holistic needs assessment: an acute hospital’s story…. – nicky laking, nurse consultant &...
TRANSCRIPT
Holistic Needs Assessment: an acute hospital’s story….
– Nicky Laking, Nurse Consultant & Lead Cancer Nurse
– Dr Clare Davies, Consultant Clinical Psychologist
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.
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
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.
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 Forgetful/confused Stress Loss of control
Spiritual / Religious Concerns Questioning values and beliefs Sense of meaning Issues relating to dying and death
Rest / Activity Sleep Fatigue Tiredness Alteration in sleep pattern
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
Physical Symptoms Difficulties in Communicating Breathing Pain Temperature Change in sensation: hands/feet Seizures Other
Eating Difficulties Indigestion Sores /painful mouth Nausea/vomiting Taste changes Swallowing difficulties Change in appetite Food preparation Other
Any other factors
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: __________________
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.
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 Forgetful/confused Stress Loss of control
Spiritual / Religious Concerns Questioning values and beliefs Sense of meaning Issues relating to dying and death
Rest / Activity
Sleep Fatigue Tiredness Alteration in sleep pattern
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
Physical Symptoms Difficulties in Communicating Breathing Pain Temperature Change in sensation: hands/feet Seizures Other
Eating Difficulties Indigestion Sores /painful mouth Nausea/vomiting Taste changes Swallowing difficulties
Change in appetite Food preparation Other
Any other factors
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___________
1
2
3
4
Patient Details Today’s 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
Highest Ranked Concerns
Rating
0-10
Description and history of concern Plan of action
1
2
3
4
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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.
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.
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.
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).
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
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 hadn’t really”
• “I found it helpful to talk about when I could resume a sex life”
• “I didn’t 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”
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
Challenges
• Engagement of staff
• Developing the therapeutic conversation
• Ensuring transfer of information to others
• Recording the use of HNA
Positive experiences
• Engagement of staff
• Involvement of Macmillan Information Centre
• Development of the information folder
• HNA training sessions
• Feedback from patients
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
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
Raising Awareness
• Clinicians – oncology/ haematology meetings
• MDT meetings
• Ultimately benefit patient care
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