Holistic Needs Assessment (HNA) - an update with Patient Perspective Clare Byrne and Barry Jones
Personalised care begins with an HNA Where does your cancer sit with you as a person? A HNA gives you a chance to think and talk about any concerns you may have in relation to you and your cancer. A HNA will be offered around the time of diagnosis and at other times during your care. Many patients find having an HNA useful as it can help you focus on what is important to you and identify what help is available.
HNA normally in 3 parts Firstly a simple set of questions or check list to identify any concerns you may have, the questions may be answered on paper or electronically and will take around ten minutes to complete
Secondly, the important discussion This is an opportunity to explore more widely the potential consequences of your concerns, any that are a priority, those that you feel are more easily resolved than others and how signposting to other services might help address them e.g benefits advice, involvement and referral to a social worker if you have young children or dependant elderly relatives. For more complex concerns, this is an opportunity discuss fears and worries, personal resources such as previous ways you have managed anxiety, how you have coped in the past with challenging episodes in your life, reflecting on your skills to self-manage in the current situation.
Thirdly, the care plan collaboratively identify a personalised written care plan to take away and identify when this will be reviewed. You will be encouraged you to share this with your GP/community team.
Nothing new about HNA. Concerns Checklist Devlen 1984 Concerns Checklist with patients with Lymphoma Cathy Heaven 1997 Quality of patient interviews in research studies Basis of Network HNA training and Clinical Supervision
an element of burnout 1.Mulley et al. (2012) Patients Preferences Matter King s Fund: London eg Youngson, R. (2012) Time to Care. Rebelheart: New Zealand..
We really need to start working across boundaries more including HNA Improving skill mix and introducing new types of cost efficient roles Enhancing the skills and confidence of existing staff and the communication between them Improving ways of working Macmillan 2017
Who offers psychological support? Doctors, nurses, HCA s, housekeepers etc Specialist nurses, AHP s etc Counsellors etc Psychologists, psychiatrists, psychotherapists etc
Two day HNA training Outcomes what good listening looks like (listening for distress, identifying expertise, being actively inquisitive, finding out what matters to the patient) sensitive, whole-person handover (as if it was you) implementation (excellence as standard) use of supervision quality control
Solution-focused stepping stones D. Bray / T. Kay April 2017
What next? CNS two day Refresher - Recovery Package including new approaches to supported self management and physical activity CNS collaborating with community navigators, closer working with primary care/community teams. Remove the silo of cancer, widen the culture to long term conditions Should CNS competencies and job planning form the basis for Clinical Supervision
patients own goals renewable energy reflection, shared decision making, Negotiation, Solution-focused