Reference no: EM133623016

Meet personal support needs

Assessment activity 1

Question 1. Jamie is a client within your service. She is an interesting woman with a number of health issues. Her physical issues include an inability to chew hard foods, she has a small appetite, bilateral hearing aids, back pain that increases if she walks on uneven surfaces and she suffers headaches if she is subject to too much glare when outside. She is a "homebody" and prefers her own company to that of others on most occasions. She enjoys reading and gardening and has a magnificent indoor courtyard full of colourful plants that she tends daily. She has a cat named sooty who she is very fond of as her husband gave it to her as a gift just before he died.

You have noticed the last couple of times that Jamie seems withdrawn and reluctant to speak at all while on other occasions she is talkative and happy to see you, however today she is crying and very distressed, she will not tell you what is wrong. You make her a cup of tea and sit with her to calm her down. She eventually settles but will not share her thoughts with you. You are aware that Jamie and her husband lived in the outback until her husband's death, this is noticeable through the way that she speaks and her preference for simple, time specific activities. You wonder whether her current state is in response to a grief issue related to the change in her culture and social supports.

a) Outline three (3) types of support that you would expect to see on Jamie's support/ care plan.

b) Identify one aspect of Jamie's care and/or support that is outside your scope. Once you have identified this provide an example of who you would refer this to apart from your supervisor.

c) You are planning an outing to the local petting zoo. You know that the clients will be in the sun and glare for a considerable amount of time. Outline the conversation that you will have with your supervisor prior to speaking with Jamie regarding the outing.

d) Jamie requires a minced diet. What does this mean?

e) Considering that Jamie has lived in the outback outline some cultural aspects of her life and preferences that you may be able to utilise to support her ongoing care needs.

f) Identify three physical and sensory needs that Jamie has and outline the considerations that you will put in place to ensure that she has appropriate support.

g) Identify two risks that you might encounter when caring for Jamie.

h) Jamie's current state of upset is concerning as you have never seen her like this before. She is responding to your cup of tea and support, what is your next step in her care?

i) Why is it important to consider Jamie's oral hygiene?

j) Which body systems are affected in Jamie's scenario?

Question 2. Darren is a 24 year old man with an intellectual disability who has some difficulty with motor movements. You are asked to speak with him regarding his support needs. Darren is independent with showering if his towel is set up for him, and can dress himself with minimal assistance if his clothes are set up for him and he has assistance with doing up zips and putting on his shoes. He can make toast and tea for breakfast and a sandwich at lunch time. he has a carer cook for him at dinner time. He requires assistance to get in and out of cars and has some balance issues

Darren's support plan indicates that he requested assistance to get in and out of cars and that he may need falls recovery assistance. You feel that he would be more independent in dressing if he had a long handle shoe horn and a zipper puller.

a) Outline two questions that you might ask Darren in your initial interview to ensure that his person centred care needs are met in a positive way.

b) Why is it important to check with Darren to confirm his ability when discussing his care and support needs?

c) What information would you provide to Darren regarding the aids that you have identified might assist him?

d) Make a file note about the conversation that you have with Darren regarding your thoughts about these aids.

e) Where would you store these documents?

f) Complete the following by indicating the correct sequence number beside the activity when assisting Darren in and out of the car

ELEMENT
Help them to gently lower themselves onto the seat. Protect their head while they do this by holding your hand above it.
Swing back or remove wheelchair footplates if getting up from a wheelchair.
Encourage the person to swing and lift their legs into the car.
If they need assistance to do this lift one leg at a time making sure you bend your knees
Bring the wheelchair or walking aid as close as possible to the car and put the brakes on.
Assist the person to stand by having them move forward from their seat and push-up using the wheelchair armrests.
Never let the person you are assisting hold or hug you around your neck while you are moving them.
Lightly support them to turn round so that the backs of their legs are touching the car seat.
Open the car door window. (The window ledge may be used to help support the person when standing.)
Push the car seat back as far as possible.
Position your body so your backside is against the inside of the door to stop it from swinging shut.
Open the car door fully and ensure that it cannot swing back.

g) Number the sequence for the following steps in falls recovery should Darren have a fall.

Element
Push up to a high kneeling position (on both knees) using the chair for support if necessary;
Bring the left leg through to place foot on the floor (half-kneeling);
The resident rolls onto left (or right) side
Push up into side sitting supported on an extended left arm;
Assume standing position independently or by pushing up with both hands on the chair to stand
The right hand is placed next to the left extended arm and the resident pushes up on both hands, turning the trunk until kneeling on all fours;

SHORT ANSWER QUESTIONS

Question 1 Janine has had a left sided CVA (stroke). She has a residual right sided hemiparesis. She is finding it difficult to attend to her daily showering, grooming and cooking as she is right handed for all tasks. She also has some problems with maintaining her balance when she is tired.

a) Outline how you would encourage Janine to maximise her independence and name three aids that you feel might assist her with her activities.

b) Why is it important to understand Janine's fluctuating levels of fatigue when negotiating her support plan?

c) Why is it important to discuss changes in the clients care and support needs with your supervisor?

Question 2 Fred requires assistance for showering. He uses a shower chair.

a) Outline the environmental assessment that you would undertake prior to working with Fr ed for the first time.

b) Fred is used to only having a weekly shower and using a dish to "splash and clean" his underarms and genitalia on the other days. It is the facilities policy for clients to shower second daily. What will you do?

c) Name two ways of ensuring infection control when showering Fred, particularly when cleaning his genitalia

Question 3. You are requested to assist moving a client up the bed using a slide sheet. Outline the proces for ensuring that this is completed in a safe manner

Question 4. Elly has confided in you that she is having trouble with her mobility. She has asked you to get her some fish oil tablets that she can keep in her draw and take before breakfast. She has asked that you do not tell anyone as she likes you best out of all the carers and knows she can trust you to keep her secret.

a) What would you do, remembering your obligations regarding the client's privacy, dignity and confidentiality?
b) Why?

Part 2 - Facilitate the empowerment of older People

Assessment activity 1
Henrietta is a 79 year old woman. She is a meek woman who does not openly participate in :onversation and tends to shy away from group interactions. She has lived in the remote north west or many years and has experienced social and geographical isolation as her husband was a grazier. She home schooled her six children and only went to town monthly to shop or once a year to the Jcal race day.

The last time Henrietta came to town she fell down the local council stairs and fractured her femur oroken hip). She has had an operation to stabilise the fracture and is now ready to go home. She -as been referred to your service to enable her to transition back into her home.

Henrietta's daughter has offered to stay with her for six months when she gets home, however Henrietta is determined that she will be able to make the transition herself once she is out of hospital and into the community setting that has been arranged for her. Her temporary accommodation is in an assisted living village which her daughter's feel she should remain in rather than returning to the family home in the country. You agree with the daughter's although you know you are unable to express your feelings.

a) Outline how you would ensure that you and Henrietta could have an open and frank discussion regarding her needs and preferences.

b) Why is it important that you respect the information that Henrietta exchanges with you?

c) While talking with Henrietta you are collecting information on her strengths and challenges. Identify two of these and identify how you would incorporate them into her care needs.

d) Henrietta confides in you that she has not seen a doctor regularly and that she is having some continence issues. She asks you not to tell anyone as she knows that this will be the thing that ensures that she will not be allowed to go back home as her daughters are so much against her return. What do you do?

e) It is identified that Henrietta has urge incontinence. Who could you refer Henrietta to if you were asked to make the referral?

f) In the space below, design an information brochure that you could provide to Henrietta to assist her to better understand continence and continence aids.

g) Identify two aspects of continence management that may be physical and social enablers and disablers that may affect Henrietta's quality of life.

h) Why is it important that Henrietta is encouraged to manage her own continence aids?

i) Why is it important that you do not impose your own values and beliefs on Henrietta when she is discussing her continence support needs?

Assessment activity 2
People face many issues as they age, particularly as the population are living longer and refuses to conform to the ageist stereotypes.

There are pressures for people to work longer, there is a tighter economy and many people live in virtual isolation within homes separated from their families due the transience of society.

1. Identify and outline three issues facing older people that relate to this statement.

2. Outline your understanding of the following

Statement
The purpose of residential care
The purpose of respite care
The purpose of home and community care
Referral agencies and networks
www.myagedcare.gov.au
Quality auditing

3. Define the following

Rights based service delivery
Person centred practice
Consumer directed care
Empowerment
Disempowerment
Re-ablement

4. When considering positive ageing why is it important to understand biases and stereotypes when discussing planning options with individual clients?

5. Complete the following table related to ageing and associated disorders.

Change                                     Effect on lifestyle or ADLs                                               Support activity
Eg loss of lung capacity           Decreased endurance to complete activities            Promote deep breathing, have regular rest stops
Loss of skin elasticity / skin disorders / skin cancer
Muscle wasting/ loss of position sense / arthritis / frailty
Changes to eyesight
Changes to hearing
Depression
Diabetes
Deconditioning and heart disease
Incontinence
Neurological disorders
Stroke
Vascular disease
Normal ageing

6. Why is it important to understand differing gender and sexuality issues when caring for people who are ageing?

7. Outline why it is important to consider the clients physical and cognitive abilities when planning programs and activities and delivering services

8. When discussing activities and routines with clients why is it important to discuss potential and actual risk as well as dignity of risk?

9. In the table below is a list of the types of abuse that can occur in the aged, community and disability services. For each type of abuse, provide indicators that could be used to identify that a client is being abused.

Type of abuse Indicator
Physical
Sexual
Psychological
Verbal

10. What do you understand by the term "mandatory reporting" of abuse?

11. Define the following

Terminology Definition
Code of practice
Discrimination
Dignity of risk
Duty of care
Human rights
Privacy and confidentiality
Disclosure
Work role boundaries
Work health and safety

Assessment activity 3

Malcolm lives in a share house. He had been living independently until a recent fall. He now requires assistance with shopping and social activities as he has lost the confidence to walk over long distances. You are Malcolm's designated worker.
You pick Malcolm up to take him shopping, and he is chatty and in quiet good spirits. He realises that his mobility is "a bit shaky" at the moment and he is keen to walk as much as possible. You are asking general questions regarding his living arrangements, when suddenly Malcolm becomes quiet and starts looking out the window. You realise that this conversation is not the best way to establish rapport with Malcolm and decide to change the direction of the conversation.

1 How would you develop a sense of trust and goodwill with Malcolm?

2 Malcolm walks around the shopping centre quiet well. You are providing positive praise, but he keeps mumbling "stupid old thing" this concerns you. You decide that Malcolm would benefit from some reassurance. You speak with your supervisor who advises you to speak with the providers of the local falls prevention program. Research who this is in your local area and identify how you might assist Malcolm to access this support.

3 Why is it important to identify strategies such as rest breaks after short distances and ensuring appropriate footwear for Malcolm?

When you return Malcolm to his room he shows you a picture that he says is dear to him as he was a "rocker in the past" and there is nothing he would like more than to be able to be a part of the picture. The picture is copied below.

You tell Malcolm that you are able to assist him to join the local music group at the Senior Citizens centre. His response is that he has already been ridiculed by the management of the Share House for being a "stupid old fool". He confides in you that he has thought about "just disappearing" as he feels that most of his life choices have been stupid.

4 Identify one strategy that you might use to encourage Malcolm to engage with a music group

5 What is your response to Malcolm's statement that he has thought about "just disappearing"? Who would you report this to?

6 Why is it important to encourage Malcolm to share the responsibility for finding ways to boost his self esteem?

7 Review the case study and identify possible situations where Malcolm's rights have been withheld or there is possible abuse

Reflecting back to your original conversation with Malcolm, you decide that now you know him a little better you will try to re-establish the conversation regarding his living arrangements. You are talking with Malcolm about his room, meals, how he gets his clothes etc. and he responds that he doesn't have to worry about clothing as the manager makes sure he has what he needs as part of the "total service". He confides that manager buys the toiletries and clothing as it is easier for them to know that everyone has appropriate clothing to meet their needs, that the requirements for personal hygiene are met and that they are not appearing to be homeless.

You ask Malcolm how he pays for this "total service" and he explains that as part of the admission process the manager takes banking details and pin numbers for all residents which allows purchases to be made on his behalf. Malcolm says that this is not ideal but he doesn't really have a choice as he needs somewhere to live.

8 Do you find this acceptable? If so why, if not why not? Explain your answer.

9 Malcolm has decided that he might like to live somewhere else and that once he has found alternate accommodation that he would like to make a complaint about how the others in the share house are treated. Identify the agency web site and phone number that should be able to provide information on accommodation choices for aged care.

10 What role might an advocate have in this scenario?

Assessment activity 4

1 Identify three aspects of healthy ageing and the impact/associated risks that they may have on the health and wellbeing of a client.

2 Considering these changes, provide one strategy that an older person could put in place to promote a healthy life style.

3 This is Marion. She is 77 years old and a little "different" to the other older women in her town. She has just moved to town and confides in you that she has been recognised by her past friends as being strong willed and eccentric, with some people saying that her appearance is bizarre for someone her age. This has led to her finding it difficult to make friends. She has a tattooed neck and chest and right arm sleeve, she also has spacers in her ears and several face piercings. Marion dresses in subtle pastels, wears boots and black socks with all her outfits regardless of the occasion.

Marion has become a client of your service. Her support plan indicates that she has had some changes to her psychological wellbeing due to bullying and harassment by her colleagues at the local thrift shop where she used to volunteer. She has made a self referral to your service for psychological support and to find a social outlet that will support her chosen lifestyle. She notes that she has some past behavioural challenges that led to her going to court but that her behaviour is now controlled by medication. She has had little time for social groups in the past but has decided that as she ages she will need the support of others and coming to a new town means it is time for a new start.

a) Outline how you would develop a relationship that was supportive of Marion and her chosen lifestyle choices

b) Marion's goal is to find a social outlet that will support her chosen lifestyle. As she feels devalued after her previous experience how would you support this?

c) Outline any risks that you feel Marion may be potentially exposed to and how you might respond to these.

d) Is it important to be selective regarding the groups that you introduce Marion to? why? why not?

6) Why is it important to validate information, that the client with dementia has given, with family and significant others?

Annette's family are distressed about her accusations of the daughter wanting money as well as the way that she is lashing out at you. They are finding it difficult to come to terms with the changes in Annette's behaviour

7) How would you reassure the family and identify a service that you could refer them to for further information?

Assessment activity 2

1. Identify five common indicators and symptoms of dementia?

2 Define the following
Amyloid plaques
Neurofibrillary fibres
Lewy bodies
Loss of connection between cells and cell death
Alzheimer's Disease
Huntington's disease
Pick's Disease
Vascular dementia
Korsakoff Syndrome
Parkinson's Disease
Younger onset dementia

3 In the table below is a list of impactors and their impacts on the client or their family. Read each impactor and link it to its corresponding impact.

Impactor	Joins to	Impact on client / family
Depression		Loss of self, loss of real person who was a loved one
Loss and grief		Fear of making mistakes, lack of confidence, impacting problems
Anger		Feeling of alones and desperation, confusion regarding direction
Despair		Demotivation, worthlessness, hopelessness
Social embarrassment/ devaluation		Part of grieving process, behaviour of concern
Isolation		Loss of self image, social exclusion
Behaviour of concern		Causes physical harm or potential harm to a person or the environment

4 Dementia is a progressive neurological condition. Research the meaning of this statement and outline your findings below.

5 Outline 4 strategies that you may consider when building an awareness of the person centred needs of the person with dementia.

6 What potential impact/s do you think that the progression of dementia has on the person and the significant others within their lives?

7 What do you understand by the term dignity of risk?

Assessment activity 3

1 Why do you think that it is important to consider a person's culture, personal and historical background, and the impacts that dementia may have upon them particularly as they relate to behaviour management and potential risk?

2 List five signs of abuse and neglect.

3 Who should a person witnessing signs of abuse or neglect report to?

4 What is your understanding of mandatory reporting?

5 Provide a response to each of the following behaviours

Behaviour                                         Response
Physical aggression
Verbal aggression, calling out, repetitive questioning
Agitation, hallucinations
Wandering, pacing, sun downing
Uncooperativeness, inappropriate actions/ reactions

6 What is the function of case conference? What is its role in contributing to team discussion on support planning and review and minimising the impact of behaviours on others?

Assessment activity 4

1 Desmond is a 63 year old male in the early stages of dementia. He is having difficulties with verbal communication. He gets some words wrong, others he does not pronounce correctly and on occasion he mumbles a lot. As a result, he gets frustrated and tends to give up. He is sometimes heard to say 'it doesn't matter' as he walks away. What strategies would you adopt to help Desmond communicate more effectively?

2 Why is it important that your verbal and non-verbal communication is complementary when conveying a message to someone who has dementia?

3 Bill has dementia and is quite agitated because his wife will not bring the children to see him anymore. You are aware that he is not married and has no children. What actions would you take if using validation strategies? explain your answer.

4. Explain what is meant by reality orientation.

5. You are trying to get a client to participate in an activity, but they have no inclination to do so and start arguing about it. They become agitated and this is having a marked effect on the other clients.

a. How would you manage the situation?
b. What could have been done to minimize the chance of the incident happening?

6. Why is it important to use creative, least restrictive approaches to behaviour management for a client with dementia?

7. In the table below is a list of behaviours of concern. List some possible triggers to the following behaviours and identify strategies to promote cooperative behaviour.

Assessment activity 5

1 How do you recognise when your stress level is reaching its limit?

2. What self-care strategies do you use to keep yourself healthy and more resilient to stress?

3. Are there any self-care strategies you would like to adopt? If so what are they? If not, why not?

4. Who could you seek support from if you are feeling overwhelmed by stress?

5. In the space below, design a poster to orientate a new staff member starting work with clients with dementia. Information should be centred around communication requirements, education regarding behaviour management, skills maintenance, the management of behaviours of concern or self care.

Deliver care using a palliative approach.

Assessment activity 1

Palliative Care is the approach that improves the quality of life for patients and their families and friends facing the problems of life threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual.
It has three forms end of life care, specialist palliative services and a palliative approach

1. Define a palliative approach and outline how it is different from a curative approach.

2. A palliative approach should be implemented:
a. When the client's needs are holistic and required over time, not just at the end of life.
b. When the relatives request it
c. When the maintenance of quality of life and comfort is vital
d. Both A and C

Assessment activity 2
Danielle has chronic lung disease and finds it difficult to participate in any activities that are offered to her. Her family are fiercely protective and demand that she is not bothered with requests to be involved in any activities at all. Danielle likes to attend church when she is able to, and has up until recently been attending the Irish club on a Sunday afternoon for poetry reading. She has not attended either activity for the last two weeks as she has had a chest infection and has felt too weak to participate. She is currently on antibiotics to relieve the flu like symptoms. A case conference is held to discuss Danielle's ongoing support and care needs and the families wishes are noted. You are concerned as you feel that Danielle does not have the energy to input into the case conference and you are sure that she will want to return to her activities when she is well enough. She does not have an Enduring Power of Attorney but she does have an Advanced Health Directive indicating that she wishes to undertake antibiotic therapy for chest infections, however she does not want to go to hospital to die.

Danielle has a double dose of antibiotics and is improving. She now wishes to return to her church services and poetry reading activities, however her care plan states that at the families request she is unable to do so.

1. Outline a discussion that you might have with your supervisor to assist Danielle to return to these activities against the families wishes.

2. What role would an Enduring Power of Attorney play in this decision making process?

3. You explain to Danielle that her family have requested that she doesn't attend any activities and confirm that she agreed to this during the case conference. She is annoyed that this was allowed to happen when she was so ill as these activities support her cultural and spiritual preferences and confides in you that her family are not aware that she has any religious beliefs nor that she has connected with the poetry group as she feels connected with her first husband, who was not the father of her children, and was not accepted by the rest of the family, when she hears the poetry being read. What is your response?

4. Once Danielle has confided in you about the connection with her first husband you suspect that she may be feeling some loss regarding this. You also think that the family need to be advised of her wish to reconnect with these social experiences as they have special significance to her. Outline your thoughts regarding discussion that should take place between Danielle and her family to ensure that Danielle's wishes are restored and that the information is dealt with discretely.

5. Outline communication strategies that you might use to ensure that Danielle feels comforted and heard during your conversation.

6. Outline your thoughts on ways that you might facilitate an open discussion regarding this issue between Danielle and her family, ensuring that you maintain her privacy and confidentiality

7. Danielle's Advanced Health Directive states that she wishes to have regular pain relief to ensure that she is as free from pain as possible. She talks to you about the fact that she has breakthrough pain and to control it she has an analgesic rub that the doctor has not prescribed and does not appear in her care plan. It is an over the counter medication and you know that she used to apply it herself when she was able. What would you do? why?

8. You report the breakthrough pain to the medication nurse and she says that Danielle has had her prescribed dose and cannot have anymore. You go back to tell Danielle and notice that she is grimacing and clutching the bed covers. You return to the medication nurse and she states that she is unable to do anything as she does not want to be responsible for Danielle becoming addicted to pain medication. What do you do?

9. Document the above scenario below

Danielle Johnson

10. List three types of alternative pain therapies that you might utilise.

11. Why is it important to identify and monitor the effects of pain relief?

Assessment activity 3
You are a worker at an aged care facility called Hillside. One of the people you care for is Mr Jones. Mr Jones has episodes of short term memory loss and confusion related to diagnosis of dementia. He has been living at Hillside for several years. He has regular visits from his family and also has friends visit occasionally.

Recently Mr Jones has been very unwell and was recently in hospital for pneumonia. During this time certain tests were performed and he has been diagnosed with bowel cancer in a very advanced stage. Since then his condition has deteriorated significantly and as a result his care plan is in need of reviewing. The medical specialists have told him and his family that he may only have a few months left to live.

Since he returned to Hillside he has been unable to attend the Anglican Service and this has agitated him a little. He feels out of touch with his pastor and would like to have the opportunity to be taken to a service or have the Pastor visit him.
Mr Jones has also been unable to have his meals in the dining room and is now required to be fed by a carer in his bedroom. However he is able to give himself a drink if the cup has a straw.

It takes a huge effort for Mr Jones to take showers, but he does prefer this to a bed-sponge. Mr Jones would prefer to have the choice each day depending on how he is feeling. Mr Jones also finds it difficult to read to himself and is a little annoyed at this small loss of independence. He prefers not to read rather than have someone else read his books to him. However, he still likes to play chess with his grandson who visits most weekends and has started listening to talk back radio as he says it takes his mind off what he can and can't do.

The family is worried that his dementia may worsen as he becomes more ill. Mr Jones does have a will but it is out of date. His eldest son has suggested that he take over the role of guardian so he can make the end of life choices on behalf of his father. But, Mr Jones' daughter believes that Mr Jones is still able to make his own end of life decisions and should be given the opportunity to do so.

Mr Jones and his family have had wonderful support from the medical professionals involved and have chosen to take a palliative care approach to Mr Jones' care. However some of the family members disagree on what this means and how they can be involved.
As the main worker for Mr Jones, you have been asked to work with him and his family to help ensure that a palliative approach is taken with Mr Jones

1 Outline why it is important that Mr Jones' holistic needs are considered as a component of his ongoing person centred care, not just in terms of palliative and end of life care.

2 As Mr Jones' affairs are not in order there are steps that must be taken to assure that his rights are protected. What advice would you give to the family, after discussion with your supervisor?

3 The family request a case conference to discuss their father's needs. Identify two areas of discussion that you would undertake to ensure that they understood the meaning and importance of adopting a palliative approach to care.

4 Mr Jones is visited by a friend on a regular basis. He shares with you that they have had a "special friendship" on and off since the death of his wife, and that his family is unaware of the depth of the relationship. You have heard other staff gossiping about the possibility that these two are more than friends and feel that you need to discuss this as a matter of urgency to protect both Mr Jones and his family, as you believe that it is Mr Jones right to retain or share this information from his family.
a. Who would you discuss this with?
a. You are feeling uncomfortable with the idea of the "special friendship" What do you do?

5 Why is it important to show empathy and provide emotional support when discussing issues with both Mr Jones and his family?

Assessment activity 4

Alec is a client living at home. He has a terminal illness and does not wish to die in hospital. His family are adamant that they do not want him to die at home as his wife is elderly and may not cope with the memory of his death in the house where she will be living alone. Alec's wife Alice has not expressed an opinion as every time she tries to speak one of two family members, who have very strong feeling on the matter, answer for her.

1 What would you do?

2 Alec is becoming weaker and there are signs that the end of his life is getting closer. You offer extra support in the form of hospice care however he refuses. How would you ensure that his wishes were upheld?

3 Why is it important that Alec and Alice's wishes, including changes to the care and support and cultural needs and decision making processes are clearly identified and documented on the care plan?

4 Alec has specific rituals outlined in his terminal wishes, this includes Alice assisting with the preparation of the body. Why is it important to know whether Alice is comfortable with this and that Alec has full disclosure regarding her ongoing comfort?

5 Outline two signs of Alec's imminent death and your response to the observations of these signs.

6 Outline your response to the support needs of the family after the death has occurred.

7 Maintaining the dignity of the client during the dying process and immediately after death is important. How are you able to do this?

Short answer questions

1. Outline the influence of the Advance Health Directive and Enduring Power of Attorney in your role, and the supporting care planning for the client

2. Why is it important to ensure that you are working within the policy and procedure of the service as well as your scope of practice when implementing the clients advanced care directive?

3. The changing needs of the client, and the attitudes and impact of family inputs are important at the end of life, particularly during decision making. Who should be involved in the discussion anc documentation regarding the end of life care?

4. There are schools of thought that providing pain relief to clients more frequently under a "PRN or whenever necessary" order as their pain levels increase may hasten death. What are your thoughts on this statement particularly where the Palliative Care Guidelines state that a person must be kept as pain free as possible in the palliative and terminal care stages of the life?

5. Why is it essential that you recognise your grief response and manage it during terminal care of the client, and seek bereavement care and support for your personal feelings of grief?

6. Identify two grief support services that are available to you should you require for your personal feelings of grief.

7. Kubler Ross identified five stages of grief that have no specific order. What are they?

8. Identify three alternative pain relief strategies that may be utilised during palliative and terminal care.

9. Hydration and nutritional requirements should be observed at all times during palliation in order to:
a. Assure the family that life will go on for as long as possible
b. Meet the wishes of the client under their Advanced Health Directive
c. Ensure that maximal condition and comfort of the client is maintained
d. Both b and c