Louise Charnock, Palliative Clinical Nurse Specialist, Southport & Ormskirk NHS Hospital Trust, UK, explains the background to her longer article that is published in the March/April issue of the European Journal of Palliative Care.
Almost two years ago I set out to search for a topic on which to write my Master’s dissertation, an Advanced Practice project within my workplace. It had to demonstrate practice that was delivered currently and what intervention I would put in place to advance, or change, clinical practice. As a clinical nurse specialist in palliative care working in an integrated specialist service, I wanted to advance and promote a practice that made me feel excited and enthusiastic to share with the team. I finally chose as my topic the use of genograms (a pictorial display of a person’s family relationships and medical history) for specialist palliative care assessment.
Despite the lack of research evidence about genograms, national policy in the UK has devolved the task of specialist assessment to local areas. Locally, genograms had been set as a standard practice for all palliative patients. However, local audit showed this standard was achieved for less than 33% of the palliative patients accessing the service. It was on this premise that I undertook my project.
I was already interested in the use of genograms and their impact on patient care. Now, the more I read and better understood their use, I could see the multiple benefits of using them; such as social support mechanisms for patients whose preferred place of care was home, bereavement risk factors, appropriate and timely psychological interventions. Most significant to me, as a health professional, was the patient’s increased engagement and change in body language when the assessment moved away from the medical model, and symptom control to discuss what was important to them – their family.
The project included an audit of existing standards, development of a teaching pack and an aide-mémoire to support a genogram implementation, with a re-audit at three, six and 12 months post-implementation programme. Current implementation rates are over 76%. It has been identified that the literature around genograms, particularly in the UK, is at best limited. There has been no decisive conclusion in the literature regarding the use of genograms in palliative care. Overall, some literature supports genogram use, whilst other literature does not find it has proven benefits to patient care.
Despite the project being small-scale to support advancing clinical practice within specialist palliative care services, it has had much wider implications than anticipated. A genogram assessment has been included in the new individualised care plan for those thought likely to be dying and on the coordination care plan. The project and its findings have been rolled out across all the local area hospitals, community services, hospice and care homes to support the implementation of genograms in end of life care. The value of genograms was recognised by the local National Health Service Trust in Southport and Ormskirk, in the north-west of England, as a tool for improving patient care.
The full benefit of a genogram still requires further research to completely endorse its use in improving patient outcomes. But meanwhile, I am delighted to have my literature search and review from this project published as it gives an opportunity to share this practice. I hope it will give readers the passion and impetus to drive this project forward. It was anticipated that the project would also contribute to, and strengthen, the minimal literature around the benefit of genogram assessment and its role in improving the quality of care.
Read the full article in the European Journal of Palliative Care
This post relates to a longer article, ‘Are genograms a fundamental aspect of specialist palliative care assessment? A review of the literature’ by Louise Charnock published in the March/April 2016 issue of the European Journal of Palliative Care (vol. 23.2).
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