Written Assessment Student Copy Assessor

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Instructions to Students

Welcome to the written assessment. To successfully complete the assessment

requirements, you need to follow the following instructions.

Step 1
Read the study guide and the related resources.

Step 2
Read this assessment to gain an understanding of what you need to do to complete the unit.
Talk to your trainer or supervisor and ask for help if you need to.

Step 3
Complete all questions in this assessment. Please write clearly in pen (not pencil). You
may attach printed answers if you prefer. Do not remove any pages from this assessment.

Step 4
Complete the cover sheet and attach to this assessment. We recommend you make and
keep a copy of your assessments.

Step 5
Submit for assessment.

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Question 1 (3 MARKS)
The following website may assist with this question
http://www.who.int/whr/2003/chapter7/en/index1.html

What are the core principles, as outlined by the World Health Organization (WHO), or
primary health care?

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Question 2 (3 MARKS)
The following websites may assist with this question
http://www.health.nsw.gov.au/statehealthplan/Pages/default.aspx
http://www.phcris.org.au/phplib/filedownload.php?file=/elib/lib/downloaded_files/publications/
pdfs/phcris_pub_1150.pdf

The NSW State Health Plan: Towards 2021 provides a strategic framework which brings
together NSW Health’s existing plans, programs and policies and sets priorities across the
system for the delivery of ‘the right care, in the right place, at the right time’.

What is the philosophical framework of primary health care?

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Question 3
The following website may assist with this question
http://www.health.nsw.gov.au/healthone/Pages/Multidisciplinary-Team-Care.aspx

Part A (3 MARKS)
Multidisciplinary care occurs when professionals from a range of disciplines with different but
complementary skills, knowledge and experience work together to deliver comprehensive
healthcare aimed at providing the best possible outcome for the physical and psychosocial
needs of a patient and their carers. As clients’ needs may change with time, the composition
of the team may also change to meet these needs. A strong culture of multidisciplinary care
is seen as critical to improving primary health care in Australia. Who may be included in the
multi-disciplinary health care team?

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Part B (4 MARKS)

The term 'health literacy' can be applied either to individual health literacy or the health
literacy environment. Individual health literacy is the knowledge and skills an individual has
to access, understand and apply health information. The health literacy environment is the
infrastructure, policies, processes, materials and relationships that exist within the health
system that enable people to navigate, understand and use health information and services
to make effective decisions about health and health care and take appropriate action.

What are the nursing interventions you can use to address health literacy and health
promotion with clients?

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Part C (2 MARKS)

Access the following website

http://www.health.gov.au/internet/main/publishing.nsf/content/6084A04118674329CA257BF
0001A349E/$File/NPHCframe.pdf

Primary health care has been described by health ministers in Australia as 'the frontline of
Australia's health care system, encompassing a large range of providers and services
across public, private and non-government sectors’. The primary health care system sets out
to provide equitable, high quality and financially sustainable services that are: universally
available; delivered appropriately by a suitably skilled workforce; offered as a first point of
contact with the health care system in the community near where people live; part of a long-
term relationship with patients and their families; and integral in referring patients on to other
health or community services. What are the four strategic outcomes focus of the National
Primary Health Care Strategic Framework?

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Part D (3 MARKS)
Discuss how, by following the nursing process, you can provide nursing care that reflects the
four strategic outcomes focus of the National Primary Health Care Strategic Framework.

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Question 4 (3 MARKS)
Primary health care focuses on families and communities as well as individuals and on
health rather than illness. It acknowledges the social, economic and political factors that
impact on health as well as biophysical, psychological and spiritual factors. Primary Health
Care also focuses on prevention at all stages of the health/illness continuum. Domiciliary
health care settings could include:

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Question 5 (3 MARKS)
The following websites may assist with this question
http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=60129547780
https://www.mja.com.au/journal/2007/187/9/challenges-health-and-health-care-australia
The Australian health Care system faces a number of challenges in providing access to
effective, timely, appropriate and coordinated health care. Outline challenges that face the
Australian health care system in providing primary health care.

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Question 6
The following websites may assist with this question
http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=10737418532
http://www.aihw.gov.au/rural-health-impact-of-rurality/
http://www.healthdirect.gov.au/rural-and-remote-health
http://www.aihw.gov.au/australias-health/2014/understanding-health-illness/

The natural and built environment can be a major determinant of health and how we live.
Our surroundings can influence our health through a variety of channels—through exposure
to physical, chemical and biological risk factors or by triggering behavioural changes.
Likewise, there is a growing awareness that humans, through their intervention in the
environment, play a vital role in exacerbating or mitigating health risks.

Part A (3 MARKS)
What are the main findings from your research into health and the environment?

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Part B (2 MARKS)
The following websites may assist with this question
http://www.who.int/healthinfo/global_burden_disease/GlobalHealthRisks_report_full.pdf
http://www.aihw.gov.au/burden-of-disease/
http://www.health.gov.au/internet/publications/publishing.nsf/Content/womens-health-policy-
toc~womens-health-policy-key~womens-health-policy-key-burden
http://www.aihw.gov.au/publication-detail/?id=60129550618

There is increasing awareness that our health and the environment in which we live are
closely linked. This growing awareness is reflected in recent health and environmental
initiatives from governments and other organisations. What is meant by the term “burden of
disease”?

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Part C (3 MARKS)
The factors in the physical environment that are important to health include harmful
substances, such as air pollution or proximity to toxic sites (the focus of classic
environmental epidemiology); access to various health-related resources (e.g., healthy or
unhealthy foods, recreational resources, medical care); and community design and the “built
environment” (e.g., land use mix, street connectivity, transportation systems).
Factors in the social environment that are important to health include those related to safety,
violence, and social disorder in general, and more specific factors related to the type, quality,
and stability of social connections, including social participation, social cohesion, social
capital, and the collective efficacy of the neighbourhood (or work) environment . Social
participation and integration in the immediate social environment (e.g., school, work, and
neighborhood) appear to be important to both mental and physical health. What also seems
important is the stability of social connections, such as the composition and stability of
household and the existence of stable and supportive local social environments or

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neighborhoods in which to live and work. Research your local community’s environment.
List the physical and social environmental health issues facing the community.

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Question 7

A range of actions are needed to create effective health promotion services,

strategies and programs.

These action areas span the continuum of work in health and community services, from
working with individuals to help them build knowledge and skills, through to building public
health policy that embeds health promoting practices at a systems level. Health and
community workers operate in a variety of ways within the one system. Some people work

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with individuals, some work with individuals and with the broader community, others work on
policy and planning. All of these workers aim to improve health outcomes by addressing
social, environmental and economic conditions, or by helping people be active self-
managers of their own health and life. This is a continuum of work.

Part A (2 MARKS)

What is the Health-Illness Continuum Model?

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Part B (3 MARKS)

Primary health care nurses work in a range of settings which include preventative, curative
and rehabilitative models, each sharing the characteristic that they are a part of the first level
of contact with the health system. In Australia, what settings may Primary health care
nurses work?

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Part C (3 MARKS)
Social justice is central to nursing practice. Primary health care is a holistic approach
incorporating body, mind, spirit, land, environment, culture, custom and socio-economic
status to the provision of essential, integrated, quality care based upon practical,
scientifically sound and socially acceptable methods and technology. It is made accessible
to all people, families and communities as close as possible to where they live and through
their full participation, in the spirit of self-reliance and self-determination; and at a cost that
the Australian community can afford.

What are the roles that a primary health care nurse may cover?

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Part D (3 MARKS)

List specific nursing interventions/clinical skills that an enrolled nurse may attend to in
primary health care.

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Part E (2 MARKS)

List the community and in-hospital resources and services available for primary health care
in your community.

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Question 8
The roles of community and primary health care nurses is integral to ensuring optimal health
outcomes for all people across their lifespan. Community and primary health care nursing
applies a social model of health care that addresses the health needs of individuals and
communities while considering the social, economic and environmental factors impacting
their health. Primary health nurses are employed as generalists and/or specialists. They
work across all geographical areas in Australia and in a wide range of service delivery
settings. These settings include community health centres, women’s health services, general
practices, schools, prisons and people’s homes and work places. Discuss the roles of
nurses working in the following primary health areas.

Discuss the roles of nurses working in the following primary health care areas. Give
examples of age specific health issues for infants, children, adolescents, adults and older
people.
Part A (3 MARKS)
Supporting people with chronic and complex conditions

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Part B (3 MARKS)
Child and Family Health Nursing

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Part C (4 MARKS)
PHC for marginalised populations

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Question 9
The concept of person-centred health care is increasingly acknowledged by health
professionals as an important focus, particularly in the care of people with long-term
conditions. The priorities of clients, their families and carers will differ according to culture
and medical condition, however, there are elements that are fundamental to person-centred
health care.

Part A (3 MARKS)
Discuss the central principles of person-centred health care.

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Part B (2 MARKS)
The following websites may assist with this question
http://www.nslhd.health.nsw.gov.au/HealthInformation/HealthPromotion/Documents/Projects
/Falls_Prevention/AprilFalls/AFD%20-%20Nutrition%20and%20Dementia.pdf
https://fightdementia.org.au/support-and-services/families-and-friends/personal-care/dental-
care
https://www.alzheimers.org.uk/site/scripts/documents_info.php?documentID=1211
http://thedementiaqueen.com/2012/01/the-5-most-preventable-problems-in-late-stage-
alzheimers-disease/

People with cognitive impairment have problems with memory, communication and/or
thinking that can be temporary or long term. Common causes of cognitive impairment for
older people are dementia and/or delirium.
Confusion can be a result of delirium, dementia, depression or psychosis. Important to work
out which one person has.

Delirium — acute disturbance of thinking, behaviour, ability to concentrate (stay on train of

thought)

o Fluctuation of conscious state, disorientation in time, place and/or person,

disturbed sleep, poor concentration and memory, hallucinations or delusions
o Usually sudden onset
o Usually due to underlying sickness. Dementia increases risk of delirium.

Dementia — progressive disturbance of thinking and behaviour, overall loss of function,

often loss of ability to learn or remember

o Problems with memory, orientation, language, personality, ability to carry out

everyday activities, maintain relationships. Can be hallucinations, delusions,
anxiety, depression, other symptoms, eg wandering, agitation, increased
confusion at end of day (sundowning)
o Usually slow onset
o Common causes include Alzheimer’s disease, vascular cognitive impairment.
No cure, but can usually be managed.

Clients with dementia and/or delirium are at increased risk of preventable complications and
adverse events. Discuss the risks for clients with dementia and/or delirium.

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Part C (4 MARKS)
The following website may assist with this question
https://www.adhc.nsw.gov.au/__data/assets/file/0016/302524/Home_Care_Emergency_Proc
edures_FS.pdf
https://www.worksafe.vic.gov.au/__data/assets/pdf_file/0006/9528/Working_Safely_in_Com
munity_Services.pdf

Primary health care workers have a duty of care to provide assistance to clients requiring
emergency or first aid management. How will you ensure that you meet your obligations
when working in the community to provide emergency and first aid management?

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Part D (3 MARKS)
Discuss the interdisciplinary care provided for the above client.
- How was the information gained from nursing assessments relayed to the
interdisciplinary team?
- How was information, including the impacts of the health problem on activities of
daily living, communicated to the family or carer
- How were actual or potential environmental health issues impacting the client
identified?

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Part E (2 MARKS)
The following website may assist with this question
https://www.adhc.nsw.gov.au/__data/assets/file/0016/302524/Home_Care_Emergency_Proc
edures_FS.pdf
https://www.worksafe.vic.gov.au/__data/assets/pdf_file/0006/9528/Working_Safely_in_Com
munity_Services.pdf

Primary health care workers have a duty of care to provide assistance to clients requiring
emergency or first aid management. How will you ensure that you meet your obligations
when working in the community to provide emergency and first aid management?

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Question 10 (4 MARKS)

The following websites may assist with this question

http://www.phcris.org.au/news/newsfeed/2015/november/phcvideo.php?promoid=803&uid=1
2668&eid=9424&mid=39&stk=ps&stype=twiphc&linkid=119402

Primary health care nurses are enrolled nurses, registered nurses and nurse practitioners
eligible for registration by the Australian Health Practitioner Regulation Agency whose
competence, as specified by the registering authority s license to practice, educational
preparation, relevant legislation, standards and codes is specific to (though not exclusive to)
the primary health care context.
Like nurses in other settings, primary health care nurses have professional, legal and ethical
responsibilities which require demonstration of a satisfactory knowledge base, accountability
for practice, functioning in accordance with legislation affecting nursing and health care, and
the protection of individual and group rights.
Grounded in their scope of practice, nurses provide socially appropriate, universally
accessible, scientifically sound, first level care. They work independently and
interdependently in teams to:
- Give priority to those most in need and addresses health inequalities
- Maximise community and individual self-reliance, participation and control
- Ensure collaboration and partnership with other sectors to promote public health.

How would you evaluate client care provided by the service?

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Question 11 (4 MARKS)
Bronfenbrenner’s Ecological Systems theory states that human development is influenced
by the different types of environmental systems. Formulated by famous psychologist Urie
Bronfenbrenner, this theory helps us understand why we may behave differently when we
compare our behaviour in the presence of our family and our behaviour when we are in
school or at work.

Reflect on your own life story. Discuss how you have been influenced by your environment,
an example is given below.
Bronfenbrenner's theory shows how people can have influence on each other and,
depending on how close you are or what system you're in, how much influence they can
have on you. I never really stopped to think about how people influence me before I learned
about Bronfenbrenner's theory. I never thought if the reason I was influenced by something
was because I thought the thing I was influenced by was important to me or not or if it was
because source of information that I got through a person who cared for me. For example,
mass media never really effected me much unless my friends said it was a cool thing. I
never really thought about how it was a tier system. How it effected me more because my
friends thought it was cool than if I had just found it on my own. Then after that I wanted to
see what it was. I never realised that the main reason I enjoyed whatever I was enjoying so
much was because my friends were enjoying it too. Whenever I think about how I'm going to
be a paediatric nurse one day, I realise that I will have an influence on children's lives. That I
could be the difference between if a child succeeds or fails educationally. It makes me proud
to know that one day I could be a special part of so many kids' lives. Brofenbrenner's theory
showed me how and why I will effect these children and it was an eye opener.

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Question 12 (3 MARKS)

List the resources available for nurses working in primary health care. Include literature and
professional bodies associated with primary health care management.

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Question 13

Case Study
Primary Health Care, which focuses on illness prevention and wellness promotion, is a
growing priority within Australian health care. Engagement in Primary Health Care services
offers exciting and challenging opportunities for health professionals The aims of this clinical
placement is to enable you to synthesise the knowledge and skills necessary for the delivery
of safe, holistic, evidence-based nursing care consistent with the expectations of a newly-
graduated enrolled nurse, and to consolidate professional and workplace capabilities for
transitioning into the enrolled nurse role in a primary health care setting.
Contemporary enrolled nurses practise across a variety of settings and in numerous
contexts. Consequently, enrolled nurses require a range of professional nursing skills
including collecting, using and documenting information about a person's health care, clinical
problem-solving and decision-making, and the ability to apply this evidence to plan and
evaluate nursing care. Complete a case study on one client ensure that you
- Follow the organisations policies and procedures and using the facilities
documentation complete a case study for one client.
- Undertake professional practice in accordance with Nursing and Midwifery
Board of Australia professional practice standards, codes and guidelines
- Consider privacy and confidentiality when completing this assessment.

Part A (10 MARKS)

Include the following in your case study:
- Client presentation
- Client assessment – as appropriate
- Neurological (GCS,pain,sedation,MMSE)
- Cardiovascular (cardiac, haemodynamic, ECG, lab)
- Respiratory (respiratory, ventilator, ABG,CXR)
- Gastrointestinal (abdominal, nutrition, bowel)
- Integumentary (skin, oedema, scars, burns, lesions, pressure points,
infection risks, wounds)
- Musculoskeletal (positioning, range of movement, x-rays)
- Genitourinary/renal (fluids, urine, lab)
- Endocrine
- Psychosocial (coping, confusion, understanding of condition, anxiety,
fear, conflict, anger)
- Nursing history
- Pathophysiology of presenting problem and current state
- Nursing interventions/actions to meet client needs
- Medical interventions: including medication orders
- Multidisciplinary team care
- Referrals

Part B (5 MARKS)
Holistic client assessment is used in nursing to inform the nursing process and provide the
foundations of client care. Through holistic assessment, therapeutic communication and the
ongoing collection of objective and subjective data, nurses are able to provide improved
person-centred care to clients. A holistic approach acknowledged and addresses the
physiological, psychological, sociological, development, spiritual and cultural needs of the
client.

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You will be required to update the care plan for your client, (in conjunction with the RN) from
the information gathered in the previous documents provided then complete a set of
progress notes accordingly. Attach copies of these documents to this assessment – ensure
that there is no identifying information.
Part C (5 MARKS)
The fifth step of the nursing process is evaluation. Evaluate the nursing care plan. Outcome
measure may be psychosocial (quality of life, improved client perception of care, reduction in
depressive and anxiety symptoms), physiologic (improved health, reduced complications), or
functional improvement. Evaluation of the process and the results may occur through client
and family consultation, peer assessment, audit and self-reflection.

o What action would an EN take in regards to referring a client for allied health
services?
o What are some services available at the facility that a client could be referred to?
o What type of documentation is required by the health care facility to refer a client
for allied / or other services?
o How does the health facility implement and monitor nursing care plans? Ensure
that you refer to the organisations policies and procedures

Case Study 1
Client presentation

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Nursing History

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Client assessment including nursing observations and vital signs

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Report and document observations. Report observations outside normal parameters

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Analyse pathophysiology of presenting problem and current state

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Consider nursing interventions/actions to meet client needs

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Medical interventions: including medication orders

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Multidisciplinary team care

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Review and update of care plan to meet primary health care needs.

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