Mental Health Nursing

Measuring health and social functioning using HoNoS 39
during their stay. Charlwood et al. (1999) recommend that ratings be
undertaken at or around the 90-day point (± 30 days) of an extensive stay,
but many staff working on in-patient units have found it useful to make
a more frequent review of progress, usually monthly. It is important to
remember that carrying out a HoNOS rating in itself does not take long.
Individuals who are familiar with the tool usually report that it takes about
five minutes to complete (Orrell et al., 1999). What is required is a full
holistic assessment of the individual, but these should be conducted as
part of regular reviews of an individual’s progress.
One of the aspects of using HoNOS which in-patient staff sometimes
report to be difficult, is gathering sufficient information about an individual’s
social circumstances to be able to rate the social items of the scale,
particularly items 11 and 12, soon after admission (McClelland et al.,
2000). In using HoNOS as a measure of outcome, it is certainly useful if
the period rated at admission reflects the period of time in the community
which led up to the admission becoming a necessity, since this is presumably
the period of time during which the health and/or social functioning
of the individual failed to such a degree that an in-patient stay was unavoidable.
Practical ways of trying to overcome this are discussed later. However,
it should be remembered that undertaking and recording a multidisciplinary
assessment of an individual’s health and social functioning is an
essential part of the admission process which enables the planning of care
and maps the pathway to discharge.
HoNOS provides a useful tool for working directly with clients on the
ward. Indeed, its principal use should be regarded as a measure of outcome
for individual patients during their stay on the ward.
The principal rationale for any assessment of an individual’s clinical
problems, is to try and find ways of improving the situation for that individual.
By repeating HoNOS ratings, we are providing routine measures
of outcome based on the client’s current clinical and social presentation.
This provides the opportunity to assess whether the health and social functioning
of the individual has improved. When considering this issue, it is
perhaps worth remembering that two caveats were used to describe the
health and social gain against which to measure outcome.
1. Improvement in mental and physical health and social functioning,
over and above what could be expected without intervention.
2. Maintenance of an optimal state of health and social functioning by preventing,
slowing and/or mitigating deterioration. (Wing et al., 1996: 10).
Thus, its use provides a standardised measure of progress for each client
on the ward, for each of the 12 individual items as well as the four subscale
scores and the total score.