Level 2 Certificate in the Principles of End of Life Care

Unit 2: Care planning in end of life care

Unit 2 Assessment

You should use this file to complete your Assessment.

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 Save a copy of this document, either onto your computer or USB drive.
 Work through your Assessment, remembering to save your work regularly
 When you’ve finished, print out a copy to keep for reference
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Study area – make sure it is clearly marked with your name, the course title and the Unit and
Assessment number.

Please note this Assessment has 7 pages and is made up of 3 parts.

Name: Mandalina Anca Popa

Part 1: The holistic approach to end of life care

This part will help you to evidence Learning Outcome 1: Understand the holistic
approach to end of life care

Learning objective Place in Assessment

1.1 Define the word ‘holistic’ as it applies to assessment Question 1a &1b Page 1
and care planning at the end of life

1.2 Describe the needs that an individual at the end of life Question 2 Page 2
may class as being important to them

1.3 Give examples of how to support individuals to meet Question 3 Page 2

their needs

1a. Give a definition of the word ‘holistic’ when used in relation to care. [1.1]

In care, holistic means taking into account the person as a whole, with all their desires and
needs. Holistic means taking care of both the physical and the mental or spiritual, so that all
a person's needs and desires are met, no matter what they are. A person's well-being must
be complete, from all points of view, so that all the methods by which well-being can be
achieved can be taken into account, whether we are talking, for example, about traditional
medicine or complementary therapies.

1b. How does holistic care apply to the following areas of end of life care: [1.1]

Assessment

A holistic assessment assesses the person in their integrity, with all their needs. The holistic
approach not only takes into account the evolution of a person's condition at the end of life
and the reduction of his abilities, but also assesses all the needs of that person. To evaluate
a person holistically at the end of life means to consider all the aspects of care that the
person may need, be it physical, mental, spiritual, etc.

Care planning

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Level 2 Certificate in the Principles of End of Life Care
Unit 2: Care planning in end of life care

In a holistic approach, care plan present not only information about how a person should be
cared for physically or how they should be approached mentally, but also how the person
wants to be considered, and to be cared for so that the things important to that person are
respected. The care plan provides information about the person's condition, treatment and
medication needed, habits and diets, mobility of the person, etc. In the holistic approach,
there are also information about the person's wishes and preferences: what they like or
dislike, the routine they agree with, their beliefs and values, family history, desires and
aspirations, information about family and friends, information about the anniversary of birth,
about the name they prefer, even if it is not the real one, or about favourite topics of
discussion. Holistic care planning means that the care plan includes information that has the
consequence of satisfying a person's medical, emotional, intellectual, cultural, spiritual, and
interpersonal needs.

2. Describe the needs that an individual at the end of life may class as being important to
them. [1.2]

At the end of life, a person's needs may change. If for each of us, the priority is physical
needs - food, shelter, safety, warmth, well-being, good relationships with those around us
and family, at the end of life, the priority of needs may change. A person may need more
pain relief and support from family and others than a person who has a life ahead of them.
Meeting psychological, religious and cultural needs can come first. Encouragement and
counselling may become more important than social relationships once were. In general,
biological, and psychological needs at the end of life are much stronger, as is the need for
safety and protection. Also, communicating desires and needs can become a priority

3. Read the case study below and answer the following question.

John is ninety years old and lives in supported accommodation. John was very active in his
youth and has always enjoyed playing and watching sport. He had one brother and one
sister who both passed away several years ago; he loves to look at photographs of them.
Although he has no children of his own, he adores his nieces and nephews and their
families. They come to visit every week and when it is John’s birthday they all visit at once,
bringing food, cards, presents and wearing party hats.

He has several medical complications including angina, which means his chest constantly
feels tight and uncomfortable. Last year John had a stroke and has lost his ability to speak;
however, his ability to read and write was unaffected.

Provide three examples of support that you would give John to help meet his needs. [1.3]

Example 1

Because John enjoys sports, he should be helped to watch sports competitions on television
or listen to radio broadcasts of a sporting event. If he can be transported, he could be helped
to walk to the stadium to attend matches or various other sporting competitions. John should
also be included in various other activities that he enjoys, as he does when he is with his
grandchildren.

Example 2

Communication solutions, for example in writing, should be found other than verbal, so that
John can communicate his desires and needs, and those around him can pass on the

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Level 2 Certificate in the Principles of End of Life Care
Unit 2: Care planning in end of life care

necessary information. At the same time, he could benefit from the support of a specialist in
language therapy. In addition, John's care workers could talk to him about his brother and
sisters.

Example 3

John should receive medication or any other complementary therapy that may alleviate his
physical distress.

Now that you have completed Part 1 of your Assessment, remember to save the work
you have done so far – you will need to send your work to your tutor for marking once
you have completed all 3 Parts of this Assessment.

© Creating Careers Ltd, 2015. All rights reserved. 3

Level 2 Certificate in the Principles of End of Life Care
Unit 2: Care planning in end of life care

Part 2: Person-centred assessment and care planning

This part will help you to evidence Learning Outcome 2: Understand person-centred
assessment and care planning

Learning objective Place in Assessment

2.1 Describe the advantages of person-centred care for an Question 1 Page 3
individual at the end of life

2.2 Explain how a health and social care worker can Question 2 Page 4
assess the needs, concerns and priorities of people
nearing the end of life
2.3 Identify risks that may be involved in meeting the needs Question 3 Page 4
of the individual

2.4 Describe how risks can be managed to support the Question 3 Page 4
individual to achieve their goals, aspirations and priorities

2.5 Explain how to apply the care planning cycle in a Question 4 Page 5
person-centred way

1. Describe three advantages of providing person-centred care for an individual at the end
of life. [2.1]

Advantage 1

The person-centred approach helps to meet the unique desires and needs of a person at the
end of life. Because the person's wishes and needs are taken into account, they feel
appreciated, and their unique characteristics and choices can be supported and encouraged.
This increases a person's self-confidence and, implicitly, their well-being.

Advantage 2

The holistic, person-centred approach helps the person become involved in the care they
receive. The person will share with those who care for them what they feel and the problems
they face, and once they are known they can be solved with the help of professionals. Also,
the person can benefit from the best care, suitable for their uniqueness

Advantage 3

Because the holistic and person-centred approach is co-opted and the family, the family can
help meet the desires and needs of an individual who cannot say what he or she wants,
knowingly speaking on behalf of that individual. Also, the family can know the situation of the
loved one and can get involved in the care provided to them.

2. Explain how a health and social care worker can assess the following things for people
nearing the end of life. [2.2]

Needs

A health care worker can assess the needs of a person at the end of life, taking into account,
first of all, the care plan of that person. Permanent monitoring of the person and

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Level 2 Certificate in the Principles of End of Life Care
Unit 2: Care planning in end of life care

collaboration with professionals can indicate a rapid change of needs. Also, communication
with the person is essential, because the person is the most important factor when
assessing their needs. Also helpful is the collaboration with the person's family, which can
indicate the needs that the person has had over time.

Concerns

Assessment of concerns should be done in collaboration with the person. When a health
care worker notices that the person becomes withdrawn, closed in on themselves, change
their behaviour, the health care worker must talk to the person, their family or even the
professionals. At the end of life, physical suffering, for example, can manifest itself in the
form of psychological changes, while some psychological suffering can cause physical
manifestations. For this reason, the evaluation should be done preferably by a
multidisciplinary team, based on the comparison of the existing information in the care plan
with the newly appeared ones. There may also be concerns about certain risks posed by the
wishes of the end-of-life person. These need to be evaluated to see what the benefits could
be for the person and what harm they could do.

Priorities

Because the end of life usually brings a change in priorities, the health care provider or
social worker must constantly monitor the person's condition. Discussions with the person
and their family, information analysis from the care plan, but especially the continuous
monitoring of the person help to evaluate his priorities.

3. Identify three risks that may be involved when trying to meet the needs of an individual at
the end of life. For each risk, describe how it could be managed in order to support the
individual to achieve their goals, aspirations and priorities. [2.3] [2.4]

Risk 1: Risk of moving or risk of not moving

How it could be managed

In the case of a person at the end of life, both movement and lack of movement can be
dangerous. In order to prevent any harm to the body, the movement must be done after
careful evaluation. The person may need different devices (hoist, standing aid, slide sheet,
etc) or methods to be moved, so that the risk of harm is minimized both by movement and
lack of movement.

Risk 2: Risk of treatment

How it could be managed

Because the treatment may be invasive or, in the case of medication, may have side effects,
the consent of the person must be sought. If the person agrees, the least invasive and best
tolerated method of treatment or complementary therapies should be used, even if it is only
to alleviate some symptoms.

Risk 3: Positive risk

How it could be managed

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Level 2 Certificate in the Principles of End of Life Care
Unit 2: Care planning in end of life care

A person may have the last wishes, the fulfilling of which could endanger them or deprive
them of certain care. However, it must be take into account that a spiritual satisfaction
generated by the fulfilling of a wish may be more important than a momentary relief from
incurable suffering, as long as the person with the specific desire fully accepts the risks.

4. Explain how the care planning cycle can be applied in a person-centred way. [2.5]

The care planning cycle can be applied in a person-centred way as long as the person, with
their unique desires and needs, is at the centre of all concerns, care and planning.
Assessing these unique desires and needs is part of the care planning cycle. Continuous
monitoring may result in a review of the assessment whenever necessary. The involvement
in the realization of the care plan of the person, of their family, of a multidisciplinary team will
make the plan to be one focused on the person and to be able to be implemented
successfully. The person-centred care planning cycle is accomplished as long as the person,
the family, is actively involved, who must be informed and involved in the decisions and
changes that affect the person's care. The service provider should also provide information
and advice on the services offered and the options available. The service provider must
follow the established and revised care plan even when the person who is at the centre of
the plan can no longer make decisions for themselves, provided that their wishes and needs
are specified in the care plan.

Now that you have completed Part 2 of your Assessment, remember to save the work
you have done so far – you will need to send your work to your tutor for marking once
you have completed all 3 Parts of this Assessment.

© Creating Careers Ltd, 2015. All rights reserved. 6

Level 2 Certificate in the Principles of End of Life Care
Unit 2: Care planning in end of life care

Part 3: Advance care planning

This part will help you to evidence Learning Outcome 3: Understand advance care
planning

Learning objective Place in Assessment

3.1 Describe the principles of advance care planning Question 1 Page 6

3.2 Define what is meant by: Question 2 Page 6

 Informed consent
 Statement of wishes and preferences
 Advance decision to refuse treatment
 Lasting power of attorney
3.3 Describe how a health and social care worker might be Question 3 Page 7
involved in advance care planning

3.4 Give examples of when advance care planning might Question 4 Page 7
be used

1. Describe the principles of advance care planning. [3.1]

A first principle is related to the fact that the process of the advanced care planning is
voluntary, if a person does not want to participate, then he does not have to participate. If
the person accepts the plan, then the discussions should be started and led by that person.
If the person refuses to touch certain subjects, then they should not be forced to do so.
There are exceptions, when there is a professional who considers that it would be useful to
start a discussion.
The family can be involved in the advanced care planning only if the person at the centre of
the plan agrees. Otherwise, sharing information would mean breaching confidentiality.
In fact, all information about the person is confidential and can be shared only under certain
conditions.
Before drawing up an advanced care plan, the mental capacity of the person for whom the
plan is created must be assessed. If the person has the mental capacity, then them must be
involved in making decisions and making the plan.

Advanced care planning also has certain principles for service providers. One of the
principles is that staff should answer questions directly and honestly or, if they do not know
the answer, they should sincerely acknowledge this and direct the person to those who can
provide the necessary information. However, this must be done with respect for the
confidentiality of the person.
Because advanced care planning is done over a longer period of time, the plan review must
be considered whenever the person changes their wishes or needs. However, it is important
that any changes to the information are recorded and updated.
Another principle is that staff should receive training when supporting someone. The training
should be especially on communication topics with people at the end of life and with their
families. Staff should be helped to understand the relevant legislation and policies in the
field.
On the other hand, service providers must know and recognize their limitations in providing
services, but also be able to inform service users about the benefits and risks of some
treatments.

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Level 2 Certificate in the Principles of End of Life Care
Unit 2: Care planning in end of life care

2. In your own words, give a definition of the following phrases: [3.2]

Informed consent

Informed consent means that a person accepts a service, an action or treatment having at
his disposal all the relevant information related to them and understands that information.
Informed consent should be required for most of the information provided in the care plan,
from the use of bed rails during the night to the administration of medication. As long as
person has mental capacity, a person has the right to refuse any action regarding him,
regardless of whether it is care or treatment. In the case of carrying out actions to which a
person with mental capacity has not consented, this can be considered an abuse. In the
case of persons without mental capacity, the legislation provides for another mode of action
in case certain interventions or treatments are required. But, even in this situation, the
decisions taken must be in the best interest of the person and with as few restrictions as
possible.

Statement of wishes and preferences

Everyone's wishes and preferences are different. A person can give a statement, which is
not a legal document or an agreement, but which must be taken into account. The statement
may refer, for example, to treatment and medical care, to factors such as their feelings,
beliefs and values that may even affect everyday decisions. Sometimes these statements
specify a person's own wishes. It may be a person who, for medical reasons, should have a
diet based on soft or pureed option, but who prefers a normal diet. If the person declares,
after receiving all the necessary information, that they do not want the soft version and gives
a statement in this regard, then their desire must be taken into account, even if the person is
at risk.

Advance decision to refuse treatment

An advance decision to refuse treatment may refer to the refusal or elimination of

medications, including the refusal of blood transfusions (in the latter case often for religious
reasons). Also, the advance decision may concern the refusal of cardio-pulmonary
resuscitation, the refusal of hospitalization, active treatment or to the elimination of life
support if the person does not show signs of awakening within a set time frame. Preliminary
decisions are legally binding and medical professionals must follow the advance decisions if
they are valid and applicable.

Lasting power of attorney

Lasting power of attorney is a legal arrangement in which, if someone cannot manage their
own finances, a nominee takes control. Usually, control is taken over by a family member or
a trusted friend, but when they do not exist, it can be taken over by a professional person.
Taking control of finances is vital when health decisions need to be made and therefore the
arrangement is usually made before someone is ill.

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Level 2 Certificate in the Principles of End of Life Care
Unit 2: Care planning in end of life care

3. Describe how a health and social care worker might be involved in advance care
planning. [3.3]

The role of health and social care workers in advanced care planning is very important, but it
varies depending on their role and situation. Usually, assessments are made by health
professionals - doctors, nurses, healthcare workers and medical experts, who can provide
advice and support in decision making by a person, when the person has mental capacity.
Social workers can also get involved in actions related to the social part of advanced care
planning, both in terms of the person's family, the money they have, the care facility that
suits them best, etc.

Other professionals will be involved by providing the necessary documents to those who
need to know the information contained in the documents. An example would be the case
where, at the time of death, a doctor will need to know a person's wishes regarding organ
donation.

4. Give three examples of when advance care planning might be used. [3.4]

Example 1

Old age - A person's physical and mental capacity decreases with age, so the ability to care
can be affected. In this case, it is useful to have a advance care planning, based on a
person's needs and desires, so that family, friends and care professionals can use care
plans to ensure that the person receives the best care according to their needs. and her
desires.

Example 2

Illness - Advanced care planning is useful for people with certain degenerative diseases, in
which the symptoms appear and gradually worsen. People with these conditions, who are
usually informed about how the disease will progress and about the support they will need at
each stage, can plan their care in advance so that it is in line with their wishes and needs.

Example 3

Accidents - In the case of a person who has suffered an accident that has affected their
mental or physical capacity, that person may need care to regain that capacity or to continue
their life with certain disabilities or precisely because the accident could have shortened their
hope of life. In all cases, advanced care planning can help service providers support the
person with the care and treatment they prefer and need.

Have you read through your work? Make sure you check your answers carefully
before submitting your Assessment.

Once you have completed all 3 Parts of this Assessment, go to

www.vision2learn.com. Log in to the platform and send your Assessment to your
tutor via your My Study page for marking. Good luck!

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