guidance and coaching in advanced practice nursing

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. 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. 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. They have a detailed action plan and may have already taken some action in the past year. Clinical coaching is a relationship for the purpose of building skills. 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. In 2008, worldwide, over 36 million people died from conditions such as heart disease, cancers, and diabetes (World Health Organization [WHO], 2011, 2012). These ideas are consistent with elements of the TTM and offer useful ideas for assessment. 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. (From R. W. Scholl. The most frequent intervention was surveillance; health teaching was the second or third most frequent intervention, depending on the patient population. Accountable care initiatives are an opportunity to implement these findings and evaluate and strengthen the guidance and coaching competency of APNs. 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. 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. 4. 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/). Patient Education Tran AN, Nevidjon B, Derouin A, Weaver S, Bzdak M. J Nurses Prof Dev. Guidance in the advanced practice nurse (APN) 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" (Hamric, 2014, p. 186). Evidence-based care transitions models side-by-side March 2011 (adrc-tae.org/tiki-download_file.php?fileId=30310). Registered nurses, including APNs, are central to a redesigned health system that emphasizes prevention and early intervention to promote healthy lifestyles, prevent chronic diseases, and reduce the personal, community, organizational, and economic burdens of chronic illness (Hess, Dossey, Southard, etal., 2012; Institute of Medicine [IOM], 2010; Thorne, 2005). 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. (2010). This is the stage in which people are ready to take action within 1 month. 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. 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). Active roles for older adults in navigating care transitions: Lessons learned from the care transitions intervention. The term is also used to refer to advising others, especially in matters of behavior or belief. 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. 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. Judith A. Spross and Rhonda L. Babine These distinctions are reflected in the definitions that follow. Self-reflection is the deliberate internal examination of experience so as to learn from it. The competency related to teams and teamwork emphasizes relationship building as an important element of patient-centered care (see Chapter 12). Situational transitions are most likely to include changes in educational, work, and family roles. 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. As with other APN core competencies, the coaching competency develops over time, during and after graduate education. Aging and Disability Resource Center. It may involve more than one person and is embedded in the context and the situation (Chick & Meleis, 1986, pp. This site needs JavaScript to work properly. Adapted from the U.S. 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). 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. Situational transitions are most likely to include changes in educational, work, and family roles. This article presents coaching, which facilitates the highest form of learning, as a potential strategy for promoting professional development in nursing. 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. Experienced APNs are more likely than inexperienced APNs to pay attention to feelings and intuitions. The competency related to teams and teamwork emphasizes relationship building as an important element of patient-centered care (see Chapter 12). However, all APNs must be skilled in dealing with organizational transitions, because they tend to affect structural and contextual aspects of providing care. Bookshelf Nurses typically have opportunities to educate patients during bedside conversations or by providing prepared pamphlets or handouts. Patient education may include information about cognitive and behavioral changes but these changes cannot occur by teaching alone. Personal communication. 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. Topeka, KS. These factors are further influenced by individual and contextual factors. 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. Earlier work on transitions by Meleis and others is consistent with and affirms the concepts of the TTM. Transitions can also be characterized according to type, conditions, and universal properties. future of advanced practice and how it may shape the career structure of nursing. 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. Log In or Register to continue As a member of the nursing leadership team, the advanced practice nurse (APN) is on the front line, involved with staff on a daily basis, and able to coach staff in a variety of different situations. Although we believe that guidance is distinct from coaching, more work is needed to illuminate the differences and relationships between the two. Even so, relapse is always possible in the action or maintenance stage and may be a response to stressful situations. A subtle distinction is that guidance is done by the nurse, whereas coachings focus is on empowering patients to manage their care needs. government site. 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). They are acutely aware of the hazards of the behavior and are also more aware of the advantages of changing the behavior. A subtle distinction is that guidance is done by the nurse, whereas coachings focus is on empowering patients to manage their care needs. 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. Method: Data sources Articles were identified through a search of CINAHL, Medline, Scopus, and PsychINFO databases. 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. They conduct client visits, use motivational interviewing techniques, and model correct strategies necessary to help patients reach self-management goals. 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. 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 bestselling textbook provides a clear, comprehensive, and contemporary introduction to advanced practice nursing today, addressing all major APRN competencies, roles, and issues. PMC The achievement and maintenance of . Experienced APNs are more likely than inexperienced APNs to pay attention to feelings and intuitions. Regular self-reflection helps APNs develop skills to describe clinical phenomena and express that which is hard to name. 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). It may involve more than one person and is embedded in the context and the situation (Chick & Meleis, 1986, pp. Extensive research on the TCM has documented improved patient and institutional outcomes and led to better understanding of the nature of APN interventions. American College of Nurse Midwives [ACNM, 2012]; National Association of Clinical Nurse Specialists [NACNS], 2013, National Organization of Nurse Practitioner Faculties [NONPF], 2012. 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). 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. Applications to addictive behaviours. 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. 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) For the purposes of discussing coaching by APNs, developmental transitions are considered to include any transition with an intrapersonal focus, including changes in life cycle, self-perception, motivation, expectations, or meanings. Aging and Disability Resource Center, 2011; Administration on Aging, 2012). A nurse practitioner (NP), doing a health history on a young woman, elicited information about binge drinking that was a concern. Transitions are paradigms for life and living. Anticipatory guidance is a particular type of guidance aimed at helping patients and families know what to expect. These initiatives suggest that APNs, administrators, and researchers need to identify those clinical populations for whom APN coaching is necessary. Teaching is an important intervention in the self-management of chronic illness and is often incorporated into guidance and coaching. With experience, APNs develop their own strategies for integrating specialty-related anticipatory guidance into their coaching activities. Nurse coaches also complete follow-up visits, track progress toward health . The definition speaks to the fact that others are affected by, or can influence, transitions. How do you think guidance and coaching in the advanced practice role is different from the RN role of teaching/coaching? Guidance and coaching Guidance and coaching is a core competency of advanced practice nursing. Table 8-3 compares the three models of care transitions that used APNs. Professional & Expert Writers: Studymonk only hires the best. Articles published in English between 2010 and 2021 were included. This is the stage in which patients have changed a behavior for longer than 6 months and strive to avoid relapse; they have more confidence in their ability to sustain the change and are less likely to relapse. APNs also apply their guidance and coaching skills in interactions with colleagues, interprofessional team members, students, and others. 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. Bethesda, MD 20894, Web Policies American Holistic Nurses Association. 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. 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). Rollnick and colleagues (2008) have described guiding as one of three styles of doing MI. This article chronicles a typical patient's journey through a post-hospital discharge nursing research study involving APNs as "intervention . The evolving criteria and requirements for certification of professional coaches are not premised on APN coaching skills. Schumacher and Meleis (1994) have proposed four types of transitionsdevelopmental, health and illness, situational, and organizational. Guidance Contemplation APNs are likely to move between guidance and coaching in response to their assessments of patients. 2011;27(3):161-7. There are several reasons for this: With experience, APNs develop their own strategies for integrating specialty-related anticipatory guidance into their coaching activities. 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). Similar to life, they may be predictable or unpredictable, joyous or painful, obvious or barely perceptible, chosen and welcomed, or unexpected and feared. Adapted from Prochaska, J.O., DiClemente, C.C., & Norcross, J.C. [1992]. 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. 4. Based on their observations of creating and implementing the CTI with coaches of different backgrounds, Parry and Coleman (2010) have asserted that coaching differs from other health care processes, such as teaching and coordination. Noting that everyone responds to this type of chemotherapy differently, JS would ask what they had heard about the drugs they would be taking. 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. 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. 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. 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. The purpose of this report is to describe the current literature related to coaching among APNs and the results of this coaching experience. Understanding patients perceptions of transition experiences is essential to effective coaching. Clinical nurse specialists (CNSs) typically have more involvement in planning and implementing organizational transitions. It is important to understand that APN guidance and coaching are not synonymous with professional coaching. Making lifestyle or behavior changes are transitions; the stages of change are consistent with the characteristics of transition phases (Chick and Meleis, 1986). 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. APNs bring their reflections-in-action to their post-encounter reflections on action. 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). Teaching and counseling are significant clinical activities in nurse-midwifery (Holland & Holland, 2007) and CNS practice (Lewandoski & Adamle, 2009). How do you think guidance and coaching in the advanced practice role is different from the RN role of teaching/coaching? 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. Adapted from the U.S. These factors are further influenced by individual and contextual factors. Throughout the process, the APN is aware of the individual and contextual factors that may affect the coaching encounter and these factors also shape interactionsfirst to elicit and negotiate patient goals and outcomes and then to collaborate with the patient and others to produce those outcomes. Primary Care Overview of the Model Although a number of "coaching" types and modalities exist, for example, health, wellness, personal, and life coaching, health coaching . 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. The term is also used to refer to advising others, especially in matters of behavior or belief. 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). 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).

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