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CHCPAL003 Learner Guide

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351 views59 pages

CHCPAL003 Learner Guide

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manpreet.satinder

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CHCPAL003

PROVIDE INDIVIDUALISED
SUPPORT

LEARNER GUIDE

Version 1.0

RTO Works
www.rtoworks.com.au
[email protected]

© 2023 RTO Works

This resource is copyright. Apart from any fair dealing for the purposes of private study, research, criticism or review as
permitted under the Copyright Act 1968, no part may be reproduced by any process without written permission as
expressed in the RTO Works License Agreement.

The information contained in this resource is, to the best of the project team’s and publisher’s knowledge true and
correct. Every effort has been made to ensure its accuracy, but the project team and publisher do not accept
responsibility for any loss, injury or damage arising from such information.

While every effort has been made to achieve strict accuracy in this resource, the publisher would welcome notification of
any errors and any suggestions for improvement. Readers are invited to write to us at [email protected].

Community Services Works is a subdivision of RTO Works. It is a suite of training and assessment resources developed
for the Community Services Industry.

RTO Number: 122208 CRICOS Number: 03373B Revision date: 04 Jul 2024
Next Review: 04 Jul 2025 Email: [email protected] Revision: 1.0
© Job Training Institute Website: www.jti.edu.au Page 2 of 59
Contents
Overview ................................................................................................................................................. 4
Topic 1: Applying principals and aims of a palliative approach .............................................................. 5
Quiz time! .............................................................................................................................................. 16
Topic 2: Supporting and respecting individual needs and preferences ................................................ 19
Quiz time! .............................................................................................................................................. 29
Topic 3: Advance care directives and end-of-life strategies ................................................................. 33
Quiz time! .............................................................................................................................................. 46
Topic 4: Emotional responses self-care strategies ............................................................................... 50
Quiz time! .............................................................................................................................................. 55
Learning activities ................................................................................................................................. 58

RTO Number: 122208 CRICOS Number: 03373B Revision date: 04 Jul 2024
Next Review: 04 Jul 2025 Email: [email protected] Revision: 1.0
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Overview
Application of the unit
This unit describes the performance outcomes, skills and knowledge required to provide care for
people with life-limiting illness and those within the normal ageing process using a palliative approach,
as well as end-of-life care.
This unit applies to workers in a residential or community context. Work performed requires some
discretion and judgement and is carried out under regular direct, indirect or remote supervision.
The skills in this unit must be applied in accordance with Commonwealth and State/Territory
legislation, Australian standards and industry codes of practice.
No occupational licensing, certification or specific legislative requirements apply to this unit at the time
of publication.

Learning goals
• The student is able to apply principles and aims of a palliative approach when supporting people.

• The student is able to respect the person’s preferences for quality-of-life choices.

• The student is able to follow the person’s advance care directives in the individualised plan.

• The student is able to respond to signs of pain and other symptoms.

• The student is able to follow end-of-life care strategies.

• The student is able to manage own emotional responses and ethical issues.

Note to the student:

The content of this learner guides includes difficult and confronting material. It is important to
consider and be respectful of the wellbeing and lived experiences of your fellow students, your
trainers/assessors and colleagues. Some content may include behaviours or situations that may
bring up difficult or unexpected reactions for you and others.
If you feel that the nature of the content in your learning materials may cause concerns for you or
for someone else, speak to your trainer/assessor or to someone else at your RTO. They will
work with you to ensure that you are supported to complete your learning and assessment in a
way that best meets your needs while still meeting the requirements of the unit of competency.

1.1. Introduction
This topic is an introduction to palliative care. It looks at the philosophy and principles of palliative
care, the role of the care worker and legal and ethical considerations which must be taken into
account.
Learning outcomes include the following:

• Understanding the philosophy, principles, benefits and scope of palliative care.

• Understanding the job role and scope of the support worker in palliative care.

• Understanding the legal and ethical considerations and requirements in palliative care.

1.2. The principles and aims of a palliative approach

Palliative care is a specialised medical care approach that focuses on improving the quality of life of
people who are suffering from serious or life-limiting illnesses. The goal of palliative care is to lessen
the symptoms and stress of the illness for the person, including physical, emotional and spiritual
distress and optimise their quality of life.

Palliative care and end-of-life care

Palliative care is not limited to end-of-life care and can be provided at any stage of a serious illness. It
is often provided alongside curative treatments and can help people manage the symptoms and side
effects of those treatments. It aims to improve the quality of life of people with serious illnesses by
addressing their physical, emotional, social and spiritual needs. It provides relief from symptoms and
stress and helps clients and their families cope with the challenges of living with a serious illness.
Palliative care can be provided alongside curative treatments and is not meant to replace them. In
fact, studies have shown that people who receive palliative care alongside curative treatments may
have better outcomes, including improved quality of life, symptom control and satisfaction with care.
While palliative care can be provided at any stage of a serious illness, it is often underutilised and
misunderstood. Clients and families should be aware of the availability of palliative care and the
benefits it can provide. Healthcare providers can also play a key role in referring people to palliative
care services when appropriate.

RTO Number: 122208 CRICOS Number: 03373B Revision date: 04 Jul 2024
Next Review: 04 Jul 2025 Email: [email protected] Revision: 1.0
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Palliative care philosophy
Dame Cicely Saunders was a British nurse, social worker and physician who is widely considered the
founder of the modern hospice care movement. She dedicated her life to improving end-of-life care for
people with serious illnesses, such as cancer.
Saunders believed in the importance of palliative care, which she defined as ‘total pain’ – physical,
emotional, social and spiritual suffering. She emphasised the need for interdisciplinary care that
addresses the person’s needs as an individual, not just their illness.
Palliative care philosophy involves providing compassionate, holistic care to clients and their families
facing serious illnesses. It focuses on improving quality of life by managing pain and other symptoms,
addressing emotional and spiritual needs, and supporting caregivers. It emphasises person-centred
care, ongoing communication and collaboration among the healthcare team, and bereavement
support for families. The goal is to relieve suffering and enhance the overall well-being of clients and
their loved ones and ensure their spiritual, cultural, physical, social and emotional needs are met.

Image by Dzmitry Dzemidovich on iStock

A person-centred approach
Palliative care is a person- and family-centred care and support service which follows a person-
centred approach to care. This means looking at each client as an individual with their own
preferences, strengths, backgrounds and beliefs. A person-centred approach makes the client the
centre of the process, identifying their individual needs and making choices about what, who, how and
when they are supported.

• treating each client as an individual with unique requirements, strengths, beliefs, preferences and
abilities

• consulting with the client, their family, carer or other significant person in relation to any specific
physical, sensory or cultural needs or preferences they may have

• ensuring their basic rights are upheld and that the client can be involved in the planning and level
of participation to meet their needs as they choose

• working with the client to determine the actions and activities involved in supporting their needs

• promoting their independence and the right to informed decision making.

Person- and family-centred care means that the needs of the client and their family form the basis of
the care planning arrangement. Depending on the client and their family’s needs, palliative care can
be provided at the client’s, hospital, in a hospice or at a residential care facility.
The place of palliative care depends on the following dynamics:

• The nature of a client’s illness and the extent of care they need.

• The amount of support available to the client from their families and the community.

• If the client has somebody in their home who can provide physical care and support for them.
As a client journeys towards their end of life, they and their families need support to cope with the
distress. They need to know that they are not alone and that they have the support and care that will
help them manage their pain and anguish. They must seek advice from their doctors to be able to
gain access to palliative care and support from respective organisations. A palliative care and support
program will include a range of specialists and allied health professions such as:

• general practitioner

• pain specialist

• physiotherapist

• speech therapist

• social workers

• personal support workers

• counsellors.

Palliative care principles

In Australia, the principles of palliative care are guided by the Palliative Care Australia Standards (5th
edition), which outlines the following principles:
1. Person-centred care: the client’s physical, emotional, social, cultural and spiritual needs are
central to care and care is tailored to their individual needs and preferences.
2. Comprehensive care: palliative care is a comprehensive approach that addresses the client’s
physical, psychological, social, cultural and spiritual needs, as well as those of their family and
carers.
3. Teamwork: palliative care is provided by an interdisciplinary team of healthcare professionals,
working together to provide holistic care and support.
4. Communication: clear and honest communication is essential, and the client and their family are
involved in decision making and care planning.

RTO Number: 122208 CRICOS Number: 03373B Revision date: 04 Jul 2024
Next Review: 04 Jul 2025 Email: [email protected] Revision: 1.0
© Job Training Institute Website: www.jti.edu.au Page 7 of 59
5. Continuity of care: palliative care is provided across different settings and care is coordinated to
ensure continuity and avoid fragmentation.
6. Accessibility: palliative care is available and accessible to all people who need it, regardless of
their age, diagnosis, cultural background or location.
7. Flexibility: palliative care is flexible and responsive to the changing needs of the client and their
family.
8. Quality improvement: palliative care is continually evaluated and improved to ensure the best
possible outcomes for the client and their family.
These principles are underpinned by a human rights-based approach, which recognises the inherent
dignity and worth of all people and their right to quality care and support at the end of life.

Activity 1.1. Read

Scope of palliative care

Although palliative care provides care for those with life-limiting illnesses and does not provide a cure,
it still has enormous benefits. It can make a significant positive difference for individuals and families
facing serious illness and it can help individuals with these illnesses and their families in many ways.

• Pain and symptom management: palliative care focuses on the prevention and relief of pain and
other distressing symptoms, such as nausea, fatigue and shortness of breath. This can help
individuals to feel more comfortable and improve their quality of life.

• Improved quality of life: palliative care aims to improve the overall quality of life for individuals
and their families, by addressing physical, psychological, social and spiritual needs.

• Psychological and emotional support: palliative care provides support for individuals and families
who may be experiencing anxiety, depression, grief or other emotional and psychological
challenges.

• Advance care planning: palliative care facilitates conversations about future care preferences
and goals and helps individuals and families make informed decisions about end-of-life care.

• Spiritual and existential support: palliative care recognises the importance of spiritual and
existential issues, such as meaning and purpose and provides support for individuals and
families to explore these issues.

• Family and caregiver support: palliative care provides support for families and caregivers,
including practical support and respite care, as well as emotional support and counselling.

• Bereavement support: palliative care provides support for families and caregivers before and
after the death of a loved one.

Benefits of palliative care

There are several benefits of palliative care. One principal aim is to raise awareness in the community
to allow others to feel comfortable enough to talk about death and how palliative care can improve the
quality of life for people who have a life-limiting illness. As well as this, some vital desirable outcomes
or benefits of using palliative care approaches are as follows:
1. The palliative care systems allows clients, families and carers to talk about death, discuss the
needs and quality care for those with a limited life and to plan the appointment of guardians,
create wills and make advance care plans.
2. Clients, families and carers are well informed about the illness and treatment, care and support
options, which is customisable as client’ circumstances change.
3. Clients and families have access to resources and support in settings suitable for their needs.
4. A holistic clinical, medical and socially integrated systems mean that clients and their family have
an opportunity to access advance care models and negotiate the goals of care plans to prioritise
the quality of life for all loved ones.
5. Clients, families and carers can receive well-timed and quality care in their chosen appropriate
settings as per their needs assessment, such as pain management, necessary aid equipment,
grief and bereavement support, psychological and spiritual support.
6. A well-coordinated and supported transition between care arrangements such as hospitals,
respite, home or residential care.
7. Access to health services, professionals and specialists that can provide the best available
treatment and care.
8. Timely response to clients who are dying imminently: clients and carers have access to support
24 hours a day, every day.
9. Families and carers can access grief and bereavement support as they grieve the loss of their
loved ones.

RTO Number: 122208 CRICOS Number: 03373B Revision date: 04 Jul 2024
Next Review: 04 Jul 2025 Email: [email protected] Revision: 1.0
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10. The feedback from clients, families and carers on their palliative care experiences is used to
improve care coordination and integration of care services as well as government planning,
funding and policy development for the palliative care program.

Activity 1.2. Watch

Watch the following video from a palliate nurse.

Dying to talk – Connie Johnson.
Video: https://www.youtube.com/watch?v=JUKEftLusZQ (1:50)
Reflection: Now consider the following scenario: Achieving a ‘good death’.
Put yourself at age 73 years with an illness that cannot be cured.
Write a list of the most critical issues for you in achieving a ‘good death.’

Activity 1.3. Read

Refer to the following websites for more information on palliative care and support in Australia:
My Aged Care: Types of Care.
Website: https://www.myagedcare.gov.au/types-care
Palliative Care Australia.
Website: https://palliativecare.org.au/
Take any notes to summarise what you have read and keep for future reference.

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Next Review: 04 Jul 2025 Email: [email protected] Revision: 1.0
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1.3. Your role in palliative care
You can make a world of difference to a client who is approaching end of life.
Lots of workers feel satisfied at being able to support clients with terminal illnesses and caring for
them at their end of life. However, some carers become concerned about matters such as: having the
right skills to care for dying clients, answering questions about death, communicating with a dying
person, and so on. Training and working with a palliative care specialist team and building skills and
experience over time can help overcome these concerns.
Working in palliative care and support roles requires you to understand and apply the principles and
aims of a palliative approach when supporting individuals. Your role is to provide compassionate care,
support and communication to the client and their family and to work collaboratively with the palliative
care team to ensure the best possible care for the client.
Here are some of the key job roles that a worker would need to carry out:

• Recognise the holistic needs of the client over time. Palliative care is not just about end-of-life
care but extends over time and therefore you should recognise the holistic needs of the client,
including their physical, emotional, social and spiritual needs.

• Encourage and support the client, carers and family to express their needs and preferences and
report this information to your supervisor.

• Communicate regularly with the client, family and carer about the client’s quality of life, pain and
comfort and report this information to your supervisor.

• Recognise the importance of the family and carers as an integral part of the care team and
ensure that they have the information and support needed. This could mean ensuring they have
all the medical information they need, supporting them emotionally or providing them with
external support services.

• Completing documentation in a timely, accurate and objective manner according to

organisational policies and procedures

Activity 1.4. Read

Read this booklet from Care Search, which provides information and support for palliative
clients, families and carers.
Palliative care support for clients, carers and families.
Website: https://www.caresearch.com.au/Portals/20/Documents/Booklet/CareSearch-
Understanding-Palliative-Care-Booklet.pdf

RTO Number: 122208 CRICOS Number: 03373B Revision date: 04 Jul 2024
Next Review: 04 Jul 2025 Email: [email protected] Revision: 1.0
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Recognising scope of your job role
Palliative care is a complex and multidisciplinary field that requires a team approach to address the
diverse needs of individuals with serious illnesses and their families. Support workers in palliative care
play a key role in this team by providing practical and emotional support to the client and their family.
However, workers may encounter situations where they are not equipped to handle or have limited
knowledge or skills to address. In such cases, it is important for workers to recognise these limitations
and refer the issues to their supervisor or other members of the palliative care team.
For example, workers are not qualified to make medical decisions for the client, so if the client or their
family needs help with medical decision making, the worker should refer them to the appropriate
healthcare professional, such as a doctor, nurse or relevant specialist.

Always follow your organisation’s policies and procedures, code of conduct and your scope of
work or job description as your point of reference for delivering quality care for your clients and
their loved ones. If you have any concerns, you must seek clarification from your supervisor or
manager.

Activity 1.5. Watch

Watch the following video about the palliative approach.

Shift Your Care to a Palliative Approach.
Video: https://www.youtube.com/watch?v=sABo3gZoAcM (04:30)
Reflect: What is the palliative approach? Think about how you can support clients using a
palliative approach?

Image by Kampus Production on Pexels

1.4. Legal and ethical considerations

Working in palliative care in Australia requires a deep understanding of legal and ethical
considerations to provide compassionate care to clients at the end of their lives.

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Dignity of risk
This principle recognises that individuals have the right to make their own decisions, even if those
decisions may result in risks or harm to themselves. In the context of palliative care, this means that
clients have the right to make decisions about their own care, even if those decisions may result in a
shorter lifespan.

Duty of care
Palliative care providers have a legal obligation to provide care that is of a reasonable standard and to
act in the best interests of their clients. This includes ensuring that clients are not subjected to
unnecessary suffering and that their wishes regarding end-of-life care are respected.

Activity 1.6. Watch

Watch the following video.

What is duty of care? Duty of care vs dignity of risk.
Video: https://www.youtube.com/watch?v=Nf4Y7v-SLtc (09:04)
If you have seen this video during your study of another unit, you can either skip it or watch it
again to refresh your memory.

Human rights
Clients receiving palliative care have a right to be treated with dignity and respect and to have their
cultural, religious and spiritual beliefs taken into account in their care. The rights of people from
discrimination and breaches of their human rights are protected by law such as the Australian Human
Rights Commission Act 1986, Age Discrimination Act 2004, Disability Discrimination Act 1992, Racial
Discrimination Act 1975 and Sex Discrimination Act 1984.
You will be familiar with these Acts and their requirements from other units of study in your course. If
you need to refresh your memory, you can return to the legislation-specific unit of your course.

Privacy, confidentiality and disclosure

Palliative care providers have a duty to maintain the privacy and confidentiality of their clients’
information, while also ensuring that relevant information is disclosed to other members of the care
team as necessary. Organisations have strict policies on the collection, use and storage of client
information and maintaining the security and confidentiality of client information is a key responsibility.
This legislation is covered in the Privacy Act 1988 and in the Australian Privacy Principles, which is a
part of the Privacy Act.
Under the Freedom of Information Act 1982 clients or their legal representatives also have a right to
read anything that you have written about them (the Act applies to information specifically held by
government departments and agencies).

Activity 1.7. Do

Research more about Australian legislation regarding human rights, discrimination and privacy
Acts using the links above.

RTO Number: 122208 CRICOS Number: 03373B Revision date: 04 Jul 2024
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Work role boundaries, responsibilities and limitations
When working in palliative care, it can be difficult to compartmentalise your emotions and feelings for
your clients and their families and carers. You must, however, adhere to role boundaries,
responsibilities and your scope of practice to ensure you can provide the best possible care and
support for your clients, their families and carers. Let’s look at some ways in which you can do this.

• Scope of practice: You must understand your scope of practice within the palliative care setting.
This includes knowing what services you can provide and what you cannot provide – you will
need to refer to your supervisor when you are unable to provide specific types of care and
support.

• Interdisciplinary teamwork: Palliative care often involves a multidisciplinary team of healthcare

professionals, including doctors, nurses, social workers, counsellors, and others. Always respect
the roles and expertise of other team members and collaborate effectively to address your
clients’ needs comprehensively.

• Person-centred care: Focus on your clients’ preferences, values and goals throughout their end-
of-life journey. Respect their autonomy and involve them in decision making to the greatest
extent possible.

• Ethical considerations: Understand and adhere to ethical principles and guidelines when
providing palliative care. This includes ensuring informed consent, confidentiality and maintaining
professional boundaries.

• Communication and family involvement: Maintain clear and open communication with your
clients and their family members, and their carers where applicable. Address their concerns,
provide honest information and involve them in care planning, ensuring they are supported
emotionally during the process.

• Physical care: Provide appropriate care to manage your clients’ symptoms and pain effectively.
Depending on the scope of your role, this could involve administering medications, wound care
and other interventions as needed.

• Psychosocial support: Offer emotional and psychological support to your clients, their families
and their carers, helping them cope with the challenges they face during this time.

• Cultural competence: Always remain sensitive to cultural and religious beliefs and practices,
ensuring care is provided in a culturally appropriate manner. Not all cultures approach end of the
life the same way, and some express their emotions different to others.

• Advance care planning: Support your clients in making decisions about their future care through
advance care planning. Help them express their wishes regarding treatment and end-of-life care
in advance directives. Do not judge their decisions or express disapproval if they do not align
with your own values and beliefs.

• Grief and bereavement support: Acknowledge the grieving process and offer support to families
and loved ones after your clients have passed.

• Legal and regulatory considerations: Stay informed about relevant laws, regulations and policies
related to palliative care to ensure compliance and avoid any legal issues.

• Self-care: Working in palliative care can be emotionally demanding. You must take care of your
wellbeing and seek support when needed to avoid burnout.

State/territory legislation relating to voluntary assisted dying

In some Australian states and territories, legislation has been introduced to legalise voluntary assisted
dying (VAD) under certain circumstances. Palliative care providers need to be aware of the legal and
ethical considerations surrounding VAD and how it may impact their practice.
RTO Number: 122208 CRICOS Number: 03373B Revision date: 04 Jul 2024
Next Review: 04 Jul 2025 Email: [email protected] Revision: 1.0
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Activity 1.8. Read

Read the End of Life Directions for Aged Care (ELDAC) website for more information about state
and territory law regarding voluntary assisted dying (VAD).
Website: https://www.eldac.com.au/tabid/5757/Default.aspx

Congratulations! You have reached the end of Topic 1.

To review what you’ve learnt, answer the following questions before continuing to Topic 2.

1. True or false?
Palliative care is always end-of- a. True.
life care, which is given when no
other treatments can be used. b. False.

Go to 1.2 for help answering.

2. Select all appropriate options. a. Person-centred.

Identify principles of palliative b. Flexible.

care. c. Comprehensive.
Go to 1.2 for help answering. d. Inaccessible.

a. Provide compassionate care, support and

communication to the client and their family
3. Complete the sentence. and to work collaboratively with the palliative
In palliative care, a support care team to ensure the best possible care.
workers role is to... b. Provide medical advice and information to the
Go to 1.3 for help answering. client and their family while working
collaboratively with other healthcare
professionals.

4. Select all appropriate options.

What is the name of this principle
that recognises that individuals a. Duty of care.
have the right to make their own
b. Dignity of risk.
decisions, even if those decisions
may result in risks or harm to c. Human rights.
themselves?
Go to 1.4 for help answering.

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5. True or false?
All states and territories in
Australia have the same federal a. True.
law regarding voluntary assisted b. False.
dying.
Go to 1.4 for help answering.

6. Fill the gap.

Palliative care extends over a. A few days.
______ and includes recognising
the holistic needs of the client, b. End of life only.
including their physical, c. Time.
emotional, social and spiritual
needs. d. Months.

Go to 1.3 for help answering.

7. Select all appropriate options. a. Physical needs.

Palliative care aims to address b. Emotional needs.
which of the following needs of
clients? c. Social needs.

Go to 1.2 for help answering. d. Spiritual needs.

a. Maintaining the privacy and confidentiality of

clients’ information.

8. Select all appropriate options. b. Disclosing relevant information to other care

team members.
What is the responsibility of
palliative care providers regarding c. Collecting, using and storing client information
privacy and confidentiality? securely.

Go to 1.4 for help answering. d. Allowing clients to read anything written about
them as per the requirements of the Freedom
of Information Act 1982 or the Australian
Privacy Principles.

2.1. Introduction
This topic is about respecting the individuals preferences. It also looks at creating a supportive
environment, dealing with individual needs and managing pain.
Learning goals include the following:

• Respecting the client’s individuality, values and beliefs in the context of support provision.

• Creating a supportive environment which encourages effective communication.

• Understanding nutritional and hydration requirements when using a palliative approach.

• Observing and documenting pain and implementing strategies to manage pain and promote
comfort in line with the individualised plan and within the scope of own job role.

2.2. Individualised care plan

An individualised care plan is a personalised and comprehensive plan of care that is tailored to the
unique needs, preferences and goals of each client. The aim of an individualised care plan is to
provide a roadmap for care that considers the client’s physical, emotional, social and spiritual needs.
In the context of palliative care, an individualised plan is particularly important because it allows for a
person-centred approach to care. Palliative care providers work with clients and their families to
develop a plan of care that is tailored to their specific needs, preferences and goals.
It may include information about the client’s pain management, symptom control, spiritual and
emotional support and end-of-life preferences. It may also include information about the client’s
cultural and religious beliefs, family dynamics and any other factors that may impact their care.
By developing an individualised care plan, palliative care providers can ensure that the client’s needs
and preferences are at the forefront of their care. This approach can help to improve the quality of life
for the client and their family and provide them with the support they need during a difficult and
challenging time.

RTO Number: 122208 CRICOS Number: 03373B Revision date: 04 Jul 2024
Next Review: 04 Jul 2025 Email: [email protected] Revision: 1.0
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2.3. Individual differences
Australia is a diverse country, and the goal of palliative care is to celebrate diversity, so that every
person in Australia can receive holistic and fair end-of-life care, no matter their ethnic background.
Therefore, individual differences such as culture, religion and spirituality, are very important
considerations when it comes to advance care directives in palliative care in Australia. Cultural and
religious beliefs can greatly influence a person’s preferences for medical treatment, end-of-life care
and decision making.
Our culture, religious and spiritual differences make us unique in the ways we think and our attitudes
and beliefs, towards death.

• Culture refers to the ideas, norms, social behaviour, customs, knowledge, laws and habits of
people in a particular group. Food, how we dress and language is also part of the culture.

• Religion refers to a specific system of belief in faith or devotion most commonly to gods. People
can differ in the ways they pray and god/gods they believe in.

• Spirituality refers to a person’s practice or belief in how they connect with something divine for
peace and purpose. A spiritual person may or may not be religious.
We do not have to learn about all cultures, religions and spiritual practices, but what we can do is
respects our clients’ and their families’ cultural, religious and/or spiritual preferences that will add
quality to their remaining lives.
It is important to take a client’s cultural and religious beliefs into consideration when discussing and
developing an advance care directive. This includes understanding cultural and religious beliefs about
death, dying and end-of-life care and how these beliefs may influence a client’s medical decisions. A
client’s preferences, culture, religious and spiritual beliefs should all be identified in the individualised
plan, so it is essential to be familiar with and follow the plan when supporting someone.
For example, some cultures may place a strong emphasis on family involvement in decision making,
while others may place a greater emphasis on individual autonomy. Similarly, some religions may
have specific beliefs about medical treatments and end-of-life care that should be taken into
consideration when developing an advance care directive.
By taking into account a person’s cultural and religious beliefs, you can help to ensure that the
person’s wishes regarding medical treatment and end-of-life care are respected and that the care
provided is culturally sensitive and appropriate.
The following are examples of Australia’s diverse culture:

• People from culturally and linguistically diverse backgrounds.

• Aboriginal and Torres Strait Islander people.

• Lesbian, gay, bisexual, transgender, intersex, queer/questioning, asexual people (LGBTIQA+).

• People living in rural or remote areas.

• People with special needs, such as people living with mental health issues and disability.

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The Australian Government requires every palliative care service provider to accommodate
Australia’s diverse cultural background in their care practice. Respecting individual differences
ensures that the palliative care framework primarily upholds the human rights-based approach. It is
illegal in Australia to discriminate; therefore, by maintaining the human-rights approach in their
palliative care practices, palliative care providers are complying with Australian legislation.

Unconscious bias
Unconscious bias can have a significant impact on the provision of palliative care. Unconscious bias
refers to the attitudes and stereotypes that we hold towards certain groups of people, which can
influence our decisions and behaviours towards them, often without us even being aware of it.
In the context of palliative care, unconscious bias can lead to workers making assumptions about a
client’s preferences and needs based on their race, ethnicity, gender, sexual orientation or other
factors. This can result in unsatisfactory care, as the workers may not fully understand or appreciate
the client’s unique needs and preferences.
For example, unconscious bias may lead a worker to assume that a client from a particular cultural
background would prefer to receive aggressive medical treatment, when in fact the client may prefer a
more palliative approach. Unconscious bias could lead a worker to make assumptions about a client’s
pain tolerance or ability to cope with their illness based on their gender or race.
To provide the best possible palliative care, workers must be aware of their own unconscious biases
and work to overcome them. This may involve undergoing cultural competency training, developing
strong communication skills and actively listening to and respecting the client’s preferences and
needs, regardless of their background.

Activity 2.1. Watch

Watch the following video about unconscious bias.

Understanding Unconscious Bias.
Video: https://www.youtube.com/watch?v=dVp9Z5k0dEE (7:40)
Reflect: Are you aware of times when you have used unconscious bias? What can you do to try
to avoid it?

2.4. A supportive environment

In palliative care, a supportive environment can make all the difference to a client’s quality of life,
comfort and end-of-life care. Support workers play a crucial role in providing a supportive environment
for clients and their families.

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Active listening
A support worker should be an active listener, taking the time to understand the client’s needs and
concerns, as well as the needs of their family and other caregivers. This involves listening to what the
client and family members are saying and acknowledging their feelings and concerns.

Emotional support
Palliative care can be an emotional and challenging time for both the client and their loved ones. A
support worker can provide emotional support by being empathetic, compassionate and sensitive to
the client’s emotional needs. This may involve offering a listening ear, providing comfort and
reassurance or simply being present to offer companionship.

Practical support
A support worker can also provide practical support to the client and their family by assisting with
activities of daily living, such as bathing, dressing and toileting. They can also help with household
tasks, such as cooking and cleaning, to ensure that the client and their family have a safe and
comfortable environment.

Advocacy
A support worker can act as an advocate for the client and their family, ensuring that their needs are
met and their rights are respected. This may involve advocating for the client’s pain management or
for their end-of-life preferences.

Communication
Communication is key in palliative care and a support worker can play a vital role in facilitating
communication with the client, their family and healthcare providers. They can help to ensure that
everyone is on the same page and that the client’s wishes and preferences are respected.
Effective communication is critical in providing high-quality, person-centred palliative care. It helps to
establish trust, address pain and symptom management, address emotional and spiritual needs and
respect client’s autonomy. You should use communication strategies that can help build trust show
empathy, demonstrate emotional support and empower the client and their family or carers.

Active listening
As we just mentioned, active listening is key to creating a supportive environment. It is also one of the
main features of effective communication. Encourage the client, family and carers to express their
concerns, feelings and needs and actively listen to what they say without interrupting or judging.

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Empathy
Show empathy by acknowledging the client’s feelings and validating their experiences. For example,
saying ‘I can see how difficult this is for you’ or ‘I can imagine how you must be feeling right now.’

Respectful language
Use language that is respectful, clear and understandable. Avoid using medical jargon or technical
terms that the client, family or carers may not understand.

Supportive body language

Use open and welcoming body language, such as sitting at the same level as the client and
maintaining eye contact (where culturally appropriate), to demonstrate support and build trust.

Collaborative decision making

Involve the client, family and carers in the decision-making process by discussing the options
available and helping them weigh the risks and benefits of each option.

Honest and clear communication

Be honest and clear when communicating with the client and their loved ones. Avoid withholding
information or sugar-coating the truth, as this can erode trust and hinder effective decision making.

Providing options
Offer choices and options to empower them to make decisions that are right for them. This can help to
promote a sense of control and autonomy, which can be especially important for people who are
facing the end of life.

Adjusting communication techniques

You may also need to adjust communication techniques to meet the individual needs of the client,
their family and others involved in the care process. There are a number of ways you can do this.

• Assess the client’s preferred mode of communication, level of understanding and any barriers to
communication they may have, such as hearing or vision impairments.

• Tailor the communication style to the client’s preferences and needs. For example, some people
may prefer direct communication, while others may respond better to a gentler approach.

• Use language that the client and their family, carer and others can understand. Avoid using
medical jargon or technical terms that may be confusing or intimidating.

• Take into account cultural differences and values when communicating with the client and their
family, carer and others.

• Adjust nonverbal communication, such as body language, tone of voice and facial expressions,
to match the client’s communication style and needs.

• Provide information in a clear and concise manner and check for understanding to ensure that
the client and their family, carer and others have understood the information.

• Provide emotional support and reassurance throughout the communication process,

acknowledging the client’s feelings and concerns and responding to them appropriately.

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Encourage clients and families to share information
Creating a supportive environment which is based on trust and communication encourages the client,
carers, family members and significant others to share information regarding changing needs and
preferences, which is an integral part of the palliative care process.
The following strategies can help:

• Meet the safety and comfort of the client balanced with dignity and respect.
• Understand that your client and their family’s circumstances are constantly changing and that
they need support to deal with the grief.
• Show compassion, empathy and be pleasant.
• Encourage clients and their families to share their stories and their preferences.
• Refer to the care plan, ask clients and their families if anything has changed.
• Report any changes in clients and their families care needs or preference to your supervisor as
soon as possible.

• Encourage family participation in the client’s social activities.

• Encourage clients and families to feel comfortable to share their concerns regarding client care.

• Be mindful of client–family time and do not interject during family conversations unless prompted.
• Pay attention to detail and do simple things well.

2.5. Nutritional and hydration requirements

Nutrition and hydration are important aspects of palliative care, as they can help manage symptoms,
maintain a client’s physical function and improve their quality of life. However, in some cases, a client
in palliative care may experience a reduced appetite or difficulty swallowing, which can make it
challenging to meet their nutritional and hydration requirements.
In general, the nutritional and hydration requirements of a client in palliative care will depend on their
individual needs and goals of care and these should all be recorded in the individualised care plan.
Some general principles for managing nutrition and hydration in palliative care include:

• Tailoring nutrition and hydration plans to the client’s individual needs: this may involve adjusting
the type and amount of food and fluids based on the client’s condition, preferences and goals of
care.

• Using medications and other interventions to manage symptoms: medications such as

antiemetics and laxatives may be used to manage symptoms such as nausea, vomiting or
constipation, which can impact a client’s appetite and ability to tolerate food and fluids.

• Supporting oral intake as much as possible: this may involve offering smaller, more frequent
meals or snacks and using techniques such as texture modification or thickened fluids to help
with swallowing difficulties.

• Considering alternative routes for nutrition and hydration: in some cases, tube feeding or
intravenous fluids may be considered if a client is unable to tolerate oral intake or is at risk of
dehydration or malnutrition.
It is important to note that nutrition and hydration goals should be discussed with the client and their
family or caregivers, taking into account their wishes and goals of care. In some cases, the focus of
care may shift from maintaining full nutrition and hydration to providing comfort and relief of
symptoms. In these situations, a client’s intake may be allowed to decrease and the emphasis may be
on providing small amounts of food and fluids that the client enjoys and finds comforting.
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Loss of appetite and a decrease in weight is typical for clients with terminal illnesses and can cause
distress in clients and their families. During the end of life, a client’s preferences for their dietary
choices must be respected. However, there is always a delicate balance between the client’s
preferences and favourites and nutritional plan as per medical requirements.

2.6. Pain
Pain is an unpleasant and uncomfortable sensation for anyone, and it can have a negative impact on
a client’s physical and emotional well-being. The experience of pain can cause a range of physical
symptoms, such as muscle tension, fatigue and difficulty sleeping. Pain can also lead to emotional
distress, including anxiety, depression and reduced quality of life.
Some people living with a terminal illness may not experience pain, some will experience chronic
pain, some will be scared of pain and think there is no treatment for it, while there will be some clients
who will be stoic and not want pain management interventions. Regardless of what a client’s
experience of pain is, it is debilitating for both the client, their loved ones and carers.
There are several reasons why someone in palliative care may not report or fully disclose the level of
pain they are in:

• Fear of addiction or side effects: some clients may be reluctant to report their pain levels due to
concerns about becoming addicted to pain medication or experiencing unpleasant side effects.

• Stoicism: some individuals may feel that they should be able to endure pain without complaint,
particularly if they come from a cultural background that values stoicism.

• Fear of burdening others: clients in palliative care may be concerned about burdening their
caregivers or loved ones with their pain and may not want to worry or upset them.

• Fear of being seen as ‘difficult’: clients may worry that reporting high levels of pain will be seen
as complaining or difficult, particularly if they have had negative experiences with healthcare
providers in the past.
• Lack of understanding: some clients may not fully understand the importance of reporting pain
levels and may not realise that effective pain management is an essential aspect of palliative
care.

Watch the following video about pain.

Life before death – what is pain?
Video: https://www.youtube.com/watch?v=nOgMtClL1xU
Reflect: How does pain impact the quality of life for terminally ill clients?
Think about your personal experience when you had an acute headache or backache. What did
you feel like doing? How did you feel about participating in family functions or activities?

Pain management strategies

The palliative care team, especially doctors and nurses, have skills that can help clients with pain
relief and controlling it.
You can encourage clients to be open and speak about their levels of pain and discomfort to their
doctors and nurses. Sometimes they will talk about it with you, then allow you to discuss it with your
supervisor, so the client’s quality of life is maintained. However, it is necessary to be mindful of the
following:

• Care plan directives for pain management preferences must be respected.

• Changes in client’s preference for pain management must be relayed to your supervisor as soon
as possible.

• Legal, ethical requirements, like duty of care must be followed.

Several pain management strategies can be prescribed to make clients with a terminal illness
comfortable. Some strategies include:

• taking medication for pain relief – for example, pain killers like an opiate, morphine and other
routine medicines for breakthrough pain only

• physiotherapy, including exercises and hydrotherapy, can help relax muscles and promote bodily
functions

• occupational therapy looks at the use of aid to lessen client’s discomfort so that they can
participate in activities and hobbies

• mental health and wellbeing using psychologists and psychiatrists can alleviate emotional pain
and suffering in clients

• diet, as good nutrition and hydration requirements during palliative care is an essential part of
pain management strategies.

You must stay within the scope of your job role and ability and make sure strategies are in line with
the individualised plan when you are managing pain and promoting comfort in your client. For
example, it may be beyond the scope of your role to administer some medications.
Here are some examples a support worker could help reduce pains and increase comfort.

• Positioning and mobility: proper positioning and mobility can also help manage pain and promote
comfort. You can help ensure that the client is positioned comfortably and in a way that
minimises pain. This may involve adjusting the client’s bed or chair, using pillows or other
positioning aids and assisting with mobility as needed.

• Environmental modifications: simple modifications to the client’s environment can also help
promote comfort and manage pain. For example, ensuring that the room is a comfortable
temperature, minimising noise and light and providing familiar items such as family photos or a
favourite blanket can all help create a calming and comfortable environment.

• Communication and emotional support: it’s important to recognise that pain and discomfort can
have emotional and psychological effects as well. You can provide emotional support to the client
and their family and help facilitate communication with healthcare professionals as needed.
You may also need to seek clarification and guidance from health professionals regarding pain relief
and comfort provision. This could involve:

• Observe and document: Observe the client’s behaviour and any signs of pain or discomfort, and
document the observations accurately and objectively.

• Communicate with the client: Engage in open and empathetic communication with the client to
understand their pain experience, its location, intensity and any exacerbating or relieving factors.

• Consult the care plan: Review the client’s care plan to understand the current pain management
interventions and medications being used.

• Collaborate with the care team: Discuss observations and concerns with the palliative care team,
including nurses, doctors and other healthcare professionals involved in the client’s care.

• Advocate for the client: Advocate for the client’s needs, preferences and comfort by sharing their
pain assessment and experiences with the care team.

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• Discuss non-pharmacological interventions: Ask about incorporating non-pharmacological
interventions, such as massage or relaxation techniques, to complement pain relief measures.

• Request a pain assessment: If a pain assessment hasn’t been conducted recently, request a
comprehensive pain assessment to guide the pain relief plan.

• Provide feedback: Offer feedback to the care team on the client’s response to pain relief
interventions and any changes in pain levels, enabling the care plan to be adjusted accordingly.
The exact process for seeking guidance and clarification will be different for each organisation and
you specific role, so it is important to follow organisational policies and procedures and the scope of
your position description.

Observing, documenting
A key part of your role is to observe and document the client’s pain and other symptoms in line with
the individualised care plan and care directives and promptly report to the appropriate member of the
care team. Observation includes using five senses to assess client’s pain level. Examples include, but
are not limited to the following:

• See: the client’s hands are trembling or they cannot use their mobility aid safely.

• Feel: the client’s hands are cold or their forehead feels warm or hot.

• Taste: the client complains about a change in their taste for food or drinks they usually enjoyed.
Chronic pain often impacts our psychological state and we quickly start disliking things that we
used to enjoy.

• Hear: the client might be moaning.

• Smell: similar to taste, you can report changes in the client’s sense of smell that can be related to
a building up of anxiety and depression due to pain levels.
Note: You cannot eat client’s food or take their medication, but you can report the client’s observation
of taste.
It is also your role to observe the effectiveness of any pain management strategies that are used. This
should then be reported and documented according to organisational policies and procedures.
You should recognise and report any concerns you have regarding the use of pain-relieving
medication in palliative care. This is important to ensure the client is receiving safe and effective pain
management, as well as to promote a culture of open communication and continuous improvement
within the workplace.

Activity 2.3. Read

Read this webpage from Healthline about types of pain and how to recognise them.
Types of pain: How to recognise and talk about them.
Website: https://www.healthline.com/health/types-of-pain

Congratulations! You have reached the end of Topic 2.

To review what you’ve learnt, answer the following questions before continuing to Topic 3.

1. Select all appropriate options.

a. Religious or spiritual beliefs.
What kind of individual
differences must be taken into b. Differences in appearance like hair colour.
account when providing person- c. Background.
centred palliative care?
d. Culture.
Go to 2.3 for help answering.

2. Select the correct answer. a. Allowing the client the independence to

make decisions and speak for themselves.
What is meant by advocacy in
relation to support work? b. The act of speaking or acting on behalf of the
client to promote and protect their rights,
Go to 2.4 for help answering. needs and interests.

a. Listening actively, being empathetic,

3. Select the correct answer. communicating clearly.
Identify features of effective b. Providing options, giving judgements, being
communication. collaborative.
Go to 2.4 for help answering. c. Using respectful language, communicating
honestly, using closed body language.

4. True or false?
In end-of-life care, a client must
always maintain full nutrition and a. True.
hydration, even if they do not wish b. False.
to or find it difficult.
Go to 2.5 for help answering.

5. Select all appropriate options.

a. Prescribing medication.
What are some tasks which are
within the job scope of a support b. Positioning and mobility.
worker when carrying out pain c. Deciding on diet and food intake.
management strategies?
d. Environmental modifications.
Go to 2.6 for help answering.

6. Fill the gap. a. Emotional.

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An individualised care plan in b. Spiritual.
palliative care is tailored to the
c. Social.
__________ needs, preferences
and goals of each client? d. Physical.

Go to 2.2 for help answering.

7. Select all appropriate options. a. Undergoing cultural competency training.

How can healthcare providers b. Developing strong communication skills.

address unconscious bias in c. Ignoring the client’s preferences.
palliative care?
d. Listening to and respecting the client’s
Go to 2.3 for help answering. needs.

8. Select the correct answer.

a. Administering tube feeding.
When a client in palliative care
experiences a reduced appetite or b. Offering smaller, more frequent meals or
difficulty swallowing, what snacks.
techniques can be used to assist c. Using texture modification for food.
with their oral intake?
d. Providing thickened fluids.
Go to 2.5 for help answering.

9. True or false?
Supportive body language, such
as maintaining eye contact and a. True.
sitting at the same level as the
client, can help build trust in b. False.
palliative care.
Go to 2.4 for help answering.

a. Fear of addiction or side effects.

10. Select the correct answer.
b. Stoicism and cultural values.
What are some reasons why
someone in palliative care may c. Fear of burdening others.
not report or fully disclose their d. Fear of being seen as ‘difficult’.
level of pain?
e. Lack of understanding.
Go to 2.6 for help answering.
f. All of the above.

3.1. Introduction
This topic is about following advance care directives and end-of-life care strategies.
Learning goals include the following:

• Understanding the role and purpose of advance care directives.

• Interpreting and following advance care directives in the individualised plan in accordance with
own job role and organisational, legal and ethical requirements.

• Complying with end-of-life decisions as documented in the individualised plan and in accordance
with legal requirements.

• Recognising any signs of the client’s deterioration or imminent death and dying.

• Following processes when death has occurred, including caring of the client’s body and providing
emotional support fort the family.

3.2. What are advance care directives?

As palliative care is focused on individuals with serious illnesses or at the end of their life, it is very
important for people in palliative care to have advance care directives. Advance care directives
(ACDs) are legal documents that allow individuals to make decisions about their future medical
treatment in the event that they become unable to make decisions for themselves. ACDs are also
known as advance directives, living wills or advance healthcare directives.
In some cases, clients may become unable to make decisions for themselves or communicate their
wishes regarding medical treatment. In these situations, an advance care directive can ensure that
the client’s wishes are known and respected. It can provide guidance to healthcare providers and
family members on what the client would want in terms of medical treatment and help to ensure that
their wishes are carried out. Having an ACD can also help to reduce stress and uncertainty for family
members and loved ones, as they can feel more confident that they are making decisions that align
with the client’s wishes.
ACDs can be used to outline a client’s preferences regarding their medical treatment, including the
types of treatment they would like to receive, the circumstances under which they would like to refuse
treatment and who they would like to make decisions on their behalf if they are unable to do so
themselves.

• whether to receive life-sustaining treatments, such as resuscitation, mechanical ventilation or

artificial nutrition and hydration

• whether to undergo surgery or other invasive procedures

• whether to participate in clinical trials or experimental treatments

• whether to donate organs or tissues after death.

ACDs are legally binding in Australia and must be followed by healthcare providers, as long as the
document is valid and applies to the specific medical situation. It is important to regularly review and
update ACDs to ensure they accurately reflect an individual’s current wishes and medical
circumstances.

Image by Andrea Piacquadio on Pexels

3.3. Legal and ethical requirements

As we have already seen, legal and ethical considerations, such as duty of care and human rights,
are an integral part of palliative care and advance care directives. In Australia, there are various laws
and guidelines that govern the provision of palliative care, such as the Palliative Care Australia
Standards (2018) and the Australian Health Practitioner Regulation Agency (AHPRA) Code of
Conduct. These laws and guidelines ensure that clients receive high-quality care that is consistent
with their wishes and values.
Ethical considerations in advance care directives are also essential, as ethical principles guide
decision making in palliative care.

• Autonomy is a principle in healthcare ethics that recognises the right of clients to make their own
decisions about their healthcare.

• Beneficence is a principle in healthcare ethics that requires healthcare providers to act in the
best interests of their clients and to promote their well-being.

• Non-maleficence is a principle in medical ethics that requires healthcare providers to do no harm

to their clients.

• Justice is a principle in healthcare ethics that emphasises the fair and equitable distribution of
healthcare resources and services.
Being treated with dignity is also an ethical principal and a requirement in healthcare and it is a key
aspect of human rights. The dignity of the client should be upheld throughout the care process,
including planned end-of-life care and the care provided immediately following death.
Here are some ways to maintain dignity:

• Make an effort to learn about the client’s personal preferences and cultural or religious beliefs
and incorporate them into your care as much as possible.

• Ensure that the client’s privacy is respected at all times. This may include using curtains or
screens to provide privacy during care and ensuring that the client’s body is covered after death.

• Use appropriate and respectful language when speaking about the client and avoid using
euphemisms or disrespectful terms.

• Provide comfort measures such as pain management, hydration and skin care, to help ensure
that the client is comfortable and free from pain and distress.

• Involve the client and their loved ones in decision making and care planning as much as possible
and ensure that they are informed and empowered to make choices about their care.

• Treat the client’s body with respect and dignity at all times and handle it with care and sensitivity
after death.

• Offer to the client and their loved ones and ensure that they have access to appropriate
resources and support services.
Remember that maintaining dignity is about treating the client as an individual, with respect,
compassion and empathy. By prioritising the client’s preferences and needs and treating them with
sensitivity and care, you can help to ensure that they receive the dignified care they deserve.

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Organisational policies and procedures
Organisational policies and procedures are an integral part of support work because they provide a
framework for delivering consistent, high-quality care that meets legal and ethical obligations and
respects clients’ autonomy and wishes.
In palliative care, policies and procedures can guide the provision of care that focuses on improving
the quality of life of clients with serious illnesses. This can include guidance on pain and symptom
management, emotional and spiritual support and end-of-life decision making.
In relation to advance care directives organisational policies and procedures are particularly important
to ensure that clients’ wishes are respected and that end-of-life decision making is facilitated in an
ethical, sensitive and appropriate manner. This includes guidance on how to assess a client’s
capacity to make decisions, how to ensure that advance care directives are documented and
communicated appropriately and how to involve clients and their families in the decision making
process.
Policies and procedures will always be in line with state and territory legislation. For example,
although the laws are similar, there are important differences to voluntary assisted dying (VAD) laws
in each state and territory which must be followed, and these will be incorporated into the
organisation’s policies and procedures for end-of-life care.

Activity 3.1. Read

Read this factsheet on standards for providing palliative care in Australia which should be
integrated into organisational policies and procedures.
Standards for Providing Quality Palliative Care for All Australians.
Factsheet: https://palliativecare.org.au/wp-content/uploads/2015/07/Standards-for-providing-
quality-palliative-care-for-all-Australians.pdf

Ethical issues or concerns

You may encounter a range of ethical issues or concerns in your support work. If this happens, you
must raise these concerns with your supervisor or the appropriate person.
Some examples of the types of issues or concerns you may need to raise with you supervisor could
include the following:

• Confidentiality: support workers must maintain strict confidentiality when it comes to the personal
information of their clients. However, after a client’s death, you may need to share information
with the client’s family or other healthcare professionals. It’s important to navigate this situation
with sensitivity and respect for the client’s privacy.

• Boundaries: support workers must maintain professional boundaries with their clients and their
families. However, after a client’s death, you may feel a personal connection to the family and
want to offer support beyond their professional role. It’s important to recognise and navigate this
situation with professionalism and respect.

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• Autonomy: the principle of autonomy requires that clients have the right to make decisions about
their own healthcare, including end-of-life care. However, after a client’s death, you may need to
navigate conflicts between the client’s wishes and the wishes of their family. It’s important to
respect the client’s autonomy and communicate openly and honestly with the family.

• Grief and emotional impact: supporting clients at the end of life can be emotionally challenging
for support workers. After a client’s death, you may experience grief and emotional distress. It’s
important for you to seek support and take care of their own emotional well-being.

• Cultural and religious considerations: palliative care clients come from diverse cultural and
religious backgrounds, and you must respect and accommodate their beliefs and practices. After
a client’s death, you may need to navigate cultural and religious rituals and practices in a
respectful and appropriate manner.
It’s important for support workers in palliative care to be aware of these and other ethical issues that
may arise and to seek guidance from your supervisor or other appropriate resources when needed.

3.4. Following ACDs

In palliative care, one of your principal roles is to interpret and follow ACDs according to
organisational, legal and ethical requirements. These are laid out in the individualised plan and it is
your responsibility to make sure the care they are receiving follows these preferences. This may
involve communicating with the client or their medical decision maker to ensure that their wishes are
respected and that their care is delivered in a way that aligns with their values and beliefs. It is also
important to document any discussions or actions related to the client’s ACD in their individualised
plan.
For example:

• End-of-life care preferences: a client may specify their preferences for end-of-life care, such as
whether they would like to be resuscitated if their heart stops, whether they would like to receive
artificial nutrition and hydration or whether they would like to receive palliative care.

• Medical treatment preferences: a client may outline their preferences for specific medical
treatments, such as surgery, chemotherapy or radiation therapy. They may also specify what
conditions must be met before they agree to receive these treatments.

• Quality of life preferences: a client may describe their preferences for their quality of life, such as
wanting to maintain independence or wanting to live in a certain environment.

• Cultural or spiritual preferences: a client may specify any cultural or spiritual preferences that
should be taken into account when making healthcare decisions, such as religious practices or
beliefs.

• Appointment of a medical decision maker: a client may appoint someone to make healthcare
decisions on their behalf if they become unable to make their own decisions. This person is
called a medical power of attorney or an enduring power of attorney.
Remember the scope of your own job role and seek guidance from your supervisor or a healthcare
professional if you are unsure about how to interpret or follow the client’s ACD or if a task is outside of
your rob role or abilities.
Advance care directives are legal documents that are created by the client and they can only be
changed by the person who created them, as long as they have the capacity to do so. If a client’s
circumstances or wishes change, they can update or revoke their advance care directive at any time,
as long as they have the capacity to make decisions. However, if a client becomes incapacitated and
is no longer able to make decisions for themselves, their advance care directive will guide healthcare
professionals and substitute decision makers in making decisions on their behalf. They are legally
binding and they cannot be changed by the client’s family, carers or healthcare professionals.
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3.5. End-of-life decisions and strategies
In palliative care, you will need to deal with end-of-life decisions and strategies. This can be an
extremely difficult and emotional time for everyone involved, especially the individual and their family
or carers. It is essential that you follow the advance care directive preferences. This means being
familiar with preferences and wishes which have been laid out in the individualised plan, such as the
client’s culture and religious beliefs. It also means closely following organisational policies and
procedures and legal and ethical requirements. This could refer to decisions such as treatments
preferences, pain management, spiritual and emotional support or communication preferences.
By familiarising yourself with the plan, communicating with the healthcare team, providing emotional
support, ensuring comfort and symptom management and complying with legal requirements, you can
help ensure that the client receives the best possible care at the end of their life.
End-of-life laws in Australia are based on common laws, statute laws, codes of conduct, guidelines
and health professional ethics. End-of-life laws can be difficult and complicated to understand,
especially in Australia because the different states have varying end-of-life legal practices. Therefore,
you must always check with your supervisor what you can and cannot do within the legal scope of
your work.
The end-of-life laws are essential in palliative and aged care environments for the following reasons:

• They can help you manage a difficult situation: if you are confused or having difficulty in
maintaining a situation, always use the legal requirements and/or organisational policies and
procedures as guidelines to manage the situation. However, you must always clarify with your
supervisor what you can and cannot do within your job role.

• They can help reduce legal risks: knowing laws and regulations can help you to act lawfully and
minimise the risk of legal and criminal liability.

• They can increase your confidence and capability to provide better quality support to clients and
families.

Location of end-of-life-care
It is essential to deliver services in a manner that supports the client’s right to choose the location of
their end-of-life care. Respecting their autonomy and agency in making decisions about their care,
especially during such a significant and sensitive time, is of utmost importance.
Individuals in palliative care may have diverse preferences when it comes to receiving end-of-life
care. The choice of location often depends on personal circumstances, cultural beliefs, medical needs
and the availability of resources. For example, a client may choose to receive end-of-life care at
home, in a hospital or in a residential care facility.
It is essential to approach discussions about end-of-life care with sensitivity and compassion. Listen
carefully to the client’s wishes, and provide them with the information they need to make informed
decisions about where they wish to receive their care. If necessary, involve the client’s family
members or healthcare professionals to help facilitate discussions and support the decision-making
process.

Changing needs
As a care worker, it is you have an ethical responsibility to report the client’s changing needs and
issues, in relation to end of life, to the appropriate team member for documentation in the care plan
according to organisational policies and procedures. This also includes delivering services in a
manner that supports the right of individuals to choose the location of their end-of-life care. You
should also regularly check the individualised plan for any changes to the client’s decisions or
preferences.
Examples of the client’s changing needs could include:
• change of mind to appoint additional or another decision-maker.
• choice of medication, treatment or organ donation
• change in goals such as excluding or including new activities or hobbies
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• need to visit families or friends
• community access
• need for spiritual guidance
• request for euthanasia.
Additionally, you are required to monitor the impact of the client’s end-of-life needs, issues and
decisions on families, carers and/or significant others and refer to an appropriate member of the care
team in line with organisational protocols and moral principles to ensure they are supported.
Examples of support that families, carers or significant others may need are:

• how to have conversations about dying

• spiritual guidance

• counselling or help for dealing with grief

• advice on financial difficulties

• self-care and mental health information

• more information regarding the client’s health

• any concerns regarding the client’s circumstances

• help around the house.

3.6. Recognising signs of imminent death and deterioration

Working with clients with a life-ending illness and knowing that their death is close can be stressful.
Signs of imminent death and deterioration of health conditions may not be the same for every client,
but knowing what to expect when the end is near can make things a little easier.
Additionally, recognising any signs of the client’s imminent death or deterioration and reporting it to
the appropriate member of the care team in line with organisational requirements is one of the critical
responsibilities of a carer or support worker. You must also regularly check for any changes on the
care plan that show that the decisions made by the substitute decision maker have been reviewed
and updated on the care plan. It is essential to follow the wishes of the client or their substitute
decision maker in the last few days of a client’s life.
The following table represents signs that allow you to tell if death is near and how you can help your
clients (sourced from https://www.medicalnewstoday.com/articles/320794#final-hours and
https://palliativecare.org.au/resources/the-dying-process).

Signs that death is near How you can support your clients

Decreasing appetite Give sips of water to the client using a straw, dropper or swab
to moisten their mouth.

A lot of sleeping in the last Ensure the client is comfortable and let them sleep. When the
couple of months client has the energy, you can encourage them to get out of
bed and move around to prevent bedsores.

A change in vital signs such Although these signs are common, keep your supervisor
as drops in blood pressure, informed about the changes as they occur.
breathing, irregular heartbeat
or hard-to-detect heartbeat

Constipation or reduced Help the client take their medications such as stool softeners
bowel movement due to or help with the administration of enemas. If the client’s bowel
reduced dietary intake movements stop, you must alert your supervisor.

Incontinence and changes in Help with effective management of catheters.

urine colour to tan or brown
due to kidney shutting down

The client is unable to Help the client lift things or seek help to turn the client’s
complete simple functions positions in bed regularly to prevent bedsores.
such as drinking or sipping
water from a cup or straw
because of weakening
muscles

Body temperature drops Ensure proper ventilation. Cover the client with a blanket and
because the brain is focused keep them comfortable.
on supplying blood to vital
organs

The client experiences Speak softly and as normal as possible. Keep the client
confusion and lack of alertness informed about what is happening around them. Introduce
each visitor.

The client experiences Avoid correcting them about their vision or imagination as it
hallucinations or distorted might further confuse them.
visions

Changes in breathing patterns, Report to your supervisor, who should speak to the doctors
such as gasping for air or about your concerns.
long pauses between breaths

Increase in pain levels Report to a supervisor so that they can organise doctors to
administer pain relief medication.

Secretions like mucus and Lift the client’s head by placing an extra pillow or two and turn
saliva may collect at the back the client’s head to the side to avoid choking.
of their throat as their ability to
cough and to swallow slows

Decreasing appetite Respect the client’s wishes but keep your supervisor informed
as situations change.

Becoming less friendly or Do not take offence. Families and friends can visit when the
sociable because they don’t client wishes to see them.
want others to see them
becoming weak

Request to be surrounded by Inform the palliative care team so that they can contact the
their loved ones when the client’s respective family members or substitute decision
time has come makers. Allow space and time for them to be together in the
last few moments.

3.7. Actions and decisions following the death of a client

It is important to be prepared for the possibility that your client may pass away while under your care.
Here are some things to keep in mind:

Signs of death
Depending on the individual, there may be physical signs that the client has passed away:

• The client will stop breathing.

• There will be no heartbeat or pulse.

• The client will not wake up.

• Their eyelids maybe half open and pupils are fixed.

• Their mouth may be open.

• They will have no muscle tension.

Verify the person’s status

Once you suspect that the client has passed away, it is important to verify their status. Check for
signs of breathing, pulse and responsiveness. You can also gently shake their shoulder and call their
name to try to elicit a response.
It is essential that you follow your organisation’s policies and procedures in the event of a death of a
client. You should also be aware of legal and ethical considerations, especially maintaining their
dignity by providing care after their death.

Notify appropriate people

If the client has passed away, you will need to notify the appropriate medical professionals and the
client’s family or next of kin. Follow any specific protocols or procedures that are in place.

Document the death

You will need to document the death in the client’s medical records, including the time and
circumstances of the death.

Provide support
In the immediate aftermath of the client’s death, it is important to provide emotional support to the
client’s loved ones, as well as any other individuals who may be affected.

Prepare the body

Depending on the specific circumstances and protocols in place, you may need to prepare the client’s
body for transport or burial.
Remember that the death of a client in palliative care can be a difficult and emotional experience. It is
important to prioritise the emotional and physical needs of both the client who has passed away and
their loved ones.

Read this article about signs of death and dying.

Medical New Today: What are the Signs That Someone is Close to Death?
Article: https://www.medicalnewstoday.com/articles/320794
Palliative Care Australia: The Dying Process.
Article: https://palliativecare.org.au/resource/resources-the-dying-process/

Caring for the body

Respecting the client’s choices after their death involves following the directives of their advance care
plan and working within the boundaries of your role. The processes for care of the body will vary
depending on their preferences and any state or territory medico-legal requirements and processes
that may apply. Here are some general guidelines:

The client’s preferences

If the client has expressed any preferences for the care of their body after death, these should be
respected as much as possible. For example, they may have expressed a preference for how their
body should be handled or dressed immediately afterward.

Cultural, spiritual and religious considerations

Any specific cultural, spiritual or religious beliefs or practices must also be taken into consideration.
Allow time and space for any cultural or religious practices to be conducted after death and before the
client is taken from their room. Certain religions may have specific requirements for the handling of
the body, cleaning the body or the timing of the funeral.

Infection control
It is important to follow appropriate infection control protocols to minimise the risk of transmission of
infectious diseases. This may include using personal protective equipment (PPE) when handling the
body and following specific procedures for handling and disposing of infectious waste.

Support for the family and others

You must ensure the client’s immediate families are informed – follow the information in the advance
care plan and the client’s records to identify next of kin. In addition to caring for the body, it is also
important to provide emotional support to the client’s loved ones. This may include providing
information about grief and bereavement support services and offering assistance with funeral
arrangements or other practical matters.

Handling of personal effects and belongings

The client’s personal effects and belongings should be handled with care and sensitivity. Depending
on the specific circumstances, these should be looked after and handed over to the decision maker or
next of kin as per the client’s wishes. There is no need to rush this process.

Medico-legal requirements

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Depending on the state or territory in which you work, there may be specific medico-legal
requirements and processes that need to be followed. These may include requirements for notification
of the coroner or medical examiner or for obtaining a death certificate.

Documentation requirements
It is important to ensure that all necessary documentation is completed accurately and promptly. This
may include completing a death certificate, documenting the care provided to the client’s body and
ensuring that any required notifications have been made.
Remember that caring for the client’s body is an important aspect of providing compassionate and
respectful care and should be done with sensitivity, dignity, respect and attention to the client’s wishes
and beliefs.

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Providing emotional support to the family, carers and others
Remember that providing emotional support to the family and others is an important aspect of your
role in palliative care. By offering empathy, active listening and practical assistance, you can help to
ease the burden of grief and provide comfort and support to those who are affected by the client’s
passing. Here are some ways you can do this:

• Respect the family members’ and loved ones’ preference to observe their cultural, religious or
spiritual practices.

• Provide emotional support by showing empathy and compassion towards other individuals,
carers, families and/or significant others.

• Provide information on grief counselling or chaplain services.

• Provide individuals and families with information regarding the death certification process and
funeral arrangements.

Congratulations! You have reached the end of Topic 3.

To review what you’ve learnt, answer the following questions before continuing to Topic 4.

a. A document that outlines an individual’s

unique needs, preferences and goals for
health and support services.
1. Select the correct answer.
b. A legal document that specifies how a
What is an advance care client’s assets and property should be
directive? distributed after their death.
Go to 3.2 for help answering. c. Legal documents that allow individuals to
make decisions about their future medical
treatment in the event that they become
unable to make decisions for themselves.

2. Select all appropriate options.

a. Dignity.
Which of these are examples of
ethical principles that should be b. Autonomy.
followed in palliative care and c. Beneficence.
healthcare in general?
d. Non-maleficence.
Go to 3.3 for help answering.

3. True or false?
Advance care directives which
are made by an individual can be
changed by their family or legal a. True.
representative if the client no b. False.
longer has the capacity to make
decisions.
Go to 3.4 for help answering.

a. They have an increased appetite.

4. Select all appropriate options. b. They experience confusion or lack of

alertness.
Which of these are common signs
that death is near for a client? c. They have changes in breathing patterns.
Go to 3.6 for help answering. d. They appear more lucid.
e. They experience increase in pain levels.

5. True or false?
a. True.
After a client dies, infection
control procedures no longer b. False.
need to be followed as the client

6. Fill the gaps.

Examples of the and client’s a. Additional family members / spiritual
changing needs could include a guidance.
change of mind to appoint b. Additional decision maker / financial advice.
__________, choice of
medication or treatment or a need c. Organ donation / community access.
for __________. d. Legal representative / mental health support.
Go to 3.5 for help answering.

a. To ensure accuracy and alignment with

7. Select all appropriate options. current wishes.

Why is it important to regularly b. To increase the likelihood of receiving

review and update advance care experimental treatments.
directives? c. To involve more family members in the
Go to 3.2 for help answering. decision-making process.
d. To comply with legal requirements.

8. Select all appropriate options.

a. Pain and symptom management.
In palliative care, organisational
policies and procedures can b. Emotional and spiritual support.
guide the provision of care in c. End-of-life decision making.
areas such as …
d. Financial management.
Go to 3.3 for help answering.

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9. Fill the gap.
In an advance care plan, a person
a. Placed on life support.
may specify their preferences for
end-of-life care, such as whether b. Administered pain medication.
they would like to be c. Resuscitated.
____________ if their heart
stops. d. Given palliative care.

Go to 3.4 for help answering.

a. Verify the person’s status by checking for

signs of breathing, pulse and
10. Select all appropriate options. responsiveness.

What should a support worker do b. Gently shake the person’s shoulder and call
once they suspect that a person their name to elicit a response.
has passed away? c. Notify appropriate medical professionals and
Go to 3.7 for help answering. the person’s family or next of kin.
d. Document the death in the person’s medical
records.

4.1. Introduction
This topic is about the psychological and emotional impacts that the palliative process, including
death and grief, can have on the family and carers. It also looks at emotional responses you might
experience and how you can manage them.
Learning goals include the following:

• Understanding the psychological and emotional impact on the person, their family, carer and
others during palliative or end of life care.

• Knowing the stages of grief and strategies for managing reactions to grief.

• Identifying and reflecting on your own emotional responses to death and dying and raising and
discuss any issues or reactions with you supervisor and seeking help when needed.

• Determining and actioning self-care strategies to address the potential impact of your own
personal responses.

4.2. Psychological and emotional impacts

Palliative care can have significant psychological and emotional impacts on the person receiving care,
as well as their family, carer and others involved. A huge part of your job role is to support the person
and their loved ones emotionally, so you need to understand the types emotional and psychological
that going through this kind of trauma can have on individuals.

• Anxiety and depression: the person receiving care, as well as their loved ones, may experience
anxiety and depression as they come to terms with the reality of the situation and the inevitability
of death.

• Grief and loss: the person, their family and carers may experience feelings of grief and loss as
they confront the reality of the situation and begin to process the end-of-life experience.

• Changes in relationships: relationships between the person receiving care and their loved ones
may change as they confront the end-of-life experience. There may be shifts in the dynamic
between the person and their family or carers as they navigate this difficult time.

• Guilt and regret: family and carers may experience feelings of guilt or regret as they reflect on
past interactions with the person receiving care and consider what they could have done
differently.

• Spiritual and existential distress: the person receiving care, as well as their loved ones, may
experience spiritual or existential distress as they confront the meaning of life and death.

• Stress and burnout: family and carers may experience high levels of stress and burnout as they
provide care for the person receiving end-of-life care.
You need to be aware of the potential psychological and emotional impacts of end-of-life care and to
provide appropriate support and resources for the person, their family and carers. This may involve
offering emotional support, connecting them with counselling services and providing education about
the end-of-life experience and the grieving process.

Read the Palliate Care NSW website for examples of support services that are available to
individuals, families and carers.
Website: https://palliativecarensw.org.au/families-and-carers/resources/

Image by Liza Summer on Pexels

4.3. Grief
Grieving is a painful but natural process of dealing with the loss of someone. To provide the best
support possible, you should also be aware of the grieving process and different stages of grief. Of
course, not everyone will react to grief in the same way and people must be allowed to grieve
However, they must remember that support is accessible if grieving starts to affect their lives
significantly.
The stages of grief were first described by psychiatrist Elisabeth Kübler-Ross in her book On Death
and Dying. They are:
1. Denial: this is the first stage of grief and involves a feeling of disbelief or shock. It may be difficult
to accept the reality of the loss.
2. Anger: this stage involves feelings of anger, frustration and resentment. The person may feel
angry at themselves, others or the world in general.
3. Bargaining: in this stage, the person may try to negotiate with a higher power or make deals with
themselves to try to avoid or lessen the pain of the loss.
4. Depression: this stage involves feelings of sadness, guilt and despair. The person may withdraw
from others and lose interest in activities they once enjoyed.
5. Acceptance: this is the final stage of grief, where the person begins to come to terms with the
loss and is able to move forward.

Strategies to support grief

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There are several strategies you can use to help manage their reactions to grief, which can help you
to support the person’s loved ones after they have passed.

• Be empathetic: show empathy towards the family and carers by listening to them and
acknowledging their feelings. Let them know that you understand what they are going through
and that you are there to support them.

• Provide emotional support: offer emotional support by being available to listen, talking through
their concerns and validating their feelings.

• Educate them about the grieving process: provide information about the stages of grief and what
they can expect during the grieving process. Help them to understand that grief is a normal and
natural response to loss.

• Encourage self-care: encourage the family and carers to take care of themselves by eating well,
getting enough rest and engaging in activities they enjoy.

• Connect them with support services: offer information about support services that are available,
such as grief counselling, support groups and other resources. Provide referrals to professionals
who specialise in grief and bereavement support.

• Respect their cultural and religious beliefs: respect the cultural and religious beliefs of the family
and carers and offer support that is sensitive to their specific beliefs and practices.

• Help with practical tasks: offer practical assistance with tasks such as funeral arrangements or
managing the deceased person’s belongings. This can help to relieve some of the burden and
stress of the grieving process.
Remember that grief is a complex process, and everyone experiences it differently. By showing
empathy, providing emotional support and connecting the family and carers with resources, you can
help them navigate the grieving process and find ways to cope with their loss.

4.4. Managing your own emotional responses

It’s important to recognise and acknowledge your own emotional responses to death and dying and to
seek support when needed.
Death and grief can cause several emotional reactions: shock, fear, anger, sadness, guilt or extreme
helplessness, as well as workplace stresses.

• stress symptoms affecting feelings and thoughts

• physical effects such as fatigue, sleep issues or headaches

• stresses on mood and behaviour such as anxiety, depression, a feeling of overwhelming, eating
disorders, drug or alcohol abuse, social withdrawal and mood swings.
Being able to recognise common stress symptoms can help in managing them. However, you must
be open to raise and discuss any issues or reactions with a supervisor or other appropriate personnel
as soon as you identify them. Getting the right type of support at the right time can help the effects or
resolves issues quicker and promote emotional wellbeing.

Self-reflection
Reflecting on your own emotions and your psychological and physical state is essential in ensuring
your own wellbeing. You organisation will have policies and procedures which are in place to help you
manage your emotional responses which you should follow.
However, there are also some general steps you can take to identify and reflect on your emotions:

• Take time for self-reflection: make time for self-reflection and identify any emotions you may be
feeling, such as sadness, grief or anxiety, related to working with and clients who are dying or
have passed away. Consider how these emotions are impacting your work and interactions with
and clients and their families.

• Seek support: it’s important to have a support system in place, whether it’s colleagues,
supervisors or mental health professionals, who can help you process your emotions and provide
guidance on how to cope with difficult situations.

• Be aware of your boundaries: it’s essential to set clear boundaries around what you can and
cannot do as a worker in palliative care and to recognise when there is a need to refer a client or
their family to a more specialised care provider.

• Communicate with your supervisor: don’t be afraid to speak with your supervisor about any
issues or reactions you may have to working with and clients who are dying or have passed
away. They can offer guidance, resources and support to help you manage your emotions and
provide the best possible care for your other clients.
Remember that you may also be grieving and it’s normal to have emotional responses to death and
dying when working in palliative care. Recognising and reflecting on your emotions means that you
can and seek support when needed and then practice self-care strategies, which ensure your own
emotional and psychological wellbeing.

Self-care strategies and responses

To provide compassionate care to your clients and their loved ones, you also need to take care of
yourself and acknowledge the impact that supporting someone through palliative care also has on
you. You need to be able to manage your own grief as well as supporting others through their grieving
process. You should prioritise self-care strategies to address the emotional and psychological impact
of grief and dying.

• Identify your triggers: reflect on your experiences and identify situations or and clients that may
trigger emotional or psychological distress. This will help you to be more aware of your
responses and take proactive steps to manage your emotions.

• Practice mindfulness: mindfulness practices such as meditation, deep breathing and yoga can
help you to manage stress and remain centred in the present moment. Take time each day to
engage in these activities, even if only for a few minutes.
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• Seek support: identify individuals who can provide support and guidance, such as colleagues,
mentors or mental health professionals. It’s important to have a support network in place to help
you manage your emotions and navigate challenging situations. There are many support
services for bereavement care in Australia which you can access.

• Take breaks: palliative care work can be emotionally and physically demanding, so it’s essential
to take regular breaks and prioritise rest and relaxation. This may include taking time off work,
going for a walk or engaging in hobbies or activities that you enjoy.

• Engage in self-reflection: reflect on your experiences and identify any areas for growth or
improvement. Regular self-reflection can help you to stay grounded and maintain perspective.

• Maintain healthy habits: engage in activities that promote physical and emotional well-being,
such as regular exercise, a healthy diet and adequate sleep.
Remember that self-care is not a one-time event, but an ongoing practice. Prioritising self-care
strategies can help you to manage the emotional and psychological impact of palliative care work and
maintain your well-being over the long term.

Activity 4.2. Read

Look at this website from Care Search which has links to different bereavement and grief
support networks.
Bereavement, Grief and Loss.
Website: https://www.caresearch.com.au/tabid/6668/Default.aspx

Activity 4.3. Read

Read this webpage about dealing with critical incidents in the workplace.
Workplace Safety - Coping with a Critical Incident.
Website: https://www.betterhealth.vic.gov.au/health/healthyliving/workplace-safety-coping-with-
a-critical-incident?viewAsPdf=true

Congratulations! You have reached the end of Topic 4.

To review what you’ve learnt, answer the following questions.

1. Select all appropriate options.

a. Guilt and regret.
Which of the following are
potential emotional or b. Anxiety and depression.
psychological impacts of palliative c. Stress and burnout.
and end-of-life care?
d. Changes in relationships.
Go to 4.2 for help answering.

a. Anger, denial, depression bargaining,

2. Select the correct answer. acceptance.
Identify the stages of grief in their b. Depression, denial, bargaining, anger,
correct order. acceptance.
Go to 4.3 for help answering. c. Denial, anger, bargaining, depression,
acceptance.

a. Help with practical tasks.

3. Select all appropriate options.
b. Connect them with support services.
How can you emotionally support
others who are grieving? c. Provide emotional support.

Go to 4.3 for help answering. d. Try not to take their cultural and religious
beliefs into account.

a. You should remain distant from the people

4. Complete the sentence. you are supporting to avoid becoming
emotionally and psychologically attached.
As a worker in palliative care…
b. It’s important to recognise and acknowledge
Go to 4.4 for help answering. your own emotional responses to death and
dying and to seek support when needed.

RTO Number: 122208 CRICOS Number: 03373B Revision date: 04 Jul 2024
Next Review: 04 Jul 2025 Email: [email protected] Revision: 1.0
© Job Training Institute Website: www.jti.edu.au Page 55 of 59
5. True or false?
Taking regular exercise, having a
healthy diet and getting adequate a. True.
sleep are all important aspects of b. False.
self-care in the grieving process.
Go to 4.4 for help answering.

6. Fill the gap.

Palliative or end-of-life care can a. Positive.
have significant __________ b. Psychological and emotional.
impacts on the person receiving
care, as well as their family, carer, c. Educational.
and others involved. d. Financial.
Go to 4.2 for help answering.

7. Select all appropriate options.

a. There may be shifts in dynamics.
How may relationships between
the person receiving care and b. They remain unchanged.
their loved ones change during c. They strengthen.
the end-of-life experience?
d. They weaken.
Go to 4.4 for help answering.

8. Select all appropriate options. a. It helps them process their emotions related
to their work.
Why is it important for support
workers to have a support system b. It provides guidance on coping with difficult
in place? situations.
Go to 4.4 for help answering. c. It offers resources and support.

About this document

The following learning activities can be completed in both the classroom and in the workplace. They are provided to further develop your skills and
knowledge and to prepare you for assessment. Your trainer will advise you on the timeframes for the activities. Make notes about the activities you
complete and hand this document to your trainer when you have finished.

Learning activity Details Completed Notes

1. Practise supporting, Your trainer will set up ☐

reporting and simulations for you to work in.
documenting issues and This will include the full range
needs of clients receiving of resources, documents and
palliative care. procedures you would need to
This should include: support clients in palliative
care.
• following their plans to
provide support that One of your clients will be
aligns with their needs receiving end of life care.
and preferences

• responding to changing
needs and circumstances

• communicating effectively
with clients, their families
and carers

• providing emotional
support to clients, their
families and their carers

• following procedures to
complete documentation
correctly, accurately,
factually and on time.

2. After you have completed

the tasks required above,
reflect on your thoughts
and emotions and
consider the types of self-
care strategies that you
believe would work best
for you.
Apply at least one of the
self-car strategies and
see if it makes a
difference.

3. Debrief with your trainer. Your trainer will provide you

Discuss the self-care with time to debrief. This may
strategy you used and occur at various stages while
how you feel now. you are completing this unit, to
help you manage the emotions
you may experience as you
move through each topic.

RTO Number: 122208 CRICOS Number: 03373B Revision date: 04 Jul 2024
Next Review: 04 Jul 2025 Email: [email protected] Revision: 1.0
© Job Training Institute Website: www.jti.edu.au Page 59 of 59

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CHCPAL003 Learner Guide

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© 2023 RTO Works

• The student is able to respond to signs of pain and other symptoms.

• The student is able to follow end-of-life care strategies.

Note to the student:

• Understanding the philosophy, principles, benefits and scope of palliative care.

1.2. The principles and aims of a palliative approach

Palliative care and end-of-life care

Image by Dzmitry Dzemidovich on iStock

• promoting their independence and the right to informed decision making.

• personal support workers

Palliative care principles

Activity 1.1. Read

Read more about principles of palliate care in Australia.

Scope of palliative care

Benefits of palliative care

Activity 1.2. Watch

Watch the following video from a palliate nurse.

Activity 1.3. Read

• Completing documentation in a timely, accurate and objective manner according to

Activity 1.4. Read

Activity 1.5. Watch

Watch the following video about the palliative approach.

Image by Kampus Production on Pexels

1.4. Legal and ethical considerations

Activity 1.6. Watch

Watch the following video.

Privacy, confidentiality and disclosure

• Interdisciplinary teamwork: Palliative care often involves a multidisciplinary team of healthcare

State/territory legislation relating to voluntary assisted dying

Congratulations! You have reached the end of Topic 1.

Go to 1.2 for help answering.

2. Select all appropriate options. a. Person-centred.

Identify principles of palliative b. Flexible.

a. Provide compassionate care, support and

4. Select all appropriate options.

6. Fill the gap.

Go to 1.3 for help answering.

7. Select all appropriate options. a. Physical needs.

Go to 1.2 for help answering. d. Spiritual needs.

a. Maintaining the privacy and confidentiality of

8. Select all appropriate options. b. Disclosing relevant information to other care

• Creating a supportive environment which encourages effective communication.

• Understanding nutritional and hydration requirements when using a palliative approach.

2.2. Individualised care plan

• People from culturally and linguistically diverse backgrounds.

• Aboriginal and Torres Strait Islander people.

• Lesbian, gay, bisexual, transgender, intersex, queer/questioning, asexual people (LGBTIQA+).

• People living in rural or remote areas.

Activity 2.1. Watch

Watch the following video about unconscious bias.

2.4. A supportive environment

Supportive body language

Collaborative decision making

Honest and clear communication

Adjusting communication techniques

• Provide emotional support and reassurance throughout the communication process,

• Encourage family participation in the client’s social activities.

2.5. Nutritional and hydration requirements

• Using medications and other interventions to manage symptoms: medications such as

Watch the following video about pain.

Pain management strategies

• Care plan directives for pain management preferences must be respected.

• Legal, ethical requirements, like duty of care must be followed.

• Hear: the client might be moaning.

Activity 2.3. Read

Congratulations! You have reached the end of Topic 2.

1. Select all appropriate options.

2. Select the correct answer. a. Allowing the client the independence to

a. Listening actively, being empathetic,

5. Select all appropriate options.

6. Fill the gap. a. Emotional.

Go to 2.2 for help answering.

7. Select all appropriate options. a. Undergoing cultural competency training.

How can healthcare providers b. Developing strong communication skills.

8. Select the correct answer.