on the death. This is a session where the
information is shared and processed by those affected – it can be therapeutic and help
people to more easily understand and accept the events surrounding the death. The session
should be run by someone who has experience and qualifications in the debriefing process
– they can help those affected recover from the distress caused. From this, they can also
identify and recommend those in need of further support and counselling.

Q21.
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.

Q22.
i.
Seeing someone deteriorate and then pass away can create emotional turmoil; the stress
and demands on things like time, money and sleep can compound on these emotions to
make the ordeal a huge burden. It can produce feelings of anger and guilt and also be
difficult to cope with physically, as well as mentally. There can also be the impact of grief
from multiple losses to consider – when you lose someone you have cared for to death, it
can mean you lose a sense of purpose from the caring role and also miss the
personality and presence of the person you have lost.
ii.
Sources of loss and grief can be:
➢ Worker may have experienced a loss of their own and be grieving
➢ Frequency and number of deaths experienced
➢ Need to resolve some issues when a client dies
➢ Different responses to loss and grief of co-workers.
iii.

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➢ Shock and disbelief – this ties in with the Kübler-Ross 'denial' stage and 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.
➢ Sadness – this is common and is expressed commonly through crying – people may feel
loneliness, despair and yearning.
➢ 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.
➢ Anger – this, again, parallels the Kübler-Ross stage and sees the person looking to blame
someone for the loss – themselves, doctors, God, or even the deceased – even if it was no-
one's fault.
➢ 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.
➢ Physical symptoms – these can include weight loss/gain, tiredness, sickness, insomnia
etc.
iv.
➢ Supervisor
➢ Member of senior management
➢ Colleagues
➢ Carers
➢ Health professionals
➢ External agencies (complaints and advocacy services and professional registering
authorities)
➢ Law enforcement officer.

Q23.
When making any ethical decision, the following principles should
help you:
➢ Beneficence – carrying out all actions for the benefit of others.
➢ Respect – you must always treat the patient with dignity and respect. This means
respecting their wishes and always treating them like an adult.
➢ 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.

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➢ 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.
➢ Confidentiality – information about the patient should remain confidential and you
should not tell anyone outside of a professional requirement to do so.
➢ 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.
➢ Justice and non-maleficence – 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.

Q24.
i.
 Attend activities and socialise with friends and family members who have an
understanding of your situation.
 Discuss subjects completely unrelated to care
 Remember the importance of maintaining a balanced diet and taking regular
exercise
 Maintain standards of personal respect and organisation of your affairs.
 Take opportunities for relaxation and ensure that you are getting enough sleep.
ii.
➢ Hospitals and community health organisations
➢ Palliative care agencies
➢ Volunteer groups
➢ Church and religious organizations
References:
SCEI pptx
SCEI Learner’s guide

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