Unit of Competency Mapping – Information for Teachers/Assessors – Information for Learners

HLTEN406B Mapping and Delivery Guide
Undertake basic wound care

Version 1.0
Issue Date: May 2024


Qualification -
Unit of Competency HLTEN406B - Undertake basic wound care
Description This unit involves the principles of infection prevention, in relation to wound care processes in a variety of health care contextsThis will include wound assessments and contemporary wound care working with the wound management health care team
Employability Skills This unit contains Employability Skills
Learning Outcomes and Application The knowledge and skills described in this competency unit are to be applied within jurisdictional nursing and midwifery regulatory authority legislative requirementsEnrolled/Division 2 nursing work is to be carried out in consultation/collaboration with registered nurses and under direct or indirect supervisory arrangements in line with jurisdictional regulatory requirements
Duration and Setting X weeks, nominally xx hours, delivered in a classroom/online/blended learning setting.
Prerequisites/co-requisites Not Applicable
Competency Field
Development and validation strategy and guide for assessors and learners Student Learning Resources Handouts
Activities 		Slides
PPT 		Assessment 1 Assessment 2 Assessment 3 Assessment 4
Elements of Competency Performance Criteria              
Element: Undertake wound assessment
  • Demonstrate understanding of common ways disease is spread and infection is developed throughout wound assessment and care
  • Apply knowledge of physiological processes of healing
  • Seek client cooperation and consent
  • Maintain client privacy and dignity
  • Utilise strategies to minimise cross-infection during assessment and implementation
  • Identify and document level of improvement in wound healing
  • Record data in line with organisation protocols, guidelines and procedures
  • Observe orders relating to non-disturbance of dressings
       
Element: Contribute to planning appropriate care for the client with a wound
  • Discuss wound care with the client in conjunction with the registered nurse
  • Observe evidence based principles and practice associated with wound care
  • Take into account the sequencing, timing and client needs when planning care
  • Take into account primary health care principles and holistic approach when planning care
  • Utilise knowledge of physiological processes associated with normal wound healing in planning and delivering treatments
  • Identify client comfort needs (eg. pain relief) before undertaking wound care
  • Identify impact of wound on activities of daily living for client, in consultation/collaboration with registered nurse
  • Consult with the registered nurse regarding analgesic administration within an optimal time frame of procedure if required
  • Be aware of the potential impact of wound on client and/or family
       
Element: Implement wound care strategies in conjunction with wound management team
  • Collect all requirements for the procedure
  • Maintain client privacy and dignity throughout all aspects of the procedure
  • Observe aseptic technique for clean surgical wound
  • Use clean techniques where appropriate for clean wounds
  • Undertake appropriate hand washing
  • Remove sutures, clips and drains as directed by a registered nurse
  • Collect specimens required for microbiology/cytology as per organisation protocol
  • Dispose of all articles including hazardous waste in line with organisation policies and procedures
  • Complete documentation and make the client comfortable
       
Element: Assist in evaluating the outcomes of nursing actions
  • Involve client in the evaluation process
  • Ensure documentation records ongoing progress
  • Report progress to and discuss with a registered nurse
       


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.

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 for assessment and evidence required to demonstrate this competency unit:

The individual being assessed must provide evidence of specified essential knowledge as well as skills

Observation of performance in a work context is essential for assessment of this unit

Consistency of performance should be demonstrated over the required range of workplace situations and should occur on more than one occasion and be assessed by a registered nurse

Context of and specific resources for assessment:

This unit is most appropriately assessed in the clinical workplace

Where, for reasons of safety, access to equipment and resources and space, assessment takes place away from the workplace, simulations should be used to represent workplace conditions as closely as possible

Method of assessment

Observation in the work place of clinical performance

Written assignments/projects

Case study and scenario as a basis for discussion of issues and strategies to contribute to best practice

Questioning verbal and written

Role play/simulation

Access and equity considerations:

All workers in the health industry should be aware of access and equity issues in relation to their own area of work

All workers should develop their ability to work in a culturally diverse environment

In recognition of particular health issues facing Aboriginal and Torres Strait Islander communities, workers should be aware of cultural, historical and current issues impacting on health of Aboriginal and Torres Strait Islander people

Assessors and trainers must take into account relevant access and equity issues, in particular relating to factors impacting on health of Aboriginal and/or Torres Strait Islander clients and communities

Related units:

This unit is recommended to be assessed in conjunction with the following related competency units:

HLTEN405B Implement basic nursing care

HLTIN301C Comply with infection control policies and procedures

HLTAP401B Confirm physical health status

Submission Requirements

List each assessment task's title, type (eg project, observation/demonstration, essay, assignment, 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.

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:

Aetiology of chronic wounds - trauma, venous/arterial insufficiency, infection

Anatomy and physiology of dermis, muscle and bone and physiology of wound healing

Biohazard and waste disposal

Chain of infection: transmission of infection, defences and immunity, host factors

Common fungi, protozoa and viral diseases

Evaluation of wounds

Evidence-based practice - compression therapy, use of honey, hyperbaric therapy.

Infection prevention interventions - hand washing, asepsis and aseptic technique, sterilisation, disinfection and decontamination

Methods of identifying bacteria and common bacterial diseases

Microbiology related to nosocomial infection, anaerobic organisms, Gram positive and Gram negative organisms

Mode of action of antiseptics, other topical solutions, hydrocolloids, agars, antibiotics

Signs and symptoms of infection

Standard precautions - compliance with current infection control practices and guidelines

Types of dressings, methods of fixation

Wound management strategies and contemporary wound healing practice

Essential skills:

It is critical that the candidate demonstrate the ability to:

Apply knowledge of processes and protocols in the setting where care is being provided

Demonstrate understanding when advice and referral to appropriate health professional is required

Maintain aseptic or 'clean' technique as appropriate

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 infection control principles in a variety of health environments

Apply Professional Standards of Practice:

ANMC code of conduct

ANMC code of ethics

ANMC national Enrolled/Division 2 nurse competency standards

scope of nursing practice decision making framework

state/territory Nurse Regulatory Nurses Act

state/territory Nursing and Midwifery Regulatory Authority standards of practice

Demonstrate critical thinking in the conduct of Enrolled/Division 2 nurse practice

Demonstrate effective interpersonal skills

Maintain reporting and documentation

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

Undertake wound assessment

Use aseptic technique

Use oral communication skills (language competence) required to fulfil job roles as specified by the organisation/service.

Use written communication skills (literacy competence) required to fulfil job roles as specified by organisation/service. The level of skill may range from reading and understanding client documentation to completion of incident reports

Undertake infection control risk assessment in relation to:

client

others

self

The Range Statement relates to the unit of competency as a whole. It allows for different work environments and situations that may affect performance

Common terms associated with microbiology may include:

Commensal

Microflora

Normal flora

Pathogen

Symbiosis

Nosocomial infection

Endogenous

Exogenous

Wounds caused by micro-organisms include:

Staphylococcus aureus boils, wound infections

Clostridium tetanus, gas gangrene, botulism

Proteus wound infections

Common fungal infections include:

Tinea pedis (athlete's foot)

Tinea capitus (ringworm)

Common viral diseases may include:

Herpes simplex I (cold sores)

Herpes simplex II (genital herpes)

Herpes zoster

Commonly seen wounds as a result of acute/chronic conditions may include:

Diabetic ulcers

Burns

Pressure (decubitus) ulcers

Tropical ulcers

Post surgical

Trauma

Harmful effects of microflora include:

Skin pimples, carbuncles, furuncles

Mouth gum disease, caries

Ears and eyes otitis externa, conjunctivitis, trachoma

Components of the chain of infection:

Infective agent

Portal of entry

Portal of exit

Reservoir

Susceptible host

Mode of transmission

Common terms associated with the spread of disease:

Antibiotic

Communicable

Contagious

Epidemiology

Epidemic

Endemic

Pandemic

Host

Incubation

Infectious

Acute infection

Chronic infection

Latent

Primary infection

Secondary infection

Local infection

Generalised infection

Sterilisation

Disinfection

Infection process may include:

Inflammatory process

Histamine

Kinins

Phagocytosis

Pus

Tissue repair

Wound assessment may include the following classifications:

Clean/dirty

Infected

Surgical/traumatic

Chronic/acute

Necrotic/sloughy

Granulating

Abrasions/skin tears

Incisions/lacerations

Punctures

Avulsions

Amputations

Burns

Pressure sores

Organisation protocols, guidelines, procedures include:

Occupational health and safety

Infection control

First Aid

Policies and procedures related to the workplace including understanding the work roles of all staff.

Wound healing protocols

Wound management strategies and contemporary wound healing practice

Wound care may include the use of:

Hyrocolloids

Films

Gels

Foams

Alginate

Low order dressings, such as dry dressing, adhesive dressing, wound closure tapes

Wound management team may function in a variety of health care contexts and may include:

Nurses

Medical practitioners

Occupational therapists

Microbiologists

Pharmacists

Carers

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
Demonstrate understanding of common ways disease is spread and infection is developed throughout wound assessment and care 
Apply knowledge of physiological processes of healing 
Seek client cooperation and consent 
Maintain client privacy and dignity 
Utilise strategies to minimise cross-infection during assessment and implementation 
Identify and document level of improvement in wound healing 
Record data in line with organisation protocols, guidelines and procedures 
Observe orders relating to non-disturbance of dressings 
Discuss wound care with the client in conjunction with the registered nurse 
Observe evidence based principles and practice associated with wound care 
Take into account the sequencing, timing and client needs when planning care 
Take into account primary health care principles and holistic approach when planning care 
Utilise knowledge of physiological processes associated with normal wound healing in planning and delivering treatments 
Identify client comfort needs (eg. pain relief) before undertaking wound care 
Identify impact of wound on activities of daily living for client, in consultation/collaboration with registered nurse 
Consult with the registered nurse regarding analgesic administration within an optimal time frame of procedure if required 
Be aware of the potential impact of wound on client and/or family 
Collect all requirements for the procedure 
Maintain client privacy and dignity throughout all aspects of the procedure 
Observe aseptic technique for clean surgical wound 
Use clean techniques where appropriate for clean wounds 
Undertake appropriate hand washing 
Remove sutures, clips and drains as directed by a registered nurse 
Collect specimens required for microbiology/cytology as per organisation protocol 
Dispose of all articles including hazardous waste in line with organisation policies and procedures 
Complete documentation and make the client comfortable 
Involve client in the evaluation process 
Ensure documentation records ongoing progress 
Report progress to and discuss with a registered nurse 

Forms

Assessment Cover Sheet

HLTEN406B - Undertake basic wound care
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

HLTEN406B - Undertake basic wound care

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: