Transcript Slide 1

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
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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.
My appearance / Body image
Social Concerns
 Skin Dry / Itchy / wound healing
 Coping with dependents
 Swollen (limbs/abdomen)
 Work/School
 Weight Changes – loss or gain
 Hobbies/Leisure activities
 Sexual Problems
 Housing
 Hair Loss
 Finances
 Other
 Travel
 Carer
Reduced Independence
 Relationships
 Bathing / Dressing
 Getting Around
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
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: __________________
Rest / Activity
 Sleep
 Fatigue
 Tiredness
 Alteration in sleep pattern
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
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
Social Concerns
 Skin Dry / Itchy / wound healing
 Coping with dependents
 Swollen (limbs/abdomen)
 Work/School
 Weight Changes – loss or gain
 Hobbies/Leisure activities
 Sexual Problems
 Housing
 Hair Loss
 Finances
 Other
 Travel
 Carer
Reduced Independence
 Relationships
 Bathing / Dressing
 Getting Around
Emotional Wellbeing
Sadness
Toileting Difficulties
 Fears
 Constipation
 Worries / Anxieties
 Diarrhoea
 Anger
 Stoma
 Alcohol/smoking/other drugs
 Changes in passing urine
 Unable to express feelings
 Feeling isolated
Physical Symptoms
 Loss of dignity
 Difficulties in Communicating
 Forgetful/confused
 Breathing
 Stress
 Pain
 Loss of control
 Temperature
 Change in sensation: hands/feet
 Seizures
Spiritual / Religious Concerns
 Other
 Questioning values and beliefs
 Sense of meaning
Eating Difficulties
 Issues relating to dying and death
 Indigestion
 Sores /painful mouth
Rest / Activity
 Nausea/vomiting
Identify the number (1-10) that best

Sleep
 Taste changes
describes how much distress has

Fatigue
 Swallowing difficulties
been experienced over recent weeks,

Tiredness
 Change in appetite
if ‘0’ is no distress and ‘10’ is high
 Alteration in sleep pattern
 Food preparation
levels of distress or anxiety.
 Other
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3
1
4
Score: ______7___________
Any other factors
NECN HOLISTIC ASSESSMENT OF CONCERNS
Developed with kind permission of the Northern Comprehensive Cancer Network (2005) from the Distress Thermometer Group
Patient Details
Today’s date:
Previous assessment date:
Staff member to print and sign name:
Assessment number:
1 2 3 4 5
Comment
Highest Ranked
Concerns
1
2
3
4
Rating
0-10
Diagnosis
Location
Duration of interview (in minutes):
Copy given to patient
Description and history of concern
Yes 
Plan of action
No 
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,
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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
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(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
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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
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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
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Engagement of staff
Developing the therapeutic conversation
Ensuring transfer of information to others
Recording the use of HNA
Positive experiences
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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?
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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.
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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