Mental Health Nursing
Mental Health Nursing
Mental Health Nursing
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easy to see why many staff have become disillusioned with HoNOS; this<br />
is unfortunate since the implementation of HoNOS is clearly a useful first<br />
step in moving towards a shift in service culture towards one which is<br />
orientated around outcome measurement. Outcome measurement will not<br />
become a day-to-day reality until clinicians view it as an essential part of<br />
good practice and it is supported with adequate IT systems (Gallagher and<br />
Teesson, 2000).<br />
It would be optimistic to believe that every Trust or Social Services<br />
Department will acquire state-of-the-art IT equipment in the short or medium<br />
term but this should not prove to be an insurmountable hurdle in implementing<br />
a data management strategy. One administrative assistant with a<br />
personal computer would be all that is needed for an organisation to store<br />
data electronically and allow staff to question the database. Obviously,<br />
giving staff direct access is preferable and this is already happening in some<br />
instances but the majority of organisations may have to work towards this<br />
ideal. Whatever the mechanism used locally, care should be taken to<br />
ensure that there are controls in place to ensure the quality and reliability<br />
of the data entered onto the system.<br />
Training of raters and their ongoing supervision is also a major issue<br />
for organisations planning to introduce HoNOS. There are known links<br />
between the quality of training and the quality of data from the wider<br />
literature on rating scales (Ventura et al., 1993) and although HoNOS is<br />
much simpler to use than many tools, the same principles apply (Amin<br />
et al., 1999; Bebbington et al., 1999; Trauer et al., 1999). It is suggested<br />
that all potential raters undergo a structured training programme before<br />
being expected to use HoNOS routinely in clinical practice. HoNOS is<br />
undoubtedly a straightforward tool to use but there are guidelines for its<br />
use which raters have to understand and follow if HoNOS ratings are to<br />
be valid and reliable. Experience has shown that despite its simplicity<br />
misunderstandings do frequently occur when raters do not have a sufficient<br />
grasp of the basic principles of rating. In addition, it is thought<br />
that a brief one-off training course is not sufficient to guarantee comparability<br />
between individual raters or between groups of raters and that<br />
practice and ongoing supervision are required to maintain reliability and<br />
data quality.<br />
Conclusion<br />
Measuring health and social functioning using HoNoS 45<br />
As stated at the beginning of the chapter, there are numerous measures of<br />
outcome in mental health care; the debate surrounding the effective use of<br />
outcome data to inform clinical practice and service evaluation obviously