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 unit:

This unit should be assessed in conjunction with the related unit:

HLTAHW514B Provide care to clients undertaking renal dialysis in the community setting

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

Basic anatomy and physiology of the renal system

Common causes of chronic renal failure (diabetes, glomerulonephritis, hypertension, urinary tract obstruction, inherited abnormalities)

Underlying environmental and social factors contributing to high rates of renal disease in Aboriginal communities

Management principles for common co-morbidities (including diabetes, high blood pressure, hyperlipidaemia)

Factors that can slow decline of renal function (eg: control of high blood pressure, use of ACE inhibitors, avoidance of NSAIDS)

Microbiology relevant to peritoneal, blood and skin infection in renal disease

Pathophysiology of chronic renal failure:

fluid retention and pulmonary oedema

electrolyte balance and hazards of high potassium

calcium metabolism and renal bone disease

anaemia

Signs and symptoms of uraemia and fluid retention

Meaning and interpretation of common pathology tests for chronic renal failure and dialysis

Haemodialysis technology - theory, machine components, terminology, infrastructure requirements, risks and benefits

Peritoneal dialysis - theory, terminology, procedures, risks and benefits

Different types of renal dialysis unit and their function (eg: tertiary in-centre, satellite units, community/home-based dialysis)

Nutritional considerations for renal dialysis clients

Medicines in common use in management of chronic renal failure including basic mechanisms of action, precautions and side effects

Essential skills:

It is critical that the candidate demonstrate the ability to:

Provide information, guidance and support to clients and their families in relation to health management options and issues for clients with chronic renal failure

Provide support and guidance to dialysis clients

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 apply skills in:

Recognise situations requiring immediate or urgent action

Work with other members of multi-disciplinary team to ensure actions determined in the client's care plan are carried out and documented

Mathematical calculation (eg: differences between weight measures, calculation of doses)

Communicate effectively with client and ensure understanding

Holistically evaluate impact of renal dialysis treatment on client's physical, mental and emotional condition and behaviour

Monitor outcomes of renal dialysis treatment and medication regimes

Administer medicines by oral and intramuscular routes

Contribute to evaluation of client's prescribed treatment/ care plan

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

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

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 wellbeing, 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

Renal replacement therapy includes:

Haemodialysis

Continuous ambulatory peritoneal dialysis

Kidney transplantation

Physical signs of fluid overload include:

Dyspnoea and tachypnoea

Ankle oedema

Crackles on lung auscultation

Signs of exit site infection include:

Soiling of exit site dressing

Blood-stained or pus discharge

Exit site redness and tenderness

Signs of catheter tunnel infection include:

Expressible pus or discharge

Tenderness, redness or pustules over peritoneal catheter tunnel

Appropriate exit site care includes:

Washing in shower and padding dry with gauze

Application of topical antiseptic

Correct placement of anchor tape

Application of adhesive absorbent dressing

Securing redundant tubing

Signs suggesting fistula stenosis or infection include:

Absent or reduced bruit or thrill

Low 'a' or high 'v' pressure readings during haemodialysis

Redness, tenderness or discharge

Routine pathology testing for dialysis clients include

Haemoglobin and blood counts

Serum creatinine, potassium, calcium and phosphate

Parathyroid hormone

Iron studies

Medicines commonly used in dialysis care include:

Common antihypertensive medicines

Common lipid lowering agents

Phosphate binders (calcium salts)

Erythropoetin

Calcitriol

Clinical features suggestive of dialysis-related peritonitis include:

Abdominal pain/tenderness

Fever

Turbid or cloudy dialysate return

Causes of peritoneal fluid failing to drain include:

Fibrin plugs

Constipation

Dialysate not instilled

Clinical features of uraemia include:

Lethargy

Nausea

Confusion

Uraemic smell

Hazards associated with haemodialysis after a number of missed dialysis sessions include:

Severe headache

Fitting

Dialysis consumables include

Dialysate fluids

Machine lines and dialysers

Needles and syringes

Normal saline

Dressing supplies and tapes

Peritoneal catheter caps

Antiseptic and cleaning supplies

Appropriate storage arrangements for dialysis consumables include:

Safe from environmental hazards (sun, water, rodents)

Secure from young children

Accessible for stock-take, resupply and daily use

Information provided to client may include:

Normal structure and functioning of the renal system, kidneys and blood

Causes of renal failure

Physical symptoms of renal failure

Different renal replacement treatment options and advantages/disadvantages

How kidney transplantation is done and what is involved

Information about self-care, including:

Dietary requirements and rationale

Fluid requirements

Medication regime

Looking after fistula sites

Recognising common dialysis problems

Specific reference for work in this area:

National Guidelines for the Management of Dialysis&Kidney Transplantation in Remote Australia