At this level, the Aboriginal and/or Torres Strait Islander Health Worker is expected to demonstrate a depth and breadth of clinical knowledge and skills and the capacity for independent decision-making and problem-solving in relation to a wide range of health problems, with a special focus on chronic diseases prevalent in Aboriginal and/or Torres Strait Islander communities

ELEMENT

PERFORMANCE CRITERIA

1. Assess client's health

1.1 Undertake detailed assessment in line with protocols for specific health condition(s)

1.2 Review client records to determine priorities and potential areas of risk for each client

1.3 Evaluate impact of previous care strategies

1.4 Initiate relevant examinations and tests as required to identify and/or clarify any identified or suspected health issues and/or abnormalities

1.5 Question client appropriately in relation to any health issues and/or abnormalities and to inform ongoing health management

2. Interpret common pathology tests

2.1 Explain significance of common haematological, biochemical and microbiological test abnormalities to clients in plain language

2.2 Assess numerical test values against normal reference ranges

2.3 Refer abnormal pathology test results to medical practitioners as appropriate

3. Develop care plan

3.1 Formulate care plan to address identified health issues

3.2 Develop care plan in collaboration with the client

3.3 Develop care plan with reference to the relevant health care team and other health care providers

3.4 Propose treatment in accordance with organisation policies and procedures and as negotiated with the client, their family and/or the community

3.5 Include measures consistent with standing orders/written protocols, based on health assessment findings

3.6 Refer clients as required to relevant health professionals in line with community, organisation and regulatory requirements

3.7 Document health care plan in the client's file in accordance with organisation policies and procedures

4. Implement care plan

4.1 Build and maintain relationship of trust with each client, with active promotion of and strict adherence to confidentiality

4.2 Provide care (treatment) to address identified health issues and manage chronic health problems

4.3 Encourage client to undertake regular health reviews to address identified health issues

4.4 Encourage client to maintain identified care practices to address identified health issues

4.5 Monitor client health regularly to assess impact of treatment(s) and care services

4.6 Provide client with information relevant to promoting and maintaining their health in a way they understand

4.7 Provide client with information about each aspect of the care plan and the rationale for its inclusion

4.8 Initiate action (including referral) as determined by effective decision-making in line with organisation policies based on results of clinical assessment and in accordance with accepted procedures and protocols

4.9 Conduct treatment in accordance with the care plan, organisation policies and procedures and occupational health and safety requirements

4.10 Use medical equipment correctly and maintain in accordance with manufacturer's specifications and organisation policies

4.11 Maintain current, complete, accurate and relevant records for each client contact

5. Review care plan

5.1 Evaluate ongoing health against identified criteria

5.2 Evaluate care plan over time against identified criteria

5.3 Question client and significant others to evaluate effectiveness of health care

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:

Depth of knowledge of anatomy/physiology, pharmacology, microbiology, treatments and associated care services and treatments relevant to client's overall health

Availability, effectiveness and risks associated with identified treatments and associated care services

Depth of knowledge of problems, other treatments or conditions that may precipitate problems; require modification of or result from specific treatments prescribed

Depth of knowledge of other conditions that may occur and require concurrent management

Commonly requested pathology tests and abbreviations, including:

full blood examination and ESR

random and fasting blood sugars

glycated haemoglobin

electrolytes and creatinine

liver function tests

lipid tests

thyroid function tests

iron studies

cardiac enzymes

urinary albumin-creatinine ratio

tests for sexually transmitted infections

microscopy, culture and sensitivities

The clinical significance of abnormal findings on common pathology tests with particular reference to use of medicines

Evaluation criteria and methods

Essential skills:

It is critical that the candidate demonstrate the ability to:

Use high level clinical knowledge and skills in delivering primary health care services to Aboriginal and/or Torres Strait Islander clients, including:

detailed client observation, questioning and assessment to determine the client's health status, issues and needs, including initiating and interpreting the result of common pathology tests

development, documentation, implementation and review of client care plans in collaboration with the client and relevant other care providers or members of a multi-disciplinary team

maintenance of client records and upholding client confidentiality

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:

Assess client condition in relation to health condition and treatments provided, taking prior history into consideration

Recognise circumstances that indicate a need to modify the care plan

Work with other members of multi-disciplinary team to:

determine actions to address changing priorities or potential areas of risk

develop and document care plan

ensure actions determined in the client's care plan are carried out and documented

Refer for further assessment as required

Communicate effectively with client to:

ensure understanding and obtain agreement to care plan

promote and obtain high level of compliance

evaluate effectiveness of and level of compliance with prescribed treatment/care plan

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

Assess client's potential for compliance in following prescribed treatment/care plan

Perform clinical procedures safely and effectively

Use, clean and store clinical equipment safely and effectively

Provide and/or manage treatment, medication and associated services in line with care plan

Apply high-level decision-making and problem solving skills

Revise treatment, medicines in consultation with multi-disciplinary team as required to enhance or maintain overall effectiveness of care plan

Refer client for further assessment, treatment and/or counselling as required

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

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 units:

This unit may be assessed independently or in conjunction with other units with associated workplace application

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

Common haematological, biochemical and microbiological tests include:

Haemoglobin

White cell count

Platelet count

Erythrocyte sedimentation rate

Blood glucose levels (random and fasting)

Glycated haemoglobin

Serum sodium and potassium

Serum creatinine

Serum bilirubin and liver transaminase levels

Thyroid function tests

Serum iron and ferritin

Cardiac enzymes

International Normalised Ratio (INR)

Urinary albumin-creatinine ratio

Genital swab tests for sexually transmissible infections (including microscopy, culture and sensitivities, polymerase chain reaction tests)

Urine microscopy, culture and sensitivity

Pus swab culture and sensitivity

Treponemal serology

Common haematological, biochemical and microbiological test abnormalities include:

Anaemia (including significance of low MCH and MCV)

Leukocytosis

Thrombocytopaenia

Raised ESR

High random or fasting blood glucose

High glycated haemoglobin

Reduced or elevated potassium

Elevated serum creatinine (and implications for drug therapy)

Elevated bilirubin and/or liver transaminases consistent with acute or chronic liver disease (and implications for drug therapy)

Low serum iron or ferritin

Elevated cardiac enzyme levels

High or low INR in relation to anticoagulant therapy

Elevated ACR levels

Positive swabs for STI, the significance of sensitivity patterns and implications for drug therapy

Pyuria, bacterial growth and antibiotic sensitivity results on urine M and C and implications for drug therapy

Pyogenic bacterial growth and antibiotic sensitivity results on pus swabs and implications for drug therapy

Raised specific treponemal antibody and reagin antibody tests

Developing a plan of action includes:

Negotiation/consultation with client, team and others.

Documentation of the care plan.

Client involvement and understanding.

Independent decision-making

Consultation with multi-disciplinary team

Obtaining agreement from the client and/or significant family/community members

Care plan may include:

Clinical treatments (as listed separately)

Referral for further assessment, counselling and/or treatment

Administration of medicines

Monitoring regime

Evaluation of care

In addition to procedures covered at Certificate IV level, treatments may include:

Insertion and management of intravenous therapy

Catheterisation

Insertion of naso-gastric tubes

Complex wound management

Implementation of care plan may include:

Initiation of treatment and monitoring of treatment provided by self and others.

Regular detailed monitoring of impact of treatment on holistic health of client

Evaluation of care plan may include:

High level decision-making about effectiveness of care provided

Consultation with appropriate authorities as required

This unit contains Employability Skills