Results: 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. Self-Reflection Chick and Meleis (1986) have characterized the process of transition as having phases during which individuals experience the following: (1) disconnectedness from their usual social supports; (2) loss of familiar reference points; (3) old needs that remain unmet; (4) new needs; and (5) old expectations that are no longer congruent with the changing situation. American College of Nurse Midwives [ACNM, 2012]; National Association of Clinical Nurse Specialists [NACNS], 2013, National Organization of Nurse Practitioner Faculties [NONPF], 2012. 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. Accountable care initiatives are an opportunity to implement these findings and evaluate and strengthen the guidance and coaching competency of APNs. American Holistic Nurses Association. In doing so, it sets out what coaching is and highlights its benefits . Referred to as the GRACE model (Counsell etal., 2006). Transition Situations That Require Coaching (From R. W. Scholl. Our Service Charter. 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). Conclusion Experienced APNs are more likely than inexperienced APNs to pay attention to feelings and intuitions. 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. While interacting with patients, APNs integrate observations and information gleaned from physical examinations and interviews with their own theoretical understanding, noncognitive intuitive reactions, and the observations, intuitions, and theories that they elicit from patients. 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). 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. Model of Advanced Practice Nurse Guidance and Coaching Rather than directing or lecturing, she asked the woman if she knew about the effects of alcohol on the body; the woman said no. The NP then asked if the woman would like to learn about the effects, to which the patient replied yes. The visit proceeded with a brief overview of the effects of alcohol and provision of more resources. Many of these transitions have reciprocal impacts across categories. As with other APN core competencies, the coaching competency develops over time, during and after graduate education. Clinical coaching is a relationship for the purpose of building skills. Review Methods Quality . 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. Clinical nurse specialists (CNSs) typically have more involvement in planning and implementing organizational transitions. 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. Self-reflection is the deliberate internal examination of experience so as to learn from it. Nurses typically have opportunities to educate patients during bedside conversations or by providing prepared pamphlets or handouts. 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. Discuss practical ways the APRN provides guidance and coaching to patients in his or her daily APRN role. Referred to as the GRACE model (Counsell etal., 2006). Findings were sustained for as long as 6 months after the program ended. Federal government websites often end in .gov or .mil. Although technical competence and clinical competence may be sufficient for teaching a task, they are insufficient for coaching patients through transitions, including chronic illness experiences or behavioral and lifestyle changes. Studies have suggested that prior embodied experiences may play a role in the expression or the trajectory of a patients health/illness experience. Accessibility 6. This assessment enables the APN to work with the patient on identifying and anticipating difficulties and devising specific strategies to overcome them, a critical intervention in this stage. As a result, enrollment is expanding in academic settings that prepare advanced practice nurses for primary care and acute care roles. APNs involve the patients significant other or patients proxy, as appropriate. Bookshelf The four pillars of advanced practice are clinical practice, leadership and management, education, and research. 3. 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. Schumacher and Meleis (1994) have proposed four types of transitionsdevelopmental, health and illness, situational, and organizational. Exemplar 8-1Anticipatory Guidance in Primary and Acute Care Understanding patients perceptions of transition experiences is essential to effective coaching. 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. 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. 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. Only gold members can continue reading. Coaching deals with empowering the sick to cope their health needs and guidance raise attentiveness, envisage, execute and maintain a compartment variation, manage illness situation and prepare patients for transitions. including direct clinical practice, guidance and coaching, consultation, evidence-based practice (EBP), leadership, collaboration, and . In todays health care system, transitions are not just about illness. It may involve more than one person and is embedded in the context and the situation (Chick & Meleis, 1986, pp. Tags: Advanced Practice Nursing An Integrative Approach
Offering specific advice in this stage is counterproductive and can increase resistance and hamper progression through the stages of change. Contemplation Conclusion: Empirical research findings that predate contemporary professional coaching have affirmed that guidance and coaching are characteristics of APN-patient relationships. 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. 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. FOIA APNs used a holistic focus that required clinical expertise, including sufficient patient contact, interpersonal competence, and systems leadership skills to improve outcomes (Brooten, Youngblut, Deatrick, etal., 2003). . 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. 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. Bethesda, MD 20894, Web Policies All nurses and APNs should be familiar with the patient education resources in their specialty because these resources can facilitate guidance and coaching. Interpersonal Competence Patient education involves helping patients become better informed about their condition, medical procedures, and choices they have regarding treatment. . There are several reasons for this: APNs are likely to move between guidance and coaching in response to their assessments of patients. These ideas are consistent with elements of the TTM and offer useful ideas for assessment. Furthermore, many APNs will have responsibilities for coaching teams to deliver patient-centered care. This is the stage in which people are not yet contemplating change; specifically, they do not intend to take any action within the next 6 months. The three components share similarities but increase gradually in terms of involvement and participation for further management of the patient's condition. [Clinical leadership competencies in advanced nursing practice : Scoping review]. (2010). 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). Building on findings from studies of the TCM, the CTI program supports older adults with complex medical needs as they move throughout the health care system (Parry and Coleman, 2010). 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. 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). They conduct client visits, use motivational interviewing techniques, and model correct strategies necessary to help patients reach self-management goals. Nurse coaches also complete follow-up visits, track progress toward health . 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. 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). How do you think guidance and coaching in the advanced practice role is different from the RN role of teaching/coaching? Similar to life, they may be predictable or unpredictable, joyous or painful, obvious or barely perceptible, chosen and welcomed, or unexpected and feared. 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. This is the stage in which people are not yet contemplating change; specifically, they do not intend to take any action within the next 6 months. Although technical competence and clinical competence may be sufficient for teaching a task, they are insufficient for coaching patients through transitions, including chronic illness experiences or behavioral and lifestyle changes. Noting that everyone responds to this type of chemotherapy differently, JS would ask what they had heard about the drugs they would be taking. 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. Transitions in Health and Illness Beginnings, June 2019. This bestselling textbook provides a clear, comprehensive, and contemporary introduction to advanced practice . 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/). Adapted from Parry, C. & Coleman, E. A. 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. 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. Empirical research findings that predate contemporary professional coaching have affirmed that guidance and coaching are characteristics of APN-patient relationships. Applications to addictive behaviours. Advanced practitioners are educated at masters level in advanced practice and are assessed as competent in practice, using expert knowledge and skills. Purposeful sampling was used to select advanced practice nurses who met the following inclusion criteria: employed as a master's pre - pared advanced practice nurse with at least 1year of experience in the APN role. Making lifestyle or behavior changes are transitions; the stages of change are consistent with the characteristics of transition phases (Chick and Meleis, 1986). Although technical competence and clinical competence may be sufficient for teaching a task, they are insufficient for coaching patients through transitions, including chronic illness experiences or behavioral and lifestyle changes. It applies APN core competencies to the major APN roles - including the burgeoning Nurse Practitioner role - and covers topics ranging from the evolution of APN to evidence-based . 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). 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. Since the last edition, developments in public health and health policy within nursing and across disciplines have influenced the conceptualization of the APN guidance and coaching competency. To guide also means to assist a person to travel through, or reach a destination in, an unfamiliar area, such as by accompanying or giving directions to the person. 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/). [J Contin Educ Nurs. Participants evaluated the structure and function, as well as the value, of the coaching circle. FIG 8-2 Coaching competency of the advanced practice nurse. Precontemplators are not interested in learning more, thinking about, or discussing their high-risk behaviors. Professional Coaching and Health Care sharing sensitive information, make sure youre on a federal (2010). Patient teaching and education (see Chapter 7) directly relates to APN coaching. Referred to as the Naylor model (Naylor etal., 2004). 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). Professional coaching now is recognized within and outside of nursing as a particular intervention, distinct from guidance, mentoring and counseling. There are a number of issues that must be considered by both students and preceptors when negotiating a clinical experienceandragological, curricular, credentialing, and legal matters must be satisfied . 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). 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. Developmental, health and illness, and situational transitions are the most likely to lead to clinical encounters requiring guidance and coaching. The Resource Hamric & Hanson's advanced practice nursing : an integrative approach, [edited by] Mary Fran Tracy, . Health Care Policy Initiatives TABLE 8-1
Do you agree that guidance and coaching is a core competency of advanced practice registered nursing? The foundational importance of the therapeutic APN-patient (client) relationship is not consistent with professional coaching principles. Change is conceptualized as a five-stage process (Fig. A subtle distinction is that guidance is done by the nurse, whereas coachings focus is on empowering patients to manage their care needs. Several assumptions underlie this model: The term is also used to refer to advising others, especially in matters of behavior or belief. Making lifestyle or behavior changes are transitions; the stages of change are consistent with the characteristics of transition phases (Chick and Meleis, 1986). Table 8-2 lists some transitions, based on this typology, that might require APN coaching. official website and that any information you provide is encrypted A serial cross-sectional survey design was used to evaluate the coaching circle experience of four cohorts of Fellows from 2013-2017. The competency of guidance and coaching is a well-established expectation of the advanced practice nurse (APN). 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. 2. 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/). Definitions: Teaching, Guidance, and Coaching J Prof Nurs. APNs also apply their guidance and coaching skills in interactions with colleagues, interprofessional team members, students, and others. This definition is necessarily broad and can inform standards for patient education materials and programs targeting common health and illness topics. The development of all major competencies of advanced practice nursing is discussed: direct clinical practice, consultation, coaching/guidance, research, leadership, collaboration, and ethical decision-making. 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; Spross, Clarke, & Beauregard, 2000; Spross, 2009). 8-2). 2. When clinicians adopt the language of change, it prevents labeling and prejudging patients, helps maintain positive regard for the patient, and creates a climate of safety and hope. In this stage, people intend to make a change within the next 6 months. They have the freedom and authority to act, making autonomous decisions in the assessment, diagnosis and . This site needs JavaScript to work properly. As with other APN core competencies, the coaching competency develops over time, during and after graduate education. Developmental, health and illness, and situational transitions are the most likely to lead to clinical encounters requiring guidance and coaching. Guidance and Coaching Competency and Outcomes APNs are likely to move between guidance and coaching in response to their assessments of patients. 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 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. Graduate programs deepen students inherent coaching skills by incorporating evidence-based coaching practices into curricula. 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). Data sources: Review of coaching literature in psychology, sports, business, and nursing. 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. Why or why not? 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). 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. Change is conceptualized as a five-stage process (Fig. Strategies for Developing and Applying the Coaching Competency What is a nurse coach? Teaching is an important intervention in the self-management of chronic illness and is often incorporated into guidance and coaching. 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, Patient-Centered Care, Culturally Competent and Safe Health Care, and Meaningful Provider-Patient Communication. 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. The achievement and maintenance of . There are several reasons for this: The foundational importance of the therapeutic APN-patient (client) relationship is not consistent with professional coaching principles. Transtheoretical Model of Behavior Change APNs also apply their guidance and coaching skills in interactions with colleagues, interprofessional team members, students, and others. The Joint Commission (TJC) published the Roadmap for Hospitals in 2010. 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). Health coaching can strengthen nurse practitioner-led group visits by enhancing peer . 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. Course Hero uses AI to attempt to automatically extract content from documents to surface to you and others so you can study better, e.g., in search results, to enrich docs, and more. Anticipatory guidance is a particular type of guidance aimed at helping patients and families know what to expect. 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. In practice, APNs remain aware of the possibility of multiple transitions occurring as a result of one salient transition. 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. Patient education involves helping patients become better informed about their condition, medical procedures, and choices they have regarding treatment. Definitions: Teaching, Guidance, and Coaching 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 (. Patient education involves helping patients become better informed about their condition, medical procedures, and choices they have regarding treatment. Thoroughly revised and updated, the 7th 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. 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. It may involve more than one person and is embedded in the context and the situation (Chick & Meleis, 1986, pp. Assumptions Does it differentiate advanced practice registered nursing from floor RN nursing for you? Understanding patients perceptions of transition experiences is essential to effective coaching. 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). Although there is variability in how this aspect of APN practice is described, standards that specifically address therapeutic relationships and partnerships, coaching, communication, patient-familycentered care, guidance, and/or counseling can be found in competency statements for most APN roles (American College of Nurse Midwives [ACNM, 2012]; National Association of Clinical Nurse Specialists [NACNS], 2013; National Organization of Nurse Practitioner Faculties [NONPF], 2012). Experienced APNs are more likely than inexperienced APNs to pay attention to feelings and intuitions. With contemplators, the focus of APN coaching is to try to tip the decisional balance. In this stage, because ambivalence is not yet completely resolved, the focus of APN coaching is to offer support related to the patients action plan and to determine the strength of the commitment. Topeka, KS. Judith A. Spross and Rhonda L. Babine APNs also apply their guidance and coaching skills in interactions with colleagues, interprofessional team members, students, and others. Schumacher and Meleis (1994) have proposed four types of transitionsdevelopmental, health and illness, situational, and organizational. In this stage, because ambivalence is not yet completely resolved, the focus of APN coaching is to offer support related to the patients action plan and to determine the strength of the commitment.