Tutor Qualifications - youth.stjohn.org.nz · Web viewHolistic care is a system of comprehensive or total patient care that considers the physical, emotional, social, economic,

Gold LevelCaregivers course

Tutor Guide

Page 1

Contents

Module PageIntroduction 3

Resource List 4

Holistic Care 6

Safety 16

Communication 26

Skin and Wound Care 34

Basic Personal Care 39

Nutrition in the Community 45

The Grieving Process 51

Observations 55

Page 2

Introduction

This course has been designed as an up to date resource of Caregivers modules for Gold Level members within St John Youth. Its purpose is to provide Gold Level members with the background knowledge and skills to care for people in their homes and informed support during civil emergencies in welfare centers.

The course is designed to be run over two days and has been specifically designed as a practical, fun way of learning basic healthcare skills and techniques. It is not intended to be run at divisional nights.

The venue for running a course must have access to sinks for hand washing, and a classroom setting for teaching.

The recommended maximum number of participants in order for the best level and quality of teaching to be delivered is 20 participants.

Tutor QualificationsIt is intended that the course be taught by Registered Nurses, or other suitably qualified people approved by the Regional Youth Manager within each Region.

Resources

Quantities are based on the maximum course number, demonstrations by the Tutor and spare equipment for extra practice. On the following page you will find a comprehensive list of equipment that will be required to run each course.

Qualification

Assessment is carried out by the Tutor and successful completion of this course will see the member qualify for their Gold Level Caregivers Badge.

Page 3

Resource List for Caregivers

Required for each modules

Student workbook one per studentPaper and colour pensWhite board and marker pens

Powerpoint presentation with supporting material

Module 1- Holistic CareResources on Treaty of Waitangi (if knowledge is limited)Resources on Consumer Rights (if knowledge is limited)Resources on Maslow’s Hierarchy of needs (if knowledge is limited)

Module 2- SafetyHand hygiene posterGlitter GlueLiquid soapRunning WaterTowelDisposable gloves (different sizes maybe needed)Apron/ GownFacemask

Module 3- CommunicationSpeaking boardCommunication resources

Page 4

Module 4 woundsSelection of dressings

- Primapore (Melolin type pad with hypafix backing)

- Opsite (Waterproof, Bacteria-proof Dressing with See-through Absorbent Pad)

- Steri strips/ Leukostrip (* is a skin closure strip combining a very strong hypoallergenic adhesive and a porous polyamide material which allows the free passage of exudate therefore lessening the likelihood of maceration under the strip.)

- Band aids

- Burns dressings

Boxes of glovesAccess to sinks for hand washingWound picture charts (from provided Power point presentation)

Module 5- personal careToothbrush and toothpaste Shampoo & ConditionerAccess to running waterWash bowlsDisposable cups (one per person)Towels (for drying hair) & Face cloths

Module 6- NutritionYoghurts (enough for each student)TeaspoonsSlings (enough for half the group)

Module 7- GriefIf possible access to YouTube (Homer Simpson 5 stages of grief or Scrubs- 5 Stages of grief- it is advisable for the tutor to watch these first to check if they are happy with the content.

Module 8- Observations30 Digital thermometer covers10 x Digital thermometersTympanic thermometer

Page 5

Module 1 – Holistic Care

90 Minutes

Content outline1. Identify what is required to provide holistic care2. Learn the rights of individuals3. Understand the implication of the Treaty of Waitangi and its relevance to health4. Identify the basic needs of all individuals5. Identify good health practices

Resources 1. Student work book (Pages 2-9)2. Large Paper3. Pens4. White board and white board markers5. Resources on Treaty of Waitangi (if knowledge is limited)6. Resources on Consumer Rights (if knowledge is limited)7. Resources on Maslow’s Hierarchy of needs (if knowledge is limited)

By the end of this session the learner will be able to

Identify what is required to provide holistic care

Know the rights of individuals

Understand the implications of the Treaty of Waitangi and its relationship to Health

Identify the basic needs of all individuals

Identify good health practices

Page 6

METHOD

Stage Student centred strategy Main teaching points

1 Introduce the subject of the Module. Explain what the learner will know by the end of the session.

2 Discuss with students the definition of holistic care

• Holistic care is a system of comprehensive or total patient care that considers the physical, emotional, social, economic, occupational, environmental and spiritual needs of the person. Wellness in all of these areas is essential to maintain good health and wellbeing.

• As caregivers we should be mindful that a deficit in health could affect one or more of these areas, causing distress and disharmony for the patient.

3 Divide students into groups and brainstorm the components of the 7 dimensions of wellness - use paper and pens to record what is said under each heading.

•• Social Wellness is the ability to

relate to and connect with other people in our world. Our ability to establish and maintain positive relationships with family, friends and co-workers contributes to our Social Wellness.

• Emotional Wellness is the ability to understand ourselves and cope with the challenges life can bring. The ability to acknowledge and share feelings of anger, fear, sadness or stress; hope, love, joy and happiness in a productive manner contributes to our Emotional Wellness.

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METHOD


• Spiritual Wellness is the ability to establish peace and harmony in our lives. The ability to develop congruency between values and actions and to realise a common purpose that binds creation together contributes to our Spiritual Wellness.

• Environmental Wellness is the ability to recognise our own responsibility for the quality of the air, the water and the land that surrounds us. The ability to make a positive impact on the quality of our environment be it our homes, our communities or our planet contributes to our Environmental Wellness.

• Occupational Wellness is the ability to get personal fulfillment from our jobs or our chosen career fields while still maintaining balance in our lives. Our desire to contribute in our careers to make a positive impact on the organizations we work in and to society as a whole leads to Occupational Wellness.

• Intellectual Wellness is the ability to open our minds to new ideas and experiences that can be applied to personal decisions, group interaction and community betterment. The desire to learn new concepts, improve skills and seek challenges in pursuit of lifelong learning contributes to our Intellectual Wellness.

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METHOD


• Physical Wellness is the ability to maintain a healthy quality of life that allows us to get through our daily activities without undue fatigue or physical stress. The ability to recognize that our behaviors have a significant impact on our wellness and adopting healthful habits (routine check ups, a balanced diet, exercise, etc.) while avoiding destructive habits (tobacco, drugs, alcohol, etc.) will lead to optimal Physical Wellness.

Source: http://wellness.ucr.edu/seven_dimensions.html

4 This session is to give students an understanding the rights of individuals and how it applies to their relationship with their patient that they may come across in the community setting.

Any reference to the word consumer= patient.

Any reference to the word provider = caregiver.

Discuss the following main rights with the group.

Consumers have rights and providers have duties:

1. Every consumer has the rights in this Code

2. Every provider is subject to the duties in this Code

3. Every provider must take action to-

Inform consumers of their rights; and

Enable consumers to exercise their rights

5 Discuss with students. Right 1: Right to be Treated with Respect:

1. Every consumer has the right to be treated with respect

2. Every consumer has the right to have his or her privacy respected

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METHOD


3. Every consumer has the right to be provided with services that take into account the needs, values, and beliefs of different cultural, religious, social and ethnic groups, including the needs, values and beliefs of Maori

6 Discuss with students.

Right 2: Right to freedom from discrimination, coercion, harassment, and exploitation:

Every consumer has the right to be free from discrimination, coercion, harassment and sexual, financial or other exploitation.


Right 3: Right to dignity and independence:

Every consumer has the right to have services provided in a manner that respects the dignity and independence of the individual.


Right 4: Right to services of an appropriate standard:

1. Every consumer has the right to have services provided with reasonable care and skill.

2. Every consumer has the right to have services provided that complies with the legal, professional, ethical and other relevant standards.

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METHOD


9 Discuss with students the main aspects and the history of the Treaty of Waitangi.

It is important not to get too in depth in this module as students should have covered the majority of these aspects in a formal education setting.

The Tutor is to emphasise the principles of the treaty and how they relate to health.

Maori had their own functioning society and structures prior to British settlers arriving

The treaty was enacted on February 06 1840

The treaty was between Maori Chiefs and the Queen

Consisted of a Preamble, and 4 Articles – each to operate simultaneously.

3 articles are in the students work book

Maori and English Version

Maori only signed the Maori Text

Crown representatives signed the English Text

The English Version: British intentions were to protect Maori interests, provide for British settlement and Establish a government to maintain peace and order.

Maori Version: Provide a government while securing the rights of the tribe, and Maori land ownership for as long as they wished to retain it.

The three articles are generally about:

Article 1 – Governance

Article 2 – Autonomy

Article 3 – Equity

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METHOD


10 Students to complete exercise in workbooks – Gains and Costs to the Maori People

Gains- New Skills- New Tools- New Knowledge- New Technology- Muskets

Costs- Loss of Land- Disease- Alcohol- Loss of life- Loss of Culture, Kinship and

social structure

11 Discuss with students the main Principles of the Treaty of Waitangi

The 3 P’s

Partnership: The sharing of power and decision-making.

Protection: The exercise of autonomy

Participation: Equity of Access and participation

12 Tutor to discuss with students the link between caring for Maori people and the 3 main principles of the treaty as shown in the student work book

The health links between the Treaty of

Waitangi and Health

Article 1 – Governance

Achieve Maori Participation in all aspects

of health. This is the Participation

principle of the Treaty of Waitangi

Article 2 – Autonomy

Achieve the advancement of Maori health

aspirations, practices and general

wellbeing. This is the Promote principle

of the Treaty of Waitangi.

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METHOD


Article 3 – Equity

Undertake health promotion, which

improves Maori health outcomes. This is

the Protect principle of the Treaty of

Waitangi

13 Using question and answer, brainstorming, discussion or buzz groups, discuss what the basic needs of all individuals are.

On large pieces of paper divide students answers into Physiological needs, safety needs, love and belonging needs, and Esteem needs

Physiological Needs:

Air,

Water

Food

Warmth

Shelter

Safety Needs:

Personal security

Financial security

Health and well-being

Safety against accidents and illness

Love and Belonging Needs:

Friendship

Family

Intimacy

Esteem Needs:

Self esteem

Self respect

Contribute to society

Respect

Fame or glory

Page 13

METHOD


14 Tutor on a whiteboard/large piece of paper draw a large triangle –similar to what is in the student workbooks and place the main needs on the triangle as follows:

This is Maslow’s Hierarchy of needs. The lower levels represent what we need a lot of to survive and function. Self-Actualisation occurs when an individual has achieved and mastered the lower needs and has become more than what they are capable of being. It is difficult to achieve and is more a spiritual power.

People such as Martin Luther King, Princess Dianna, Einstein, Mother Theresa have achieved self actualisation

15 Using question and answer, brainstorming, discussion or buzz groups, discuss good health practices

Students to answer questions in student work book

Exercise regularly

Eat healthy

Maintain appropriate weight for height and sex

Get 8-9 hours sleep a night

Start each day with healthy breakfast

Good hygiene practices

Page 14

Self ActualisationEsteem Needs

Love and Belonging Needs

Safety Needs

Physiological Needs

METHOD


Time out with friends/family and recreation

Don’t smoke

Take prescribed medication

See medical professionals/Optometrists/Dentist regularly for check ups

Talk to friends/teachers/parents/St John leaders about problems don’t bottle them up.

16 Review:

Reform group. Review learning elements. Learners to state if and how well the learning elements have been achieved.

Module 2 – Safety

90 Minutes

Page 15

Content outline1. Informed Consent2. Effective hand washing3. Infection control 4. Use of Personal Protection Equipment5. Care and custody of medication6. Medication safety in the home7. Environmental home safety

Resources 1. Student workbook (pages 10-18)2. Paper and colour pens3. White board and marker pens4. Glitter Glue or paint5. Liquid soap6. Paper towels7. Disposable gloves (different sizes maybe needed)8. Apron/ Gown9. Facemask


Understand informed consent

Understand the importance of hand washing

State the principals of infection control in a home or community setting

Demonstrate how to use Personal Protection Equipment in a home or community setting

Understand the care and custody of medicine in the home and community setting

Identify the correct procedures to follow when using medicines in the home.

METHOD


1 Introduce the subject of the Module.

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METHOD


Explain what the learner will know by the end of the session. Check for understanding with learners.

2 Using question and answer, brainstorming, discussion or buzz groups, and the workbook scenarios discuss the statement

“Informed consent is a process rather than a one off event. The essential elements of this process are effective communication, full information and freely given competent consent”

Please be aware that informed consent is a complex and often grey area in health and medical law.

Informed Consent is a legal and ethical requirement under the Code of the Health and Disability services Consumer’s rights. Informed consent must be gained before any health care or first aid interaction can take place.

It is more than asking permission to do ‘something’ to ‘someone’; it is a basic right to the individuals’ freedom, rights and self determination.

Informed Consent requires effective communication. Communication must be honest, non threatening, and culturally specific. If required the individual giving consent should be given the opportunity to have an interpreter present.

Informed Consent requires Competence i.e. the person giving consent for a service must have the ability and/or support to make a decision based on the information that is given to this person. Key point is that competence is not necessary determined by age, but is more to do with the persons ability to make a reasonable and sound decision.

Informed consent requires voluntarism (i.e. the decision is voluntary) the person giving consent must do so and their own free will.

Informed consent requires full information to be given. This

Page 17

METHOD

Stage Student centred strategy Main teaching pointsmeans that all the necessary information for the individual to make a decision must be given – nothing must be withheld.

As this is a process if new information comes to hand or if the plan of care is to change, then the individual giving consent must be informed.

Consent may also be withdrawn at anytime.

Implications at home: If the learner is to do administer health care in the home to family or friends, then they still must gain informed consent before the service is delivered, as it is a basic right of all individuals.

3 Using question and answer, brainstorming, discussion or buzz groups, discuss the five moments of hand washing

Moment 1- Before touching a patientMoment 2- Before a procedureMoment 3- After a procedure or body fluid exposure risk

Moment 4- After touching a patient Moment 5- After touching patient’s surroundings Emphasise the importance of

washing hands between patients.

Emphasise the importance of covering personal cuts and grazes.

Wash hands before putting gloves on and after the removal of gloves.

4 Explain to the student the difference between a social hand wash, a procedural hand wash (what a caregiver would do) and a surgical scrub (what a surgeon would do)

A social hand wash is the basic procedure of washing hands and should be conducted whenever any first aid or health care interaction with a patient occurs – it should be conducted with warm

Page 18

METHOD

Stage Student centred strategy Main teaching pointssoapy water and or an alcohol gel solution. The hand wash should last for 20 seconds or 2 rounds of ‘Happy Birthday to you” and followed by careful drying.

A Procedural hand wash is an extension of the social hand wash (used for procedures that require aseptic technique (such as changing a sterile dressing). Often at the completion of this alcohol gel will also be used – should last for 2 minutes

A Surgical scrub is a more intense hand/arm wash and scrub, with specialized wash/scrub solution. It involves using nail brush and nail picks and is only used prior to a surgical procedure – should last for 5 minutes.

5 The tutor will now demonstrate the correct process for a procedural hand wash.

Once completed students will then demonstrate a hand wash. Students will massage glitter glue all over their hands and wrists and then wash it off using the techniques demonstrated by the tutor. Once wash completed student is to show their hands to the tutor, if glitter is not all removed student is to wash hands again.

1. Remove non-standard jewellery.

2. Wet hands and forearms with warm running water.

3. Apply liquid soap, lathering hands and forearms with copious suds for at least 20 seconds before rinsing, paying particular attention to palms, between finger and thumbs and backs of hands. You must rub their hands vigorously to provide friction.

4. Rinse thoroughly from fingertips down to the elbows, holding hands in an upward position. Ensure that

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METHOD

Stage Student centred strategy Main teaching pointsall soap residues is removed to decrease irritation and dryness of the skin.

5. Inspect hands to ensure there is no visible soiling.

6. Hold hands up and use a paper towel to dry hands and then forearms.

7. Turn off taps with elbows or a clean paper towel.

8. Discard paper towel into a foot operated rubbish disposal unit.

9. Hot Air Dryers are not a recommended method for hand drying in any health care setting.Resources: www.infectioncontrol.org. nz / hand hygiene/

6 Using question and answer, brainstorming, discussion or buzz groups, discuss ways on how infection enters the body

Eaten with food or drink Breathed in from the air Entering through a break in the

skin Spread by people and objects

7 Divide the class into groups, asking them to discuss ways in which the spread of infection can be controlled/ prevented in the community.

Well ventilated room – separate from others if possible

Wear overalls/gowns and disposable gloves when caring for an infected patient

Careful hand washing before and after attending patients for any reason

Careful disposal of excreta Careful wrapping and disposal of

Page 20

http://www.infectioncontrol.org.nz/handhygiene/

http://www.infectioncontrol.org.nz/handhygiene/

METHOD


dressings Careful handling, wrapping and

disposal of food scraps Separate washing of utensils used

by patient Provide an occupation which can

be destroyed or washed thoroughly after use (e.g. magazines, plastic toys)

Use disposables wherever possible

Isolate patient from vulnerable family members

8 Tutor to Introduce the term PPE (Personal Protection Equipment) and discuss its definition, and types of PPE available

Personal protective equipment (PPE) is any type of facemask, glove, or clothing that acts as a barrier between infectious materials and the Mouth, Eyes, Nose or Skin (MENS). When used properly, personal protective equipment can help prevent the spread of infection from one person to another.

8a Tutor to demonstrate putting PPE on and then removing it safely and disposing appropriately.

Students to practice putting on PPE and then removing PPE

Mask Gown Goggles Cap Gloves Wash hands

9 Tutor to discuss the importance of the correct care and custody of prescription medications in the home.

Do not share prescription medication with others

Dispose of expired and discontinued medication through your pharmacist

Read and follow the instructions on the bottle/packet before

Page 21

METHOD

Stage Student centred strategy Main teaching pointsadministrating the medication to the patient

Be aware on what the medication looks like

Do not crush/break or chew any medication unless instructed to do so

For liquid medication use an appropriate measuring device (household teaspoons and tablespoons are not very accurate.

Do not discontinue a patients medication without consulting the doctor/pharmacist

Never combine more than one type of medication in a bottle or packet.

Keep medications in a set and safe location up high so young children or family pets cannot reach.

Use child proof bottles Consider locking medications up in

a high cupboard. Keep tubes of cream and ointment

away from toothpaste and other personal creams.

Keep liquid medications/vials in the fridge

Ensure the necessary medications are taken before/with or after food as prescribed.

Keep needles/syringes out of reach of children

If helping with an injection never recap the needles – discard in a labelled sharps container

Page 22

METHOD


10 Using question and answer, brainstorming, discussion or buzz groups, discuss some ways medications can be administered

Injection (intra muscular/Sub cutaneous)

Tablet Oral liquid Cream/Ointment rubbed onto skin Patch Inhaler Nasal spray Eye/nose drops Sub lingual (under the tongue) Intravenous Per rectum

11 Tutor to discuss the importance of the correct administration of medicines – using the 5 rights of medication safety in the home/community.

Check medicine to ensure it is the right one

Check expiry date

Give it only to the person for whom it is prescribed

Give the exact amount ordered

Give it at the time ordered by the doctor

Give it by the correct method

An easy way of remembering the above is with the pneumonic DRPAT.

Drug

Route

Person

Amount

Time

ime

Note: Always check the patient actually swallows the medication, and record it on a chart.

Page 23

METHOD


12 Review:


CHECKLIST – Washing hands – procedural wash

Materials collected together

Remove all jewellery and watches

Wet wrists and hands

Apply sufficient soap to hands

Lather soap and scrub hands palm to palm

Scrub between and around fingers

Scrub back of each hand with palm of other hand

Scrub fingertips of each hand in palm of opposite hand

Scrub each thumb clasped in opposite hand

Scrub each wrist clasped in opposite hand

Continue for at least 30 seconds

Rinse thoroughly in running water

Wipe and dry hands thoroughly with paper towels

Turn off tap using paper towel

Page 24

CHECKLIST – Removal of disposable gloves

Washes hands

Explains to patient why caution is necessary

Chooses correct size of glove – not loose fitting

Puts gloves on and checks for holes and tears

Carries out any necessary procedures for patient

Removes first glove by peeling it backwards from the wrist, using finger and thumb. Glove pulled inside out

Using exposed hand, picks up first glove (touching the clean inside only) and uses it to pull off second glove from wrist

Takes care not to touch outside of second glove with clean hand

Disposes of glove appropriately

Washes hands

Page 25

Module 3 – Communication

60 Minutes

Content Outline1. Verbal communication2. Non- verbal communication3. Communicating with impairments4. Listening5. Contacting the Emergency services and NZ Health Line

Resources

Student workbook (pages 19-21)

Communication resources


Demonstrate effective communication with individuals from all age groups

Demonstrate effective communication with individuals with specific communication needs

Identify barriers to effective communication and ways to overcome them

Demonstrate the ability to dial both the New Zealand Health Line and Emergency Services

Page 26

METHOD


1 Introduce the subject of the Module. Explain what the learner will know by the end of the session. Check for understanding with learners.

2 Discuss

1. What is communication?

2. Using question and answer, brainstorming, discussion or buzz groups, discuss non-verbal signs.

Facial Happy, sad or angry May look tense, totally blank or

screwed up in pain

Posture A weary or dejected person

slumps. A depressed patient huddles in the

corner A headache makes a patient turn

away from the light or cover their eyes

Abdominal pain is seen when the patient lies on their side and draws up their legs

Frightened person Grips your arm or hand

Frustrated child Bangs head against cot

Agitated elderly person

Mutters to themselves

2b Expressing feelings Using the Expression cards students to demonstrate the feelings on each of the cards without talking

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METHOD


3 Understand how to communicate with people of different ages

Baby

Cannot answer questions or express symptoms

Need to rely on a parent to explain what is normal behaviour

Toddler

Can answer simple questions Can take time to get information,

need to be patient Non verbal cues communication,

facial expressions. Picture boards

Teenager

Want information and want to be part of decision making

Can tell you symptoms and other information if you ask questions

Like to feel safe and in control Use words that are suitable and

appropriate and not patronising

Adult

Can speak and answer questions Will give information they think is

important Like to have things explained and

be part of open communication Use words that are suitable and

appropriate and not patronising

Older Adult

Will only answer question, will not give up information

Don’t like to cause worry or work Need patients and time and extra

TLC

Page 28

METHOD


4 Using question and answer, brainstorming, discussion or buzz groups, discuss considerations the caregiver must think about when communicating with the patient.

Main difficulty is how to approach the patient

Be patient and give time and opportunity for patient to express wants and feelings

Address the patient directly Talk about your leisure activities, or

any subject that will give interest and pleasure

Patient who cannot talk Requires to be taught to speak by

a speech therapist Use picture card Use speaking board Offer constant encouragement Do not rush them when they are

trying to talkHearing impaired patient Encourage use of a hearing aid Use plenty of non-verbal signs Face patient as directly as possible Place yourself in good light Never turn your back when talking

to them Do not obscure patient’s view of

your mouth with your hands Try and use lower tones of your

voice range Include the person in your smiles

and gestures where possible Have pen and paper available Learn some basics of sign

language Get help from voluntary

organisations for the hearing impaired

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METHOD

Stage Student centred strategy Main teaching pointsSight impaired patient

Can hear and talk, but non-verbal communication is largely inaccessible to them

Seek help through the blind foundation

Ensure safety of surroundings Announce your approach and all

potential hazards the patient needs to be made aware of

Use touch as a method of reassurance

Orientate thoroughly to surroundings

5 Tutor to show the learners the speaking board. After the demonstration, allow learners to use and experiment with the board.

A great way to communicate with those that cannot speak the language, or at all.Tell partner what they want, by pointing

6 Using question and answer, learners to discuss difficulties in communicating with a patient who does not speak the carers language.

Identify means of overcoming difficulties.

Communicating through a language barrier

Use of gestures and objects to explain things

Seek an interpreter

6a Communicating with people in stressful situations.

Some of the people we meet within our roles in St John are in stressful situations.

Stress as a barrier

Noise

Worried/ Concern for others

Distraction

Pain

Anxiety

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METHOD


Scared

Best ways to communicate in stressful situations Speak slowly and clearly Don’t use big words Maintain eye contact Keep Calm

6b Split students into pairs. Using the Communication Picture Chart, have one person from each pair come to the Tutor and have a look at a picture. Student then must go to partner, sit back to back and describe the picture while their partner draws what they think it is. Person describing cannot use true words e.g. draw a boat,. They are to describe lines and shapes to build the picture.

6c Divide the students into pairs- they need to give 5 facts about themselves in 30 seconds- they need to be about 5 meters apart.

The idea is that the whole group will do this at one time to demonstrate poor communication. Evaluate ways in which communication can be improved for this task.

Poor communication

External noise

Distractions

Distance

7a Play a game of charades. Evaluate ways in which communication can be improved for this task.

Discuss barriers to charades and communication.

7b Give each person an expression card- perform this to the group and guess what expression it is that they are portraying.

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METHOD


8 Discuss with the group the importance of listening

" The most important thing in communication is to hear what isn't being said,"

Peter F. Drucke

Use the mnemonic SOLER when communicating

S- Sit squarely- face the person

O- Open Posture

L- Lean towards the person

E- Eye contact

R- Relax whilst listening.

9 Contacting the Emergency Services

Discuss which services you can get via 111

Discuss when you would need to call 111

http://www.111.govt.nz/index.html

Ambulance

Fire Service

Police

A fire or chemical spill

Someone is having breathing difficulties, is seriously ill or injured

Someone is in danger

A serious risk to life or property

A crime is being committed

You’ve come across a major public inconvenience

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http://www.111.govt.nz/index.html

METHOD


10 Contacting Healthline

How and when to contact Health Line

National Poisons Centre

Healthline is New Zealand’s national telephone triage and health service. It is funded by the Ministry of Health and provided by Medibank Health Solutions in association with St John.

Healthline has three main functions:

1. Assessment and triage of callers with symptoms

2. General health advice and information for callers without symptoms

3. Information on health services throughout New Zealand.

Free phone 0800 611 116

Contact Health line if you’re Feeling unwell – but not sure

whether you need to see a doctor Needing some urgent advice about

a family member or friend who’s sick

On holiday and want to know where the nearest doctor or pharmacy is.

www.health.govt.nz

0800 POISON (0800 764 766)

http://www.poisons.co.nz/index.php

11 Review: Reform group. Review learning elements. Learners to state if and how well the learning elements have been achieved.

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http://www.poisons.co.nz/index.php

http://www.health.govt.nz/

Module 4 – Skin and Wound Care

45 Minutes

Content outline

1. Skin care

2. Care of wounds

3. Cleaning wounds

4. Community dressing products

Resources


Selection of dressings

- Primapore (Melolin type pad with hypafix backing)- Opsite (Waterproof, Bacteria-proof Dressing with See-through Absorbent

Pad)- Steri strips/ Leukostrip (* is a skin closure strip combining a very strong

hypoallergenic adhesive and a porous polyamide material which allows the free passage of exudate therefore lessening the likelihood of maceration under the strip.)

- Band aids- Burns dressings

Boxes of gloves

Access to sinks for hand washing

Wound picture charts (provided on Power point presentation)


Identify common causes of pressure areas and prevention methods

Identify the difference between healthy and unhealthy wounds

Demonstrate the ability to clean a wound effectively

Have an understanding of difference dressing products available in the community

Page 34

METHOD



2 Discuss what Pressure Ulcers are.

A pressure ulcer is an area of skin and tissue that becomes injured or broken down. Generally, pressure ulcers occur when a person is in a sitting or lying position for too long without shifting his or her weight. The constant pressure against the skin causes a decreased blood supply to that area. Without a blood supply, the area cannot survive and the affected tissue dies.

The most common places for pressure ulcers are over bony prominences (bones close to the skin), such as the elbow, heels, hips, ankles, shoulders, back, and the back of the head.

May occur on bedridden patients who are unable to move freely or those who must sit in chairs or wheel chairs for several hours per day

Occur as a result of prolonged pressure on one part of the body, causing poor circulation to that area and subsequent tissue damage

Occur on the bony prominences of the body e.g. bottom of spine, heels, elbows, hips, skull

If not treated, quickly increase in size, become painful and infection often complicates

3 Tutor to describe how pressure sores are formed.

Continuous pressure on one area

Dampness

Break in skin surface

Poor nutrition

Dehydration

Poor blood circulation

Presence of bacteria

Friction

Oedema (swelling)

At risk groups:

- Elderly and immobile- Diabetics

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METHOD


4 Discuss methods of preventing the skin damage.

Patient’s sheets must be clean, dry and smooth

Change patient’s pyjamas when soiled or wet. Ensure skin is DRY.

Keep area between the folds of the skin clean and dry

Treat all bony prominences with a recommended cream regularly

Change patient’s position regularly

Use sheepskins, foams and sponges to protect pressure-bearing areas

Make sure patient is receiving good nutrition and adequate fluids

5 Using question and answer, brainstorming, discussion or buzz groups, discuss the causes of wounds

Surgical interference (operations)

Injury (from any source)

6 Using the provided power point show the wound pictures to the group and discuss the visible differences between a healthy wound, and an unhealthy.

7 In groups the students are to not document the difference between health and unhealthy wounds

Healthy Wounds Pink Visible blood (not bleeding) No discharge No scabbing Smooth edges

Unhealthy wounds Hot to touch Painful Red edges Green or yellow discharge Black areas Odorous

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METHOD


8 Tutor to demonstrate how to correctly clean and dress a wound. After demonstration students to verbalise the steps of the procedure while tutor repeats demonstration.

9 Divide students into groups. Students to practice skills using the checklist in their workbooks.


Page 37

CHECKLIST – Cleaning a wound

Materials collected together

Introduces self and explains procedure

Washes hands

Puts on gloves

Expose the wound by removing previous dressing

Inspects wound for healing, discharge or redness

Dispose of previous dressing

Removes dirty gloves and discards appropriately

Washes hands

Puts on clean gloves

Applies warm water (or available wound cleaning solution) to swabs

Clean wounds with swabs

Dries wounds with dry swabs

Recovers wounds with appropriate dressing

Removes rubbish

Removes dirty gloves and discards appropriately

Washes hands

Page 38

Module 5 – Basic Personal Care

90 Minutes

Content Outline1. Dignity and respect2. Preparing a room3. Bathroom preparation4. Assisting a patient with dressing where limbs are affected5. Skin Care6. Hair care7. Mouth Care

Note: The student is to both learn the required skills for and be put in the position of a patient.

Resources Student workbook (pages 26-32) Washbowls Toothpaste Shampoo Toothbrushes Conditioner Disposable cups – one per person Wet shampoo revision cards Flannels Towels


To acknowledge dignity, respect and privacy at all times when providing care

Show an understanding of requirements of different individuals bedrooms

have and understanding of how to prepare a bathroom for an individuals use

Demonstrate the ability to assist individuals to dress themselves

Demonstrate the correct procedures for:Face WashingHair washingTeeth cleaning

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METHOD



2 Brain storm what feelings they think the carer and the individual who is having care provided for them would have.

Individual having care providedEmbarrassing

Degrading

Intrusive

Shameful

Thankful/ grateful

Helpless/ Useless

Rushed

“a bother”

CarerPrivilegedEmbarrassedHelpfulHonouredRespectfulIntrusive

3 Explain to the group the need to be sensitive when dealing with this topic.

CultureConsider peoples different cultural needs

Consider Age

Age difference of the carer and the patient, many elder people would not want a young person to help them with their personal care.

Gender Maori Touching of head is sacred in some

religions

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METHOD


4 Divide class into groups, giving each group one of the following ‘physical needs and safety aspects of the home environment’ to discuss:

The room

The bed

The furniture

Nursing Aids

Record on large paper or in workbooks and feedback to group.

Room

The patients room should: Be regularly cleaned Get the sun if possible Have a view to the outside Be as near to the bathroom as

possible Be well ventilated without being

draughty Be comfortable for the patient Free of clutter/equipment not in

use Power points accessible Extension cords limited Furniture at easy height for reach No furniture/items near heating

source

Bed

The patient’s bed should: Be a single bed (preferably) Be elevated for ease of nursing – if

required Have a firm, comfortable mattress Have an adequate number of

pillows Have sufficient space around it to

allow carer to move around Have suitable (and wrinkle-free)

bed linen Avoid electric blankets or hot water

bottles – only wheat bags.

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METHOD


Furniture

The patient’s bedroom furniture should include:

Table or bedside cabinet for the patient

Comfortable chair for the person to sit in

Commode if necessary

Work areas as necessary Cupboard for the storage of

clothing etc Furniture should be in good

condition and checked regularly. Dispose of furniture that is not up

to standard.

Nursing aids Bedpan, urinal, washbowl,

commode – not to be placed on surfaces for eating or washing head/face

Bed tray as a working surface for the patient

Bell/intercom at easy reach Recreation material: Books,

magazines, television, radio, handcrafts etc

Bed cradle (and/or other aids specific to the condition) – bed sides as appropriate and with patient/families informed consent

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METHOD


5 Using question and answer, brainstorming, discussion or buzz groups, discuss procedures the caregiver takes when the patient wishes to bathe in the bath.

Room warm and window closed

Gather bathing equipment and clothes

Place non-skid mat in bath

Run cold water first, then add hot to mix

Test water temperature

Tell patient when bath is ready and assist to the bathroom

Never allow the door to be locked

Place a bell within easy reach

Clean bath and clear bathroom when finished

6 Tutor to demonstrate assisting a patient to dress themselves where limbs are affected. After the demonstration students are to verbalise the steps of the procedure while the tutor performs the skill.


8 Discuss the need for good mouth care.

Ask the group how we care for our mouth.

What problems can occur with our mouth (include teeth, gums, and tongue)

Particles of food left in the mouth decompose, and harmful bacteria flourish and multiply.

- Cleaning teeth- Using mouthwash

Chewing gum- Regular dental check ups

DenturesGingivitisUlcersTooth ache

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METHOD


9 Tutor to demonstrate mouth care. Check the procedure with the group.

10 Divide students into groups. Students to practice skills using the checklist in their workbooks, and answer the questions.

11 Tutor to demonstrate how to wash a patients face.

After the demonstration students are to verbalise the steps of the procedure while the tutor performs the skill

Importance of wiping away from the eyes

Using a different bit of the face cloth for each eye.

12 Divide students into groups. Students to practice skills using the checklist in their workbooks, and answer the questions.

13 Tutor to demonstrate giving a wet shampoo. After the demonstration students are to verbalise the steps of the procedure while the tutor performs the skill



Page 44

Module 6 – Nutrition in the Community

60 Minutes

Content outline

1. General guidelines of nutrition

2. Different meal preparations

3. Feeding technique for a helpless patient

4. Nutritional Complication of Diarrhoea and vomiting

Resources


Large sheets of paper and markers

Yoghurts

Slings

Disposable spoons

Feeding patient revision cards


Understand the basic nutritional needs of an individual on a daily basis and when unwell

Identify difference food preparations for special conditions and injuries

Demonstrate the ability to correctly feed someone who is unable to feed themselves

Understand the nutritional complications of persistent diarrhoea and vomiting

Page 45

METHOD



2 Using question and answer, brainstorming, discussion or buzz groups, discuss the healthy food pyramid and food proportions per meal

Dietician’s recommend that people eat a certain amount of food from key groups every day. A pyramid best represents these food groups and serving sizes

Page 46

Protein

Carbohydrate

Vegetables

METHOD


3 Using question and answer, brainstorming, discussion or buzz groups, discuss Which foods to eat more and which foods to eat less of if you are suffering from a cold/flu, stomach bug, or physical injury

When you are unwell your body needs different things to normal to help you get better

Foods have different contents, some of which are helpful to healing and others which are not

With all illnesses it’s important to increase your vitamin and mineral uptake and limit your fat consumption

With cold/flu’s especially with congestion symptoms, limiting dairy production consumption can help in reduction congestion

Cold and flu’s need high volumes of vitamin C and fluids

Stomach bugs need plain bland foods in small volumes, things with little flavour or spice

Replacing good stomach bacteria is important easy with certain yoghurts or supplements

When healing from injury the body requires protein and calcium found in meat, eggs and dairy

4 Divide the class into groups, asking them to come up with as many people of different ages and circumstances who may need food prepared in a different way.

Each group to discuss and record their findings on a large sheet of paper and feedback to class.

Important to stress the fact that there are many different people who may not be able to eat food like the participant.

Some examples for these include: Babies

Infants

People with compromised swallow reflex

Post oral surgery

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METHOD


Post facial surgery

5 Using discussion talk about the different ways to prepare food

The people and circumstances listed in stage 4 need food made in different ways

These people may be able to eat the same food as the other people in their households, just prepared differently

Ways to prepare food:

Pureed

Liquefied

Thickened

Shakes or smoothies

6 Using question and answer, brainstorming, discussion or buzz groups, discuss how to make meal time pleasant.

Keep temperature of the food appropriate; hot or cold. If the food or liquid is hot, warn the patient to test it slowly

Use the utensils normally used for the food being served wherever possible

Be careful not to spill food

Do not overfeed

Remove the tray promptly once patient has finished the meal

Sit and chat after the meal

Food should be artistically arranged

Tray cover clean and attractive – use a fresh one each meal

Napkins clean and colourful

Dishes clean and uncracked

Serve foods your patient likes

Stay with patient during the meal

Keep the sick room bright, clean and well ventilated

Place a small flower on the tray

Music

Page 48

METHOD


7 Divide the class into groups, asking them to discuss items which may help them feed someone requiring assistance to eat.

Some item will make helping someone eat easier

They may include:

Tray

Straws

Closed lid cups

Napkins

Easy hold cutlery

8 Tutor to demonstrate feeding a helpless patient. After the demonstration, students to verbalise the steps of the procedure while the tutor performs the skill.

8a Divide students into groups. Students to practice skills using the checklist in their workbooks. Patients are to be blindfolded with a sling.

9 Using questions and answers or brainstorming discuss the nutritional complications of a persistent Gastro bug

Dehydrations Electrolyte imbalance Increase heart rate Dizziness Exhaustion

10 Discuss the signs and symptoms of dehydration

Thirst Tenting of the skin Dry lips and tongue Concentrated urination Increased heart rate


Page 49

CHECKLIST – Assisting Someone with Food

Introduces self and explains procedure

Checks if the patient needs to use the toilet and offers to wash individuals hands and faceHelps patient into a comfortable position. Protects bedclothes

Asks patient about any preferences they may have regarding flavour and temperatureGathers Materials together and washes hands

Brings tray to bed. Sits down by patient

Using fork or spoon, feeds patient. Allows time for chewing

Gives drink by patient’s preferred method

Clears tray away.

Offers to wash patients face and hands

Washes hands

.

Page 50

Module 7 – The Grieving Process

30 Minutes

Content outline

1. Feelings and fear of death

2. Patient comfort

3. Recognising signs of death

4. What to do at time of death

5. Coping with the death of your patient

Resources

Student workbook (Pages 39-40)

Extra resources about Enduring Power Of Attorney, Advanced Directive/Living Will, and Death Certificate (if knowledge is limited)


Understand the physical changes that occur at the end stages of life

Have an awareness of the feelings of all people involved in an individual’s death

Identify the 5 stages of grief

Have an awareness of the documentation an individual may complete prior to the end of life

Page 51

METHOD



2 Using question and answer, brainstorming, discussion and groups, discuss your own feelings and fears regarding death.

3 Using question and answer, brainstorming, discussion or buzz groups, identify the signs of approaching death.

Growing weaker

Sleeping more

Lack of appetite

Diminished sensations

Laboured breathing

Confusion

4 Using question and answer, brainstorming, discussion and groups, discuss the fears of the patient.

Pain

Loneliness

Being a burden

5 Using question and answer, brainstorming, discussion or buzz groups, discuss the feelings of the caregiver after the death of a patient. Initial and long-term grief.

Shock and numbness

Strong and painful feelings

Unstable emotions (Sadness, anger, guilt and regret)

Confusion and forgetfulness

Loss

6 Discuss physical reaction possibly experienced by carer after the death of their patient.

Tiredness

Difficulty in sleeping

Loss of appetite

Tightness in chest

Inability to cope at work

7 Tutor to explain the support available in the community.

GP and Practice Nurses

District Nurses

Support Groups

Financial support (Government)

Page 52

METHOD


8 Tutor to discuss with students self help methods of coping with grief.

Rely on a counsellor or friend

Rest

Set small, achievable goals

Keep decision-making to a minimum

Ask for help

Eat well

Draw on spiritual resources

9 Discuss the stages of grief. Tutor to explain how this will enable carer to anticipate the patient’s needs.

To bring light to his subject there are a few videos available on YouTube that show this process in a light hearted way.

1. Disbelief and shock

2. Anger

3. Bargaining

4. Depression

5. Acceptance

10 Tutor to discuss available relevant paperwork.

Enduring Power of Attorney

An EPA for personal care and welfare concerns decisions about your care, such as how you should be looked after if you became unable to do this yourself. This type of EPA only takes effect if you become mentally incapable

An EPA for property is about how you would like your property and finances managed. With an EPA for property you can choose whether it comes into effect straight away, or only when you can no longer manage your affairs

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METHOD


Advanced Directive/ Living Will"Advance directive" is defined in the Code as meaning "a written or oral directive - (a) By which a consumer makes a choice about a possible future health care procedure; and (b) That is intended to be effective only when he or she is not competent". (The term "living will" is used by people as an alternative to "advance directive") Some advance directives fitting this definition are used in every day medical practice.

Death CertificateThe law requires that all deaths in New Zealand are notified to Births, Deaths and Marriages within three working days after the burial or cremation of the body. There is no charge for registering the death.If a funeral director is in charge of funeral arrangements, he or she will collect all of the information required and forward it to Births, Deaths and Marriages for registration.

Where a funeral director is not involved, the person in charge of the funeral arrangements is responsible for notifying Births, Deaths and Marriages of the death.

11 Review:


Page 54

Module 8 – Observations

75 Minutes

Content outline

1. Collecting information

2. Baseline observation, taking and recording

3. Assessment of all ages

4. Household aliments

Resources


30 Digital thermometer covers

10 x Digital thermometers

Tympanic thermometer


Learn different ways of collecting information from individuals using multiple tools

Demonstrate the correct procedure in taking baseline observations and recording them appropriately

Understand the differences when assessing individuals from varying age groups

Have knowledge of common household ailments and at what point medical assistance is required.

Page 55

METHOD



2 Using question and answer, discuss the difference between signs and symptoms

A sign is something that can be seen or measures, opposed to a symptom which is how an individual is feeling.

EG: Vomiting is a sign

Nausea is a symptom

3 Using question and answer, brainstorming, discussion or buzz groups, discuss different ways to gather information

Look

Listen

Smell

Touch

Taste

Measure

4 Using question and answer, brainstorming, discussion or buzz groups, discuss different ways to gather information

HEAD

Eyes

- Colour

- Discharge Nose

- Discharge

- Breathing Mouth

- Moisture

- Colour Face

- Colour

- Temperature

- Pain

Voice, throat, emotion

Page 56

METHOD


BREATHING

Breathing

- Smell

- Rate and effort

- Through nose or mouth

- Use of accessory muscles Cough

- Producing sputum

- Sound

- Frequent

- Colour of sputum Posture

- Showing undue discomfort or weakness

URINE & STOOL- Colour

- Odour

- Frequency

- Pain

- Quantity

- Blood

5 Discuss the acronym SAMPLE and its use for gather information

S - signs and symptoms

A - allergies

M - medications

P - past medical history

L - last meal

E - events prior

Page 57

METHOD


6 Tutor is to discuss Pain assessment and the PQRST acronym with the class.

P – ProvokesWhat brought on the pain?

What makes it worse?

What makes it better?

Q - QualityAsk the patient to describe the

pain.

Beware of leading questions.

R – Region

Where is the pain?

Does it radiate elsewhere?

S – SeverityLook for the effects of stress on the patient.

T – TimingWhen did the pain start?

Was onset gradual or sudden?

Has the patient had this pain before?

Is the pain consistent or does it come and go?

It is important to acknowledge that not all people respond the same to pain assessment and you may have to try different assessments to get an accurate result. Three pain assessments are featured in the workbook.

Page 58

METHOD


7 Divide students into groups. Students are to discuss how gathering information is altered by the age of the individual.

Baby

Cannot answer questions or express symptoms

Need to rely on a parent to explain what is normal behaviour

Eating and toilet habits can tell you a lot about a baby

Toddler

Can answer simple questions Can take time to get information,

need to be patient Can use Wong/Baker pain scale

faces

Teenager

Want information and want to be part of decision making

Can tell you symptoms and other information if you ask questions

Like to feel safe and in control

Adult

Can speak and answer questions Will give information they think is

important Like to have things explained and

be part of open communication

Older Adult

Will only answer questions, will not give up information

Don’t like to cause any worry or work

Need patience, time and extra TLC

Page 59

METHOD


8 Using question and answer, brainstorming, discussion or buzz groups, discuss the observations temperature, pulse and respirations

Pulse:

Radial

Carotid

Brachial (for babies)

Femoral

Pedal

Temperature:

Auxiliary

Tympanic

Rectal

Oral

Normal body temperature 36.5 – 37.5

Hypothermia ≤ 35.5°C

Hyperthermia ≥ 38°C

Page 60

METHOD


9 Tutor to demonstrate taking a radial pulse, an auxiliary temperature and respiration rate.

10 Divide students into groups. Students to practice skills using the checklist in their workbooks and record results.

11 Using question and answer, brainstorm, discussion or buzz groups, discuss how and why we should keep good records

Date and time Individuals name Legible hand writing Blue or black pen Use correct abbreviations and

units of measurement Name of person who took the

observations

12 Using question and answer, brainstorm, discussion or buzz groups, discuss the signs and symptoms of each of the following household aliments and when a visit to the family doctor is required

Cold & Flu

Signs and Symptoms- Running or blocked nose- Cough- Sore throat- Tiredness- Temperature- Muscle aches- Sore ears- Photo phobia- Neck stiffness

Family Doctor- Cough or nose discharge

becomes green- Temperature is consistently

above 38- Symptoms last for longer than

4-5 days- Pain in throat reduces the

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METHOD


ability to eat and drink

Gastro (Tummy Bug)

Signs and Symptoms- Nausea- Vomiting- Diarrhoea- Stomach pain- Temperature

Family Doctor- Signs and symptoms

continuously for 2 days or more

- Signs and symptoms ≥ 24 hours for children

- Temperature consistently over 38

- Inability to consume any food or liquid

Skin rash

Signs and symptoms- Red skin- Itchy- Raised lumps- Welts- Temperature- Pain

Family Doctor- Associated cold and flu

symptoms- Unrelieved by antihistamines- Temperature constantly over

38- Swelling to face or neck- Positive tumbler test

13 Review:

Page 62

METHOD



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Documents

Tutor Qualifications - youth.stjohn.org.nz · Web viewHolistic care is a system of comprehensive or total patient care that considers the physical, emotional, social, economic,