Assessor Resource

HLTENN011
Implement and monitor care for a person with acute health problems

Assessment tool

Version 1.0
Issue Date: April 2024


This unit describes the skills and knowledge required to contribute to the care of the person with an acute health problem by performing clinical nursing skills and interventions that support the person’s health care needs and assist them to regain optimal function and lifestyle.

This unit applies to enrolled nursing work carried out in consultation and collaboration with registered nurses, and under supervisory arrangements aligned to the Nursing and Midwifery Board of Australia regulatory authority legislative requirements.

The skills in this unit must be applied in accordance with Commonwealth and State/Territory legislation, Australian/New Zealand standards and industry codes of practice.

You may want to include more information here about the target group and the purpose of the assessments (eg formative, summative, recognition)



Evidence Required

List the assessment methods to be used and the context and resources required for assessment. Copy and paste the relevant sections from the evidence guide below and then re-write these in plain English.

ELEMENT

PERFORMANCE CRITERIA

Elements define the essential outcomes

Performance criteria describe the performance needed to demonstrate achievement of the element.

1. Identify impact of acute health problems on a person, family or carer.

1.1 Identify actual and potential health issues of the person presenting with an acute health problem using information from a preliminary health assessment and in discussion with relevant interdisciplinary health care team members.

1.2 Explain to the person, family or carer the potential physical and psychological impacts of acute health problems on daily living activities.

1.3 Identify the pathophysiology of the person’s underlying or presenting condition, and confirm with the person, family or carer.

2. Contribute to planning care for a person with acute health problems.

2.1 Contribute effectively to discussions about the care of the person with registered nurse and other members of the health team.

2.2 Gather information and accurately document and report changes in the person’s condition to appropriate interdisciplinary health care team members.

3. Perform nursing interventions to support health care of a person with acute health problems.

3.1 Assist in providing care for the person with a compromised airway including clearing of airways and interpreting health status using monitoring devices.

3.2 Provide care to the person requiring nutrition administered through a feeding tube or intravenous line.

3.3 Use critical thinking and problem-solving approaches in prioritising and modifying nursing interventions to reflect changes in the person’s condition.

3.4 Contribute to the person’s understanding of health care provided to assist them to regain optimal function through nursing interventions and health education.

3.5 Observe the person to identify any psychological support and care required due to the impact of acute health problems.

3.6 Ensure nursing interventions for pre- and post-procedure care for the person are in accordance with organisation policy and procedures.

4. Contribute to pre- and post-operative nursing care of a person.

4.1 Contribute to pre-operative nursing management of the person for specific surgical procedures.

4.2 Ensure pre-operative care takes into account the relationship between pre-operative care and post-operative complications.

4.3 Contribute to post-anaesthetic observation of the person following surgery including identifying deterioration when the person is not regaining consciousness.

4.4 Assist the person recovering from a range of anaesthesia to regain optimal health status, and take appropriate actions to reduce risks associated with immobility.

4.5 Promote the person’s post-operative comfort using pain management strategies and nursing care actions.

5. Contribute to an emergency response in the acute care environment.

5.1 Identify and confirm the roles and responsibilities of members of the emergency response team.

5.2 Prepare and check emergency equipment.

5.3 Identify emergency situations and respond to first aid requests from emergency response team, including accessing and preparing drugs used during advanced cardiopulmonary resuscitation.

The candidate must show evidence of the ability to complete tasks outlined in elements and performance criteria of this unit, manage tasks and manage contingencies in the context of the job role. There must be evidence that the candidate has:

undertaken nursing work in accordance with Nursing and Midwifery Board of Australia professional practice standards, codes and guidelines

analysed health information and the clinical presentation of 1 person in the workplace or simulated environment to reach an accurate conclusion on possible health care planning and nursing interventions related to their acute health condition, in consultation with a registered nurse

performed nursing interventions for 1 person undergoing a surgical procedure in the workplace, including pre-operative preparation and post-operative care

implemented nursing interventions in the workplace or in a simulated environment specific to care of 1 person with acute health problems.

The candidate must be able to demonstrate essential knowledge required to effectively complete tasks outlined in elements and performance criteria of this unit, manage tasks and manage contingencies in the context of the work role. This includes knowledge of:

acute health problems including:

acute renal disorders

acute gastrointestinal disorders

acute neurological disorder

acute pain

acute respiratory disorders

acute unconscious state

angina

burns

cellulitis

deep vein thrombosis, venous thromboembolism

dehydration

fractures

haemorrhage

head injury

myocardial infarction

renal calculi

sepsis

shock

holistic approach to care in the acute care environment including nursing interventions and outcomes

clinical manifestations of acute disease states and illnesses requiring complex nursing interventions

emergency management protocols for first aid procedures and cardiac and respiratory arrest

pre- and post-operative nursing management

equipment used in acute care environments

post-operative pain management strategies

post-anaesthetic and post-operative observations, which may include:

level of consciousness and awareness of deterioration when the person is not regaining consciousness

fluid intake - intravenous (IV), central venous catheter (CVC), total parenteral nutrition (TPN), oral, nasogastric (NG)

complications of acute bed rest

risk assessment of patient’s stability on their feet

how to perform complex interventions including:

tracheostomy suctioning

underwater seal drainage (UWSD) tube management

intercostal catheter care

how to monitor a person with medical devices including:

continuous positive airway pressure (CPAP) and Bilevel positive airway pressure (BiPAP)

peripherally inserted central catheter (PICC)/midline management

principles of surgical nursing and associated surgical procedures and related terminology including:

elective/emergency surgery

general, local, epidural and spinal anaesthetic and peripheral nerve block

amputation

open reduction

hip replacement

craniotomy

tonsillectomy

appendectomy

laparotomy

hysterectomy

prostatectomy

cataract extraction

internal bleeding due to trauma.

Skills must have been demonstrated in the workplace or in a simulated environment as specified in the performance evidence. The following conditions must be met for this unit:

use of suitable facilities, equipment and resources in line with the Australian Nursing and Midwifery Accreditation Council’s Standards including:

monitoring device for oxygen therapy measurements

wound drains suction equipment

dressing packs

personal protective equipment

organisation policy and procedures on which the candidate bases the planning

modelling of industry operating conditions including access to real people for simulations and scenarios in enrolled nursing work.

Assessors must satisfy the Standards for Registered Training Organisations (RTOs) 2015/AQTF mandatory competency requirements for assessors.

In addition, assessors must hold current registration as a Registered Nurse with Nursing and Midwifery Board of Australia.


Submission Requirements

List each assessment task's title, type (eg project, observation/demonstration, essay, assingnment, checklist) and due date here

Assessment task 1: [title]      Due date:

(add new lines for each of the assessment tasks)


Assessment Tasks

Copy and paste from the following data to produce each assessment task. Write these in plain English and spell out how, when and where the task is to be carried out, under what conditions, and what resources are needed. Include guidelines about how well the candidate has to perform a task for it to be judged satisfactory.

ELEMENT

PERFORMANCE CRITERIA

Elements define the essential outcomes

Performance criteria describe the performance needed to demonstrate achievement of the element.

1. Identify impact of acute health problems on a person, family or carer.

1.1 Identify actual and potential health issues of the person presenting with an acute health problem using information from a preliminary health assessment and in discussion with relevant interdisciplinary health care team members.

1.2 Explain to the person, family or carer the potential physical and psychological impacts of acute health problems on daily living activities.

1.3 Identify the pathophysiology of the person’s underlying or presenting condition, and confirm with the person, family or carer.

2. Contribute to planning care for a person with acute health problems.

2.1 Contribute effectively to discussions about the care of the person with registered nurse and other members of the health team.

2.2 Gather information and accurately document and report changes in the person’s condition to appropriate interdisciplinary health care team members.

3. Perform nursing interventions to support health care of a person with acute health problems.

3.1 Assist in providing care for the person with a compromised airway including clearing of airways and interpreting health status using monitoring devices.

3.2 Provide care to the person requiring nutrition administered through a feeding tube or intravenous line.

3.3 Use critical thinking and problem-solving approaches in prioritising and modifying nursing interventions to reflect changes in the person’s condition.

3.4 Contribute to the person’s understanding of health care provided to assist them to regain optimal function through nursing interventions and health education.

3.5 Observe the person to identify any psychological support and care required due to the impact of acute health problems.

3.6 Ensure nursing interventions for pre- and post-procedure care for the person are in accordance with organisation policy and procedures.

4. Contribute to pre- and post-operative nursing care of a person.

4.1 Contribute to pre-operative nursing management of the person for specific surgical procedures.

4.2 Ensure pre-operative care takes into account the relationship between pre-operative care and post-operative complications.

4.3 Contribute to post-anaesthetic observation of the person following surgery including identifying deterioration when the person is not regaining consciousness.

4.4 Assist the person recovering from a range of anaesthesia to regain optimal health status, and take appropriate actions to reduce risks associated with immobility.

4.5 Promote the person’s post-operative comfort using pain management strategies and nursing care actions.

5. Contribute to an emergency response in the acute care environment.

5.1 Identify and confirm the roles and responsibilities of members of the emergency response team.

5.2 Prepare and check emergency equipment.

5.3 Identify emergency situations and respond to first aid requests from emergency response team, including accessing and preparing drugs used during advanced cardiopulmonary resuscitation.

The candidate must show evidence of the ability to complete tasks outlined in elements and performance criteria of this unit, manage tasks and manage contingencies in the context of the job role. There must be evidence that the candidate has:

undertaken nursing work in accordance with Nursing and Midwifery Board of Australia professional practice standards, codes and guidelines

analysed health information and the clinical presentation of 1 person in the workplace or simulated environment to reach an accurate conclusion on possible health care planning and nursing interventions related to their acute health condition, in consultation with a registered nurse

performed nursing interventions for 1 person undergoing a surgical procedure in the workplace, including pre-operative preparation and post-operative care

implemented nursing interventions in the workplace or in a simulated environment specific to care of 1 person with acute health problems.

The candidate must be able to demonstrate essential knowledge required to effectively complete tasks outlined in elements and performance criteria of this unit, manage tasks and manage contingencies in the context of the work role. This includes knowledge of:

acute health problems including:

acute renal disorders

acute gastrointestinal disorders

acute neurological disorder

acute pain

acute respiratory disorders

acute unconscious state

angina

burns

cellulitis

deep vein thrombosis, venous thromboembolism

dehydration

fractures

haemorrhage

head injury

myocardial infarction

renal calculi

sepsis

shock

holistic approach to care in the acute care environment including nursing interventions and outcomes

clinical manifestations of acute disease states and illnesses requiring complex nursing interventions

emergency management protocols for first aid procedures and cardiac and respiratory arrest

pre- and post-operative nursing management

equipment used in acute care environments

post-operative pain management strategies

post-anaesthetic and post-operative observations, which may include:

level of consciousness and awareness of deterioration when the person is not regaining consciousness

fluid intake - intravenous (IV), central venous catheter (CVC), total parenteral nutrition (TPN), oral, nasogastric (NG)

complications of acute bed rest

risk assessment of patient’s stability on their feet

how to perform complex interventions including:

tracheostomy suctioning

underwater seal drainage (UWSD) tube management

intercostal catheter care

how to monitor a person with medical devices including:

continuous positive airway pressure (CPAP) and Bilevel positive airway pressure (BiPAP)

peripherally inserted central catheter (PICC)/midline management

principles of surgical nursing and associated surgical procedures and related terminology including:

elective/emergency surgery

general, local, epidural and spinal anaesthetic and peripheral nerve block

amputation

open reduction

hip replacement

craniotomy

tonsillectomy

appendectomy

laparotomy

hysterectomy

prostatectomy

cataract extraction

internal bleeding due to trauma.

Skills must have been demonstrated in the workplace or in a simulated environment as specified in the performance evidence. The following conditions must be met for this unit:

use of suitable facilities, equipment and resources in line with the Australian Nursing and Midwifery Accreditation Council’s Standards including:

monitoring device for oxygen therapy measurements

wound drains suction equipment

dressing packs

personal protective equipment

organisation policy and procedures on which the candidate bases the planning

modelling of industry operating conditions including access to real people for simulations and scenarios in enrolled nursing work.

Assessors must satisfy the Standards for Registered Training Organisations (RTOs) 2015/AQTF mandatory competency requirements for assessors.

In addition, assessors must hold current registration as a Registered Nurse with Nursing and Midwifery Board of Australia.

Copy and paste from the following performance criteria to create an observation checklist for each task. When you have finished writing your assessment tool every one of these must have been addressed, preferably several times in a variety of contexts. To ensure this occurs download the assessment matrix for the unit; enter each assessment task as a column header and place check marks against each performance criteria that task addresses.

Observation Checklist

Tasks to be observed according to workplace/college/TAFE policy and procedures, relevant legislation and Codes of Practice Yes No Comments/feedback
 
Identify actual and potential health issues of the person presenting with an acute health problem using information from a preliminary health assessment and in discussion with relevant interdisciplinary health care team members. 
Explain to the person, family or carer the potential physical and psychological impacts of acute health problems on daily living activities. 
Identify the pathophysiology of the person’s underlying or presenting condition, and confirm with the person, family or carer. 
Contribute effectively to discussions about the care of the person with registered nurse and other members of the health team. 
Gather information and accurately document and report changes in the person’s condition to appropriate interdisciplinary health care team members. 
Assist in providing care for the person with a compromised airway including clearing of airways and interpreting health status using monitoring devices. 
Provide care to the person requiring nutrition administered through a feeding tube or intravenous line. 
Use critical thinking and problem-solving approaches in prioritising and modifying nursing interventions to reflect changes in the person’s condition. 
Contribute to the person’s understanding of health care provided to assist them to regain optimal function through nursing interventions and health education. 
Observe the person to identify any psychological support and care required due to the impact of acute health problems. 
Ensure nursing interventions for pre- and post-procedure care for the person are in accordance with organisation policy and procedures. 
Contribute to pre-operative nursing management of the person for specific surgical procedures. 
Ensure pre-operative care takes into account the relationship between pre-operative care and post-operative complications. 
Contribute to post-anaesthetic observation of the person following surgery including identifying deterioration when the person is not regaining consciousness. 
Assist the person recovering from a range of anaesthesia to regain optimal health status, and take appropriate actions to reduce risks associated with immobility. 
Promote the person’s post-operative comfort using pain management strategies and nursing care actions. 
Identify and confirm the roles and responsibilities of members of the emergency response team. 
Prepare and check emergency equipment. 
Identify emergency situations and respond to first aid requests from emergency response team, including accessing and preparing drugs used during advanced cardiopulmonary resuscitation. 

Forms

Assessment Cover Sheet

HLTENN011 - Implement and monitor care for a person with acute health problems
Assessment task 1: [title]

Student name:

Student ID:

I declare that the assessment tasks submitted for this unit are my own work.

Student signature:

Result: Competent Not yet competent

Feedback to student

 

 

 

 

 

 

 

 

Assessor name:

Signature:

Date:


Assessment Record Sheet

HLTENN011 - Implement and monitor care for a person with acute health problems

Student name:

Student ID:

Assessment task 1: [title] Result: Competent Not yet competent

(add lines for each task)

Feedback to student:

 

 

 

 

 

 

 

 

Overall assessment result: Competent Not yet competent

Assessor name:

Signature:

Date:

Student signature:

Date: