CHCPAL003:Deliver Care Services Using a Palliative Approach

Assessment Process for the Student

If you feel you can demonstrate or have prior skills for this unit, it is recommended that you inform your assessor and apply for Recognition of Prior Learning (RPL) for this.

Overall Assessment

As a student you are required to demonstrate competency for each unit within your chosen qualification.
To achieve competency, follow the steps below:

1. Knowledge Assessment

2. Application Assessment

Conditions of Assessment

All work submitted must be your own work. Should you add content from other sources, please make sure this is referenced in your assessment.

Case Studies

Page 10 – Question 2 (Expanded as you requested)

2. What decisions do William and Gladys need to make as William’s illness progresses?

They need to decide on the future care settings, specifically whether William prefers to stay at home with increased services or move to a hospice or hospital. They must also finalize legal documents for end-of-life decision-making.

Additional points (as you requested: “what else will need to be discussed? think about other care needs”)

They also need to discuss:

• Pain and symptom management options as his illness becomes more complex.

• Medication plans, including managing side effects and when to switch or increase medication.

• Mobility and equipment needs, such as hospital beds, wheelchairs, or hoists if he stays at home.

• Home care service levels, including nursing visits, personal care workers, and respite support for Gladys.

• Emergency planning, including when to call the palliative care team and when hospital transfer is needed.

• Psychological and emotional support needs for both William and Gladys.

• Spiritual or cultural care needs, if relevant.

• Financial and practical arrangements, including organising bills, paperwork, or support services.

• After-death wishes, such as funeral planning or cultural preferences.

Michelle’s Story

Michelle, a 38-year-old who lives with her partner Peter and two children. She has a recurrence of breast cancer with metastatic deposits on her spine, managed with palliative radiation therapy and palliative chemotherapy. As Michelle’s condition deteriorates, palliative care is introduced by the cancer care team, with support from the palliative care nurse to help prepare and support Michelle and Peter for Michelle’s end-of-life care at home.

Transcript from Video

Michelle:
It was such a shock to hear the doctor say that I had breast cancer.
That was two years ago now, my whole world turned upside down. The initial treatment was really full on, not to mention losing my hair and everything that goes along with chemo, but I got through it all. The cancer responded well to the chemo, and I’m feeling great. My life’s balanced again, Pete and I are happy, the kids are great and they’re doing so well at school. I love my job, teaching is fantastic, and my boss was brilliant. Everyone has been so supportive.

A month or so ago I noticed that I had this nagging cough and lately I’ve been feeling a bit breathless. I did wonder if the cancer had come back, they said it might, but no, I’ve just been overdoing it. The kids have been sick; you know it’s just a viral thing. Anyway, I went to see my GP last week just to have it checked out. She did a whole load of tests. I’m just waiting now to hear back about the results. I’m sure everything will be alright.

1. What are some of the fears and concerns that Michelle is experiencing at this time?

S NS: Michelle fears that her cancer has returned, despite her attempts to rationalize the symptoms as some minor problems. She is deeply concerned of losing her balanced life with her family and her job.

2. What are your immediate personal reactions to Michelle’s situation?

S NS: My immediate reaction would be sadness and sense of unfairness given her young age and high hopes for life. I react this way due to feeling empathic about her situation and the emotional impact of a life-limiting disease on a family.

Michelle’s Story – Receiving Distressing News

Michelle’s CT scan shows that her cough is caused by the spread of the cancer to her lungs. She also has evidence of metastases in her liver. She attends an appointment with Dr Meredith North, her medical oncologist.

Transcript from Video

1. What are the main sources of distress for Michelle and Pete at this time?

S NS: Michelle is distressed with the spread of the disease and the loss of her healthy, balanced life. Pete is distressed by the lack of cure and struggles with devastating news, wanting to fight to solve the problem.

2. How aware of her symptoms and possible diagnosis does Michelle appear to be?

S NS: Michelle had noticed symptoms like coughing and breathlessness, but she attributed them to minor issues, optimistically downplaying the possibility of recurrence. She appears to be in some denial about the severity of her condition.

3. What specific communication strategies did Meredith use?

S NS: Meredith showed empathy using words like “I wish it was under better circumstances”, acknowledging past efforts, giving direct clear information, and offering immediate next steps.

4. What additional strategies could the oncologist use?

S NS: The oncologist could explicitly pause to allow Michelle and Pete to process the news before moving to treatment. Offering a support person or follow-up sooner might help.

What could be given to them during the consult so they can take information away and read/digest what has been said

Michelle’s Story

1. What are the main sources of distress for Michelle at this time?

S NS: Michelle is distressed by the continued spread of her illness to new areas like the spine. She is also scared about how her treatment will turn out and the uncertainty the process holds.

2. What communication strategies did Jeremy use?

S NS: Jeremy used a reassuring tone and empathetic communication. He acknowledged feelings, explained “palliative”, differentiated it from last treatment, and showed equipment.

3. What additional strategies could Jeremy use?

S NS: Jeremy could have checked Michelle’s emotional state before giving detailed information. Offering printed materials of the treatment plan would help her recall the conversation.

Michelle’s Story – Michelle’s Illness Progresses

1. Main sources of distress

S NS :Michelle is distressed by worsening breathlessness and cancer spread. Pete feels helpless and fears Michelle’s imminent death.

2. Communication strategies used by Meredith

a) Responding to distress
Validated exhaustion, acknowledged hard news, shifted to management plan.

b) Introducing palliative care
Explained that palliative care is not only for dying, but for support and symptom management.

3. Additional strategies
The oncologist could provide a warning before the prognosis. Offer to involve additional family for support.

Michelle’s Story – Raising Concerns

1. Concerns about discussing prognosis with children
Michelle and Pete fear upsetting the children and are unsure how to explain the worsening condition.

2. Suggestions Dawn provided

S NS
Be honest, start by asking what they know, maintain routine, express love, create a scrapbook.

3. Communication strategies Dawn used
Empathy, reassurance, practical advice, offering team support.

4. Additional strategies
Provide child-friendly resources, schedule follow-up after talking with children.

Palliative Care Nurse Interaction

Palliative care nurse: Alright.

1. What does Michelle state is important to her at this time?
Michelle states that her family and friends are the most important, providing her with daily support and strength.
She values their constant and unwavering support and how easy it is to connect with them.

2. What specific strategies does James use to explore the meaning of illness and dying to Michelle?
James uses open-ended questions like “What is it that scares you the most?” and “What is important to you right now?”. This encourages Michelle to articulate her thoughts and feelings about the inevitable end to life.

3. What specific strategies does James use to explore the meaning of illness and dying to Michelle?

a) Michelle’s question: “I am going to die soon, aren’t I?”

James directly acknowledges Michelle’s impending death by validating her question. He then immediately explored her fear by asking, “What is it that scares you the most?”

b) Michelle’s questions about dying?

James provided factual, empathetic information about physical signs of approaching death, like fatigue and drowsiness. He also reassured her about managing symptoms like medication administration if swallowing becomes difficult.
What else is used by James?

4. What other strategies would you recommend to:

a) Explore the meaning of illness and dying to Michelle?

I would use more reflective listening to validate her unspoken fears and help her explore them. Offering to facilitate a conversation with specific loved ones, like Pete or Meg, could also be beneficial.

b) Respond to Michelle’s questions about dying?

I would offer to bring in other team members like a social worker or a spiritual care provider if it aligns with her needs. Providing information about grief support for her family would also be valuable.
What are the strategies you would use to answer questions about dying.

Michelle’s Story 

Assessment Questions

1. What are Pete’s main concerns at this time?

S NS: Pete is primarily concerned about the declining physical state of Michelle, including her lack of eating, drinking and noisy breathing. He feels helpless and is worried about how to take care in the best way possible during her final days.

2. How does James help Pete deal with these concerns?

S NS: James provides clear, empathetic explanations for Michelle’s symptoms, like noisy breathing, reassuring Pete that they are not distressing for Michelle. He offers practical solutions like repositioning and ongoing support for the family.

3. What other strategies would provide emotional support to Pete, Michelle and their family at this time?

S NS: Offering bereavement counselling referrals for Pete and the children would provide crucial emotional support after Michelle’s passing. Facilitating a visit from a child life specialist could help Ben and Elyse process their grief.

4. What simple terms did James use to help describe the terminal phase and how could he have improved his interactions?

S NS: James used phrases like “body is shutting down” and “quietly stop breathing.” He could have improved by explicitly asking Pete what he understood first and by offering to provide information to the children directly if appropriate.

5. These conversations can be difficult for health professionals. Consider how you would respond if you became emotional or teary.

S NS: If I become emotional, I would acknowledge my feelings briefly, perhaps by saying, “This is very difficult to witness.” I would then refocus on the patient and family, ensuring their needs remain the priority, and take a moment to compose myself if needed.

Herbert’s Story

1. What were some of the common symptoms Herbert reported that led to his diagnosis?

S NS: Herbert reported feeling much more tired than usual and struggling to catch his breath, even with minimal activity. He also needed to sleep on extra pillows to breathe comfortably when lying down.

2. How have Herbert’s symptoms affected his quality of life and ability to function?

S NS: His symptoms forced him to cut his holiday short due to increased fatigue and breathlessness. This progression affects his ability to maintain his active retiree lifestyle, limiting his activities.

Herbert’s Story 

1. What observations indicate deterioration in Herbert’s illness?
Herbert reports feeling “not good,” experiences significant breathlessness with simple activities, constant unrefreshing fatigue, and poor appetite with little pleasure in eating.

2. Consider Herbert's illness over 6 months:

a) Evidence-based alignment

Herbert’s worsening breathlessness, fatigue, and poor appetite are consistent with advancing heart failure.

b) Influencing factors

His underlying systolic heart failure and his “man of action” personality influencing overexertion.

3. Common symptoms with Class III heart failure

4. Herbert’s psychosocial needs

5. Pathophysiology

a) Fatigue

c) Breathlessness

Herbert’s Story – Illness Progresses

1. What symptoms does Herbert describe?

2. Interventions for Breathlessness

3. Herbert’s concerns about morphine

4. Other pharmacological agents

Bassam’s Story

1. Pain Assessment Table

2. Influence of perceptions on symptom experience
How does he describe his pain

3. Sources of comfort

4. Using physical assessment for pain

5. Why oral route is preferred

6. Indications for subcutaneous route

7. Importance of complementary therapies what else?
what pain assessment tool, and how would you use it?

Bob’s Story

1. What types of loss does Bob discuss?
Loss of job, career, breadwinner role, responsibilities.

2. How did he react to these losses?

Assessment Requirements Summary

The assessment aimed to evaluate the student’s competency in delivering care services using a palliative approach. Key requirements included:

1. Knowledge Assessment – Demonstrate understanding of palliative care principles, communication strategies, symptom management, and psychosocial support.

2. Application Assessment – Apply knowledge to real-life case studies, including:

   • Decisions for care planning (e.g., William and Gladys).

   • Understanding patient fears and concerns (e.g., Michelle, Herbert, Bassam, Bob).

   • Communication and empathy strategies for patients and families.

   • Symptom assessment and management, including pain, breathlessness, and fatigue.

   • End-of-life planning and family support.

3. Conditions of Assessment – All work must be original or correctly referenced if sourced externally.

4. Case Study Analysis – Multiple patient stories (Michelle, Herbert, Bassam, Bob) were used to test comprehension of palliative care interventions, psychosocial considerations, and ethical decision-making.

Assessment Approach by the Academic Mentor

The Academic Mentor guided the student through a step-by-step process:

1. Initial Orientation

   • Reviewed assessment requirements and learning objectives.

   • Explained the difference between Knowledge and Application Assessment.

   • Highlighted the importance of reflecting empathy and professional communication.

2. Case Study Analysis

   • William and Gladys: Guided the student to identify critical decisions regarding care settings, legal documentation, symptom management, home support, emergency planning, and financial/after-death arrangements.

   • Michelle’s Story: Step-by-step analysis of each transcript:

     • Identified fears, concerns, and emotional responses.

     • Noted effective communication strategies by healthcare professionals (e.g., Meredith, Jeremy, James).

     • Suggested additional strategies for addressing emotional, spiritual, and family needs.

   • Herbert, Bassam, Bob: Focused on symptom identification, impact on quality of life, interventions, and psychosocial support needs.

3. Knowledge Integration

   • Explained underlying principles of palliative care, symptom pathophysiology, and pharmacological/non-pharmacological interventions.

   • Encouraged linking theory to practice in real-life scenarios.

4. Reflective and Analytical Guidance

   • Prompted the student to reflect on personal reactions, ethical dilemmas, and professional conduct.

   • Guided the student to propose additional strategies, e.g., involving family members, using educational materials, and planning bereavement support.

5. Documentation and Referencing

   • Ensured answers were clearly structured (S/NS format) and referenced as needed.

   • Advised on clarity, conciseness, and alignment with assessment instructions.

Outcome Achievement

Through this structured guidance, the student:

• Successfully analyzed each case study, identifying key issues in palliative care.

• Demonstrated understanding of patient-centered communication and empathy.

• Applied theoretical knowledge to practical scenarios, including symptom management and psychosocial support.

• Reflected on personal and professional responses in emotionally challenging situations.

• Produced original, well-structured responses aligned with competency requirements.

Learning Objectives Covered

1. Understanding and applying palliative care principles.

2. Effective communication with patients and families about prognosis and end-of-life issues.

3. Recognizing and managing physical symptoms such as pain, breathlessness, fatigue, and medication side effects.

4. Identifying psychosocial, spiritual, and cultural needs of patients and families.

5. Facilitating care planning, including legal, financial, and emergency considerations.

6. Reflecting on professional practice and maintaining emotional resilience.

7. Using evidence-based approaches for symptom management and supportive care.

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