The evolving criteria and requirements for certification of professional coaches are not premised on APN coaching skills. Tags: Advanced Practice Nursing An Integrative Approach 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. 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. It is concluded that coaching can be a powerful tool in enhancing nurses' and other health professionals' ability to contribute to the success of healthcare organisations. Referred to as the Naylor model (Naylor etal., 2004). Evidence in the literature related to the use of coaching specifically among APNs is limited. sharing sensitive information, make sure youre on a federal APNs can use nurses theoretical work on transitions to inform assessments and interventions during each of the TTM stages of change and tailor their guiding and coaching interventions to the stage of readiness. For example, in the Adverse Childhood Experiences (ACE) Study (Centers for Disease Control and Prevention, 2010), adverse experiences in childhood, such as abuse and trauma, had strong relationships with health concerns, such as smoking and obesity. Following a critical content analysis, the roles and responsibilities of the forensic nurses were described and compared with the seven core competencies of advanced nursing practice as outlined . Nurses typically have opportunities to educate patients during bedside conversations or by providing prepared pamphlets or handouts. National Library of Medicine 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. Acute Care Guidance and coaching is a core competency of advanced practice nursing. Advanced practitioners are educated at masters level in advanced practice and are assessed as competent in practice, using expert knowledge and skills. 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. APNs must be able to explain their nursing contributions, including their relational, communication, and coaching skills, to team members. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). View Guidance and Coaching Competency.docx from NUR 5081 at William Paterson University. Discuss practical ways the APRN provides guidance and coaching to patients in his or her daily APRN role. (2011). These initiatives suggest that APNs, administrators, and researchers need to identify those clinical populations for whom APN coaching is necessary. 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. 2011;27(3):161-7. 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). Controlled trials of this model have found that APN coaching, counseling, and other activities demonstrate statistically significant differences in patient outcomes and resource utilization (e.g., Brooten, Roncoli, Finkler, etal., 1994; Naylor, Brooten, Campbell, etal., 1999). 10.1111/jocn.14636. 2020 Jan 1;51(1):12-14. doi: 10.3928/00220124-20191217-04. Adapted from Prochaska, J.O., DiClemente, C.C., & Norcross, J.C. [1992]. JS would review the common side effects, what could be done pharmacologically and nonpharmacologically to minimize the effects, and what other patients had done to manage their time and activities during the period receiving chemotherapy. The competency of guidance and coaching is a well-established expectation of the advanced practice nurse (APN). Interprofessional Teams This description of transitions as a focus for APN coaching underscores the need for and the importance of a holistic orientation to caring for patients. 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. 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 APN guidance and coaching competency reflects an integration of the characteristics of the direct clinical practice competency (see Chapter 7) but is particularly dependent on the formation of therapeutic partnerships with patients, use of a holistic perspective and reflective practice, and interpersonal interventions. For example, TCM programs have begun to use baccalaureate-prepared nurses to provide transitional care; Parry and Coleman (2010) have reported on the use of other providers in CTI interventions, including social workers. Noting that everyone responds to this type of chemotherapy differently, JS would ask what they had heard about the drugs they would be taking. Attending to the possibility of multiple transitions enables the APN to tailor coaching to the individuals particular needs and concerns. Patient education involves helping patients become better informed about their condition, medical procedures, and choices they have regarding treatment. These distinctions are reflected in the definitions that follow. Guidance The most frequent intervention was surveillance; health teaching was the second or third most frequent intervention, depending on the patient population. In a clinical case study, Felitti (2002) proposed that, although diabetes and hypertension were the presenting concerns in a 70-year-old woman, the first priority on her problem list should be the childhood sexual abuse she had experienced; effective treatment of the presenting illnesses would depend on acknowledging the abuse and referring the patient to appropriate therapy. 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. The aging population, increases in chronic illness, and the emphasis on preventing medical errors has led to calls for care that is more patient-centered (Devore & Champion, 2011; IOM, 2001; National Center for Quality Assurance [NCQA], 2011). Experienced APNs are more likely than inexperienced APNs to pay attention to feelings and intuitions. As APNs assess, diagnose, and treat a patient, they are attending closely to the meanings that patients ascribe to health and illness experiences; APNs take these meanings into account in working with patients. These distinctions are reflected in the definitions that follow. The APN coaching process can best be understood as an intervention. Developmental, health and illness, and situational transitions are the most likely to lead to clinical encounters requiring guidance and coaching. 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. The four pillars of advanced practice are clinical practice, leadership and management, education, and research. Although the primary focus of this chapter is on guiding and coaching patients and families, applications of the coaching model to students and staff are discussed. Hamric & Hanson's Advanced Practice Nursing, 7th Edition - 9780323777117 ISBN: 9780323777117 Copyright: 2023 Publication Date: 11-04-2022 Page Count: 736 Imprint: Elsevier List Price: $96.99 Hamric & Hanson's Advanced Practice Nursing, 7th Edition Based on studies of smokers, Prochaska and associates (2008) learned that behavior change unfolds through stages. Patient Education APNs involve the patients significant other or patients proxy, as appropriate. Data sources Articles were identified through a search of CINAHL, Medline, Scopus, and PsychINFO databases. Currently, the TCM process is focused on older adults and consists of screening, engaging the older adult and caregiver, managing symptoms, educating and promoting self-management, collaborating, ensuring continuity, coordinating care, and maintaining the relationship (www.transitionalcare.info/). The ability to self-reflect and focus on the process of coaching as it is occurring implies that APNs are capable of the simultaneous execution of other skills. The site is secure. The three components share similarities but increase gradually in terms of involvement and participation for further management of the patient's condition. Addressing all major advanced practice nursing competencies, roles, and issues, Advanced Practice Nursing: An Integrative Approach, 5th Edition provides a clear, comprehensive, and current introduction to APN today. Early studies documented the nature, focus, content, and amount of time that APNs spent in teaching, guiding and coaching, and counseling, as well as the outcomes of these interventions (Brooten, Youngblut, Deatrick, etal., 2003; see Chapter 23). Med Klin Intensivmed Notfmed. Topeka, KS. Transitions are paradigms for life and living. These competencies are the following: direct clinical practice, expert coaching and advice, consultation, research skills, clinical and professional leadership, collaboration, and ethical decision making. Coaching Difficult Patients Thoroughly revised and updated, the 7 th edition of this bestselling text covers topics ranging from the evolution of advanced practice nursing to evidence-based practice, leadership, ethical decision-making, and health policy. 8-1), in which change can be hastened with skillful guidance and coaching. Evidence That Advanced Practice Nurses Guide and Coach 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. The most frequent intervention was surveillance; health teaching was the second or third most frequent intervention, depending on the patient population. The APN uses self-reflection during and after interactions with patients, classically described as reflection-in-action and reflection-on-action (Schn, 1983, 1987). 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. Related and transmitted securely. In this chapter, health and illness transitions are defined as transitions driven by an individuals experience of the body in a holistic sense. 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. Adapted from Prochaska, J.O., DiClemente, C.C., & Norcross, J.C. [1992]. 3. 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). Aging and Disability Resource Center. Design Systematic review and narrative synthesis. Guidance and coaching in the nursing practice are part of the work of nursing midwives, clinical specialist nurses, and nurse practitioners. Debates started in the late 1980s and early 1990s as service and strategic interest in advanced nurse roles grew (Kaufman, 1996; 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. Precontemplators are not interested in learning more, thinking about, or discussing their high-risk behaviors. It is important to understand that APN guidance and coaching are not synonymous with professional coaching. Using coaching as a leadership skill assists the APN in making a significant contribution to the health care field and to employee growth and . 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. The term encompasses four commonly identified role . This definition of guidance draws on dictionary definitions of the word and the use of the term in motivational interviewing (MI). Referred to as the GRACE model (Counsell etal., 2006). They reflect changes in structures and resources at a system level. Several assumptions underlie this model: The Joint Commission (TJC) published the Roadmap for Hospitals in 2010. In contrast to mentoring, coaching can specifically be used for guidance related to a specific event, new assignment, or new challenge, with specific objectives in mind. Unauthorized use of these marks is strictly prohibited. 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. The focus of APN coaching is to work with the patient to avoid relapse by reviewing the stages of change, assessing the stability of the change, assessing for new stressors or reduced capacity to cope with stress, reviewing the patients plans to overcome barriers to change, reminding the patient that vigilance is required, and identifying resources for dealing with new stressors. This is the stage in which people are ready to take action within 1 month. Guidance and coaching are part of the advance practice registered nurse (APRN) competencies, and it leads the change to a patient's healthier life. This strategy is aimed at increasing foundational staff nurse knowledge and skills. Both guidance and coaching competencies are equally important elements that help in the treatment of a patient. 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. Developmental transitions are those that reflect life cycle transitions, such as adolescence, parenthood, and aging. Regular self-reflection helps APNs develop skills to describe clinical phenomena and express that which is hard to name. Wise APNs pay attention to all four types of transitions in their personal and professional lives. Anticipatory guidance is a particular type of guidance aimed at helping patients and families know what to expect. As a result, enrollment is expanding in academic settings that prepare advanced practice nurses for primary care and acute care roles. Open Longevity Science, 4, 4350. APN students need to be taught that the feelings arising in clinical experiences are often clues to their developing expertise or indicate something that may require personal attention (e.g., a patient who repeatedly comes to clinic intoxicated elicits memories and feelings of a parent who was alcoholic). Beginnings, October 2019. In identifying these elements, the model of APN guidance and coaching breaks down what is really a holistic, flexible, and often indescribable process. In 2008, 107 million Americans had at least one of six chronic illnessescardiovascular disease, arthritis, diabetes, asthma, cancer, and chronic obstructive pulmonary disease (U.S. Department of Health and Human Services [HSS], 2012); this number is expected to grow to 157 million by 2020 (Bodenheimer, Chen, & Bennett, 2009). There is no federal regulation of APNs across the 4. Why or why not? This edition draws from literature on professional coaching by nurses and others to inform and build on the model of APN guidance and coaching presented in previous editions. With contemplators, the focus of APN coaching is to try to tip the decisional balance. 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). Coaching and guidance 4. These core competency domains are as follows: values and ethics for interprofessional practice; roles and responsibilities; interprofessional communication; and teams and teamwork. The transtheoretical model (TTM; also called the Stages of Change theory), is a model derived from several hundred psychotherapy and behavior change theories (Norcross, Krebs & Prochaska, 2011; Prochaska, Redding, & Evers, 2008). Assumptions Empirical research findings that predate contemporary professional coaching have affirmed that guidance and coaching are characteristics of APN-patient relationships. Such guidance needs to be wisely crafted to avoid leading the witness or creating self-fulfilling prophecies (see Exemplar 8-1). For example, the ability to establish therapeutic relationships and guide patients through transitions is incorporated into the DNP Essentials (American Association of Colleges of Nursing [AACN], 2006). Care Transition Models Using Advanced Practice Nurses Studies have suggested that prior embodied experiences may play a role in the expression or the trajectory of a patients health/illness experience. Coaching is a relatively new application to promote the development of leadership skills in health care and nursing. Transition Situations That Require Coaching. ANP is an umbrella term that refers to "an advanced level of nursing practice that maximizes the use of in-depth nursing knowledge and skill in meeting the health needs of clients (individuals, families, groups, populations or entire communities)" ( Canadian Nurses Association, 2006: p. 1). As APN-based transitional care programs evolve, researchers are examining whether other, sometimes less expensive providers can offer similar services and achieve the same outcome. Similar to life, they may be predictable or unpredictable, joyous or painful, obvious or barely perceptible, chosen and welcomed, or unexpected and feared. The teaching-coaching role of the APN The demand for well-educated and skilled healthcare providers has never been greater. Advanced practice nurses use role modelling, teaching, clinical problem solving and change facilitation to promote evidence-based practice among . APNs do this by reinforcing the health benefits of the change, and acknowledging the personal qualities and resources that the patient has tapped to make and sustain this change. There is also a model of practice-based care coordination that used an NP and social worker, the Geriatric Resources for Assessment and Care of Elders (GRACE) model (Counsell, Callahan, Buttar, etal., 2006). Patient teaching and education (see Chapter 7) directly relates to APN coaching. Tasks and activities of Advanced Practice Nurses in the psychiatric and mental health care context: A systematic review and thematic analysis. 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. Bookshelf This practice, by nurses and other disciplines, focuses on health, healing, and wellness; as the broad understanding of professional coaching evolves, it will influence the evolution of the APN guidance and coaching competency. The purpose of this article is to describe a novel approach for behavior modification that integrates health coaching with group visits facilitated by nurse practitioners. According to these authors, a commitment and ability to adopt a coaching role and foster empowerment and confidence in the patient is more important than a disciplinary background. Studies have suggested that prior embodied experiences may play a role in the expression or the trajectory of a patients health/illness experience. 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. Professional coaching now is recognized within and outside of nursing as a particular intervention, distinct from guidance, mentoring and counseling. Contemplation is not a commitment, and the patient is often uncertain. These factors are further influenced by individual and contextual factors. For example, patients with diabetes may be taught how to monitor their blood sugar levels and administer insulin with technical accuracy, but if the lifestyle impacts of the transition from health to chronic illness are not evaluated, guidance and coaching do not occur. 1. At least 1year of APN experience is needed to define and implement all APN role dimensions, including leadership (Baker, To help the reader begin to discern the subtle differences among coaching actions, the terms that inform this model are defined here, in particular, patient education, APN guidance, including anticipatory guidance, and a revised definition of APN coaching (to distinguish it from professional coaching). It may involve more than one person and is embedded in the context and the situation (Chick & Meleis, 1986, pp. 8-2). Clinical Nurse Specialist<br>Direct clinical practice--includes expertise in advanced assessment, implementing nursing care, and evaluating outcomes.<br>Expert coaching and guidance encompassing . [2012]. 2019;50(4):170-175.]. This article chronicles a typical patient's journey through a post-hospital discharge nursing research study involving APNs as "intervention . The term is also used to refer to advising others, especially in matters of behavior or belief. According to these authors, a commitment and ability to adopt a coaching role and foster empowerment and confidence in the patient is more important than a disciplinary background. These nurses can spend most of their time teaching and counseling patients; nursing students also practice this skill. 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/). 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. Offering specific advice in this stage is counterproductive and can increase resistance and hamper progression through the stages of change. It may involve more than one person and is embedded in the context and the situation (Chick & Meleis, 1986, pp. Self-Reflection Although a number of "coaching" types and modalities exist, for example, health, wellness, personal, and life coaching, health coaching . Guidance may also occur in situations in which there may be insufficient information for a patient to make an informed choice related to a desired outcome. APNs should also be alert to expressions of emotions about the unhealthy behavior because these are often opportunities to raise a patients awareness of the impact of the unhealthy behavior, an important precursor to committing to change. Health coaching and group visits are emerging as 2 effective strategies to improve patients' behavior in chronic care management. Referred to as the Naylor model (Naylor etal., 2004). To qualify as a medical or health care home or ACO, practices must engage patients and develop communication strategies. These initiatives signal increasing recognition by all stakeholders that improving health care depends on a patient-centered orientation in which providers communicate meaningfully and effectively and provide culturally competent and safe care (IOM, 2010; Hobbs, 2009; TJC, 2010; Woods, 2010). Nurse coaches also complete follow-up visits, track progress toward health . Guidance can be seen as a preliminary, less comprehensive form of coaching. The APN coaching process can best be understood as an intervention. Aging and Disability Resource Center, 2011, Schumacher and Meleis (1994) have defined the term. Aging and Disability Resource Center, 2011; Administration on Aging, 2012). (2010). Aging and Disability Resource Center. Evocation requires close attention to the patients statements and emotions to uncover possible motivations that will move the patient forward; so, interventions in this stage are not directed toward overcoming resistance or increasing adherence or compliance to treatment. International Council of Nurses (ICN) | ICN - International Council of . Definitions: Teaching, Guidance, and Coaching Clinical nurse specialists (CNSs) typically have more involvement in planning and implementing organizational transitions. The ability to self-reflect and focus on the process of coaching as it is occurring implies that APNs are capable of the simultaneous execution of other skills. 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. Direct clinical practice 2. Studies of the transitional care model (TCM) and care transitions intervention (CTI) have used APNs as the primary intervener. Would you like email updates of new search results? Action 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. Some health and illness changes are self-limiting (e.g., the physiologic changes of pregnancy), whereas others are long term and may be reversible or irreversible. Coaching as a Model for Facilitating the Performance, Learning, and Development of Palliative Care Nurses. adrc-tae.org/tiki-download_file.php?fileId=30310, Extensive research on the TCM has documented improved patient and institutional outcomes and led to better understanding of the nature of APN interventions. 2021 Jun;118:103759. doi: 10.1016/j.ijnurstu.2020.103759. Definitions: Teaching, Guidance, and Coaching The focus of APN coaching is to work with the patient to avoid relapse by reviewing the stages of change, assessing the stability of the change, assessing for new stressors or reduced capacity to cope with stress, reviewing the patients plans to overcome barriers to change, reminding the patient that vigilance is required, and identifying resources for dealing with new stressors. 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.