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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 andor 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 himherself 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 andor 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

Range Statement



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

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HLTAHW401B - Assess client's physical well being

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Elements and Performance Criteria

Required Skills

Evidence Required

Range Statement