Mental Health Nursing

40 Acute Mental Health Nursing
HoNOS score
4
3
2
1
0
1 2 3 4 5 6 7 8 9 10 11 12
HoNOS item
Figure 2.2 Graphical representation of HoNOS scores
Admission
Discharge
It can of course be recorded as a quick checklist in an individual’s clinical
records, but the use of an IT system which allows the presentation of
scores as a graphical output does improve the ease with which outcome
for an individual can be assessed, as Figure 2.2 illustrates.
Many nurses who are routinely collecting HoNOS data report that not
only is it useful in informing their own clinical work and care planning,
but also that it provides a useful means of sharing information with their
patients (as well as their carers) when reviewing their progress since it
provides a clear focus for discussion across the 12 clinical and social
items. This is of even greater value when this can be produced in a graphical
format as a result of using an IT system.
Another way in which HoNOS scores can be used in routine clinical
practice is to use each score as a measure of the severity of an individual’s
problems at that moment in time and use this as a benchmark to assess the
adequacy of the current plan of care which has been devised for that individual.
Each of the 12 items represents an aspect of that individual’s health
and social functioning, and they are all rated on the same 0 to 4 scale. Any
aspect of functioning scoring a ‘2’ or above is of clinical significance and
thus should be reflected in the current plan of care. Indeed, if the planning
of care for discharge from the point of admission is to be more than
rhetoric, it is of particular importance that the item scores relating to the
individual’s social functioning are rated, since the resolution of social
problems (where these exist) is often the key element in reducing the
length of stay. This can prove to be a useful tool in the assessment of the
quality of planned care for an in-patient population, both at an individual
level and in examining a wider in-patient population. It also stresses the
importance of gathering sufficient information about a client as quickly as
possible after admission from as many sources as possible, particularly
those in the community. It should be remembered that ratings that include
‘9’ (no rating) cannot be used to measure outcomes either for individual
items or overall scores or indeed for any of the sub-scales for which there