The benefits of HNA speak for themselves: improved profiling can lead to more accurate prev- alence statistics, which can lead to more effective targeting of resources and interventions.
Better statistics can also lead to better commissioning to underpin and support the physical health agenda. Service users may feel that their physical health is incorporated into a holistic nursing assessment. Advantages and disadvantages of HNA are outlined in Table 2.3.
Table 2.2 Example of a caseload profile
Rationale 1 Demographic
breakdown
Gender Ethnicity Age Social class Employment status
Demographic characteristics can help to identify specific at-risk groups and explore exposure to risk factors or physical conditions, e.g. smoking rates in men or diabetes risk in clients from ethnic minorities
2 Psychiatric diagnosis
Current diagnosis Some diagnoses may increase risk of physical illness, e.g. schizophrenia can increase risk of diabetes
3 Current physical illness
Current physical diagnosis – signs and symptoms (This can be integrated into each category below to reduce repetition)
To ensure effective clinical management, screen for signs and symptoms of undiagnosed physical illness, e.g. monitor blood cholesterol levels
4 Current medications
Risk of metabolic disorders, risk of cardiac disorders, risk of toxicity
Medication regimes require effective monitoring, e.g. monitor lithium levels in clients with bipolar disorder
5 Respiratory health
Number of smokers Degree of tobacco use – light, moderate, heavy Prevalence and severity of respiratory disorders – TB, asthma, chronic obstructive pulmonary disease Current treatment regimes
Smoking cessation
Health surveillance of smoking and related disorders
To determine nicotine replacement therapies for those wanting to quit
To determine the impact of respiratory conditions on activities of daily living, e.g. on levels of physical activity
Ensure appropriate treatment and monitoring of progress – assess drug interactions also. MHSU education important here also
Referral to smoking cessation services, prescription and monitoring of nicotine replacement therapy
6 Cardiovascular health
Number of people with cardiovascular problems Severity of problems Current treatment regimes
Risk factors
Health surveillance of heart health and associated risk factors
Impact of physical problem on performance of activities of daily living
Ensure appropriate treatment and monitoring of progress – assess drug interactions also. MHSU education important here also
Map CHD risk factors from other profile sections, e.g. smoking, obesity
(continued)
Rationale 7 Substance
misuse
Number of alcohol users Degree of alcohol use by policy defined units Prevalence of alcohol- related disorders Number of substance users
Degree and type of substance use Mode of substance use Prevalence of associated disorders
To identify specific problems related to this NHS (UK) recommends
Men: 3–4 units daily (21 units/week) Women: 2–3 units daily (14 units/week) Jaundice, cirrhosis, Korsakoff’s syndrome To determine other complications, e.g. abscesses with injecting drug use
Highlight infection control issues for users and also staff
Blood-borne disorders and possible complications
8 Nutritional status
Prevalence of sub- optimal weight – under/
overweight/obesity Malnutrition in groups such as eating disorders and care of older people Degree of under/
overweight/obesity as measured by body mass index, waist-to-hip ratio, waist circumference Prevalence of diabetes by type
Prevalence of metabolic syndrome
Prediabetes?
Current treatment for diabetes
Complications of diabetes
Health surveillance of lifestyle factors linked to conditions such as diabetes and CHD also helps to prioritize healthy eating/dietary advice
Will help to develop care plans by giving useful measurements for goal-setting, e.g. reduce waist size by 2 cm per month
Ensure correct treatment regime
To implement health education and promotion To initiate primary health promotion to prevent or slow development of diabetes
Ensure appropriate treatment and monitoring of progress – assess drug interactions also. MHSU education important here also
Review of psychotropic medication regimes where metabolic disorders are indicated as ADRs
9 Physical activity
Prevalence of inactivity Barriers to physical activity (This might also include frailty in older people)
To determine the need for bespoke exercise programmes to engage MHSUs in physical activity To determine if ADRs (e.g. movement disorders) prevent MHSUs from exercising
10 Social factors Benefits Social support Housing
Debt/poverty/hardship
Appropriate benefits may enable MHSUs to make positive lifestyle choices
To determine if there are peer support networks, e.g. group walks or smoking cessation support Ensure housing conditions do not compromise health, e.g. infestation
Monitor indebtedness to prevent disconnection of utilities or homelessness
Table 2.2 Example of a caseload profile (Continued)
Rationale 11 Screening/
prevention
Breast screening Cervical smear Testicular screening Immunizations/
vaccinations Sex education Family planning
Health surveillance to promote positive health and positive choices. This will empower MHSUs to engage with primary care and preventative screening services
12 Family history
Table 2.3 Possible advantages and disadvantages of HNA
Advantages Disadvantages
Accurate local health needs to inform target-setting
Services and interventions rationed to specific areas Better statistics for more appropriate
commissioning
Needs classified as ‘unmet’, as few resources for commissioning available
Improved services/access to service No extra resources means redistribution of mental health budgets that are already low
Improved physical health of MHSUs Whose responsibility is it for improving physical health – mental health services or primary care services?
Improved practitioner knowledge, skills, and practice
Practitioners may not see this as part of their role and may not be confident in extending their scope of practice