Level 2 Certificate in. Understanding End of Life Care (QCF) Specification. Ofqual Accreditation Number 601/1405/8

Transcription

1 Level 2 Certificate in Understanding End of Life Care (QCF) Specification Ofqual Accreditation Number 601/1405/8 Ofqual Accreditation Start Date 01/10/2013 Ofqual Accreditation End Date 31/10/2016 Ofqual Certification End Date 31/10/2017 Page 1 of 39

2 ASCENTIS MISSION STATEMENT About Ascentis Ascentis was originally established in 1975 as OCNW, a co-operative scheme between Universities and Colleges of Further Education. Ascentis was the first Open College in the UK and served the needs of its members for over 34 years. Throughout this period, OCNW grew yet maintained its independence in order that it could continue to respond to the requirements of its customers and provide a consistently high standard of service to all centres across the country and in recent years to its increasing cohorts of overseas learners. In 2009 OCNW became Ascentis - a company limited by guarantee and a registered educational charity. Ascentis is distinctive and unusual in that it is both: An Awarding Organisation regulated by the Office of Qualifications and Examinations Regulation (Ofqual) and an Access Validating Agency (AVA) for Access to HE Programmes licensed by the Quality Assurance Agency for Higher Education (QAA). Ascentis is therefore able to offer a comprehensive ladder of opportunities to centres and their students, including Foundation Learning, vocational programmes and progressing to QAA recognised Access to HE qualifications. The flexible and adult-friendly ethos of Ascentis has resulted in centres throughout the UK choosing to run its qualifications. ASCENTIS CONTACT DETAILS Ascentis Office 4 Lancaster Business Park Mannin Way Caton Road Lancaster LA1 3SW Tel Company limited by guarantee. Registered in England and Wales No Registered Charity No Page 2 of 39

3 TABLE OF CONTENTS LEVEL 2 CERTIFICATE IN UNDERSTANDING END OF LIFE CARE Introduction 4 Aims 4 Target Group 4 Ofqual Qualification Accreditation Number 4 Rationale for the Rules of Combination 5 Rules of Combination 5 Recommended Guided Learning Hours 5 Time Limit for the Process of Credit Accumulation and Exemptions 5 Recommended Prior Knowledge, Attainment and / or Experience 5 Age Range of Qualification 5 Opportunities for Progression 5 Mapping / Relationship to Common Core Competencies & National Occupational Standards 6 Resources to Support the Delivery of the Qualification 6 Centre Recognition 6 Qualification Approval 6 Registration 6 Status in England, Wales and Northern Ireland 6 Reasonable Adjustments and Special Considerations 6 Enquiries and Appeals Procedure 6 ASSESSMENT AND VERIFICATION ARRANGEMENTS Assessment 8 Internal Assessment 8 Verification 8 Internal Verification 8 External Verification 9 Knowledge, Understanding and Skills Required of Assessors and Internal Verifiers 9 UNIT SPECIFICATIONS Understand how to work in end of life care 10 Understand how to support individuals who are distressed 13 Understand how to provide support to manage pain and discomfort 16 Understand how to support individuals during the last days of life 18 Understand the care process for a deceased person 21 Appendix 1 Summary Record of Achievement 23 Appendix 2 Tracking Sheet 24 Appendix 3 Mapping / Relationship to Common Core Competencies & National Standards 35 Appendix 4 Resources to Support the Delivery of the Qualification 38 Page 3 of 39

4 UNDERSTANDING END OF LIFE CARE Introduction This qualification will allow learners to understand the principles of end of life care and develop a thorough knowledge of the policies, procedures and support networks available within an end of life care environment. The qualification will enable learners to function more effectively in the health and social care / end of life care environment. It will prepare learners to be able to progress on to one of the competency based end of life care qualifications and / or a role within the sector as well as allowing them to provide support to staff that are currently providing more practical based care. There are several features of this qualification that make it very appropriate for its target learners Aims Unit certification is available for each of the units Verification and certification can be offered throughout the year, allowing maximum flexibility for centres Can be delivered either as a classroom-based course or as a blended learning programme Evidence can be generated within a wide range of organisational contexts allowing the qualification to meet the specific occupational requirements of the learners. The aims of the qualification are to enable learners 1 To develop a thorough understanding of current end of life care policies and procedures 2 To support other staff working in end of life care 3 To be able to progress on to one of the competency based end of life care qualifications 4 To understand how to access the support networks available to others and themselves Target Group This qualification is aimed at a range of learners, including Senior workers and managers in services listed below First line supervisors working at Level 3 and above Team leaders working at Level 3 Care assistants / support workers / key workers in residential settings Support workers in community and primary care environments Care assistants / support workers / key workers in domiciliary services Care assistants / support workers / key workers in day services Support workers in supported living projects Community-based care assistants / support workers / key workers, including those working in specialist areas, e.g. dementia, learning disabilities Family support workers Personal assistants employed directly by the individual they support or their families Volunteers Ofqual Qualification Accreditation Number: 601/1405/8 Page 4 of 39

5 Rationale for the Rules of Combination To achieve the qualification, the learner must achieve a total of 14 credits from the 5 mandatory units. Rules of Combination Level 2 Certificate in Understanding End of Life Care Minimum credits: 14 Title Level Credit Value GLH QCF Unit ref Understand how to work in end of life care L A/503/8085 Understand how to support individuals who are distressed Understand how to provide support to manage pain and discomfort Understand how to support individuals during the last days of life Understand the care process for a deceased person Unit certification is available for all units. L F/504/5460 L T/504/5519 L J/503/8137 L D/504/5529 Recommended Guided Learning Hours The recommended guided learning hours for this qualification is 121. Time Limit for the Process of Credit Accumulation and Exemptions Credit accumulation is usually within the life span of the qualification. Exemptions may have been achieved previous to the qualification start date; each case will be considered separately. Recommended Prior Knowledge, Attainment and / or Experience No previous knowledge of end of life care is required. Age Range of Qualification This qualification is suitable for learners aged and Opportunities for Progression This qualification will prepare learners to be able to progress on to one of the competency based end of life care qualifications such as: Level 3 Certificate in Working in End of Life Care Learner develops their understanding of end of life care, especially around advance care planning, to develop specific communication skills and to demonstrate competence in managing symptoms and pain in end of life care, supporting individuals with loss and grief before death and in their spirituality. Level 5 Certificate in Leading and Managing Services to Support End of Life and Significant Life Events a CPD qualification to support managers to demonstrate how they can lead and manage end of life care services that promote positive experiences for individuals and their families at the end of life. Page 5 of 39

6 Mapping / Relationship to National Occupational Standards Whilst this qualification is knowledge based rather than competence based it is informed by the Common core competences and principles for health and social care workers working with adults at the end of life which forms part of the National End of Life Care Strategy. Resources to support the Delivery of the Qualification These are outlined in Appendix 4. Centre Recognition This qualification can only be offered by centres recognised by Ascentis and approved to run this qualification. Details of the centre recognition and qualification approval process are available from the Ascentis office (tel ) or from the website at Qualification Approval If your centre is already a recognised centre, you will need to complete and submit a qualification approval form to deliver this qualification. Details of the qualification approval process are available from the Ascentis office (tel ) or from the website at Registration All learners must normally be registered within seven weeks of commencement of a course via Rhombus (the Ascentis learner registration portal). Guidance can be downloaded from the Ascentis website at Status in England, Wales and Northern Ireland This qualification is available in England, Wales and Northern Ireland. It is only offered in English. If a centre based overseas (including Scotland) would like to offer this qualification, they should make an enquiry to Ascentis. Reasonable Adjustments and Special Considerations In the development of this qualification Ascentis has made every attempt to ensure that there are no unnecessary barriers to achievement. For learners with particular requirements reasonable adjustments may be made in order that they can have fair assessment and demonstrate attainment. There are also arrangements for special consideration for any learner suffering illness, injury or indisposition. Full details of the reasonable adjustments and special considerations are available from the Key Information / Policies area of the Ascentis website or through contacting the Ascentis office. Enquiries and Appeals Procedure Ascentis has an appeals procedure in accordance with the regulatory arrangements in the Ofqual General Conditions of Recognition 1. Full details of this procedure, including how to make an application, are available from the Key Information / Policies area of the Ascentis website or through contacting the Ascentis office. 1 The Scottish Qualifications Authority (SQA) have developed some high level principles that cover the same requirements as the Ofqual Conditions. These are the SQA Accreditation Regulatory Principles (2011). Page 6 of 39

7 ASSESSMENT AND VERIFICATION ARRANGEMENTS Assessment All units are internally assessed through the learner building up a portfolio of evidence that covers the relevant assessment criteria, internally assessed and verified by the centre and then externally verified by Ascentis. On completion of the learners evidence for either the individual units or the certificate, the assessor is required to complete the Summary Record of Achievement for each learner. The Summary Record of Achievement asks assessors and the internal verifier to confirm that the rules of combination have been followed. This is particularly important in cases where a learner has taken units at different levels. The Summary Record of Achievement form is provided in Appendix 1. Centres are required to retain all evidence from all learners for external verification and for 4 weeks afterwards should any appeal be made. Internal Assessment Evidence for each unit is through building up a portfolio of evidence to demonstrate that all the assessment criteria within the unit have been achieved. The evidence will be assessed by the assessor at the centre, who may or may not be the tutor teaching the course. Portfolios of evidence should include a variety of evidence to demonstrate that the assessment criteria for each unit have been met. Examples of evidence that could be included are Observation record Questions and discussions Worksheets Tape recordings Self assessments Workbook activities If the learner fails to meet the assessment criteria on the first attempt at an activity they may redraft the work following feedback given by the tutor. However tutors must not correct the work of the learner, and all feedback given by the tutor must be included within the learner s evidence. Learners portfolio work should include a tracking sheet to show where the evidence for each assessment criterion is to be found. Some activities could produce evidence for more than one unit, which is acceptable as long as there is clear reference to this on the tracking sheet. Examples of tracking sheets are found in Appendix 2. Verification Internal Verification Internal verification is the process of ensuring that everyone who assesses a particular unit in a centre is assessing to the same standards i.e. consistently and reliably. Internal verification activities will include: ensuring any stimulus or materials used for the purposes of assessment are fit for purpose; sampling assessments; standardisation of assessment decisions; standardisation of internal verification decisions. Internal Verifiers are also responsible for supporting assessors by providing constructive advice and guidance in relation to the qualification delivered. Further information is available from the Key Information section of the Ascentis website Page 7 of 39

8 External Verification Recognised centres will normally be visited twice a year for external verification; although more frequent verifications can be requested from the Ascentis Quality Assurance team, for which there is usually an additional charge. External verification will usually focus on the following areas A review of the centre s management of the accredited provision The levels of resources to support the delivery of the qualification, including both physical resources and staffing Ensuring the centre is using appropriate assessment methods and making appropriate assessment decisions according to Ascentis requirements Ensuring the centre has appropriate internal quality assurance arrangements as outlined within the relevant qualification specification Checking that the centre is using appropriate administrative arrangements to support the function of delivery and assessment External Verifiers will usually do this through discussion with the centre management team; assessment and Internal Quality Assurance staff; verifying a sample of learners evidence; talking to learners, reviewing relevant centre documentation and systems. Staff development, including guidance and support for assessors and internal quality assurance staff can be requested either as part of an external verification visit or as a bespoke session for centres. Please contact the Ascentis Quality Assurance team for further details (qualityassurance@ascentis.co.uk.) Knowledge, Understanding and Skills required of Assessors and Internal Verifiers Assessors and those delivering this qualification should be occupationally knowledgeable and competent within areas of End of Life Care in which they are making assessment decisions / delivering the qualification. Assessors must be qualified to make assessment decisions. Relevant qualifications include Level 4 Certificate in Education and Training Level 5 Diploma in Education and Training Award in Assessing Vocationally Related Achievement Certificate in Assessing Vocational Achievement Legacy qualifications such as A1, A2, D23, D33 Legacy qualifications remain valid providing the assessor has up to date experience of assessing and has undertaken relevant annual Continuing Professional Development. Those delivering the qualification should hold a recognised teaching qualification such as the Level 4 Certificate in Education and Training, Level 5 Diploma in Education and Training or working towards such a qualification. Training for this role is available through an Ascentis Internal Quality Assurance course. The purpose of the course is to provide staff in centres with knowledge and understanding of Ascentis IQA processes and procedures, which will enable them to carry out their role more effectively. To book your place on a course or request further information, please contact the Ascentis Quality Assurance Team (qualityassurance@ascentis.co.uk). Page 8 of 39

9 UNIT SPECIFICATIONS Understand how to work in end of life care Credit Value of Unit: 3 GLH of Unit: 28 Level of Unit: 2 Introduction The purpose of this unit is to enable the learner to understand some of the fundamentals of working in end of life care. This includes different perspectives on death and dying, principles and policy, communication and the range of support services available to the individual affected and others. Learning Outcomes The learner will be able to 1 Know different perspectives on death and dying 2 Understand the aims, principles and policies of end of life care 3 Understand factors regarding communication in end of life care 4 Know how to access the range of support services available to individuals and others Assessment Criteria The learner can 1.1 Outline the factors that can affect an individual s views on death and dying 1.2 Outline the factors that can affect own views on death and dying 1.3 Outline how the factors relating to views on death and dying can impact on practice 1.4 Define how attitudes of others may influence an individual s choices around death and dying 2.1 Explain the aims and principles of end of life care 2.2 Explain why it is important to support an individual in a way that promotes their dignity 2.3 Describe the importance of maintaining comfort and wellbeing in end of life care 2.4 Explain the stages of the local end of life care pathway 2.5 Describe the principles of advance care planning 2.6 Define local and national policy and guidance for care after death 3.1 Explain how an individual s priorities and the ability to communicate may vary over time 3.2 Explain your role in responding to key questions and cues from individuals and others regarding their end of life experience 3.3 Describe how you might respond to difficult questions from individuals and others 3.4 Outline strategies to manage emotional responses from individuals and others 3.5 Explain the importance of sharing appropriate information according to the principles and local policy on confidentiality and data protection 4.1 Identify the range of support services and facilities available to an individual and others 4.2 Identify the key people who may be involved within a multi-disciplinary end of life care team 4.3 Identify the potential barriers an individual may face when accessing end of life care 4.4 Suggest ways to minimise the barriers an individual may face when accessing end of life care Page 9 of 39

10 Know different perspectives on death and dying Indicative Content Factors that can affect an individual s views on death and dying include: religion; culture; gender; own experience of death and dying; support available; mental wellbeing; health and wellbeing; links with practitioners. Factors that can affect own views on death and dying include: past experience of death and dying; familial views / perceptions; religion; culture; role and responsibilities; training and development. How the factors relating to views on death and dying can impact on practice: coping mechanisms; support structures; avoidance; inappropriate approaches / communication skills; competence; support / care needs not met; family and carers not included in service delivery. How attitudes of others may influence an individual s choices around death and dying, e.g. limited choices / preferences; choices made for them; little involvement; pre-planned; ease of planning; knowledge of local facilities / resources; preferred options. Understand the aims, principles and policies of end of life care The aims and principles of end of life care: choices; priorities; the person is at the centre of planning and delivery; effective communication; efficient and effective multi-disciplinary / inter agency working; carers / family / friends informed as appropriate; carers / family / friends involved in care planning; person centred approach to service delivery; care and support available to any person affected by end of life and death; practitioners are supported to develop their knowledge, skills and attitudes; practitioners take responsibility for continuing professional development. Why it is important to support an individual in a way that promotes their dignity: self-esteem; privacy; respect; independence; choices; preferences; person centred approaches. The importance of maintaining comfort and wellbeing in end of life care, e.g. choices; care planning; physical and mental wellbeing; relatives / carers wellbeing; symptom management; pain relief; encourages and supports communication and interaction. The stages of the local end of life care pathway Step 1: Discussions as the end of life approaches Step 2: Assessment, care planning and review Step 3: Co-ordination of care Step 4: Delivery of high quality care in care; homes Step 5: Care in the last days of life Step 6: Care after death The principles of advance care planning include: a voluntary process during which a person expresses their wishes and preferences about future care; to make clear a person s wishes in anticipation of a deterioration in their condition in the future / loss of capacity to make decisions and / or ability to communicate needs / preferences to others; outcome is not legally binding but should be taken into account when making best interest decisions about future care; can be made up of several elements which do not have to be completed all at once; wishes, needs and preferences should be reviewed and updated on a regular basis. Local and national policy and guidance for care after death, e.g. guidelines for care after death; policies; procedural guidance; local / national guidelines; support for family / carers; cultural / religious guidance. Understand factors regarding communication in end of life care How an individual s priorities and the ability to communicate may vary over time, e.g. ability, wellbeing; impact of medication; impact of illness / disease; pain management; assessment of needs. Own role in responding to key questions and cues from individuals and others regarding their end of life experience, e.g. effective communication; boundaries of confidentiality; roles and responsibilities; seeking advice when beyond scope of own knowledge; openness. Page 10 of 39

11 How to respond to difficult questions from individuals and others, e.g. active listening skills; seeking guidance when beyond scope of own knowledge; maintenance of confidentiality; sensitivity; monitoring responses; privacy; signposting to specialist practitioners. Strategies to manage emotional responses from individuals and others, e.g. privacy; active listening skills; support from others as necessary; ongoing support; space / time; signposting if necessary; clarity; effective communication; accuracy and timeliness of information provision. The importance of sharing appropriate information according to the principles and local policy on confidentiality and data protection, e.g. boundaries; need to know basis; agreement from the person; roles and responsibilities; competence; recording and reporting. Know how to access the range of support services available to individuals and others Support services and facilities available to an individual and others include: statutory services; nonstatutory; independent providers; specialist services and facilities; third sector services and facilities; health care; social care. Key people who may be involved within a multi-disciplinary end of life care team include: GPs; consultants; clinical nurse specialists; Macmillan nurses, Marie Curie nurses; counsellors, therapists; psychologists; psychiatrists; dieticians; occupational therapists; speech therapists; religious / spiritual care workers; social workers; benefit advisers. Barriers an individual may face when accessing end of life care, e.g. resource availability; attitudinal; knowledge / understanding; acceptance; communication issues; emotional; social / cultural; bias; denial. Ways to minimise the barriers an individual may face when accessing end of life care, e.g. accuracy and availability of information; effective communication; support networks; resourcing; accessibility; training / development for practitioners. Page 11 of 39

12 UNIT SPECIFICATIONS Understand how to support individuals who are distressed Credit Value of Unit: 3 GLH of Unit: 20 Level of Unit: 2 Introduction The purpose of this unit is to enable the learner to support individuals who are distressed. This includes understanding the causes and effects of distress, how to prepare to support distressed individuals, and how to help individuals through periods of distress. Learning Outcomes Assessment Criteria The learner will be able to The learner can 1 Understand causes and effects of distress 1.1 Identify common causes of distress 1.2 Describe signs that may indicate an individual is distressed 1.3 Explain how distress may affect the way an individual communicates 1.4 Explain how working with an individual who is distressed may impact on own well being 2 Know how to prepare to support individuals 2.1 Describe how to access information and advice who are experiencing distress about supporting an individual through a time of loss 2.2 Describe signs of distress that would indicate the need for specialist intervention 2.3 Describe how to access specialist intervention 2.4 Identify sources of support to manage own feelings when working with an individual who is 3 Know how to support individuals through periods of distress 4 Understand how individuals can be supported to reduce distress 5 Know how to record and report on an individual s distress distressed 3.1 Identify ways to communicate empathy and reassurance in ways that respect an individual s dignity, culture and beliefs 3.2 Describe how to alleviate immediate distress 3.3 Describe how to provide support in response to an individual s reactions 3.4 Identify ways to involve others in supporting an individual who is distressed 4.1 Describe ways to encourage an individual to express thoughts and feelings about troubling aspects of their life 4.2 Outline ways of identifying triggers for distress with an individual and others 4.3 Describe how to reduce triggers or alleviate causes of distress with an individual and others 4.4 Explain how an individual can be encouraged to review their usual ways of coping with distress 5.1 Describe how records should be maintained relating to an individual s distress Page 12 of 39

13 Understand causes and effects of distress Indicative Content Common causes of distress include: Anxiety; major life changes; work; relationship difficulties; financial problems; children and family; poor time management; illness; lack of assertiveness; dealing with uncertainty. Signs that may indicate an individual is distressed: e.g. aches and pains; eating too much / too little; a change to sleep pattern; chest pain; breathing difficulties; dizziness; nausea; nervous habits; using alcohol or drugs to relax; isolating themselves. How distress may affect the way an individual communicates: e.g. withdrawn; not willing to face reality / responsibilities; over anxious; impact on confidence; low self-esteem. How working with an individual who is distressed may impact on own wellbeing: e.g. impact on communication; limited interaction; impact on assessment / support provided; interpersonal relationship; sharing of problems / anxieties. Know how to prepare to support individuals who are experiencing distress How to access information and advice about supporting an individual through a time of loss: e.g. manager / senior; referral; counsellors; advocates; family / friend / carer support; statutory services; nonstatutory; independent providers; specialist services and facilities; third sector services. Signs of distress that would indicate the need for specialist intervention: e.g. threatening behaviour; angry / emotional reactions; threats about self harm / harm to others; being confrontational; marked changes to personality / behaviour; changes to appearance; substance abuse; crying excessively. How to access specialist intervention: e.g. referrals; GP; statutory services; non-statutory; independent providers; specialist services and facilities; third sector services. Sources of support to manage own feelings when working with an individual who is distressed: e.g. manager / senior; colleagues; counsellor; GP; occupational health service. Know how to support individuals through periods of distress Ways to communicate empathy and reassurance in ways that respect an individual s dignity, culture and beliefs: e.g. empathy; privacy; active listening skills; support from others as necessary; ongoing support; space / time; clarity; effective communication; accuracy and timeliness of information provision. How to alleviate immediate distress: e.g. remain calm and composed; provide privacy; effective communication; non-confrontational; assess the risk; take charge of the situation; summon additional support if required. How to provide support in response to an individual s reactions: e.g. assess the risk; listen; speak quietly and calmly; acknowledge their feelings; offer additional support; record interaction; active listening skills. Ways to involve others in supporting an individual who is distressed: e.g. carer support; agreed ways of working; roles and responsibilities; referral; advocacy; specialist practitioners. Understand how individuals can be supported to reduce distress Ways to encourage an individual to express thoughts and feelings about troubling aspects of their life: e.g. counselling; therapeutic approaches; active listening; preferred method of communication; the use of signs; symbols; pictures; writing; objects of reference; communication passports; other non-verbal approaches. Ways of identifying triggers for distress with an individual and others: e.g. monitoring; observation; knowledge of behaviour patterns; carer / family input; baseline measurements; supervision; open communication. Page 13 of 39

14 How to reduce triggers or alleviate causes of distress with an individual and others: e.g. identification of triggers; changes to lifestyle / support networks; review of needs; medication review; access to resources. How an individual can be encouraged to review their usual ways of coping with distress: e.g. discussion; care needs review; involvement of carers / family; person centred approach; mentor; advocate; specialist intervention. Know how to record and report on an individual s distress How records should be maintained relating to an individual s distress: e.g. currency; legibility; accuracy; confidentiality; in line with agreed ways of working. Page 14 of 39

15 UNIT SPECIFICATIONS Understand how to provide support to manage pain and discomfort Credit Value of Unit: 2 GLH of Unit: 20 Level of Unit: 2 Introduction The purpose of this unit is to enable the learner to understand how to provide support to manage pain and discomfort. This includes understanding approaches to pain management, how to help in minimising pain and how to monitor, record and report on pain management. Learning Outcomes The learner will be able to 1 Understand approaches to managing pain and discomfort 2 Know how to assist in minimising individuals pain or discomfort 3 Know how to monitor, record and report on the management of individuals pain or discomfort Assessment Criteria The learner can 1.1 Explain the importance of a holistic approach to managing pain and discomfort 1.2 Describe the different approaches to alleviate pain and minimise discomfort 1.3 Outline agreed ways of working that relate to managing pain and discomfort 2.1 Describe how pain and discomfort may affect an individuals wellbeing and communication 2.2 Identify ways of encouraging an individual to express feelings of discomfort or pain 2.3 Describe how to encourage an individual to use self-help methods of pain control 2.4 Explain how to position an individual safely and comfortably 3.1 Identify monitoring activities required to manage an individual s pain or discomfort 3.2 Explain how records should be completed Indicative Content Understand approaches to managing pain and discomfort The importance of a holistic approach to managing pain and discomfort, e.g. assessing all needs; impact of pain and discomfort on all aspects of person s life; identifying causes of pain and discomfort; changes to lifestyle / medication / pain relief. The different approaches to alleviate pain and minimise discomfort, e.g. medication; exercise; manual therapy mobilisation, manipulation, massage; transcutaneous electrical nerve stimulation (TENS); cognitive behavioural approach; long-term devices, i.e. intrathecal pumps; complementary therapies; pain management programme. Agreed ways of working that relate to managing pain and discomfort include: assessment; planning; review; ongoing monitoring; observation; communication; policies / procedures; roles and responsibilities; currency of approaches / practice. Know how to assist in minimising individuals pain or discomfort How pain and discomfort may affect an individual s wellbeing and communication, e.g. focus on pain / discomfort; inability; energy; motivation; comprehension; mobility; independence self-esteem; lethargy. Ways of encouraging an individual to express feelings of discomfort or pain include: counselling; therapeutic Page 15 of 39

16 approaches; active listening; preferred method of communication; the use of signs; symbols; pictures; writing; objects of reference; communication passports; other non-verbal approaches. How to encourage an individual to use self-help methods of pain control: assessment; supervision; effective communication; clarification; review; trial / fitness for purpose; inclusion of relatives / carers. How to position an individual safely and comfortably: agreed ways of working; risk assessment; reference to care plan; effective communication; competence; training; roles and responsibilities Know how to monitor, record and report on the management of individuals pain or discomfort Monitoring activities required to manage an individual s pain or discomfort, e.g. assessment; observation; feedback; communication; follow care plan; recording updates / changes; monitoring intervals. How records should be completed: currency; legibility; accuracy; confidentiality; in line with agreed ways of working. Page 16 of 39

17 UNIT SPECIFICATIONS Understand how to support individuals during the last days of life Credit Value of Unit: 3 GLH of Unit: 28 Level of Unit: 3 Introduction The purpose of this unit is to enable the learner to understand how to support individuals during the last days of life. This includes the common features of support and the impact of the last days of life on an individual and others. Learning Outcomes The learner will be able to 1 Understand common features of support during the last days of life 2 Understand the impact of the last days of life on the individual and others 3 Know how to support individuals and others during the last days of life 4 Understand the actions to be taken following an individual s death 5 Know how to manage own feelings in relation to an individual s dying or death Assessment Criteria The learner can 1.1 Describe the most common signs of approaching death 1.2 Define the circumstances when life-prolonging treatment can be stopped or withheld 1.3 Analyse the importance of any advance care plan in the last days of life 1.4 Identify the signs that death has occurred 2.1 Describe the possible psychological aspects of the dying phase for the individual and others 2.2 Explain the impact of the last days of life on the relationships between individuals and others 2.3 Outline possible changing needs of the individual during the last days of life 3.1 Describe a range of ways to enhance an individual s wellbeing during the last days of life 3.2 Explain the importance of working in partnership with key people to support the individual s wellbeing during the last days of life 3.3 Describe how to use an integrated care pathway according to agreed ways of working 3.4 Define key information about the process following death that should be made available to appropriate people according to agreed ways of working 4.1 Explain national guidelines, local policies and procedures relating to care after death 4.2 Explain the importance of being knowledgeable about an individual s wishes for their after-death care 4.3 Explain the importance of acting in ways that respect the individual s wishes immediately after death 4.4 Describe agreed ways of working relating to prevention and control of infection when caring for and transferring a deceased person 4.5 Describe ways to support others immediately following the death of a close relative or friend 5.1 Define possible impact of an individual s death on own feelings 5.2 Identify available support systems to manage own feelings in relation to an individual s death Page 17 of 39

18 Indicative Content Understand common features of support during the last days of life The most common signs of approaching death include: a decrease in activity; increased periods of sleep; lethargy; decreased intake of food and liquids; oedema; coma; much longer periods of pausing in the breathing; changes to the breathing pattern; severely increased respiratory congestion or fluid build up in lungs; incontinence; decrease in urine output and darkening colour of urine or very abnormal colours; extremities cold to the touch; drop in blood pressure; cyanosis, or a bluish or purple colouring to the patient s arms and legs, especially the feet and hands; body is held in rigid unchanging position; jaw drop. The circumstances when life-prolonging treatment can be stopped or withheld, e.g. if activity in the brain has stopped, it is known as brain stem death. In this case, all treatments can be stopped. The relatives / friends of the person receiving the treatment, along with the healthcare professionals responsible for the person s care, should decide whether treatment should be continued. Consent to treatment is the principle that a person must give their permission before they receive any type of medical treatment. There are rules governing when life-prolonging treatment can be withheld or withdrawn when the patient's consent is not available. The importance of any advance care plan in the last days of life: adherence to plans; review and revision of plan; inclusion; wishes of person; comfort for friends / relatives; decisions made; quality of service delivery. The signs that death has occurred, e.g. no breathing; no heartbeat; loss of control of bowel or bladder; no response to attempts to awaken; skin colour turns pale, bluish then a whitish or ashen grey as the blood settles; arms and legs become limp; body temperature drops; person's eyes remain open, as eyelid muscles can no longer close; mouth may fall open as the jaw muscles relax. Understand the impact of the last days of life on the individual and others The possible psychological aspects of the dying phase for the individual and others, e.g. anxiety; distress; stress; depression; trauma; withdrawal; fear; apprehension. The impact of the last days of life on the relationships between individuals and others, e.g. distress; apprehension; frustration; anticipatory loss; anger; closer relationships; loss or breakdown of relationships. Possible changing needs of the individual during the last days of life, e.g. care needs; holistic assessment / review; support; carer / family support; additional needs; impact of pain relief. Know how to support individuals and others during the last days of life Ways to enhance an individual s wellbeing during the last days of life, e.g. environment; support provided; effective communication; pain / symptom management. The importance of working in partnership with key people to support the individual s wellbeing during the last days of life, e.g. needs assessment; meeting of needs; specialist practitioners; pain / symptom management. How to use an integrated care pathway according to agreed ways of working, e.g. effective / clear communication; reporting; recording; review; evaluation; monitoring; managing; outcomes; evidence based. Information about the process following death that should be made available to appropriate people according to agreed ways of working, e.g. information provision prior to death; clarification; guidance; signpost to services; access to services. Understand the actions to be taken following an individual s death National guidelines, local policies and procedures relating to care after death, e.g. infection control policies / procedures; confidentiality guidelines / procedures; health and safety policies / procedures; safeguarding procedures. The importance of being knowledgeable about an individual s wishes for their after-death care, e.g. actions can immediately be carried out; carers / relatives do not need to guess / suggest; meeting of agreed needs; advance care plan. Page 18 of 39

19 The importance of acting in ways that respect the individual s wishes immediately after death, e.g. personcentred; respecting person s wishes / carer s wishes; advance care plan; dignity. Agreed ways of working relating to prevention and control of infection when caring for and transferring a deceased person, e.g. use of personal protective equipment (PPE); effective hand washing; use of body bags; waste disposal; clearing of bodily fluids; inform relevant practitioners if person has infectious disease; report injuries; packing of leaking orifices. Ways to support others immediately following the death of a close relative or friend, e.g. active listening skills; empathy; time; privacy; practicalities; sign posting to services. Know how to manage own feelings in relation to an individual s dying or death The possible impact of an individual s death on own feelings, e.g. loss; change of role; areas for development; competence; team working; sharing. Support systems to manage own feelings in relation to an individual s death include: colleagues; manager; senior; counselling; family / friends (confidentiality issues); specialist practitioners. Page 19 of 39

20 UNIT SPECIFICATIONS Understand the care process for a deceased person Credit Value of Unit: 3 GLH of Unit: 25 Level of Unit: 2 Introduction The purpose of this unit is to enable the learner to understand the care process for a deceased person. This includes understanding the requirements for caring for the deceased individual and those close to them. Learning Outcomes The learner will be able to 1 Know the factors that affect how individuals are cared for after death 2 Understand the role of supporting those who are close to deceased individuals 3 Understand the process of preparing deceased individuals prior to transfer 4 Understand the process of transferring deceased individuals Assessment Criteria The learner can 1.1 Outline legal requirements and agreed ways of working that underpin the care of deceased individuals 1.2 Describe how beliefs and religious and cultural factors affect how deceased individuals are cared for 1.3 Identify the physical changes that take place after death and how this may affect laying out and moving individuals 1.4 Identify diseases and conditions that necessitate specialist treatment or precautions when caring for and transferring deceased individuals 1.5 Describe the precautions needed when undertaking the care and transfer of deceased individuals with specific high risk diseases and conditions 2.1 Describe the likely immediate impact of an individual s death on others who are close to the deceased individual 2.2 Identify ways to support others immediately following the death of an individual in ways that Reduce their distress Respect the deceased individual 3.1 Describe agreed ways of working to ensure that the deceased person is correctly identified 3.2 Identify agreed ways of working to ensure the deceased individual is prepared in a manner that respects their dignity, beliefs and culture 3.3 Outline the correct use of protective clothing to minimise the risk of infection during preparation of a deceased individual 3.4 Explain why it is important to record any property and valuables that are to remain with the deceased individual 4.1 Identify which organisations should be contacted 4.2 Outline the details to be recorded when caring for and transferring a deceased person Page 20 of 39

21 Indicative Content Know the factors that affect how individuals are cared for after death Legal requirements and agreed ways of working that underpin the care of deceased individuals, e.g. health and safety; verification / certification; local policies / procedures; infection control; safeguarding; confidentiality. How beliefs and religious and cultural factors affect how deceased individuals are cared for, e.g. agreed care plans; family / carer involvement; roles and responsibilities; impact on how procedures are conducted; respect for wishes and preferences. The physical changes that take place after death and how this may affect laying out and moving individuals, e.g. rigor mortis; relaxation of sphincter and stomach muscles; blood moves to pool in the lowest parts of the body; decomposition / decay. Care at all times; infection control; health and safety; sensitivity; viewing; moving; risk assessment; PPE. Diseases and conditions that necessitate specialist treatment or precautions when caring for and transferring deceased individuals, e.g. infectious diseases; blood borne virus (BBV); notifiable diseases. The precautions needed when undertaking the care and transfer of deceased individuals with specific high risk diseases and conditions, e.g. body / cadaver bags; PPE; reporting and recording; COSHH; hand washing; disposal of waste / equipment standard precautions. Understand the role of supporting those who are close to deceased individuals The likely immediate impact of an individual s death on others who are close to the deceased individual, e.g. stages of grief; shock; distress; loss; disbelief; sadness; fear; depression; loss of role. Ways to support others immediately following the death of an individual in ways that Reduce their distress, e.g. privacy; space; active listening skills; access to further resources; information made available; following policies and procedures. Respect the deceased individual, e.g. notification; method of communication; available support; refer to care plan / advance care plan; confidentiality; safeguarding. Understand the process of preparing deceased individuals prior to transfer Agreed ways of working to ensure that the deceased person is correctly identified, e.g. checks; name band on wrist / ankle; verification with records. Agreed ways of working to ensure the deceased individual is prepared in a manner that respects their dignity, beliefs and culture, e.g. care plan; advance care plan; policies and procedures; guidance from relatives / carers; equality; diversity; confidentiality. The correct use of protective clothing to minimise the risk of infection during preparation of a deceased individual, e.g. risk assessment; selection; use; removal; disposal. Why it is important to record any property and valuables that are to remain with the deceased individual, e.g. security; following policies / procedures; continuity; safeguarding; care plan; needs assessment. Understand the process of transferring deceased individuals Which organisations should be contacted, e.g. funeral director; mortuary; following agreed ways of working. The details to be recorded when caring for and transferring a deceased person include: identifying information (name, date of birth, address, NHS number); date and time of death; implantable devices; notifiable infections; any jewellery left on body; name of person responsible for care after death / confirming death. Page 21 of 39

22 APPENDIX 1 Summary Record of Achievement Level 2 Certificate in Understanding End of Life Care Unit Title Level Credit Value Date completed Assessor Signature Internal Verifier Signature (if sampled) Understand how to work in end of life care L2 3 Understand how to support individuals who are distressed L2 3 Understand how to provide support to manage pain and discomfort L2 2 Understand how to support individuals during the last days of life L3 3 Understand the care process for a deceased person L2 3 Learner Name I confirm that the minimum number of credits at the appropriate level have been achieved in order for a claim for certification to be made. I can confirm that the credit has been achieved from the correct combination of mandatory and optional units as specified within the Rules of Combination. Assessor Signature Internal Verifier Signature (if sampled) Page 22 of 39

23 APPENDIX 2 Tracking Sheet Understand how to work in end of life care Criteria 1.1 Outline the factors that can affect an individual s views on death and dying Assessment Method Evidence Details Portfolio Reference Completion Date 1.2 Outline the factors that can affect own views on death and dying 1.3 Outline how the factors relating to views of death and dying can impact on practice 1.4 Define how attitudes of others may influence an individual s choices around death and dying 2.1 Explain the aims and principles of end of life care 2.2 Explain why it is important to support an individual in a way that promotes their dignity 2.3 Describe the importance of maintaining comfort and wellbeing in end of life care 2.4 Explain the stages of the local end of life care pathway 2.5 Describe the principles of advance care planning 2.6 Define local and national policy and guidance for care after death 3.1 Explain how an individual s priorities and the ability to communicate may vary over time 3.2 Explain your role in responding to key questions and cues from individuals and others regarding their end of life experience 3.3 Describe how you might respond to difficult questions from individuals and others Page 23 of 39