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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.
Page 7
METHOD
Stage Student centred strategy Main teaching points
• 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.
Page 8
METHOD
Stage Student centred strategy Main teaching points
• 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
Page 9
METHOD
Stage Student centred strategy Main teaching points
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.
7 Discuss with students.
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.
8 Discuss with students.
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.
Page 10
METHOD
Stage Student centred strategy Main teaching points
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
Page 11
METHOD
Stage Student centred strategy Main teaching points
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.
Page 12
METHOD
Stage Student centred strategy Main teaching points
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
Stage Student centred strategy Main teaching points
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
Stage Student centred strategy Main teaching points
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
By the end of this session the learner will be able to
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
Stage Student centred strategy Main teaching points
1 Introduce the subject of the Module.
Page 16
METHOD
Stage Student centred strategy Main teaching points
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
Page 19
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
METHOD
Stage Student centred strategy Main teaching points
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
Stage Student centred strategy Main teaching points
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
Stage Student centred strategy Main teaching points
12 Review:
Reform group. Review learning elements. Learners to state if and how well the learning elements have been achieved.
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
By the end of this session the learner will be able to
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
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. 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
Page 27
METHOD
Stage Student centred strategy Main teaching points
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
Stage Student centred strategy Main teaching points
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
Page 29
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
Page 30
METHOD
Stage Student centred strategy Main teaching points
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.
Page 31
METHOD
Stage Student centred strategy Main teaching points
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
Page 32
METHOD
Stage Student centred strategy Main teaching points
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.
Page 33
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
Student workbook (pages 22-25)
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)
By the end of this session the learner will be able to
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
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. Check for understanding with learners.
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
Page 35
METHOD
Stage Student centred strategy Main teaching points
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
Page 36
METHOD
Stage Student centred strategy Main teaching points
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.
10 Review: Reform group. Review learning elements. Learners to state if and how well the learning elements have been achieved.
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
By the end of this session the learner will be able to
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
Page 39
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. Check for understanding with learners.
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
Page 40
METHOD
Stage Student centred strategy Main teaching points
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.
Page 41
METHOD
Stage Student centred strategy Main teaching points
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
Page 42
METHOD
Stage Student centred strategy Main teaching points
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.
7 Divide students into groups. Students to practice skills using the checklist in their workbooks.
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
Page 43
METHOD
Stage Student centred strategy Main teaching points
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
14 Divide students into groups. Students to practice skills using the checklist in their workbooks.
15 Review: Reform group. Review learning elements. Learners to state if and how well the learning elements have been achieved.
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
Student workbook (pages 33-38)
Large sheets of paper and markers
Yoghurts
Slings
Disposable spoons
Feeding patient revision cards
By the end of this session the learner will be able to
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
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. Check for understanding with learners.
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
Stage Student centred strategy Main teaching points
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
Page 47
METHOD
Stage Student centred strategy Main teaching points
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
Stage Student centred strategy Main teaching points
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
11 Review: Reform group. Review learning elements. Learners to state if and how well the learning elements have been achieved.
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)
By the end of this session the learner will be able to
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
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. Check for understanding with learners.
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
Stage Student centred strategy Main teaching points
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
Page 53
METHOD
Stage Student centred strategy Main teaching points
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:
Reform group. Review learning elements. Learners to state if and how well the learning elements have been achieved.
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
Student workbook (pages 46-52)
30 Digital thermometer covers
10 x Digital thermometers
Tympanic thermometer
By the end of this session the learner will be able to
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
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. Check for understanding with learners.
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
Stage Student centred strategy Main teaching points
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
Stage Student centred strategy Main teaching points
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
Stage Student centred strategy Main teaching points
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
Stage Student centred strategy Main teaching points
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
Stage Student centred strategy Main teaching points
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
Page 61
METHOD
Stage Student centred strategy Main teaching points
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