FOIA APNs can usually coach patients independent of setting, cognitive capacity, and stage of illness; it can be done at a distance or face to face. The https:// ensures that you are connecting to the Referred to as the GRACE model (Counsell etal., 2006). Judith A. Spross and Rhonda L. Babine APNs also attend to patterns, consciously and subconsciously, that develop intuition and contribute to their clinical acumen. Professional Coaching and Health Care The deliberate use of guidance in situations that are acute, uncertain, or time-constrained, offers patients and families ideas for examining alternatives or identifying likely responses. The preceptors and sites must meet standards established by the academic institution, advanced practice nurse certification organizations, and state legislatures. The purposes of this chapter are to do the following: offer a conceptualization of APN guidance and coaching that can be applied across settings and patients health states and transitions; integrate findings from the nursing literature and the field of professional coaching into this conceptualization; offer strategies for developing this competency; and differentiate professional coaching from APN guidance and coaching. Nurse health coaches focus on chronic disease prevention through lifestyle and integrative healthcare techniques. APNs integrate self-reflection and the competencies they have acquired through experience and graduate education with their assessment of the patients situationthat is, patients understandings, vulnerabilities, motivations, goals, and experiences. 2015 Jun;24(11-12):1576-84. doi: 10.1111/jocn.12757. Actions may be small (e.g., walking 15 minutes/day) but are clearly stated and oriented toward change; individuals are more open to the APNs advice. To be categorized as being in the action stage, a measurable marker must be met as a result of an action the patient took that reduced the risk for disease or complications. The three components share similarities but increase gradually in terms of involvement and participation for further management of the patient's condition. 5. APNs interpret these multiple sources of information to arrive at possible explanations and interventions. Currently, the TCM is a set of activities aimed at providing comprehensive in-hospital planning and home follow-up for chronically ill high risk older adults hospitalized for common medical and surgical conditions (Transitional Care Model, 2008-2009; www.transitionalcare.info/). Early studies of the model from which TCM evolved have provided substantive evidence of the range and focus of teaching and counseling activities undertaken initially by CNSs, and later NPs, who provided care to varied patient populations. These can also result from changes in intangible or tangible structures or resources (e.g., loss of a relationship or financial reversals; Schumacher & Meleis, 1994). TTM has been used successfully to increase medication adherence and to modify high-risk lifestyle behaviors, such as substance abuse, eating disorders, sedentary lifestyles, and unsafe sexual practices. Leadership For a schematic illustration of the model, see Fig. Guidance and coaching are essential components of work for an advanced practice nurse (APN). Med Klin Intensivmed Notfmed. Parry and Coleman (2010) have offered useful distinctions among different strategies for helping patients: coaching, doing for patients, educating, and guiding along five dimensions (Table 8-1). You may also needDirect Clinical PracticeThe Certified Nurse-MidwifeHealth Policy Issues in Changing EnvironmentsLeadershipIntegrative Review of Outcomes and Performance Improvement Research on Advanced Practice NursingConceptualizations of Advanced Practice NursingUnderstanding Regulatory, Legal, and Credentialing RequirementsRole Development of the Advanced Practice Nurse Transitions can also be characterized according to type, conditions, and universal properties. Teaching and counseling are significant clinical activities in nurse-midwifery (Holland & Holland, 2007) and CNS practice (Lewandoski & Adamle, 2009). Hamric & Hanson's Advanced Practice Nursing: An Integrative Approach: 9780323777117: Medicine & Health Science Books @ Amazon.com . APNs have the knowledge and skills to help institutions and practices meet the standards for meaningful provider-patient communication and team-based, patient-centered care. Although guidance and coaching skills are an integral part of professional nursing practice, the clinical and didactic content of graduate education extends the APNs repertoire of skills and abilities, enabling the APN to coach in situations that are broader in scope or more complex in nature. All nurses and APNs should be familiar with the patient education resources in their specialty because these resources can facilitate guidance and coaching. Participants evaluated the structure and function, as well as the value, of the coaching circle. Furthermore, Hayes and colleagues (2008) have affirmed the importance of the therapeutic APN-patient alliance and have proposed that NPs who manage patients with chronic illness apply TTM in their practice, including the use of coaching strategies. Only gold members can continue reading. Guidance and coaching require that APNs be self-aware and self-reflective as an interpersonal transaction is unfolding so that they can shape communications and behaviors to maximize the therapeutic goals of the clinical encounter. Transitional care has been defined as a set of actions designed to ensure the coordination and continuity of health care as patients transfer between different locations or different levels of care within the same location (Coleman & Boult, 2003, p. 556). Clinical coaching is a relationship for the purpose of building skills. With experience, APNs develop their own strategies for integrating specialty-related anticipatory guidance into their coaching activities. Making lifestyle or behavior changes are transitions; the stages of change are consistent with the characteristics of transition phases (Chick and Meleis, 1986). These goals may include higher levels of wellness, risk reduction, reduced morbidity and suffering from chronic illness, and improved quality of life, including palliative care. This report offers insight into strategies of coaching that would be useful in a variety of health care settings to promote the advancement of nurse leaders. For example, Chick and Meleis (1986) have characterized the process of transition as having phases during which individuals go through five phases (see earlier). I provide guidance and best practices from my 20+ years of acute hospital experience to help create the best nursing experience possible for our nurses and their patients. Earlier work on transitions by Meleis and others is consistent with and affirms the concepts of the TTM. In practice, APNs remain aware of the possibility of multiple transitions occurring as a result of one salient transition. Eight core competency domains are delineated in the Caring advanced practice nursing model: 1. Advanced Practice Nurse Guidance and Coaching Competency: Theoretical and Empirical Perspectives Clinical leadership in nursing practice is recognized when APNs independently control treatment processes in complex nursing situations, exert influence, develop and implement change strategies, consult, coach, train, collaborate, and establish a connection to other health professionals and management. Early work by Schumacher and Meleis (1994) remains relevant to the APN coaching competency and contemporary interventions, often delivered by APNs, designed to ensure smooth transitions for patients as they move across settings (e.g., Coleman & Boult, 2003; Coleman & Berenson, 2004; U.S. APN-led patient education and monitoring programs for specific clinical populations have demonstrated that coaching is central to their effectiveness (Crowther, 2003; Brooten, Naylor, York, etal., 2002; Marineau, 2007). Interprofessional Teams APNs can usually coach patients independent of setting, cognitive capacity, and stage of illness; it can be done at a distance or face to face. In this stage, the focus of APN coaching is to support and strengthen the persons commitment to the changes that he or she has made. 3. Because motivational interviewing (MI) has been part of CTI training, these findings suggest that integration of TTM key principles into APN practice, such as helping patients identify their own goals and having support (coaching) in achieving them, contributes to successful coaching outcomes. While eliciting information on the primary transition that led the patient to seek care, the APN attends to verbal, nonverbal, and intuitive cues to identify other transitions and meanings associated with the primary transition. Referred to as the Naylor model (Naylor etal., 2004). The aim in offering this model is not only to help APNs understand what coaching is but to give them language by which to explain their interpersonal effectiveness. As interprofessional teamwork becomes more integrated into health care, guidance and coaching will likely be seen as a transdisciplinary, patient-centered approach to helping patients but will be expressed differently, based on the discipline and experience of the provider. Accountable Care Organizations and Patient-Centered Medical Homes This chapter considers the core competency of APN guidance and coaching within the context of the nursing professions efforts to extend and advance the coaching functions of nurses. The deliberate use of guidance in situations that are acute, uncertain, or time-constrained, offers patients and families ideas for examining alternatives or identifying likely responses. Regular self-reflection helps APNs develop skills to describe clinical phenomena and express that which is hard to name. Interpersonal Competence JS pointed out that the first treatment was the hardest because of unknown factors and that if the patient paid attention to his or her own experienceif and when side effects occurredthey would be in a position to work together to make subsequent treatments more tolerable. The Patient Protection and Affordable Care Act (PPACA; HHS, 2011) in the United States and other policy initiatives nationally and internationally are aimed at lowering health costs and making health care more effective. The foundational importance of the therapeutic APN-patient (client) relationship is not consistent with professional coaching principles. Regardless of how difficult life becomes, patients are confident that they can sustain the changes they have achieved and will not return to unhealthy coping mechanisms. The growth in programs has led to a corresponding increased demand for clinical Addressing all major advanced practice nursing competencies, roles, and issues, Advanced Practice Nursing: An Integrative Approach, 5th Edition provides a clear, comprehensive, and . Graduate Nursing Education: Influence of Faculty and Preceptors 239-240). Health Care Policy Initiatives 2020 Sep;115(6):466-476. doi: 10.1007/s00063-020-00716-w. Epub 2020 Sep 1. Using coaching as a leadership skill assists the APN in making a significant contribution to the health care field and to employee growth and . Hill LA, Sawatzky JA. APNs have the knowledge and skills to help institutions and practices meet the standards for meaningful provider-patient communication and team-based, patient-centered care. In search of how people change. APNs also attend to patterns, consciously and subconsciously, that develop intuition and contribute to their clinical acumen. Change is conceptualized as a five-stage process (Fig. 5. Share this:Click to share on Twitter (Opens in new window)Click to share on Facebook (Opens in new window)Click to share on Google+ (Opens in new window) official website and that any information you provide is encrypted To qualify as a medical or health care home or ACO, practices must engage patients and develop communication strategies. After multiple experiences with cancer patients, one of the authors (JS) incorporated anticipatory guidance at the start of cancer chemotherapy, using the following approach. Relapse can occur over time (e.g., several just this once, I can occasions), but even one slip can initiate a return to the old behavior. Organizational transitions are those that occur in the environment; within agencies, between agencies, or in society. APNs are likely to move between guidance and coaching in response to their assessments of patients. For example, the ability to establish therapeutic relationships and guide patients through transitions is incorporated into the. Advanced practitioners are educated at masters level in advanced practice and are assessed as competent in practice, using expert knowledge and skills. More often, one is likely to ruminate on negative experiences because the feeling of failure is more uncomfortable than the feeling of satisfaction or success. When patient-centered approaches are integrated into the mission, values, and activities of organizations, better outcomes for patients and institutions, including safer care, fewer errors, improved patient satisfaction, and reduced costs, should ensue. In doing so, it sets out what coaching is and highlights its benefits . In identifying these elements, the model of APN guidance and coaching breaks down what is really a holistic, flexible, and often indescribable process. The provision of patient-centered care and meaningful patient-provider communication activates and empowers patients and their families to assume responsibility for initiating and maintaining healthy lifestyles and/or adopting effective chronic illness management skills. Coaching circles are a technique used in the Duke-Johnson & Johnson Nurse Leadership Program to provide guidance and expertise to small groups of advanced practice nurse (APN) Fellows to facilitate completion of a transformational project. The term is also used to refer to advising others, especially in matters of behavior or belief. APNs involve the patients significant other or patients proxy, as appropriate. This chapter explores the complex processes of APN role development, with the objectives of providing the following: (1) an understanding of related concepts and research; (2) anticipatory guidance for APN students; (3) role facilitation strategies for new APNs, APN preceptors, faculty, administrators, and interested colleagues; and (4) Log In or, Click to share on Twitter (Opens in new window), Click to share on Facebook (Opens in new window), Click to share on Google+ (Opens in new window), The competency of guidance and coaching is a well-established expectation of the advanced practice nurse (APN). In addition, patient-centered communication and interprofessional team communication are important quality and safety education for nurses (QSEN) competencies for APNs (Cronenwett, Sherwood, Pohl, etal., 2009; qsen.org/competencies/graduate-ksas/). In addition, each of the 6 core competencies of the APN role identified by Murray LA, Buckley K. Using simulation to improve communication skills in nurse practitioner preceptors. Similarly, in the United States, chronic diseases caused by heart disease result in 7 out of 10 deaths/year; cancer and stroke account for more than 50% of all deaths (Heron, Hoyert, Murphy, etal., 2009). Strategies for Developing and Applying the Coaching Competency This is the stage in which people have already made lifestyle changes within the last 6 months that are leading to a measurable outcome (e.g., number of pounds lost, lower hemoglobin A1c [HbA1C ] level). The competency of guidance and coaching is a well-established expectation of the advanced practice nurse (APN). Accountable care initiatives are an opportunity to implement these findings and evaluate and strengthen the guidance and coaching competency of APNs. Results: Are there certain elements of this competency that are more important than others? Accountable care initiatives are an opportunity to implement these findings and evaluate and strengthen the guidance and coaching competency of APNs. The Interprofessional Collaborative Expert Panel (ICEP) has proposed four core competency domains that health professionals need to demonstrate if interprofessional collaborative practice is to be realized (ICEP, 2011; www.aacn.nche.edu/education-resources/ipecreport.pdf. According to Hamric, guidance is typically done by a nurse while coaching is something done by an advanced practice nurse (APN) because it is resolute, multipart, and collective process in which the APN works with the patient and their families to achieve attainable goals which are thought of together (2014). The Joint Commission (TJC) published the Roadmap for Hospitals in 2010. Method: 2. Do you agree that guidance and coaching is a core competency of advanced practice registered nursing? They include adapting to the physiologic and psychological demands of pregnancy, reducing risk factors to prevent illness, changing unhealthy lifestyle behaviors, and numerous other clinical phenomena. When the risks of not changing the behavior are approximately equivalent to the advantages of changing, people can become stuck in ambivalence. Table 8-2 lists some transitions, based on this typology, that might require APN coaching. The Institute for Healthcare Improvement [IHI] has asserted that patient-centered care is central to driving improvement in health care Johnson, Abraham, Conway, etal., 2008). They reflect changes in structures and resources at a system level. However, all APNs must be skilled in dealing with organizational transitions, because they tend to affect structural and contextual aspects of providing care. J Nurses Prof Dev. Understanding patients perceptions of transition experiences is essential to effective coaching. Data sources Articles were identified through a search of CINAHL, Medline, Scopus, and PsychINFO databases. Thorne (2005) has analyzed findings from a decade of qualitative research on nurse-patient relationships and communication in chronic illness care in the context of the health policy emphasis on accountable care; many findings were associated with better outcomes. American Psychologist, 47, 1102.). Patient Education Rollnick and colleagues (2008) have described guiding as one of three styles of doing MI. Over the last decade, the importance of interprofessional teamwork to achieve high-quality, patient-centered care has been increasingly recognized. Guidance and coaching in the nursing practice are part of the work of nursing midwives, clinical specialist nurses, and nurse practitioners. Coaching and guidance 4. Primary Care Instead of providing the patient with the answers, the coach supports the patient and provides the tools needed to manage the illness and navigate the health care system. National Library of Medicine Aging and Disability Resource Center, 2011, Schumacher and Meleis (1994) have defined the term. Patient education is important to enable individuals to better care for themselves and make informed decisions regarding medical care (, www.enotes.com/patient-education-reference/patient-education, The notion of transitions and the concept of transitional care have become central to policies aimed at reducing health care costs and increasing quality of care (Naylor, Aiken, Kurtzman, etal., 2011). The purposes of this chapter are to do the following: offer a conceptualization of APN guidance and coaching that can be applied across settings and patients health states and transitions; integrate findings from the nursing literature and the field of professional coaching into this conceptualization; offer strategies for developing this competency; and differentiate professional coaching from APN guidance and coaching. The most frequent intervention was surveillance; health teaching was the second or third most frequent intervention, depending on the patient population. Table 8-3 compares the three models of care transitions that used APNs. The definition speaks to the fact that others are affected by, or can influence, transitions. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Silver Spring, MD: Nursebooks.org Beginnings, December 2019. Patient-Centered Care, Culturally Competent and Safe Health Care, and Meaningful Provider-Patient Communication Stages of Change Transtheoretical Model of Behavior Change 3. Experienced APNs are more likely than inexperienced APNs to pay attention to feelings and intuitions. All nurses and APNs should be familiar with the patient education resources in their specialty because these resources can facilitate guidance and coaching. Epub 2015 Feb 9. Patients know that, if and when they are ready to change, the APN will collaborate with them. In this chapter, health and illness transitions are defined as transitions driven by an individuals experience of the body in a holistic sense. Guidance and coaching by APNs have been conceptualized as a complex, dynamic, collaborative, and holistic interpersonal process mediated by the APN-patient relationship and the APNs self-reflective skills (Clarke & Spross, 1996; Parry and Coleman (2010) have offered useful distinctions among different strategies for helping patients: coaching, doing for patients, educating, and guiding along five dimensions (, Patient teaching and education (see Chapter 7) directly relates to APN coaching. Aging and Disability Resource Center, 2011; Administration on Aging, 2012). Referred to as the Naylor model (Naylor etal., 2004). There is evidence that psychosocial problems, such as adverse childhood experiences, contribute to the initiation of risk factors for the development of poor health and chronic illnesses in Americans (Centers for Disease Control and Prevention [CDC], 2010; Felitti, 2002). Advanced practice nurses use role modelling, teaching, clinical problem solving and change facilitation to promote evidence-based practice among . Studies have suggested that prior embodied experiences may play a role in the expression or the trajectory of a patients health/illness experience. Interprofessional Teams Outcomes of successful transitions include subjective well-being, role mastery, and well-being of relationships (Schumacher and Meleis, 1994), all components of quality of life. The APN coaching process can best be understood as an intervention. During an illness, patients may transition through multiple sites of care that place them at higher risk for errors and adverse events, contributing to higher costs of care. Developmental, health and illness, and situational transitions are the most likely to lead to clinical encounters requiring guidance and coaching. It is important to note that all elements of the model work synergistically to create this competency; separating them for the sake of discussion is somewhat artificial. In addition, patient-centered communication and interprofessional team communication are important quality and safety education for nurses (QSEN) competencies for APNs (Cronenwett, Sherwood, Pohl, etal., 2009; qsen.org/competencies/graduate-ksas/). For example, Chick and Meleis (1986) have characterized the process of transition as having phases during which individuals go through five phases (see earlier). *Referred to as the Coleman model (Coleman etal., 2004) The most frequent intervention was surveillance; health teaching was the second or third most frequent intervention, depending on the patient population. Advanced practice nursing is more a concept than a defined role and cannot be described as a specific set of skills or regu- . Such guidance needs to be wisely crafted to avoid leading the witness or creating self-fulfilling prophecies (see Exemplar 8-1). Earlier work on transitions by Meleis and others is consistent with and affirms the concepts of the TTM. Secondary analyses of data from early transitional care trials have identified the specific interventions that APNs used for five different clinical populations (Naylor, Bowles, & Brooten, 2000): health teaching, guidance, and/or counseling; treatments and procedures; case management; and surveillance (Brooten etal., 2003). J Clin Nurs 2018. Transitions can also be characterized according to type, conditions, and universal properties. Instead of providing the patient with the answers, the coach supports the patient and provides the tools needed to manage the illness and navigate the health care system. These nurses can spend most of their time teaching and counseling patients; nursing students also practice this skill. Patient Education [2012]. This definition of guidance draws on dictionary definitions of the word and the use of the term in motivational interviewing (MI). Topeka, KS. APNs involve the patients significant other or patients proxy, as appropriate. Extensive research on the TCM has documented improved patient and institutional outcomes and led to better understanding of the nature of APN interventions. For example, Chick and Meleis (1986) have characterized the process of transition as having phases during which individuals go through five phases (see earlier). 1. Thus, guidance and coaching by APNs represent an interaction of four factors: the APNs interpersonal, clinical, and technical competence and the APNs self-reflection (Fig. Burden of Chronic Illness Contemplation is not a commitment, and the patient is often uncertain. Early studies of the model from which TCM evolved have provided substantive evidence of the range and focus of teaching and counseling activities undertaken initially by CNSs, and later NPs, who provided care to varied patient populations. Int J Nurs Stud. Making lifestyle or behavior changes are transitions; the stages of change are consistent with the characteristics of transition phases (Chick and Meleis, 1986). They have a detailed action plan and may have already taken some action in the past year. Becoming a parent, giving up cigarettes, learning how to cope with chronic illness, and dying in comfort and dignity are just a few examples of transitions.