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

HLTRNL602C Mapping and Delivery Guide
Provide support and management of the client undergoing peritoneal dialysis therapy

Version 1.0
Issue Date: May 2024


Qualification -
Unit of Competency HLTRNL602C - Provide support and management of the client undergoing peritoneal dialysis therapy
Description This unit of competency describes the knowledge and skills required to support the client undertaking peritoneal dialysis and to use current technologies in peritoneal dialysis including the safe administration of medications via dialysis
Employability Skills This unit contains employability skills
Learning Outcomes and Application The unit involves application of specialised skills and knowledge by Enrolled/Division 2 nurses or Aboriginal and/or Torres Strait Islander health workers, for clinical assessment and follow up of client care plans under direct or indirect supervisory arrangements in line with jurisdictional and regulatory requirements.For Enrolled/Division 2 nurses the knowledge and skills described in this unit of competency are to be applied within jurisdictional nursing and midwifery regulatory authority legislative requirements.Enrolled 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.For Aboriginal and/or Torres Strait Islander health workers, this unit of competency addresses the delivery of renal health care services in Aboriginal and/or Torres Strait Islander communities.Work performed by Aboriginal and/or Torres Strait Islander health workers is to be carried out in consultation/collaboration with registered nurses and/or medical practitioners 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 Pre-requisite unitsThis unit must be assessed after successful achievement of the following related units of competency:HLTRNL601C Support the client with chronic kidney diseaseHLTRNL602C Provide support and management of the client undergoing peritoneal dialysis therapyAND one of the following units:HLTEN519C Administer and monitor intravenous medication in the nursing environmentORHLTAHW606B Manage medicines in Aboriginal and/or Torres Strait Islander health care
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: Establish a therapeutic relationship with the client
  • Provide the client with the opportunity to ask questions and discuss areas of concern
  • Ask the client questions clearly, in an appropriate manner, level and pace, and in a way that encourages the client to provide full answers
  • Provide accurate feedback and education, appropriate to the client's needs and concerns, within scope of role and responsibilities
  • Encourage client independence throughout the procedure according to their level of capability
       
Element: Assess physicalhealth status of client undergoing peritoneal dialysis
  • Complete a dialysis assessment of the client through observation and interview and report to other members of the health care team if required in accordance with scope of work role and organisation guidelines
  • Review pathology results, identify significant variations and report to other members of the health care team according to organisation policies and procedures
  • Examine the catheter and exit site to identify any problems
  • Obtain specimen swab from catheter site if necessary, according to organisation policies and procedures, and send for microbiological analysis
  • Identify any significant physical health issues in relation to dialysis prescription and requirement for adjustments and report to other members of the health care team in accordance with scope of work role and organisation guidelines
  • Recognise and refer actual and potential problems that vary from the client's normal health status to other members of the health care team as required in consultation with registered nurse and within scope of work role and organisation guidelines
       
Element: Assist the client in self-care management of peritoneal dialysis treatment
  • Review the client's understanding of the procedure in accordance with legal requirements and organisation policies and procedures
  • Assess the client's self-care strategies
  • Appraise the client's technique for dressing exit site and provide effective education as required
  • Assist the client as necessary with their peritoneal exchange according to organisation policies and procedures and infection control guidelines
  • Assess the client's peritoneal dialysis exchange technique in accordance with organisation and infection control guidelines
  • Monitor the client during treatment within scope of work role and within organisation guidelines and refer to other members of the health care team
  • Recognise and respond appropriately to actual and potential problems of peritoneal dialysis treatment
  • Obtain an effluent specimen if necessary, according to organisation policies and procedures, and send for microbiological analysis
  • Assess the client's response to treatment within scope of work role and organisation policies and procedures
  • Document and report outcomes to appropriate members of the health care team
  • Assist the client manage peritoneal dialysis consumables
       
Element: Perform peritoneal dialysis exchange for the client unable to undertake procedure
  • Examine the peritoneal dialysis exit site and perform exit site dressing as required
  • Prepare peritoneal dialysis additives for dialysis bag in line with delegation
  • Perform peritoneal exchange according to organisation policies and procedures and infection control guidelines
  • Monitor client during treatment within own scope of practice and within organisation guidelines and refer to other members of the health care team
  • Recognise and respond appropriately to actual and potential problems of peritoneal dialysis treatment
  • Assess the client's response to dialysis additives as administered within scope of work role
  • Recognise acute and delayed adverse reactions to dialysis additives and respond within scope of work role
  • Obtain an effluent specimen if necessary, according to organisation policies and procedures, and send for microbiological analysis
  • Assess the client's response to treatment within scope of work role and organisation policies and procedures
  • Document and report outcomes to appropriate members of the health care team
  • Assist the client manage peritoneal dialysis consumables
       
Element: Assess physical health status of the client at completion of peritoneal dialysis
  • Complete the post-dialysis assessment of the client
  • Evaluate the client's response to treatment within scope of work role and organisation guidelines
  • Document and report outcomes to the appropriate members of the health care team
  • Provide feedback to the client on physical health assessment in order to maintain optimal health status
  • Encourage the client to voice concerns and respond appropriately
  • Incorporate referral to community services into advanced care planning strategies in consultation/collaboration with registered nurse and other members of the health care team
       


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 competency in this unit

Candidates must demonstrate their ability to apply essential knowledge identified for this unit of competency before undertaking workplace application

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

Consistency of performance should be demonstrated over the required range of workplace situations and should occur on more than one occasion

Assessment of medication administration must include a written calculation test with 100% mastery

Context of and specific resources for assessment

This unit of competency is most appropriately assessed in the clinical workplace and under the normal range of clinical environment conditions

Method of assessment

Observation in the workplace

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

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/or Torres Strait Islander communities, workers should be aware of cultural, historical and current issues impacting on health of Aboriginal and/or 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

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:

Application of infection control principles, including environmental hazards, relating to peritoneal dialysis

Common pathology tests to diagnose and monitor CKD and their interpretation

Concepts of ideal weight and assessment of ideal body weights in clients undergoing peritoneal dialysis

Consumables and equipment relating to peritoneal dialysis

Fluid, electrolyte and acid base balance

Health status monitoring of client undergoing peritoneal dialysis

Immunity and the importance of vaccinations

Medications associated with the dialysis process such as intra-peritoneal antibiotics, heparin and insulin including basic mechanism of action, precautions, contraindications and side effects

Medicines in common use in management of clients with Stage 5 CKD including basic mechanism of action, precautions, contraindications and side effects

Organisation policies, procedures and protocols relating to peritoneal dialysis

Pathophysiology of Stage 5 chronic kidney disease (CKD)

Physiological principles of osmosis, diffusion, ultra filtration and convection

Principles of peritoneal dialysis including:

dialysis adequacy

dwell time

fluids - osmotic agent, volume

frequency of exchanges

modalities

number of exchanges

the differences of performing peritoneal dialysis in a variety of environments

Relevant medical/medication terminology and approved abbreviations

Reportable limits for patients vital signs and biochemical and haematological results for clients undergoing peritoneal dialysis

Signs and symptoms of actual and potential problems associated with peritoneal dialysis and the appropriate response

Structure and function of the peritoneum

Structure and function of the urinary, cardiovascular, lymphatic and immune systems

Understanding of own role and responsibilities and those of other health care team members in the delivery of care to clients with CKD

Essential skills:

It is critical that the candidate demonstrate the ability 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 formulae for drug calculations for administration of medications via dialysis

Apply interpersonal skills, including working with others, using sensitivity when dealing with people and relating to persons from differing cultural, social and religious backgrounds

Collect specimens in accordance with organisation and infection control guidelines

Correctly instruct client in the preparation for peritoneal dialysis

Correctly prepare equipment for peritoneal dialysis

Demonstrate accountability for personal outputs and broad client group outcomes

Evaluate the impact of peritoneal dialysis treatment on the client - physically, psychologically and emotionally

In consultation with the health care team contribute to effective plans of care to meet the needs of the peritoneal dialysis patient

Monitor the health status of the client undergoing peritoneal dialysis

Perform emergency treatment for a client experiencing an adverse response to medications administered via dialysis

Perform, and assist client to perform, a peritoneal dialysis exchange

Recognise actual and potential problems associated with peritoneal dialysis and respond appropriately

Safely administer additives to a peritoneal dialysis bag (e.g. antibiotics, heparin, insulin)

Use appropriate communication skills (non-verbal, openness, sensitivity and non-judgemental attitudes)

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

interviewing techniques

asking questions

active listening

asking for clarification

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

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

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.

Clients are limited to:

Adolescent

Adult

Assessment of physical health status may include:

Blood pressure, pulse and respiration

Weight

Evidence of uraemia and electrolyte imbalance e.g. lethargy, confusion, anorexia, nausea and vomiting

Signs of fluid overload e.g. dyspnoea, tachypnoea, ankle oedema, weight gain over a short period of time and high blood pressure readings

Signs of dehydration e.g. dry mouth, dizzy, postural drop in blood pressure, low blood pressure and weight loss over short period of time

Blood sugar levels

Pathology results from routine testing for dialysis clients

Peritoneal dialysis exit-site status

Abnormalities of peritoneal dialysis fluid

Returns on peritoneal dialysis exchanges

Evidence of infection

Peritoneal dialysis may include:

Continuous ambulatory peritoneal dialysis (CAPD)

Automated peritoneal dialysis (APD)

Members of the health care team may include:

Enrolled/Division 2 nurse

Registered nurse

Nurse practitioner

General practitioner

Renal physician

Chronic disease management team

Dietitian

Social worker

Pharmacist

Podiatrist

Aboriginal and/or Torres Strait Islander health worker

Scope of work role refers to:

Enrolled/Division 2 nurses

Aboriginal and/or Torres Strait Islander health workers

Pathology resultsmay include:

Haematological tests:

haemoglobin

iron studies

Biochemical tests:

urea

creatinine

calcium

phosphate

Dialysis adequacy tests:

Kt/Vs

urea reduction ratio

fraction reduction urea

Catheter and exit site problemsmay include:

Exit site infection, signs and symptoms:

redness and tenderness at exit site

exudate at exit site

soiling of exit site dressing with blood-stained or pus discharge

Cracking, splitting and discolouration of the catheter

Cuff extrusion

Mobile catheter

Tension of catheter

Extravasation to surrounding tissue or along inguinal canal to scrotum or labia

Contamination of catheter or 'Y' line on bag during exchange process

Leakage from site, extravasation or bag

Blocked catheter due to constipation, catheter movement, fibrin plug

Actual and potential problemsmay include:

Peritonitis, signs and symptoms:

fever

cloudy bag

abdominal pain

nausea and vomiting

Hypertension/hypotension

Fluid imbalance:

dehydration

fluid overload

Electrolyte imbalance:

hyperglycaemia

Inadequate dialysis

Malnutrition/obesity

Large amount of weight loss

Failure of peritoneal fluid to drain in or out of peritoneal dialysis cavity during an exchange

Excessive or insufficient ultra filtration leading to overload or dehydration

Infusion of incorrect peritoneal dialysis fluid:

incorrect osmotic agent

incorrect volume

incorrect concentration of osmotic agent

Raised intra-abdominal pressure

Provide effective education includes:

Develop lesson plan

Time management of education session

Evaluating education session

Evaluating client learning

Recognising teachable moments

Assessing teaching and learning resources

Infection control guidelines may include:

Standard and additional precautions

Aseptic technique

Collection site preparation

Sample collection procedures

Waste handling and disposal

Response to treatment may include:

Change in client's hydration status

Signs and symptoms of uraemia

Move towards client's ideal weight

Stabilisation of blood pressure

Documentation may include:

Record of test procedures

Complete and sign request form

Medical record notation

Labelling specimens and all documents

Data entry on paper and electronically

Management ofperitoneal dialysis consumables may include:

Stock management principles:

stocktake

ordering cycle

count stock on hand

ordering supplies

method of ordering

check expiry dates

Delivery mode

Timeframes

Storage requirements

Requirement to rotate stock

Check equipment

Prepare peritoneal dialysis additives must include:

Identification of contraindications of medications

Confirmation of client identity and check for known allergies

Identification of the purpose and function of prescribed medication

100% accurate calculation of medication doses for administration as prescribed

Contributing to the provision of information provided to clients and carers on side effects of medication administration

Peritoneal dialysis additives may include:

Heparin

Antibiotics

Insulin

Delegation refers to:

Conferring of authority to perform specific medication administration activities to a worker not usually authorised but who has been determined as appropriate for the task by the delegating health professional

Delegation is within the context of a care plan or other written instruction

Where delegation is provided verbally it must be confirmed as soon as practicable according to organisation procedures in writing and incorporated in the care plan

The authority is specific to an individual client within a specific care context and is not transferable

Delegation instructions must include:

medication and its purpose

dosage and related instructions

route

contraindications

any other relevant instructions or information, especially information specific to the client

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
Provide the client with the opportunity to ask questions and discuss areas of concern 
Ask the client questions clearly, in an appropriate manner, level and pace, and in a way that encourages the client to provide full answers 
Provide accurate feedback and education, appropriate to the client's needs and concerns, within scope of role and responsibilities 
Encourage client independence throughout the procedure according to their level of capability 
Complete a dialysis assessment of the client through observation and interview and report to other members of the health care team if required in accordance with scope of work role and organisation guidelines 
Review pathology results, identify significant variations and report to other members of the health care team according to organisation policies and procedures 
Examine the catheter and exit site to identify any problems 
Obtain specimen swab from catheter site if necessary, according to organisation policies and procedures, and send for microbiological analysis 
Identify any significant physical health issues in relation to dialysis prescription and requirement for adjustments and report to other members of the health care team in accordance with scope of work role and organisation guidelines 
Recognise and refer actual and potential problems that vary from the client's normal health status to other members of the health care team as required in consultation with registered nurse and within scope of work role and organisation guidelines 
Review the client's understanding of the procedure in accordance with legal requirements and organisation policies and procedures 
Assess the client's self-care strategies 
Appraise the client's technique for dressing exit site and provide effective education as required 
Assist the client as necessary with their peritoneal exchange according to organisation policies and procedures and infection control guidelines 
Assess the client's peritoneal dialysis exchange technique in accordance with organisation and infection control guidelines 
Monitor the client during treatment within scope of work role and within organisation guidelines and refer to other members of the health care team 
Recognise and respond appropriately to actual and potential problems of peritoneal dialysis treatment 
Obtain an effluent specimen if necessary, according to organisation policies and procedures, and send for microbiological analysis 
Assess the client's response to treatment within scope of work role and organisation policies and procedures 
Document and report outcomes to appropriate members of the health care team 
Assist the client manage peritoneal dialysis consumables 
Examine the peritoneal dialysis exit site and perform exit site dressing as required 
Prepare peritoneal dialysis additives for dialysis bag in line with delegation 
Perform peritoneal exchange according to organisation policies and procedures and infection control guidelines 
Monitor client during treatment within own scope of practice and within organisation guidelines and refer to other members of the health care team 
Recognise and respond appropriately to actual and potential problems of peritoneal dialysis treatment 
Assess the client's response to dialysis additives as administered within scope of work role 
Recognise acute and delayed adverse reactions to dialysis additives and respond within scope of work role 
Obtain an effluent specimen if necessary, according to organisation policies and procedures, and send for microbiological analysis 
Assess the client's response to treatment within scope of work role and organisation policies and procedures 
Document and report outcomes to appropriate members of the health care team 
Assist the client manage peritoneal dialysis consumables 
Complete the post-dialysis assessment of the client 
Evaluate the client's response to treatment within scope of work role and organisation guidelines 
Document and report outcomes to the appropriate members of the health care team 
Provide feedback to the client on physical health assessment in order to maintain optimal health status 
Encourage the client to voice concerns and respond appropriately 
Incorporate referral to community services into advanced care planning strategies in consultation/collaboration with registered nurse and other members of the health care team 

Forms

Assessment Cover Sheet

HLTRNL602C - Provide support and management of the client undergoing peritoneal dialysis therapy
Assessment task 1: [title]

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Assessment Record Sheet

HLTRNL602C - Provide support and management of the client undergoing peritoneal dialysis therapy

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

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