Evidence in the literature related to the use of coaching specifically among APNs is limited. The physical, emotional, social, and economic burdens of chronic illness are enormous but, until recently, investing in resources to promote healthy lifestyles and prevent chronic illnesses has not been a policy priority. Log In or Register to continue 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. MeSH Advanced Practice Nurse Guidance and Coaching Competency: Theoretical and Empirical Perspectives How do you think guidance and coaching in the advanced practice role is different from the RN role of teaching/coaching? APNs are likely to move between guidance and coaching in response to their assessments of patients. APNs bring their reflections-in-action to their post-encounter reflections on action. Mentoring is used in a variety of professional settings. As with other APN core competencies, the coaching competency develops over time, during and after graduate education. Patient Education Patient education involves helping patients become better informed about their condition, medical procedures, and choices they have regarding treatment. Advanced practice is a level of practice in which a practitioner has demonstrated their ability to work autonomously at a high level (level 7/ Masters level) across all four pillars of advanced practice. Attending to the possibility of multiple transitions enables the APN to tailor coaching to the individuals particular needs and concerns. Adapted from Prochaska, J.O., DiClemente, C.C., & Norcross, J.C. [1992]. 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. Bookshelf 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). Assumptions All that is changing as nurse coaches are becoming more common and helping nurses achieve success. They have a detailed action plan and may have already taken some action in the past year. American Holistic Nurses Association. Dossey and Hess (2013) state that the purpose of coaching in nursing is "to advocate, identify, and focus on factors that promote health, healthy people, and healthy communities" (p. 10). The most frequent intervention was surveillance; health teaching was the second or third most frequent intervention, depending on the patient population. Murray LA, Buckley K. Using simulation to improve communication skills in nurse practitioner preceptors. 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. 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. This bestselling textbook provides a clear, comprehensive, and contemporary introduction to advanced practice nursing today, addressing all major APRN competencies, roles, and issues. View Guidance and Coaching Competency.docx from NUR 5081 at William Paterson University. 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). Guidance and coaching elements have been conceptualized in recent decades as a complex and dynamic interpersonal process in the APN-patient relationship aimed at collaborative and holistic care. Graduate Nursing Education: Influence of Faculty and Preceptors The publication of these competencies, together with research on interprofessional work in the health professions (e.g., Reeves, Zwarenstein, Goldman, etal., 2010), are helping educators determine how best to incorporate interprofessional competencies into APN education. Health coaching can strengthen nurse practitioner-led group visits by enhancing peer . Why or why not? Self-Reflection Among the studies of APN care are those in which APNs provide care coordination for patients as they move from one setting to the other, such as hospital to home. After multiple experiences with cancer patients, one of the authors (JS) incorporated anticipatory guidance at the start of cancer chemotherapy, using the following approach. Effective guidance and coaching of patients, family members, staff, and colleagues depend on the quality of the therapeutic or collegial relationships that APNs establish with them. A subtle distinction is that guidance is done by the nurse, whereas coachings focus is on empowering patients to manage their care needs. Advanced Practice Nurse Guidance and Coaching Competency: Theoretical and Empirical Perspectives and transmitted securely. 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). 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. Situational transitions are most likely to include changes in educational, work, and family roles. TABLE 8-1 With experience, APNs develop their own strategies for integrating specialty-related anticipatory guidance into their coaching activities. Chapter Contents It is important to understand that APN guidance and coaching are not synonymous with professional coaching. describes all competencies, including direct clinical practice, guidance and coaching, consultation, evidence-based practice (EBP), leadership, collaboration . 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. 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. 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. Accountable care initiatives are an opportunity to implement these findings and evaluate and strengthen the guidance and coaching competency of APNs. Studies of NPs and NP students have indicated that they spend a significant proportion of their direct care time teaching and counseling (Lincoln, 2000; OConnor, Hameister, & Kershaw, 2000). 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. Over the last decade, the importance of interprofessional teamwork to achieve high-quality, patient-centered care has been increasingly recognized. Transitions in Health and Illness 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. The interaction of self-reflection with these three areas of competence, and clinical experiences with patients, drive the ongoing expansion and refinement of guiding and coaching expertise in advanced practice nursing. Patient teaching and education (see Chapter 7) directly relates to APN coaching. The term is also used to refer to advising others, especially in matters of behavior or belief. Teaching is an important intervention in the self-management of chronic illness and is often incorporated into guidance and coaching. Design Systematic review and narrative synthesis. 8-2). Background: 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. Exemplar 8-1Anticipatory Guidance in Primary and Acute Care. Wise APNs pay attention to all four types of transitions in their personal and professional lives. Int J Nurs Stud. The APN coaching process can best be understood as an intervention. 2. Self-Reflection Although a number of "coaching" types and modalities exist, for example, health, wellness, personal, and life coaching, health coaching . All nurses and APNs should be familiar with the patient education resources in their specialty because these resources can facilitate guidance and coaching. It is mediated by the APN-patient relationship and the APNs self-reflective skills and interpersonal, clinical, and technical skills. 2019 May/Jun;35(3):152-159. doi: 10.1097/NND.0000000000000534. The teaching-coaching role of the APN The demand for well-educated and skilled healthcare providers has never been greater. 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). The PPACA has led payers to adopt innovative approaches to financing health care, including accountable care organizations (ACOs) and patient-centered medical homes (PCMHs; see Chapter 22). For example, Chick and Meleis (1986) have characterized the process of transition as having phases during which individuals go through five phases (see earlier). 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. 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. Examination Level Eligibility Criteria ; NC-BC (Nurse Coach Board Certified) HWNC-BC (Health and Wellness Nurse Coach Board Certified) - same exam as NC-BC - must hold AHNCC Holistic Certification: Unrestricted, current U.S. RN license* Active practice as an RN for a minimum of 2 years full-time or 4,000 hours part-time within the past 5 years if you have a Baccalaureate Degree in . Overview of the Model Quantitative studies, qualitative studies, and anecdotal reports have suggested that coaching patients and staff through transitions is embedded in the practices of nurses (Benner, Hooper-Kyriakidis, etal., 1999), and particularly APNs (Bowles, 2010; Cooke, Gemmill, & Grant, 2008; Dick & Frazier, 2006; Hayes & Kalmakis, 2007; Hayes, McCahon, Panahi, etal., 2008; Link, 2009; Mathews, Secrest, & Muirhead, 2008; Parry & Coleman, 2010). Care Transition Models Using Advanced Practice Nurses 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). Graduate programs deepen students inherent coaching skills by incorporating evidence-based coaching practices into curricula. 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. Coleman and colleagues have found results similar to those of TCM, a decreased likelihood of being readmitted and an increased likelihood of achieving self-identified personal goals around symptom management and functional recovery (Coleman, Smith, Frank, etal. Health and illness transitions were primarily viewed as illness-related and ranged from adapting to a chronic illness to returning home after a stay in the hospital (Schumacher and Meleis, 1994). Subsequent studies of CTI have demonstrated significant reductions in 30-, 90-, and 180-day hospital readmissions (Coleman, Parry, Chalmers & Min, 2006). There are a number of issues that must be considered by both students and preceptors when negotiating a clinical experienceandragological, curricular, credentialing, and legal . The publication of these competencies, together with research on interprofessional work in the health professions (e.g., Reeves, Zwarenstein, Goldman, etal., 2010), are helping educators determine how best to incorporate interprofessional competencies into APN education. Precontemplators are not interested in learning more, thinking about, or discussing their high-risk behaviors. Evidence That Advanced Practice Nurses Guide and Coach They have a detailed action plan and may have already taken some action in the past year. 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/). Guidance 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. Anticipatory guidance is a particular type of guidance aimed at helping patients and families know what to expect. The evolving criteria and requirements for certification of professional coaches are not premised on APN coaching skills. These factors are further influenced by individual and contextual factors. Discuss practical ways the APRN provides guidance and coaching to patients in his or her daily APRN role. This bestselling textbook provides a clear, comprehensive, and contemporary introduction to advanced practice . As with other APN core competencies, the coaching competency develops over time, during and after graduate education. Schumacher and Meleis (1994) have defined the term transition as a passage from one life phase, condition, or status to another: Transition refers to both the process and outcome of complex person-environment interactions. 8-1), in which change can be hastened with skillful guidance and coaching. 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. Transtheoretical Model of Behavior 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. APN coaching is defined as a purposeful, complex, dynamic, collaborative, and holistic interpersonal process aimed at supporting and facilitating patients and families through health-related experiences and transitions to achieve health-related goals, mutually determined, whenever possible. 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. Leadership For a schematic illustration of the model, see Fig. A nurse coach is a nurse that focuses on whole body wellness - body and mind. Do you agree that guidance and coaching is a core competency of advanced practice registered nursing? 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. Similarly, two of ten criteria that primary care PCMHs are expected to meet are written standards for patient access and communication and active support of patient self-management (NCQA, 2011). The goals of APN guidance are to raise awareness, contemplate, implement, and sustain a behavior change, manage a health or illness situation, or prepare for transitions, including birth and end of life. 239-240). The physical, emotional, social, and economic burdens of chronic illness are enormous but, until recently, investing in resources to promote healthy lifestyles and prevent chronic illnesses has not been a policy priority. Schumacher and Meleis (1994) have proposed four types of transitionsdevelopmental, health and illness, situational, and organizational. Regular self-reflection helps APNs develop skills to describe clinical phenomena and express that which is hard to name. Studies of NPs and NP students have indicated that they spend a significant proportion of their direct care time teaching and counseling (Lincoln, 2000; OConnor, Hameister, & Kershaw, 2000). 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. There are at least three types of evidence-based transitional care programs that have used APNs to support transitions from hospital to home (, U.S. Agency on Aging and Disability Resource Center, 2011, Referred to as the Coleman model (Coleman etal., 2004). Stages of Change 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 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. 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). Understanding patients perceptions of transition experiences is essential to effective coaching. A subtle distinction is that guidance is done by the nurse, whereas coachings focus is on empowering patients to manage their care needs. However, all APNs must be skilled in dealing with organizational transitions, because they tend to affect structural and contextual aspects of providing care. APNs involve the patients significant other or patients proxy, as appropriate. 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. APN guidance is a style and form of communication informed by assessments, experiences, and information that is used by APNs to help patients and families explore their own resources, motivations, and possibilities. Health Care Policy Initiatives 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. Transitions are paradigms for life and living. Individual elements of the model include clinical, technical, and interpersonal competence mediated by self-reflection. A nurse practitioner (NP), doing a health history on a young woman, elicited information about binge drinking that was a concern. In this stage, the focus of APN coaching is to make the patient feel understood, avoid giving advice, keep lines of communication open, and convey a willingness to be available when the patient is ready to make a change. Active roles for older adults in navigating care transitions: Lessons learned from the care transitions intervention. 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. Similarly, two of ten criteria that primary care PCMHs are expected to meet are written standards for patient access and communication and active support of patient self-management (NCQA, 2011). Burden of Chronic Illness 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 There are at least three types of evidence-based transitional care programs that have used APNs to support transitions from hospital to home (U.S. Agency on Aging and Disability Resource Center, 2011). J Clin Nurs. Our writers are specially selected and recruited, after which they undergo further training to perfect their skills for specialization purposes. 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; Prochaskas stages of change: The five stages of change. Only gold members can continue reading. Experienced APNs are more likely than inexperienced APNs to pay attention to feelings and intuitions. 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. cal mentors and preceptors. Hamric & Hanson's Advanced Practice Nursing: An Integrative Approach: 9780323777117: Medicine & Health Science Books @ Amazon.com . The purpose of this report is to describe the current literature related to coaching among APNs and the results of this coaching experience. Distinctions Among Coaching and Other Processes. is directly linked to the competencies of direct clinical practice, coaching, and guidance, complemented by the other components and competencies.9 Regulatory. Professional coaching now is recognized within and outside of nursing as a particular intervention, distinct from guidance, mentoring and counseling. Studies have suggested that prior embodied experiences may play a role in the expression or the trajectory of a patients health/illness experience. Nurses typically have opportunities to educate patients during bedside conversations or by providing prepared pamphlets or handouts. 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. [J Contin Educ Nurs. These core competency domains are as follows: values and ethics for interprofessional practice; roles and responsibilities; interprofessional communication; and teams and teamwork. As health care reform in the United States steadily moves the pendulum from sickness and disease to wellness and prevention, new interventions have arisen in the name of coaching to guide and thus improve the life, health, and health risk of individuals. Silver Spring, MD: Nursebooks.org Beginnings, December 2019. However, reflecting on satisfying and successful experiences and discerning why they were effective contributes to developing competence and expertise and reveals knowledge about assessments and interventions that will be useful in future interactions. The evolving criteria and requirements for certification of professional coaches are not premised on APN coaching skills.
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