Decision Making Framework For NSW Health Aboriginal
ABORIGINAL WORKFORCESTRATEGIC FRAMEWORKTaking the next STEP UP in growinga strong and culturally supportedAboriginal WorkforceDecision Making Framework forNSW Health AboriginalHealth Practitionersundertaking clinical activities
NSW MINISTRY OF HEALTH73 Miller StreetNORTH SYDNEY NSW 2060Tel. (02) 9391 9000Fax. (02) 9391 9101TTY. (02) 9391 9900www.health.nsw.gov.auProduced by:Workforce Planning & Development (WPD)NSW Ministry of HealthThis work is copyright. It may be reproduced in whole or in part for studytraining purposes subject to the inclusion of an acknowledgement of the source.It may not be reproduced for commercial usage or sale. Reproduction forpurposes other than those indicated above requires written permission fromthe NSW Ministry of Health. NSW Ministry of Health 2018SHPN (WPD) 180345ISBN 976-76000-878-9Further copies of this document can be downloaded from theNSW Health website www.health.nsw.gov.auMay 2018
ContentsINTRODUCTION. 3PURPOSE OF A DECISION MAKING FRAMEWORK FOR ABORIGINAL HEALTHPRACTITIONERS. 4DEFINITION OF A NSW HEALTH ABORIGINAL HEALTH PRACTITIONER. 4SCOPES OF PRACTICE FOR ABORIGINAL HEALTH PRACTITIONERS. 51. Level of Education, Knowledge, Skills and Work Experience.52. Requirements of the Position (Job Description).53. Supervision and Support for the position.5DELEGATION OF CLINICAL ACTIVITIES TO ABORIGINAL HEALTH PRACTITIONERS. 6Responsibilities when delegating.6Responsibilities when accepting a delegation.6HOW TO USE THE DECISION MAKING FRAMEWORK. 7 Decision Making Framework for the Aboriginal Health PractitionersUndertaking Clinical Activities.7Desired Client Outcomes.7Lawful.7Organisation/Cultural Support. 7Professional Consensus . 7Competent.7Assessed. 7Ready.7Clinical Supervision and Support.7Reflection and Evaluation.7HOW TO ENSURE ABORIGINAL HEALTH PRACTITIONERS ARE PREPARED. 8Ask These Questions.8Desired Client Outcomes.8Lawful.8Organisational Support.8Professional Consensus.9Competent.9Assessed.9Ready.9Clinical Supervision and Support.9Reflection and Evaluation.9Decision Making Framework for Aboriginal Health PractitionersNSW Health PAGE 1
ContentsGLOSSARY OF TERMS.11Accountability/Accountable. 11Activity/Activities. 11Client. 11Clinical Activities. 11Competence/Competent. 11Competence assessment. 11Comprehensive (health) assessment. 12Context. 12Delegation/Delegate. 12Direct Supervision. 12Education. 12Evaluation/Evaluate. 13Health professional. 13Identified positions. 13Indirect supervision. 13Organisation/Organisational support. 13Refer/Referral. 13Risk Assessment/Management Framework. 13Scope of Practice. 14Supervision/Supervise. 14REFERENCES.15PAGE 2 NSW HealthDecision Making Framework for Aboriginal Health Practitioners
IntroductionTraditionally, Aboriginal Health Workersin NSW Health have been employed innon-clinical roles such as liaison, culturalbrokerage, advocacy, health promotion,prevention and education. Over the past20 years the scopes of practice of NSWHealth Aboriginal Health Workers haschanged due to the variety of AboriginalHealth Worker training that has beenavailable across the sector.On the 1st July 2012 national registration ofAboriginal Health Practitioners occurred.Aboriginal Health Practitioners providedirect clinical services to the Aboriginalcommunity. The registrable qualificationfor Aboriginal Health Practitioners is theCertificate IV Aboriginal Primary HealthCare Practice.In the past, education for Aboriginal HealthWorkers has been varied and nonspecified in NSW Health. It has contributedpositively in increasing the knowledge,skills and abilities of Aboriginal HealthWorkers but there is still a lack ofunderstanding around the scopes ofpractice due to this variety.Not only does this impinge on the ability ofthe Aboriginal Health Worker to fulfil theirroles, it also impacts on the ability of otherhealth professionals to understand theirroles and support them.According to the 2012 NSW HealthAboriginal Workforce Survey, 80% ofAboriginal Health Workers had undertakenpost-secondary education (12% haveattained a Certificate III, 21% haveCertificate IV, 17% hold a Diploma and 27%hold a degree based qualification).It is due to this wide variety in educationthat it is essential to ensure that scopes ofpractice, or delegation of activities, to anyAboriginal Health Worker is applied withina robust risk management framework.Application of this framework will enableLocal Health Districts the process ofensuring that Aboriginal HealthPractitioners are trained, competent,ready and supported to undertake clinicalactivities.This Framework aligns with the Nursingand Midwifery Board of Australia’sProfessional Codes & Guidelines.Within the workforce there is also limitedunderstanding of the qualificationsunderpinning Aboriginal HealthPractitioners – the Certificate IV AboriginalPrimary Health Care Practice. A lack ofrole clarity and minimum qualificationsframework for Aboriginal Health Workershas made it difficult to standardise scopesof practice and direct Aboriginal HealthWorkers into appropriate education ortraining programs.Decision Making Framework for Aboriginal Health PractitionersNSW Health PAGE 3
Purpose of a Decision MakingFramework for AboriginalHealth PractitionersThis framework will enable NSW Healthorganisations to make local decisionsregarding Aboriginal Health Practitionersundertaking clinical activities. It will helpto address the fact that Aboriginal HealthPractitioners currently have a variety ofqualifications at differing levels, and thatthe NSW Aboriginal community needs areever changing.Clinical activities in this Framework aredefined as being ‘concerned withobservation and treatment of a disease inthe patient. Clinical activities can also beperformed in the delivery of preventativehealth services.This framework aims to provide a processwhereby an individual’s scope of practicecan be rigorously considered under adecision making framework, including theundertaking of clinical activities that aresafe, timely and meet the Aboriginalcommunity and health service needs.It will also assist other health professionalsin delegating clinical activities which wouldnormally fit within their own scopes ofpractice, to Aboriginal Health Practitionerswho have been appropriately trained andqualified in that particular clinical activitye.g. audiometry, basic physicalassessments, venipuncture etc.Definition of a NSW HealthAboriginal Health PractitionerAn Aboriginal Health Practitioner isdefined as the following.1. An Aboriginal and/or Torres StraitIslander person which means someonewho: is of Aboriginal and/or Torres StraitIslander descent; and identifies as an Aboriginal and/orTorres Strait Islander; and is accepted as such by the Aboriginaland/or Torres Strait Islandercommunity in which they live, orformerly lived.*See Glossary of Terms for the meaning of identified positionsPAGE 4 NSW HealthDecision Making Framework for Aboriginal Health Practitioners2. Is employed in an Aboriginal identifiedAboriginal Health Practitioner position*in NSW Health;3. Has undertaken a Certificate IVAboriginal Primary Health CarePractice (including undergoingrecognition of prior learning processesagainst current qualifications);4. Works within a primary health careframework to achieve better healthoutcomes and better access to healthservices for Aboriginal people; and5. Provides flexible, holistic and culturallysensitive health services to Aboriginalclients and the community.
Scopes of Practice for AboriginalHealth PractitionersThe scopes of practice for AboriginalHealth Practitioners are to be bound anddefined within the following threeparameters:1. Level of Education,Knowledge, Skills andWork ExperienceAn Aboriginal Health Practitioner’spractice will be determined by theeducation, knowledge, skills and workexperience they have gained throughaccredited education and qualifications.2. Requirements of theRole (Job Description)The requirements of the role will alsodetermine the scope of practice ofAboriginal Health Practitioners.Job descriptions should articulate positiondetails, qualification requirements, keyfunctions, scope of practice, responsibilitiesand specific clinical activities.3. Supervision andsupport for the positionThe types of clinical activities that anAboriginal Health Practitioner canundertake is dependent on the type ofclinical supervision and support that isprovided.Aboriginal Health Practitioners will requiredirect or indirect clinical supervision andsupport, depending on the types of activitybeing performed and the context with whichthe clinical activity is being performed.Direct supervision is when the supervisoris present and observes, works with,guides and directs the Aboriginal HealthPractitioner.Indirect supervision is when thesupervisor works in the same facility ororganisation, but does not constantlyobserve the activities of the AboriginalHealth Practitioner. The supervisor mustbe available for reasonable access. Whatis reasonable will depend on the clinicalactivity, the context, the needs of theconsumer and the needs of the AboriginalHealth Practitioner.Job descriptions should be developed andreviewed in accordance to an appropriatehealth service delivery evaluation ofcommunity need.Decision Making Framework for Aboriginal Health PractitionersNSW Health PAGE 5
Delegation of clinical activities toAboriginal Health PractitionersDelegation relates to a process wherebymembers of a certain health professionalgroup delegate certain clinical activities toan Aboriginal Health Practitioner, whichwould normally fit within those healthprofessionals scopes of practice.The delegator retains accountability for thedecision to delegate and for monitoringoutcomes.Delegation may either be: A key component of delegation is thereadiness of the Aboriginal HealthPractitioner to accept the delegation.The Aboriginal Health Practitionerhas the responsibility to: To maintain a high standard of care whendelegating clinical activities, the healthprofessional’s responsibilities include: teaching (although this may beundertaken by another competentperson; and teaching alone is notdelegation)competence assessmentproviding guidance, assistance, supportand clinically focused supervisionensuring that the Aboriginal HealthPractitioner understands theiraccountability and is willing to acceptthe delegationDecision Making Framework for Aboriginal Health Practitionersevaluation of outcomes (healthoutcomes and service deliveryoutcomes)reflection of practice.Responsibilities whenaccepting a delegationResponsibilities whendelegating PAGE 6 NSW HealthTransfer of authority to a competentAboriginal Health Practitioner toperform a specific clinical activity in aspecific context; orConferring of authority to perform aspecific clinical activity in a specificcontext on a competent AboriginalHealth Practitioner who would notnormally have autonomous authority toperform the activity. negotiate, in good faith, the teaching,competence assessment and level ofclinically-focussed supervision needednotify in a timely manner if unable toperform the activity for an ethical orother reasonbe aware of the extent of the delegationand the associated monitoring andreporting requirementsseek support and direct clinicallyfocussed supervision until confident ofown ability to perform the activityperform the activity safelyparticipate in evaluation of thedelegation.It is the health professionals responsibilityto provide direct or indirect supervisionaccording to the nature of the delegatedtask. The health professional shouldunderstand the role and function of theAboriginal Health Practitioner to ensurethat they are not required to function beyondthe limits of their education, competence,experience and lawful authority.
How to Use the DecisionMaking FrameworkThis Decision Making Framework is to beused when developing scopes of practicefor Aboriginal Health Practitionersincluding delegating any clinical activitiesto Aboriginal Health Practitioners in NSWHealth.ALL components of the Decision MakingFramework must be achieved prior todelegation of a clinical activity to anAboriginal Health Practitioner. Thecomponents of the Framework are listed inno particular order and can be completedin any order.Decision Making Framework for Aboriginal HealthPractitioners Undertaking Clinical ActivitiesThe performance of the clinical activity by an Aboriginal Health PractitionerDesired Client will achieve the desired client outcomes, and the client consents, if at allOutcomespossible, to the clinical activity being performed by an Aboriginal HealthPractitioner.LawfulThe performance of the clinical activity by an Aboriginal Health Practitioneris lawful (legislation, common law).There is organisational and cultural safety support in the form of national,state and local policies/frameworks/guidelines/WH&S practices andprotocols for Aboriginal Health Practitioners performing clinical activities.OrganisationalOrganisations have a responsibility to ensure Aboriginal Health/CulturalPractitioners delivering such activities are also supported by allSupportprofessionals including Principal Aboriginal Health Workers, SeniorAboriginal Health Workers and other Aboriginal staff in a culturally safehealth care and work environment.ProfessionalConsensusThere is professional consensus (i.e. support from a professional group– nursing/midwifery profession, allied health profession, oral health ormedical profession) and evidence for the performance of this clinical activityby an Aboriginal Health Practitioner.CompetentThe Aboriginal Health Practitioner is competent (i.e. has the necessaryqualification, education, experience and skill) to perform the clinical activitysafely.AssessedThe Aboriginal Health Practitioner’s competence in relation to the clinicalactivity has been assessed by a relevant health professional (i.e.RegisteredNurse/Midwife, Allied Health Professional, Oral Health Professional orDoctor).ReadyThe Aboriginal Health Practitioner is ready (prepared and confident) toperform the clinical activity and understands their level of accountability forthe clinical activity and knows who to ask for assistance and to whom theyreport.ClinicalSupervisionand SupportThere is a Registered Nurse/Midwife, Allied Health Professional , OralHealth Professional or Doctor available to provide the required level ofclinical supervision and support, including education.The Aboriginal Health Practitioner must undergo a process of reflectiveReflection and practice/performance development to ensure that the Aboriginal HealthEvaluationPractitioner remains clinically competent and the Clients health outcome ismonitored.Decision Making Framework for Aboriginal Health PractitionersNSW Health PAGE 7
How to Ensure Aboriginal HealthPractitioners are PreparedASK THESE QUESTIONSBelow is a series of questions that can beasked in order to prepare yourorganisation for an Aboriginal HealthPractitioner to undertake clinical activities:Desired Client OutcomesIs the performance of the clinical activityby an Aboriginal Health Practitioner in theClient’s best interests?Has a Health Professional undertaken acomprehensive health assessment toestablish Client’s needs/or the need toimprove access to care?Has the health care team consulted withthe Client in regards to the AboriginalHealth Practitioner providing some clinicalactivities?LawfulIs the clinical activity being undertaken byeither an Aboriginal Health Practitioner orAboriginal Health Practitioner beingsupervised by an appropriately qualifiedand/or registered health practitioner? Isthis clinical activity within the current,contemporary scope of Aboriginal HealthPractitioner practice? Is there anylegislation which prohibits the AboriginalHealth Practitioner from undertaking theclinical activity?Is the Aboriginal Health Practitionerappropriately registered to undertake theclinical activity?Aboriginal Health Practitioners arerequired to hold a Certificate IV AboriginalPrimary Health Care Practice and beregistered with the Aboriginal and TorresStrait Islander Health Practice Board ofAustralia (ATSIHPBA) supported by theAustralian Health Practitioner RegulationAgency (AHPRA).If other health professionals should assist,supervise or perform the clinical activity,are they readily available?Organisational SupportIs this practice supported by theorganisation (e.g. policies, procedures,models of care and scopes of practice forthe Aboriginal Health Practitioner’s,clinical pathways for normal and abnormalfindings, referral mechanisms)?Does the Aboriginal Health Practitionerhave an up-to-date job description whichindicates skills required, qualifications,responsibilities and clinical activities thatcan be performed?If organisational authorisation is needed,does the Aboriginal Health Practitionerhave it or can it be obtained beforeperforming the clinical activity?Is the skill mix in the organisationadequate for the level of support/supervision needed to safely perform theclinical activity?PAGE 8 NSW HealthDecision Making Framework for Aboriginal Health Practitioners
Have potential risks been identified andstrategies to avoid or minimise them beenidentified and implemented? Client’s health statusComplexity of care required by theClientKnowledge and skills of the AboriginalHealth PractitionerIf this is a new practice: Are there processes in place formaintaining performance into thefuture?Have relevant parties been involved inthe planning for implementation?Professional ConsensusHave discussions occurred across themultidisciplinary team in relation to theAboriginal Health Practitioner undertakingcertain clinical activities?Is there consensus from the healthprofessional group in which that clinicalactivity would normally sit?Does the multidisciplinary teamunderstand the qualifications and trainingthat the Aboriginal Health Practitioner hasundertaken in order to complete theclinical activity?AssessedHas the Aboriginal Health Practitionerbeen adequately assessed by a HealthProfessional (outside of the educationalinstitution) ensuring they are competentin undertaking the clinical activity?Is there a documented process wherebythe Aboriginal Health Practitioner willmaintain their skills through annualcompetence assessment and ongoingeducation? (e.g. First Aid, Work Health &Safety, Infection Control, Manual Handling,etc.) and Professional Development.ReadyIs the Aboriginal Health Practitionerconfident and do they understand theiraccountability and reportingresponsibilities in performing the clinicalactivity?Does the Aboriginal Health Practitionerunderstand the extent of their individualscopes of practice and what to do whenasked to work outside of their scope? (e.g.referral, consultation with Manager etc.)CompetentDoes the Aboriginal Health Practitionerhave the knowledge, skill, authority andability (capacity) to undertake the clinicalactivity autonomously or with education,support and supervision? (Assessment toreview qualifications, past experience, onthe job training etc.)Decision Making Framework for Aboriginal Health PractitionersNSW Health PAGE 9
Clinical Supervision and SupportIs the level of education, supervision/support available by another healthprofessional adequate?Is there a system for ongoing educationand maintenance of competence in place?Have those health professionals who areproviding clinical supervision and supportundertaken Aboriginal cultural training asper the Respecting the Difference:Aboriginal Cultural Training Frameworkfor NSW Health (PD2011 069) to betterunderstand some of the issues that anAboriginal Health Practitioner may face?Have supervision and support requirementsbeen identified according to the types ofsettings that the clinical activity will beundertaken (e.g. acute hospital setting,community health setting and homesetting)? What kind of supervision andsupport is required in each setting?Reflection and EvaluationIs there a formal monitoring process ofthe Client’s health status to ensure thatperformance of the clinical activity by anAboriginal Health Practitioner is meetingtheir needs?Is there a formal monitoring process ofthe program outcomes to ensure thatperformance of the clinical activity by anAboriginal Health Practitioner is positivelycontributing to the program?Is there a process of reflective practice/performance management in place toensure that the Aboriginal HealthPractitioner remains competent atundertaking this clinical activity?PAGE 10 NSW HealthDecision Making Framework for Aboriginal Health PractitionersIF YOU HAVE ANSWERED ‘YES’TO ALL OF THE ABOVE THEN:1. T he Aboriginal Health Practitioner canperform the clinical activity;2. Document all decisions and actions.
Glossary of TermsAccountability/AccountableAccountability means that Aboriginal Health Practitioners mustbe prepared to answer to others, such as health care consumers,other health professionals, their regulatory authority, employersand the public for their decisions, actions, behaviours and theresponsibilities that are inherent in their roles. Accountabilitycannot be delegated. The health professional who delegates anactivity to an Aboriginal Health Practitioner is accountable, notonly for the delegation decision, but also for monitoring thestandard of performance of the activity by the Aboriginal HealthPractitioner, and for evaluating the outcomes of the delegation.Activity/ActivitiesAn activity is a service provided to consumers as part of a plan ofcare. Activities may be clearly defined individual tasks, or morecomprehensive care. The term can also refer to interventions, oractions taken by a health worker to produce a beneficial outcomefor a health consumer. These actions may include, but are notlimited to: direct care, monitoring, teaching, counselling,facilitating and advocating.ClientClients are individuals, groups or communities of health careconsumers who work in partnership with Aboriginal HealthPractitioners and health professionals to plan and receive healthcare. The term Client includes patients, residents and/or theirfamilies/representatives/significant others.Clinical ActivitiesClinical activities are defined as being concerned with observationand treatment of a disease in the patient and processesundertaken for primary health care including early identificationand intervention.Competence/CompetentCompetence is the combination of knowledge, skills, attitudes,values and abilities that underpin effective performance in aprofession. It encompasses confidence and capability.CompetenceassessmentAssessment of an individual’s competence may occur throughstructured educational programs or a peer review process.Evidence of a person’s competence may include: written transcripts of the skills/knowledge they have obtainedin a formal course their in-service education session records direct observation of their skill questioning of their knowledge base assessment from the consumer’s perspective using agreedcriteria self-assessment through reflection on performance incomparison with professional standards.Decision Making Framework for Aboriginal Health PractitionersNSW Health PAGE 11
Comprehensivehealth assessmentA comprehensive health assessment is the assessment of aconsumer’s health status for the purposes of planning orevaluating care. Data is collected through multiple sources,including, but not limited to, communication with the consumer,and where appropriate their significant others, reports fromothers involved in providing care to the consumer, health carerecords, direct observation, examination and measurement, anddiagnostic tests.The interpretation of the data involves the application of healthprofessionals knowledge and judgement. A comprehensive healthassessment also involves the continuous monitoring andreviewing of assessment findings to detect changes in theconsumer’s health status.ContextContext refers to the environment in which Aboriginal HealthPractitioners practice, and which in turn influences that practice.It includes: the characteristics of the Client and the complexity of carerequired by them the model of care, type of service or health facility andphysical setting the amount of clinical support and/or supervision that isavailable the resources that are available, including the staff skill mixand level of access to other health care professionals.Delegation/DelegateA delegation relationship exists when one member of themultidisciplinary health care team delegates aspects of consumercare, which they are competent to perform and which they wouldnormally perform themselves, to another member of the healthcare team from a different discipline, or to a less experiencedmember of the same discipline.Delegations are made to meet consumers’ needs and to ensureaccess to health care services; that is, that the right person isavailable at the right time to provide the right service to aconsumer. The delegator retains accountability for the decision todelegate and for monitoring outcomes.Direct SupervisionDirect supervision is when the supervisor is actually present andpersonally observes, works with, guides and directs the personwho is being supervised.EducationFormal education includes courses leading to a recognisedqualification. Informal educational methods include, but are notlimited to: reading professional publications completing self-directed learning packages attending in-service education sessions attending seminars or conferences individual, one-to-one education with a person competent inthe subject or skill reflection on practice alone or with colleagues.Practical experience and assessment
PAGE 4 NSW Health Decision Making Framework for Aboriginal Health Practitioners This framework will enable NSW Health organisations to make local decisions regarding Aboriginal Health Practitioners undertaking clinical activities. It will help to address the fact that Aboriginal Health Practitioners currently have a variety of
state postcode suburb nsw 2000 barangaroo nsw 2000 dawes point . nsw 2004 alexandria mc nsw 2004 eastern suburbs mc nsw 2006 the university of sydney nsw 2007 broadway nsw 2007 ultimo nsw 2008 chippendale nsw 2008 darlington nsw 2009 pyrmont nsw 2010 darlinghurst nsw 2010 surry hills nsw 2011 elizabeth bay nsw 2011 hmas kuttabul nsw 2011 .
z z chang beverly hills nsw beverley hills newsagency beverly hills nsw k q wang & y yao bexley nsw l z daniel pty ltd bexley north nsw billinudgel post & news billinudgel nsw hanlons store bilpin nsw binalong newsagent & stor binalong nsw r g & s c king bingara nsw binnaway newsagency binnaway nsw birchgrove newsagency birchgrove nsw
Bruksanvisning för bilstereo . Bruksanvisning for bilstereo . Instrukcja obsługi samochodowego odtwarzacza stereo . Operating Instructions for Car Stereo . 610-104 . SV . Bruksanvisning i original
He was the dark god of Chaos, worshipped by the devil's tribe. On the contrary, . PROPER NSW-BigBlueBox[ ]10 Second Run RETURNS NSW-iND[ ]1001 Ultimate Mahjong 2 NSW-iND[ ]103 NSW-iND[ ]103 Update v1.0.1 NSW-iND[ ]112th Seed NSW-VENOM[ ]12 is Better . 3D Billiards - Pool & Snooker NSW-iND[ ]
Second Run RETURNS NSW-iND[ ]1001 Ultimate Mahjong 2 NSW-iND[ ]103 NSW-iND[ ]112th Seed NSW-VENOM[ ]12 is Better Than 6 eShop NSW-SUXXORS[ ]12 is Better Than 6 Update v1.0.1 NSW-SUXXORS[ ]12 Labours of Hercules II: The Cretan Bull NSW-iN
10 tips och tricks för att lyckas med ert sap-projekt 20 SAPSANYTT 2/2015 De flesta projektledare känner säkert till Cobb’s paradox. Martin Cobb verkade som CIO för sekretariatet för Treasury Board of Canada 1995 då han ställde frågan
service i Norge och Finland drivs inom ramen för ett enskilt företag (NRK. 1 och Yleisradio), fin ns det i Sverige tre: Ett för tv (Sveriges Television , SVT ), ett för radio (Sveriges Radio , SR ) och ett för utbildnings program (Sveriges Utbildningsradio, UR, vilket till följd av sin begränsade storlek inte återfinns bland de 25 största
Hotell För hotell anges de tre klasserna A/B, C och D. Det betyder att den "normala" standarden C är acceptabel men att motiven för en högre standard är starka. Ljudklass C motsvarar de tidigare normkraven för hotell, ljudklass A/B motsvarar kraven för moderna hotell med hög standard och ljudklass D kan användas vid
