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B

CH HM2 Provide a treatment and management plan to meet the needs of the client

Overview

This standard is based on the premise that for effective treatment planning and implementation to take place, you need to understand the context of the client and the holistic nature of health, effective functioning and well-being. You must be able to communicate effectively with clients and any companion(s) of the client and integrate your work with that of other practitioners. Throughout the process, clients and any companion(s) are encouraged and supported to take an active part and this is enhanced by you using, as far as is possible, interventions which are sustainable by the client in their own context. Element one involves negotiating and formulating a treatment and management plan with the client. This includes giving dietary and lifestyle advice and explaining how to handle positive and adverse outcomes of the treatment. Element two is about evaluating the effectiveness of the herbal medicine treatment, it includes making any adjustments to the treatment to accommodate any changes in the needs of the client and agreeing future treatment sessions. Element three is concerned with completing post-consultation activities such as recording the outcomes of the consultation, writing the prescription and dealing with between consultation communications from clients. It is also concerned with evaluating the effectiveness of the herbal dispensary, which you may or may not run yourself. Users of this standard will need to ensure that practice reflects up to date information and policies. Version No 1

Knowledge and Understanding

You will need to know and understand:

  1. structure and functions of the cells and their components
  2. structure and functions of tissues: epithelium, connective tissue, membranes
  3. structure and functions of biomolecules: carbohydrates, lipids, proteins, co-factors,enzymes
  4. the metabolism of carbohydrates, lipids and proteins including control andintegration
  5. structure and functions of the musculoskeletal system: bones, joints, muscles,ligaments
  6. structure and functions of the nervous system: central and peripheral systems,autonomic nervous system, sense organs
  7. structure and functions of the endocrine system: hypothalamus and the pituitary gland, thyroid gland and adrenal glands, feedback control
  8. structure and functions of the lymphatic system: the lymphoid tissues and lymphatic circulation, natural (innate) resistance to disease, immunity
  9. structure and functions of the cardiovascular system and components of blood and blood clotting
  10. structure and functions of the respiratory system
  11. structure and functions of the digestive system
  12. structure and functions of the genito-urinary system and prenatal and postnatal growth and development
  13. how to recognise conditions:
    1. for which herbal medicine is appropriate
    2. where herbal medicine must be used with caution
    3. for which herbal medicine is contra-indicated
    4. for which herbal medicine is inappropriate
  14. the structural characteristics and function of key macronutrients and micronutrients
  15. the processes involved in the catabolism of food components
  16. terms used in Western dietetics to include RDA, RDI, DRV, EAR, LRNI, RNI, safe intakes, BMR, BMI, PAL and bioavailability
  17. the effects of food additives, processing and drugs on nutrition
  18. how to evaluate dietary assessment methodologies such as weighed dietary and portion records, questionnaires and surveys, food tables
  19. the similarities and differences between different dietary approaches
  20. dietary needs at different stages of development
  21. the relationships between diet and disease
  22. diets for individual specific cases
  23. the relationship between herbal medicines and diet
  24. the diagnostic techniques and clinical applications in orthodox medical practice and how to compare and contrast them with your traditional herbal medicine
  25. the distribution of disease in the community and the approach to prevention from the orthodox and holistic points of view
  26. how normal cell and tissue structure and function can change to produce genetic changes, abnormal cell growths, tissue injury, inflammation and repair
  27. the general nervous, endocrine and metabolic responses to ageing, stress and tissue injury
  28. the principles of infection and the ways in which alterations in natural and acquired defences (immunity) can lead to disease
  29. the consequences of changes in the circulation, resulting from vascular narrowing and obstruction, fluid excess and loss and organ failure
  30. diseases leading to the differential diagnosis of common symptoms and signs affecting the covering and support systems of the body (skin, joints and bone), control systems (nervous and endocrine systems) and maintenance systems (cardiovascular, respiratory, gastro- intestinal and urinary systems)
  31. how to take effective case histories
  32. how to perform a clinical examination of the major body systems
  33. how to interpret basic pathology laboratory data and results of investigative procedures
  34. the major actions and side effects of the major classes of orthodox drugs and how to access drug information (use of National Formularies etc)
  35. how to recognise potentially serious signs and symptoms and when to refer clients to orthodox medical practitioners
  36. the nature and properties of plant substances
  37. the procedures for chemical identification tests
  38. the value and uses of chemical identification tests and separation techniques
  39. the pharmacological effects of the major groups of plant compounds
  40. the mode of action of common medicinal plants
  41. the limitations of plant biochemistry as an explanatory model for herb actions
  42. how to carry out information searches and evaluate current information on plant biochemistry and phytopharmacognosy
  43. the processes and issues of quality assurance in relation to herbal medicines
  44. the identifying characteristics of commonly used herbs
  45. the botanical terms used to describe herbs, including Latin terms and/or tradition specific names where relevant, for parts of plants
  46. the legal requirements relating to the storage, labelling and dispensing of herbal medicine
  47. the different forms of administering herbs and how to select the most appropriate form
  48. the procedures for interacting with pharmacists, licensing authorities, the medical profession and toxicologists
  49. the taxonomy and morphology of medicinal plants. How to recognise and identify a wide range of medicinal plants both growing and dried. How to use botanical reference material
  50. how to classify plants according to their actions e.g. as stimulants, astringents etc. How to relate the action of an individual herb to its indications in treatment
  51. the pharmacological actions of medicinal plants on the body in health and disease and which specific tissues, organs and physiological systems are affected by the administration of a given medicinal plant. The influence of plant remedies on the psycho-social and spiritual aspects of a client’s being
  52. the relative merits of whole plant preparations, standardised extracts and isolated plant constituents for application in holistic treatment
  53. the dosage range for a wide range of medicinal plants
  54. the contraindications and incompatibilities of a wide range of medicinal plants
  55. the role of rationality, intuition and experience in prescribing treatment
  56. the relative merits of simple and/or complex herbal prescriptions
  57. the debate concerning the use of native versus foreign herbal remedies
  58. conservation issues as they relate to herbal medicine. The merits of organic and wildcrafted herbs
  59. the history and fundamental characteristics of Chinese medicine including the stages of development and literary landmarks; holism – seeing patterns of disharmony and the relationship between Traditional Chinese Medicine and Western Medicine in modern China
  60. the concept of Yin-Yang, the basic aspects of the Yin-Yang relationship and the medical applications of Yin-Yang
  61. the concept of the Five Phases, the Five Phase relationships of engendering (sheng), restraining (ke), rebellion (wu) and overwhelming (chang) and the medical applications of the Five Phase concept
  62. the fundamental substances in Traditional Chinese Medicine i.e.
    1. qi – as a central concept in Chinese philosophy and medicine; the sources, functions and forms of Qi
    2. blood (xue) – the sources and functions of blood and the relationship to Qi and to the Zang Fu
    3. essence (jing) – the characteristics and functions of essence
    4. spirit (shen) – the characteristics and manifestations of spirit
    5. body Fluids – the characteristics and functions of thinner fluids (jin) and thicker fluids (ye)
  63. the function of the internal organs including:
    1. differences between the Zang Fu in Chinese Medicine and the anatomical organs of Western medicine
    2. the Five Yin organs (wu zang): the functions of the heart (xin)/pericardium (xin bao); the liver (gan); the spleen (pi); the lungs (fei); the kidneys (shen) and the relationships between the Zang
    3. the Six Yang organs (liu fu): the functions of the gall bladder (dan); stomach (wei); small intestine (xiao chang); large intestine (da chang); bladder (pang guang); triple burner (san jiao) and their relationships with the Zang
    4. the Extraordinary organs (qi heng zhi fu): the functions of the brain (nao); the marrow (sui); bone (gu); vessels (mai); the uterus (zi gong) and the gall bladder (dan)
  64. the function of the channels (jing) and network vessels (luo mai) i.e.
    1. the distinction between channels (jing) and network vessels (luo mai)
    2. the channel system: the twelve regular channels (shi er jing mai); the eight extraordinary channels (qi jing ba mai); the channel divergences (jing bie); the channel sinews (jing jin); the cutaneous regions (pi bu); the relationship between the channels and the Zang Fu
  65. the causes of diseases (aetiology):
    1. external causes: the six pathogenic factors (liu xie): wind (feng), cold (han), heat (re) or fire (huo), dampness (shi), dryness (zao), (summer-) heat (shu) and the relationship between the normal or upright (zheng) Qi and pathogenic or evil (xie) Qi
    2. internal causes: the seven emotions (qi qing): joy (xi), anger (nu), worry (you), pensiveness (si), sadness (bei), fear (kong), fright (jing)
    3. not external and not internal causes (bu nei wai yin): diet, imbalances of work and rest, sexual excesses
    4. miscellaneous factors including trauma, burns, bites, parasites
  66. how to identify patterns (bian zheng) of disharmony (pathology) according to:
    1. the eight principles (ba gang): patterns of the interior (li) and exterior (biao); cold (han) and heat (re); deficiency (xu) and excess (shi); yin and yang
    2. qi, blood and body fluids: Qi deficiency (qi xu), Qi sinking (qi xian), Qi stagnation (qi yu), Qi counterflow (qi ni); blood deficiency (xue xu), blood stasis (xue yu), blood heat (xue re); oedema (shui zhong), dictinction between thin mucus (yin) and phlegm (tan); phlegm patterns (tan zheng) including phlegm heat (tan re), damp phlegm (shi tan), cold phlegm (han tan), wind phlegm (feng tan), Qi phlegm
    3. pathogenic factors: wind patterns (feng zheng): wind cold (feng han), wind heat (feng re), wind dampness (feng shi); damp patterns (shi zheng): cold dampness (han shi), damp heat (shi re); cold patterns (han zheng): excess cold (shi han), deficiency cold (xu han); heat/fire patterns (re-/huo zheng): excess heat (shi re), deficiency heat (xu re); summer heat patterns (shu zheng); dryness patterns (zao zheng)
    4. the internal organs: patterns of the heart/pericardium, lung, liver, spleen, kidney; patterns of the stomach, small intestine, large intestine, gall bladder, bladder, triple burner
    5. the six stages (liu-jing): in accordance with the theory of injury by cold: greater yang (tai yang), yang brightness (yang ming), lesser yang (shao yang), greater yin (tai yin), lesser yin (shao yin), absolute yin (jue yin)
    6. the four levels: in accordance with the theory pf warm diseases: defence aspect (wei fen), Qi aspect (qi fen), nutritive aspect (ying fen), blood aspect (xue fen)
  67. methods used to examine clients:
    1. looking – the shen, physical shape and movement, facial colour, tongue, other external manifestations: eyes, nose, ears, mouth/lips/teeth/gums, throat, limbs, skin
    2. listening and smelling – sound of the voice; breathing cough; body odours
    3. asking about – sensations of cold and hot; sweating; headaches and dizziness; pain/aching/numbness in whole body, in joints, in back, in limbs; chest and abdomen: including epigastric and lower abdominal fullness and pain, oppression of the chest, palpitations, shortness of breath, hypochondriac pain; stools and urine; thirst, appetite and diet, tastes in the mouth, nausea/vomiting; ears and eyes: including tinnitus, hearing loss, pain or pressure in the eyes, blurred vision, floaters; sleep; vitality; mental-emotional state; gynaecological: cycle, periods, discharges; paediatric: including special events during pregnancy, traumas at birth, breast-feeding and weaning, vaccinations; medical history; medication
    4. touching – the pulse: method of palpation; levels of pressure; pulse-positions; pulse qualities including: floating (fu), sinking or deep (chen), slow (chi), rapid (shuo), empty (xu), full (shi), thin or thready (xi), wiry or stringlike (xian), slippery (hua), tight (jin), flooding (hong), soggy (ru) or soft (ruan), choppy (se), knotted (jie), interrupted (dai), and hurried (cu); integration of positions and qualities; palpating the skin, the hands and feet, the epigastrium and abdomen
  68. the principles (zhi ze) and methods (zhi fa) of treatment i.e.
    1. treating in accordance with the season, the locality, and the individual
    2. supporting the upright (zheng) Qi and expelling the evil (xie) Qi
    3. treating the manifestation (biao) and the root (ben)
    4. straightforward treatment (zheng-zhi) and paradoxical treatment (fan-zhi)
    5. the eight methods (ba fa) of treatment: sweating (han), vomiting (tu), draining downward (xia), harmonising (he), warming (wen), clearing (qing), reducing (xiao), tonifying (bu), applications, variations, contraindications
  69. the differentiation and treatment of common diseases (refer to the list provided by the Regulatory Authority)
  70. the identification, harvesting and storage of Chinese herbs
  71. the preparation and treatment of Chinese herbs
  72. the natures and properties of Chinese herbs i.e.
    1. four Qi and five tastes
    2. ascending, descending, floating and sinking
    3. repairing and draining
    4. targeting of channels
    5. categories
  73. the utilisation of Chinese herbs including:
    1. combining herbs
    2. contraindications: symptomatic contraindications, contraindicated combinations, contraindications for pregnant women, contraindicated food and drink
    3. dosage: as determined by the nature of the herbs, as determined by the combination and the type of prescription, as determined by the disease situation, the constitution and age of the client
    4. administration
  74. the name, category, properties (four Qi and five tastes), actions and indications, dosage, contraindications, main combinations, differences between members of the same category and appropriate methods of preparations of the Essential Chinese herbs (refer to the list provided by the Regulatory Authority)
  75. the name, category, main actions and indications and differences between members of the same category of the Useful Chinese herbs (refer to the list provided by the Regulatory Authority)
  76. the general principles of composing and modifying formulae:
    1. internal structure of Chinese herbal formulae – the principles of formula building and of herb construction
    2. adjustment of formulae to fit the individual case – adding and deleting herbs and flavours, altering herb combinations and altering dose ratios
    3. categories of formula – pre-modern and modern categorisations
    4. types of formulation – decoctions, powders, pills, soft extracts, special pills, tinctures
    5. preparation and administration
  77. the category, ingredients and dosage, indications of dosage, contraindications, major modifications, differences in properties and usage between formulae in the same category of the Essential Model Formulae (refer to the list provided by the Regulatory Authority)
  78. the category, main ingredients, indications of usage, differences in properties and usage between formulae in the same category of the Useful Model Formulae (refer to the list provided by the Regulatory Authority)
  79. the elemental nature of the universe and the five elements i.e. earth, water, fire, air and space
  80. the Fourfold Treatise, the relationship between the individual and the environment, mutual dependence and interaction and its use in determining the timing and suitability of treatments
  81. the root treatise
    1. normal physical condition viewed as the basis of illness
    2. the diagnosis and symptoms of disorders
    3. treatment, as diet, behaviour, medication and other therapies
    4. the tree metaphor – three roots, nine stems, 47 branches and 224 leaves
  82. the explanatory treatise
    1. the object of treatment i.e.
      1. the body - formation of the body (embryology); metaphors for the body; nature of the body (quantitative anatomy dealing with the proportion of bodily constituents, nerves and blood vessels and other important channels in the body); characteristics (physiology) of the body; types of physical constitutions; signs of death
      2. illness - causes of illness; contributing factors of illness; mode of inception of illness; characteristics of illness; classification of diseases
    2. the treatment i.e.
      1. lifestyle – behaviour including usual, seasonal and occasional behaviour
      2. diet - survey of foods and their nutritional value; dietary restrictions; the right amount of food and drink to ingest
      3. medicines - ‘taste’ and ‘post-digestive taste’; six basic tastes and eight fundamental ‘potencies’ which give each substance its own properties. What the basis is for compounding medicines, in order to achieve the desired curative effect, and the principles involved in compounding medicines.
      4. instruments used in external treatments - surgical and medical instruments
    3. the means of treatment i.e.
      1. health preservation - remaining healthy (preventive medicine)
      2. diagnosis - diagnosing the actual condition of the client; diagnosing by indirect questioning: gaining the client’s confidence; four criteria and their use to investigate whether a disease can be treated or not
      3. treatment of illness - general method of treatment; specific methods of treatment; common and specific means of treatment
    4. the one who treats i.e.
      1. the qualities and ethical standards required of a doctor
  83. the instruction treatise
    1. ‘disruption of the three Nyes pa’ – diagnosis and treatment of Rlung disorders; Mkhris pa disorders; Bad kan disorders and the combination of all three in diagnosis and treatment
    2. ‘cold’ diseases (‘consumptive’ disorders) – digestive problems; tumours; 1st , 2nd and advanced stage oedemas; chronic metabolic disorder resulting in wasting of bodily constituents
    3. ‘hot’ disorders (fevers, inflammations, infectious diseases) – hot disorders in general; clarification of possible errors about hot and cold diseases; ‘borderline situations’ (‘Nyes pa’ reactions following the treatment of a fever); immature fever; fully-developed fever; empty fever; hidden or latent fever; old (chronic) fever; ‘turbid’ fever; post-traumatic fever; ‘disturbing’ fever; contagious diseases; pox-type diseases; infectious disease of intestines; infectious disease of throat and of muscle tissues; common cold and influenza
    4. diseases of the upper part of the body – head; eyes; ears; nose; mouth; goitre and throat diseases
    5. visceral diseases – heart; lungs; liver; spleen; kidneys; stomach; small intestine; large intestine
    6. sexual diseases – male genital disorders; female genital disorders
    7. miscellaneous diseases – problems of voice production; loss of appetite; intense chronic thirst; hiccups; breathing difficulties; sharp abdominal pains of infectious origin; infections/inflammations; vomiting; diarrhoea; constipation; urinary retention (12 different sorts of disorders); polyuria ( 20 sorts of disorders); infectious diarrhoea; gout; rheumatic diseases (osteoarthritis); ‘Chu-Ser’ disorders (skin affections of various sorts); neurological disorders; dermatological diseases; miscellaneous minor disorders
    8. ‘endogenous sores/swellings’ – swellings, tumours, cysts, growths; haemorrhoids; ‘fire heat’ (burn-like blisters); ‘Surya’ swellings (blood clots); swelling of glands; swelling of scrotum and testicles; swelling of lower limbs; anal fistula
    9. children’s diseases (paediatrics) – child care; children’s diseases; disturbances in children caused by negative influences in their environment
    10. women’s diseases (gynaecology) – general, specific and common disorders
    11. disorders due to ‘Severe Mental Disturbance’ (Neurology and Psychiatry) disruptive influence of negative emotional states such as hatred and jealousy and their roots in the ultimate demon ‘ego fixation’ – ‘elementals’ influence; various patterns of mental disturbance accompanied by physiological manifestations and erratic behaviour; ‘insanity makers’ – physical signs and disturbed behaviour akin to bipolar affective disorders; ‘making one forget’ – neurological disorder possibly akin to dementia; ‘planetary influence’ – neurological disorders including strokes leading to hemiplegia and/or epilepsy; ‘naga influence’ relating mostly to leprosy l. wounds and injuries – general, head wounds; neck wounds; abdominal wounds; limb wounds
    12. poisons – specially formulated poisons; food poisoning; natural poisons
    13. geriatrics – revitalisation treatment
    14. virility/fertility treatment – virility; women’s fertility treatment
  84. the final treatise
    1. diagnosis through examination of pulse and urine
    2. ‘calming’ medicinal treatment – decoctions; powders; pills; pastes; medicinal butters ‘calcinates’; extracts; medicinal brews; preparations based on precious stones or substances; herbal preparations
    3. ‘cleansing’ medicinal treatment – lubrication (oil therapy); the five works: purgatives; emetics; cleansing via the nose; gentle enema; forceful enema; ‘channel’ cleansing as a supplement to the five works; five gentle and forceful external treatments: bloodletting; moxibustion; hot/cold applications; baths/steam baths; ointments; minor surgery as a supplement to the five external treatments; conclusion and entrustment
  85. how to determine a specific treatment strategy, to select appropriate herbal prescriptions and dietary plans for a wide range of conditions and having regard to the pattern of disharmony particular to the individual concerned
  86. how to select for any particular scenario or condition a range of possible herbal formulae, and the difference of approach in each case
  87. how to adapt a prescription appropriately to respond to changing circumstances in the progress of an individual treatment
  88. how to recognise and deal with adverse reactions
  89. the factors involved in prognosis
  90. the factors involved in selecting appropriate dosages of herbs and treatments for particular individuals and conditions, including dosages for the elderly, children and infants. Schedule III herbs and the contraindications in pregnancy
  91. the history, principles and development of herbal medicine and its relationship to other healthcare modalities
  92. how to recognise those occasions when herbal medicine may complement other healthcare which the client is receiving
  93. how to recognise conditions for which herbal medicine is incomplete in itself and for which the client should seek advice from other sources (discipline specific)
  94. the circumstances when you may choose not to accept a client:
    1. herbal medicine is unlikely to succeed
    2. the client does not want herbal medicine
    3. you do not wish to provide herbal medicine
  95. the circumstances when you must not accept a client:
    1. your specific complementary healthcare discipline is contra-indicated
    2. you do not have the requisite experience or expertise
  96. the range, purpose and limitations of different methods, which may be used for different clients with different needs
  97. how to determine the most appropriate method(s) for different clients and their particular needs
  98. how to tailor herbal medicine appropriately for each individual
  99. how to judge whether self-care procedure(s) is/are appropriate for the client
  100. how to provide an appropriate assessment environment for the client and the importance of doing so
  101. how to select, prepare and use a range of equipment and materials that are needed to assess the client
  102. how to prepare and present yourself correctly to carry out assessment
  103. why it is important to introduce everyone present and confirm their role within the assessment process
  104. how to clarify and confirm the client’s (and any companion’s) understanding of the assessment process
  105. how to interpret the client’s initial approach and manner and identify their needs
  106. how to select and use different assessment methods effectively
  107. the amount of time which each assessment method is likely to take to establish the client’s needs
  108. the importance of respecting the client’s privacy and dignity and affording them as much comfort as possible during assessment
  109. how to establish valid and reliable information about the client, determine the priority of need and to formulate your initial hypothesis
  110. the information which would confirm or deny initial hypothesis and the reasons for this in particular cases
  111. the likely causes of particular conditions and the possibility of changing these
  112. the potential risks of various courses of action for the client and how to assess these realistically
  113. how to determine the meaning and significance of the information given by the client and how to deal with any inconsistent information gained during assessment
  114. why it is important to acknowledge your own limitations and when there may be a need to refer the client on to other healthcare practitioners
  115. why it is important to explain the reasons for any delay between requests and assessment
  116. the appropriate actions to take on the basis of the assessment to suit the client’s condition and identified needs.
  117. the importance of explaining treatment/self-care options and methods to meet the needs of the client and what the potential consequences of not doing so may be
  118. the role which the client (and others) may take, and may need to take, if the treatment or self-care is to be successful and how to explain and agree them with the client (and any companion)
  119. how to support the client to make informed choices
  120. the importance of agreeing the location and timing of the herbal medicine sessions with the client, and the factors which may intervene and alter plans
  121. why evaluation methods should be determined at the planning stage and what the client’s role will be in the evaluation
  122. the importance of encouraging the client to be as actively involved as possible and the relationship of this to the promotion of their health, effective functioning and well-being
  123. how to monitor and evaluate changes in the client, assess which changes are related to herbal medicine and use this information to inform future practice
  124. how to evaluate efficacy and suitability of herbal medicine for a client and how to decide when it should be halted and/or discontinued
  125. methods and processes for evaluating information as treatment proceeds and using this to inform future practice
  126. the potential risks associated with client self-care and the extent of your responsibilities
  127. the importance of giving clear and accurate instructions on self-care and the consequences of not doing so
  128. what information is needed for the review to be carried out effectively
  129. how to review the effectiveness of the herbal medicine treatment and management plan with the client and evaluate the extent to which their needs have been met
  130. the importance of evaluating the herbal medicine treatment and management plan as a whole
  131. how and why you should encourage the client (and any companion) to take a full and active part in the review process and offer their views
  132. how the client (and any companion) may indicate concerns in the process without making their concerns clear and explicit
  133. the importance of active listening in evaluating the herbal medicine treatment and management plan with the client
  134. the range of different ways in which the herbal medicine treatment and management plan can be altered to meet the needs of the client and the ways in which their needs may have changed
  135. why it is necessary to help and support the client to consider the implications of any changes made to their herbal medicine treatment and management plan
  136. how to record the content and outcomes of the review process and what information should be included
  137. the variety of reasons there may be for discontinuing the herbal medicine treatment and management plan with the client
  138. the professional standards and code of conduct for your discipline
  139. the role of the professional body setting the rules and ethics of your discipline
  140. the rules, ethics and codes of conduct of your profession and how they apply to your own practice
  141. why it is important to keep your understanding of professional rules and codes of conduct up to date
  142. how to balance your own responsibilities as a professional with any contractual or other requirements of any organisation within which you work
  143. current relevant health and safety legislation and how it applies to your own work role
  144. legislation relating to obtaining, storing and using information and supplying services
  145. the importance of keeping your understanding of legislation up to date including legislation on banned and restricted herbs and medicinal products
  146. the roles and functions of the principal agencies with whom you work
  147. how to obtain information from the principal agencies with whom you may be working
  148. why it is important to respect the rights of clients
  149. the extent of your own remit as a practitioner and the limits of your responsibilities
  150. how your own role relates to that of other professionals within the principal agencies
  151. the organisational requirements and restrictions relating to the use of resources
  152. the range of resources and options available to meet the client’s needs
  153. how to achieve effective communication through observation, sensitive questioning and listening
  154. how to adapt vocabulary, pace and tone of speaking to meet the needs of the client
  155. what forms of verbal and non-verbal communication are available and how to use these positively
  156. what signals can be used to check the understanding of the client and how to interpret them
  157. how to position self and client to encourage communication
  158. how to recognise and overcome barriers to communication
  159. why certain environments can inhibit communication and how to minimise this
  160. why it is important to encourage the client (and any companion(s)) to ask questions, seek advice and express any concerns
  161. the nature of a professional relationship and how to develop it with clients
  162. how to respond to conflicting advice which clients may receive from different practitioners
  163. why it is important to reflect on your own practice and identify any development needs
  164. how to evaluate the effectiveness of your own actions and learn from experience
  165. the information available on effective complementary healthcare and how to evaluate and use this information within your own practice
  166. how the models and concepts in your area of practice have evolved and developed, how they tend to change with time and the similarities and differences between different versions
  167. how to develop links with other healthcare providers and the protocols for doing this
  168. how to acknowledge the limits of your own knowledge and competence and the importance of not exceeding these
  169. the importance of recognising and maintaining the client’s right to confidentiality
  170. how to balance the client’s rights against your responsibility to others
  171. what to take into account when passing on information about clients
  172. what the procedures and requirements on confidentiality, security and transmission of information are for your organisation and for any other organisation that you may need to contact regarding a client
  173. the ways in which confidentiality may be breached and how to prevent their occurrence
  174. what is meant by “implied” and “informed” consent and the circumstances in which these may arise
  175. the guidance given by your professional body on implied and informed consent and when written consent should be obtained
  176. why it is important to ensure that clients have been given sufficient information to give or refuse consent
  177. who holds responsibility for gaining consent and when this should be done
  178. how informed consent may be obtained for clients who are unable to give the consent themselves and who has the right to give this consent
  179. how to confirm that the agreements reached are likely to be in the clients’ best interest
  180. what the policies on consent, including any specific requirements under contractual agreements are for your organisation and for any other organisation that you may need to contact regarding a client
  181. why it is important to protect client confidentiality
  182. how to keep records to protect confidentiality and security of information
  183. how to keep records so that an audit can be undertaken
  184. why it is important to record all the necessary information in a format suitable for further use
  185. who has the right of access to information held on records
  186. why it is important to acknowledge and respect an individual’s rights and dignity and ways of doing this
  187. what circumstances may indicate a need for the presence of a third party
  188. who may act as a companion for the client and how to interact with them
  189. what your legal and ethical responsibilities are in relation to the client’s health and safety
  190. how to maintain your practice in line with health and safety legislation
  191. how to be supportive to the client (and any companion(s)) whilst managing time effectively
  192. how to obtain information on commonly encountered diseases, drugs and their side effects
  193. the concept of health, effective functioning and well-being that is consistent with the practice, principles and theory underlying your discipline
  194. why it is important to recognise that the client’s previous and present care may affect their health, effective functioning and well-being
  195. how the psychological and emotional balance of the client may affect their health, effective functioning and well-being
  196. how to recognise when the body is in health balance and when it is not functioning as it should
  197. how signs and symptoms may be suppressed or altered by other factors such as medication, exercise, diet
  198. how the client’s diet, lifestyle and emotional state can affect their health, effective functioning and well-being
  199. how the physical, social, emotional and economic context in which people live affects their health, effective functioning and well-being
  200. how personal beliefs and preferences affect how clients live and the choices they make
  201. what resources are available to clients to make changes to the context in which they live and make choices about their lifestyles
  202. the nature of illness and the impact this may have on a client’s health, effective functioning and well-being
  203. why it is important to recognise conditions which may pose a serious risk to the client and when to seek immediate help or advice from other professional sources
  204. the nature of disability and your role in working with those who have disabilities
  205. how an individual’s abilities and disabilities may affect the nature and form of help and support and the manner in which you provide it

Performance Criteria

You must be able to do the following:

  1. ensure information about the client is sufficient to plan the treatment
  2. explain the outcomes of the consultation clearly and in a manner that is understandable by the client
  3. discuss your initial diagnosis and potential outcomes with the client, check their understanding and support them to make informed choices
  4. explain the available treatment options and methods which meet the client’s circumstances, identified needs and their personal beliefs and preferences
  5. obtain the consent of the client to proceed with formulating the treatment and management plan and determine any issues of confidentiality with the client and confirm their agreement
  6. balance potential outcomes with any inherent risks and the legal duty of care to the client
  7. advise the client when herbal medicine is unsuitable and enable them to seek other healthcare where appropriate
  8. devise and provide dietary and lifestyle advice in consultation with the client
  9. discuss with the client the content, level of risk, duration, frequency of visits and projected costs of the proposed action and explain how the treatment will be evaluated and reviewed
  10. finalise the treatment and management plan and explain any restrictions to the use of herbal medicines and advise on realistic expectations
  11. offer clear and accurate aftercare advice and support to the client where needed
  12. interact with any companion(s) of the client in ways that are appropriate to the needs of the client and to your needs
  13. discuss the outcomes of the overall treatment and management plan and its effectiveness in a manner, level and pace suited to the client
  14. encourage the client to evaluate their herbal medicine treatment and suggest possible modifications
  15. encourage clients to take responsibility for their own health, effective functioning and well-being
  16. advise the client where herbal medicine is unsuitable and enable them to seek other healthcare where appropriate
  17. make appropriate adjustments to the treatment to meet the client’s changing needs
  18. obtain the client’s consent to pass on confidential information where appropriate
  19. negotiate the duration and frequency of subsequent treatment sessions with the client
  20. interact with any companion(s) of the client in ways that are appropriate to the needs of the client and to your needs
  21. record the outcomes of the consultation accurately and in sufficient detail to meet professional requirements
  22. write the prescription in a form suitable for dispensing
  23. provide written advice for the client, where necessary
  24. respond to requests for aftercare advice and support from clients
  25. store the records securely
  26. evaluate the experience you have gained from treating the client to inform future practice
  27. evaluate the effectiveness of Standard Operating Procedures and legal and ethical procedures carried out by the herbal dispensary

Additional Information

This National Occupational Standard was developed by Skills for Health. This standard links with the following dimension within the NHS Knowledge and Skills Framework (October 2004): Dimension: HWB2 Assessment and care planning to meet people's health and wellbeing needs
CH HM2 Provide a treatment and management plan to meet the needs of the client
Final version approved June 2010 © copyright Skills For Health,
For competence management tools visit tools.skillsforhealth.org.uk