Holistic Needs Assessment: an acute hospital

1

• Holistic Needs Assessment an acute hospitals
  story.

• Nicky Laking, Nurse Consultant Lead Cancer
  Nurse
• Dr Clare Davies, Consultant Clinical Psychologist
  

2

• Background

• Cancer Action Team 2007
• All NHS patients with a diagnosis of cancer
  and/or receiving care in any setting should be
  offered this assessment.
• North East Cancer Network Holistic Assessment
• Developed with permission from Northern
  Comprehensive Cancer Network, USA.

3

• Methodology

• Working group to explore delivery and
  effectiveness of the Holistic Needs Assessment
  (HNA).
• Minimal modification to HNA.
• Identification of training needs.
• Establishment of the ability to audit
• Formation of a pilot group

4
This screening tool is aimed to encourage
professionals and patients to explore current
problems and issues that may be affecting
patients physical, psychological, social and
spiritual well-being. The outcome (including
patient score) of this assessment is to be
documented in the patients ongoing record with an
agreed plan of care and referral on for symptom
control, rehabilitation, social, spiritual or
psychological care where necessary.

• My appearance / Body image
• Skin Dry / Itchy / wound healing
• Swollen (limbs/abdomen)
• Weight Changes loss or gain
• Sexual Problems
• Hair Loss
• Other
• Reduced Independence
• Bathing / Dressing
• Getting Around
• Toileting Difficulties
• Constipation
• Diarrhoea
• Stoma
• Changes in passing urine

• Social Concerns
• Coping with dependents
• Work/School
• Hobbies/Leisure activities
• Housing
• Finances
• Travel
• Carer
• Relationships
• Emotional Wellbeing
• ? Sadness
• Fears
• Worries / Anxieties
• Anger
• Alcohol/smoking/other drugs
• Unable to express feelings
• Feeling isolated
• Loss of dignity

Identify the number (1-10) that best describes
how much distress has been experienced over
recent weeks, if 0 is no distress and 10 is
high levels of distress or anxiety. Score
__________________
5
This screening tool is aimed to encourage
professionals and patients to explore current
problems and issues that may be affecting
patients physical, psychological, social and
spiritual well-being. The outcome (including
patient score) of this assessment is to be
documented in the patients ongoing record with an
agreed plan of care and referral on for symptom
control, rehabilitation, social, spiritual or
psychological care where necessary.

• My appearance / Body image
• Skin Dry / Itchy / wound healing
• Swollen (limbs/abdomen)
• Weight Changes loss or gain
• Sexual Problems
• Hair Loss
• Other
• Reduced Independence
• Bathing / Dressing
• Getting Around
• Toileting Difficulties
• Constipation
• Diarrhoea
• ? Stoma
• Changes in passing urine

• Social Concerns
• Coping with dependents
• Work/School
• Hobbies/Leisure activities
• Housing
• ? Finances
• Travel
• Carer
• Relationships
• Emotional Wellbeing
• ?Sadness
• Fears
• Worries / Anxieties
• Anger
• Alcohol/smoking/other drugs
• Unable to express feelings
• Feeling isolated
• Loss of dignity

2
3
1
4
Identify the number (1-10) that best describes
how much distress has been experienced over
recent weeks, if 0 is no distress and 10 is
high levels of distress or anxiety. Score
______7___________
6
Patient Details Todays date Previous assessment date
Staff member to print and sign name Assessment number 1 2 3 4 5
Comment
Diagnosis Location
Duration of interview (in minutes) Copy given to patient Yes ? No ?
NECN HOLISTIC ASSESSMENT OF CONCERNS Developed
with kind permission of the Northern
Comprehensive Cancer Network (2005) from the
Distress Thermometer Group

Highest Ranked Concerns Rating 0-10 Description and history of concern Plan of action
1
2
3
4
7

• Pilot Group

• 5 site cancer specialist teams (11 specialist
  nurses)
• 10 assessments per tumour group
• SPCT, Urology, UGI, Breast, Haematology (All on
  JCUH site)
• 3 month pilot, or 10 assessments completed
• Training session.

8

• Training

• 3 hour session Nicky and Clare
• Presentation Background to Holistic Assessment,
  What do we mean by distress?, What deters
  patients from expressing concern, exploratory /
  open-ended questions , Therapeutic Conversation.
• Role-play modelling use of administering HNA.
• Introduction, Eliciting information, action
  points.
• Group practice scenarios, specific cases.
• Documentation and Quick Guide.

9

• Training

• Information Folder The assessor should have
  access to up to date information about local
  service providers, referral criteria and support
  services. (Cancer Action Team)
• Macmillan Information Centre updating
  information.

10

• Pilot Group Results

• 9 out of 11 individual questionnaires were
  returned (89)
• 4 of the 5 specialist services (80)
• Years spent as a specialist nurse ranged from 1
  to 15 years ( mean average 7 years).

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• Patient feedback
•  
• Improved Communication / focused time

• Having someone to talk too
• I felt someone cared
• Spending time with clinical nurse specialist
  herself was really beneficial for me
• The time felt focused on me
• The opportunity was never there before to
  actually ask questions without a rush

15

• Chance to discuss issues that would not normally
  come up in conversation

• To be asked about sexual and financial problems
  was a chance for me to think about these things
  I hadnt really
• I found it helpful to talk about when I could
  resume a sex life
• I didnt think I could offload about all my
  problems in clinic I was asked bout things I
  was worrying about but usually I am just in and
  out of clinic

16

• Conclusion

• Time
• Not all patients appropriate
• Environment
• Patients verbalised a positive process
• Peer review measure
• Community environment a positive experience for
  both patient and staff

17

• Challenges

• Engagement of staff
• Developing the therapeutic conversation
• Ensuring transfer of information to others
• Recording the use of HNA

18

• Positive experiences

• Engagement of staff
• Involvement of Macmillan Information Centre
• Development of the information folder
• HNA training sessions
• Feedback from patients

19

• Recommendations and Outcomes

• Full role out of HNA across all tumour sites
• March 2012
• 6 month evaluation of the tool
• June 2012
• 3 month audit of its use
• July 2012
• Full compliance with the peer review measure
• May 2012

20

• Who did we train?

• Nurse Consultants
• Clinical Sisters
• Specialist Nurses
• Therapy Radiographers
• Ward Clinic Staff
• 90 staff undertaken Advanced Comms, Some Level 2
  Psychology trained, All band 6 or above

21

• Raising Awareness

• Clinicians oncology/ haematology meetings
• MDT meetings
• Ultimately benefit patient care

22

• Acknowledgments

• Dr James Brennan, Consultant Clinical
  Psychologist. Bristol Haematology Oncology
  Centre. University Hospitals Bristol NHS
  Foundation Trust.
• Specialist Nurses for embracing the tool
• Macmillan Information Centre
• Andrea Harris Macmillan Specialist Nurse SPCT