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:

Organisation policies and procedures relating to client confidentiality

Key elements of comprehensive and accurate physical, social/emotional and mental health assessment

Common presenting problems and procedures and protocols of relevant action to be taken

Indicators/requirements for initiating health assessment (specific to organisation, region, community)

Underpinning knowledge of anatomy/physiology; microbiology, pathophysiology (disease processes) and pharmacology related to:

circulatory system (including blood pressure, the pulse)

respiratory tract

male and female urinary and genital tracts

gastrointestinal tract

skeletal system

nervous system

endocrine system

the ear

the skin

the eye

components of mouth and tooth structure

Basic knowledge of micro-organisms which are pathological to humans and the conditions which they precipitate

Correct procedures and protocols used:

to assess common client presentations

during health assessment to limit infection and cross infection

'Normal' range of test outcomes, including:

blood pressure (for adults and children)

temperature

pulse rate

respiratory and peak flow rates

height and weight

components of urine

standard eye tests

visual examination of eye and ear

blood glucose (sugar) and haemoglobin levels

continued ...

Essential knowledge (continued):

Nature and associated signs/symptoms and implications of range of test outcomes for relevant health conditions, including:

respiratory conditions

genito-urinary conditions

gastrointestinal problems

ear conditions

eye problems

sexually transmitted infections

Basic nature, management and associated risk factors for common diseases, including:

cardiovascular diseases

rheumatic fever and rheumatic heart disease

diabetes

infectious conditions

renal disease

Limits of own ability and authority and when to refer or seek assistance

Knowledge of specific pathology tests, and the correct methods of collection, storage and transport of specimens; significance of results

Knowledge relating to pregnancy and birthing, including:

mechanics of pregnancy and birthing

impact of smoking, alcohol and poor nutrition in pregnancy

recognition of common or potentially serious pregnancy problems (eg. premature labour, bleeding, high BP)

Knowledge of reproductive health, including:

physiology of conception

recognition of sexually transmitted infections (STIs)

contraceptive options

Links between environment and health, including:

crowding

clean water

sanitation

food contamination

insect vectors

Key elements of accurate reporting via radio/ telephone, in writing and during case discussion

continued ...

Essential knowledge (continued):

Commonly requested pathology tests and abbreviations, including:

full blood examination and ESR

random and fasting blood glucose (sugar) level

glycated haemoglobin

electrolytes and creatinine

liver function tests

lipid tests

thyroid function tests

iron studies

cardiac enzymes

urinary albumin-creatinine ratio

tests for sexually transmitted infections

microscopy, culture and sensitivities

The clinical significance of abnormal findings on common pathology tests with particular reference to use of medicines

Essential skills:

It is critical that the candidate demonstrate the ability to:

Work independently and consistently in delivering primary health care services to Aboriginal and/or Torres Strait Islander clients, including:

detailed client observation, questioning and assessment to determine the client's health status, issues and needs

summary and presentation of findings in line with client needs and workplace requirements

maintenance of client records and upholding client confidentiality

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:

Communicate effectively and establish a relationship of trust with clients and significant others

Conduct accurate and effective client assessment, including:

take, consider and record relevant details of client's history (including body language)

observe and assess client's health, using appropriate tests and medical instrumentation

comply with (and enforce) infection control guidelines

use a structured approach to assessment

interpret common pathology tests

take full responsibility for assessment findings

continued ...

Essential skills:

Carry out clinical procedures safely, effectively and within guidelines

Elicit relevant information from client or documents

Explain assessment methods and procedures to client

Identify situations when assistance is required

Initiate appropriate actions in response to assessment in line with organisation procedures and protocols for commonly presented health conditions

Interpret available documented health information

Interpret, document and report detailed findings of simple routine assessments.

Interpret, document and report findings of standard pathology tests

Make timely and appropriate referrals, providing accurate and relevant details to clients and referral agencies

Recognise signs/symptoms of:

uncontrolled pain

potentially serious underlying conditions

Reflect on and improve own level and application of skills and knowledge to achieve desirable outcomes and maintain own capabilities

Take into account opportunities to address waste minimisation, environmental responsibility and sustainable practice issues

Use appropriate procedures, tests and protocols to conduct routine health assessments for Aboriginal and/or Torres Strait Islander clients (adults and children)

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

An accurate history includes:

History of the presenting problem (character, severity and duration of symptoms)

Client concerns and beliefs regarding their problems

Past medical history, including use of alcohol, tobacco and other substances

Medicines being taken

Allergies

Family and community circumstances, including identifying environmental health factors that may contribute to client's health problems

Basic dietary information, including diet history to determine food and drink intake

Related health care providers may include:

Personnel internal to the service provider

External health care providers

Other service providers

Client information may include:

Significant ongoing health problems

Current medications

Clinical progress notes relevant to the presenting problem

Record of allergies

Family history

Medical and surgical history, including but not limited to:

pain

respiratory symptoms

urinary symptoms or abdominal symptoms

diseases such as diabetes, rheumatic fever or valvular heart disease

immunisation status

surgical history

use of alcohol and other drugs

oral health care history

Documents such as:

client file/notes

reports/results from referral, allied professionals and specialists (including x-ray, pathology tests)

Standing orders/written care protocols include:

Written guidelines or orders that support the clinical assessment and management of presenting health problems (eg. CARPA)

Medical equipment includes, but is not limited to:

Steriliser

Auroscope

Haemoglobinometer

Eye charts

Tape measure

Sphygmomanometer

Stethoscope

Ophthalmoscope

Glucometer

Scales

Thermometers (relevant types)

Urinalysis strips

Peak expiratory flow rate meters

Blood glucose testing units

Surgical instruments

Centrifuge

Plaster cutter

Nebulisers

Resuscitation equipment (including oxygen equipment)

Vital signs include:

Temperature

Pulse

Blood pressure

Respiratory rate

Non-clinical factors responsible for abnormal readings may include:

Failure to properly shake down a mercury thermometer

Effect of ingestion of hot or cold beverage on oral temperature measurement

Differences in temperature measurements taken at sites (ie. oral, axillary, ear)

Effect of exertion and anxiety on pulse rate and blood pressure

Impact of cuff size on the accurate measurement of blood pressure

Faulty equipment

Failure to correctly calibrate equipment

Impact of environmental factors on equipment

Health assessments may include:

Routine health assessments for clients with chronic disease

Well-person's health check

Assessment of client with presenting physical problems

Routine health assessments may be initiated for:

Clients with identified chronic disease, such as:

diabetes

chronic renal impairment

heart disease

joint disease

hypertension

asthma

Well-person's health check, appropriate to:

age

sex

ethnicity

regional disease prevalence

Observation of client includes:

Physical appearance

Body language and speech

General appearance (the 'unwell child')

Clinical tests may be initiated in response to:

Standard protocols for routine health checks

Results of other tests and/or observations

Request from client, another practitioner or specialist

Examination/testing of client includes:

Assessment for signs and symptoms of serious underlying causes of fever, including:

general appearance (the 'unwell child')

history of pain, respiratory symptoms, urinary symptoms or abdominal symptoms

history of diabetes, rheumatic fever or valvular heart disease

respiratory rate and pulse rate

urinalysis

examination of skin for infection

examination of ears and throat

Urine specimen collection using multi-reagent sticks and including:

mid-stream urine collection

first pass urine collection

paediatric bag collection

Use of capillary and venous blood glucose levels (BGL) [also referred to as blood sugar levels (BSL)] in diagnosis and monitoring control of clients with diabetes

Examination of extremities, including:

feet of people with diabetes are examined for protective sensation, ulcers, calluses, infections, nail condition and peripheral circulation

extremities of clients with Hansen's disease are examined for ulceration and infection

Peripheral circulation problems

Assessment of infant and child growth, including:

measure, document and plot weight and height

compare growth with major developmental milestones and identify potential delayed growth

identify possible causes of delayed growth

Identify symptoms of pregnancy and calculate expected date of delivery.

Identify:

abnormal post-natal conditions

common or serious neonatal conditions

continued ...

Examination/testing of client includes:
(continued)

Test:

blood pressure

blood glucose level

haemoglobin level

urinalysis

Measure (monitor):

height, weight and head circumference using correct equipment

Examine/assess:

external eye and eyelid

ear

skin (for infection and other significant variations)

peak flow rate

Simple abdominal examination:

locate tenderness

simple tests for peritoneal inflammation

presence of abdominal masses

Simple peripheral nerve examinations, including:

testing extremities (hands, feet) for light touch and sharp sensation

visible wasting of hand muscles

grip strength and finger abduction

Basic oral health assessment, including:

visual inspection of oral cavity, teeth and gums

palpation of gums and jaw-line for tenderness

identification of common dental variations from normal

Clinical assessment of eye problems, including:

lid eversion

identification of the signs and symptoms of trachoma (in children and adults), using the WHO simplified trachoma grading system

retinal photography

use of fluorescein staining

Visual acuity testing, including:

Snellen or Bailey-Lovie chart

E-chart

counting fingers

light perception

continued ...

Examination/testing of client includes:
(continued)

Respiratory assessments, including:

measurement of adult, child and infant respiratory rates

chest auscultation, measurement of peak expiratory flow rate (adult, child)

recognition of signs of respiratory distress;

spirometry; oximetry

Ear examinations, including:

use of otoscope to identify abnormal appearance of tympanic membrane and/or ear canal

audiometry

tympanometry

Examination of extremities for:

protective sensation

ulcers

calluses

infections

nail condition

peripheral circulation

Especially hands and feet of people with chronic conditions (eg. diabetes or Hansens' disease)

Screen for:

diabetes

proteinuria

urinary tract infection

hypertension

Specimen collection includes:

Urine (mid-stream, first pass urine and paediatric bag collection)

Blood

Sputum

Faeces

Swabs for culture and sensitivity and for pcr testing from wounds, skin and bodily orifices where appropriate (e.g. throat, ear and nasal swabs)

Tissue samples (for example skin scrapings for fungal infections)

Correct procedures for collection and handling of human pathology samples include:

Correct use of both sealed vacuum system and needle and syringe

Observance of universal precautions in collection and handling of specimens for pathology testing

Use of appropriate sample/specimen containers

Accurate labelling in line with organisation policies and procedures

Correct packaging, storage and transportation, in accordance with legislative and regulatory requirements for specific samples/specimens

Correct disposal of waste (including sharps)

Presence of health signs and symptoms to be identified and described include:

Common respiratory problems, including:

nasal discharge

sore throat

cough

breathlessness

haemoptysis (blood in sputum)

Genitourinary conditions, including:

dysuria (urinary tract infection [UTI], sexually transmitted infection [STI])

urinary frequency (UTI, prostatism, diabetes)

haematuria (UTI, kidney trauma, urinary stones, tumour)

symptoms of sexual assault

Gastro-intestinal and abdominal conditions, including:

indigestion and heartburn

diarrhoea and/or vomiting

constipation

acute abdominal pain

Signs of trauma, such as burns, assault

Common ear health conditions, including:

ear ache

discharging ear

deafness

foreign bodies or impacted wax in the ear canal

vertigo

bleeding from the ear

continued ...

Presence of health signs and symptoms to be identified and described include:
(continued)

Common types of skin conditions, including:

impetigo

cellulitis

boils

scabies

fungal infections

Common dental problems, including:

tooth decay or abscess

bleeding gums

poor dental hygiene (dental plaque, halitosis, gum recession)

inability to chew food (toothache, malocclusion, tooth loss)

jaw problem

Common eye problems, including:

red eyes (conjunctivitis, injury)

discharging eyes (conjunctivitis)

itchy eyes (allergic conjunctivitis)

squint, cross eye, misalignment

pain on blinking

rapid visual deterioration

gradual visual deterioration

Peripheral circulation problems

Clinical features suggesting potentially serious health problems include:

The 'unwell child'

Features suggesting dehydration

Chest pain, productive cough, haemoptysis, breathlessness or fast breathing

Pelvic pain, pain passing urine or blood in the urine

Abdominal tenderness or unexplained abdominal pain

Fever among high risk persons (infants, elderly and clients with chronic disease, valvular heart disease or past rheumatic fever)

Fever with features that might indicate serious infection (eg. abdominal pain, urinary symptoms, headache, productive cough, skin infection)

Wounds or sores that are deep, extensive, on the face or on the extremities of clients with diabetes

Unexplained weight loss

Heavy vaginal bleeding

Bleeding or pain in pregnancy

Rash with fever as sign of meningitis or measles.

Joint pain (possibly moving from limb to limb) and/or swollen face and/or heart murmur and fever (or recent history of fever) as a sign of rheumatic heart fever

Headache, pain, fever, photophobia and/or neck stiffness as sign of meningitis or encephalitis

Rash, high pitched cry, fever, skin discolouration as signs of meningococcal disease

Potentially serious or complicated health conditions include

Serious infections (pneumonia, blood poisoning, meningitis, endocarditis, kidney infection)

Cancers (lung, bowel, throat, breast, leukaemia)

Heart disease (heart attack, angina and heart failure)

Asthma and chronic obstructive lung disease

Sexually transmitted infections (gonorrhoea, chlamydia, syphilis, HIV/AIDS, warts, genital herpes, pubic lice)

Pregnancy complications (miscarriage, ectopic pregnancy, placental abruption)

Surgical causes of abdominal pain (appendicitis, pancreatitis, biliary colic, renal stones)

Stroke, spinal cord injury, intra-cerebral bleeding

Information to promote and maintain good health may include:

Summary of test results and readings

Information on links between heart disease and smoking, diet and physical activity

Information on management of uncomplicated gastrointestinal conditions, such as:

constipation (ie. eat more fibre, drink more water, appropriate use of laxatives)

gastroenteritis (ie. maintain fluid intake, eat according to appetite, continue breast-feeding, handwashing and infection control)

indigestion and heartburn (eg. trial of antacids, avoid late meals, identify other aggravating factors - alcohol, aspirin, anti-inflammatory medicines, smoking)

food handling and storage

Information on causes of health problems, such as:

ear problems (ie. infection and relationship to poverty and crowding; traumatic and noise-induced deafness)

skin infections (ie. crowding; poor access to water; high levels of scabies infestation)

Information on strategies to manage health problems, such as diabetes, including:

physical activity, healthy diet (low fat, low sugar, high fibre carbohydrates, high vegetables and fruits), weight loss and foot care (eg. appropriate footwear, regular foot self-care, ongoing review)

use of medicines

importance of regular health checks

Information on dental health, including:

link between dental health and diet
(ie. consumption of simple sugars and developing dental caries; specific risks such as lolly-pops and baby bottle with sweet drinks or cow's milk; suckling on breast all night)

chart showing oral assessment findings and teeth development

good dental hygiene practices (regular brushing and use of dental floss)

importance of regular dental checks, especially for clients with rheumatic heart disease

Signs of respiratory distress include:

Raised respiratory rate

Raised pulse rate

Increased respiratory effort (use of accessory muscles, inspiratory in-drawing of soft tissues)

Inability to speak through breathlessness

Anxiety

Presentations of common sexually transmitted infections include:

Male urethral discharge and/or dysuria

Vaginal discharge

Female pelvic pain

Ulcerative genital disease

Genital lumps

Reasons for testing urine include:

Screening for urine infection

Screening for kidney disease

Assessment of possible renal trauma

Ante-natal care