2020 Jan 1;51(1):12-14. doi: 10.3928/00220124-20191217-04. The aim in offering this model is not only to help APNs understand what coaching is but to give them language by which to explain their interpersonal effectiveness. Offering specific advice in this stage is counterproductive and can increase resistance and hamper progression through the stages of change. The preceptors and sites must meet standards established by the academic institution, advanced practice nurse certification organizations, and state legislatures. Organizational transitions are those that occur in the environment; within agencies, between agencies, or in society. 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/). Distinctions Among Coaching and Other Processes. 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. They have a detailed action plan and may have already taken some action in the past year. Nationally and internationally, chronic illnesses are leading causes of morbidity and mortality. 2. The teaching-coaching role of the APN The demand for well-educated and skilled healthcare providers has never been greater. 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. Federal government websites often end in .gov or .mil. Running Head: GUIDANCE AND COACHING FOR THE ADVANCED PRACTICE NURSE 1 Guidance and Coaching for the Advanced Expert Help This site needs JavaScript to work properly. The aim in offering this model is not only to help APNs understand what coaching is but to give them language by which to explain their interpersonal effectiveness. They conduct client visits, use motivational interviewing techniques, and model correct strategies necessary to help patients reach self-management goals. These ideas are consistent with elements of the TTM and offer useful ideas for assessment. 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. Background: Similar to life, they may be predictable or unpredictable, joyous or painful, obvious or barely perceptible, chosen and welcomed, or unexpected and feared. New graduates entering a professional field of practice as well as established nurses moving into a new practice setting or a new role may receive mentoring as part of the role transition process. 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. Extensive research on the TCM has documented improved patient and institutional outcomes and led to better understanding of the nature of APN interventions. The term is also used to refer to advising others, especially in matters of behavior or belief. 2019 May/Jun;35(3):152-159. doi: 10.1097/NND.0000000000000534. 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. 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. This report offers insight into strategies of coaching that would be useful in a variety of health care settings to promote the advancement of nurse leaders. Transitions can also be characterized according to type, conditions, and universal properties. 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. Only gold members can continue reading. Nurse health coaches focus on chronic disease prevention through lifestyle and integrative healthcare techniques. For example, Chick and Meleis (1986) have characterized the process of transition as having phases during which individuals go through five phases (see earlier). There are several reasons for this: The Institute for Healthcare Improvement [IHI] has asserted that patient-centered care is central to driving improvement in health care Johnson, Abraham, Conway, etal., 2008). Patient education involves helping patients become better informed about their condition, medical procedures, and choices they have regarding treatment. After multiple experiences with cancer patients, one of the authors (JS) incorporated anticipatory guidance at the start of cancer chemotherapy, using the following approach. Regular self-reflection helps APNs develop skills to describe clinical phenomena and express that which is hard to name. Change is conceptualized as a five-stage process (Fig. Clinical Nurse Specialist<br>Direct clinical practice--includes expertise in advanced assessment, implementing nursing care, and evaluating outcomes.<br>Expert coaching and guidance encompassing . 1. 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). 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. 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. Studies of the transitional care model (TCM) and care transitions intervention (CTI) have used APNs as the primary intervener. Chapter Contents Health Care Policy Initiatives Nurses typically have opportunities to educate patients during bedside conversations or by providing prepared pamphlets or handouts. The evolving criteria and requirements for certification of professional coaches are not premised on APN coaching skills. This definition is necessarily broad and can inform standards for patient education materials and programs targeting common health and illness topics. Evidence in the literature related to the use of coaching specifically among APNs is limited. Reflection-in-action requires astute awareness of context and investing in the present moment with full concentration, capabilities that take time to master and require regular practice. official website and that any information you provide is encrypted 2. APNs must be able to explain their nursing contributions, including their relational, communication, and coaching skills, to team members. In doing so, it sets out what coaching is and highlights its benefits . FOIA These ideas are consistent with elements of the TTM and offer useful ideas for assessment. APNs can use the TTM model to tailor interactions and interventions to the patients specific stage of change to maximize the likelihood that they will progress through the stages of behavioral change. Guidance and coaching Guidance and coaching is a core competency of advanced practice nursing. Guidance 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). Bookshelf Health Care Policy Initiatives 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. (2010). In this chapter, health and illness transitions are defined as transitions driven by an individuals experience of the body in a holistic sense. Earlier work on transitions by Meleis and others is consistent with and affirms the concepts of the TTM. With contemplators, the focus of APN coaching is to try to tip the decisional balance. Patients know that, if and when they are ready to change, the APN will collaborate with them. health coaching primarily falls within a nursing scope of practice, with nurses being the most commonly cited professionals administering health coaching and evaluating its effectiveness. Similarly, in the United States, chronic diseases caused by heart disease result in 7 out of 10 deaths/year; cancer and stroke account for more than 50% of all deaths (Heron, Hoyert, Murphy, etal., 2009). 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. Do you agree that guidance and coaching is a core competency of advanced practice registered nursing? Overview of the Model 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. APNs bring their reflections-in-action to their post-encounter reflections on action. 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. The APN coaching process can best be understood as an intervention. APRNs are nurses who have met advanced educational and clinical practice requirements, and often provide services in community-based settings. Teaching and counseling are significant clinical activities in nurse-midwifery (Holland & Holland, 2007) and CNS practice (Lewandoski & Adamle, 2009). 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. 1. Understanding patients perceptions of transition experiences is essential to effective coaching. 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. Only gold members can continue reading. 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). Reflection in action is the ability to pay attention to phenomena as they are occurring, giving free rein to ones intuitive understanding of the situation as it is unfolding; individuals respond with a varied repertoire of exploratory and transforming actions best characterized as strategic improvisation. 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. I provide guidance and best practices from my 20+ years of acute hospital experience to help create the best nursing experience possible for our nurses and their patients. In 2008, worldwide, over 36 million people died from conditions such as heart disease, cancers, and diabetes (World Health Organization [WHO], 2011, 2012). What is a nurse coach? An important assessment prior to the next chemotherapy cycle focused on the patients responses to treatment, and what worked and what didnt work, so that a more appropriate side effect management program could be developed. Referred to as the Naylor model (Naylor etal., 2004). More often, one is likely to ruminate on negative experiences because the feeling of failure is more uncomfortable than the feeling of satisfaction or success. 8-1), in which change can be hastened with skillful guidance and coaching. Precontemplators are not interested in learning more, thinking about, or discussing their high-risk behaviors. Several assumptions underlie this model: 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). Schumacher and Meleis (1994) have proposed four types of transitionsdevelopmental, health and illness, situational, and organizational. 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. Tasks and activities of Advanced Practice Nurses in the psychiatric and mental health care context: A systematic review and thematic analysis. Key Features Table 8-2 lists some transitions, based on this typology, that might require APN coaching. This definition is necessarily broad and can inform standards for patient education materials and programs targeting common health and illness topics. This is the stage in which people have already made lifestyle changes within the last 6 months that are leading to a measurable outcome (e.g., number of pounds lost, lower hemoglobin A1c [HbA1C ] level). 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. Earlier work on transitions by Meleis and others is consistent with and affirms the concepts of the TTM. 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. Participants evaluated the structure and function, as well as the value, of the coaching circle. There is evidence that psychosocial problems, such as adverse childhood experiences, contribute to the initiation of risk factors for the development of poor health and chronic illnesses in Americans (Centers for Disease Control and Prevention [CDC], 2010; Felitti, 2002). 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. 4. These distinctions are reflected in the definitions that follow. In practice, APNs remain aware of the possibility of multiple transitions occurring as a result of one salient transition. 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). FIG 8-2 Coaching competency of the advanced practice nurse. However, all APNs must be skilled in dealing with organizational transitions, because they tend to affect structural and contextual aspects of providing care. Unauthorized use of these marks is strictly prohibited. Guidance and Coaching Guidance can be seen as a preliminary, less comprehensive form of 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). 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. Because the GRACE model is similar to the TCM and CTI models, it will not be discussed further here. APNs are likely to move between guidance and coaching in response to their assessments of patients. 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). 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. Active roles for older adults in navigating care transitions: Lessons learned from the care transitions intervention. 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. . 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. Patient Education FIG 8-1 Prochaskas stages of change: The five stages of change. Mentoring up: A grounded theory of nurse-to-nurse mentoring. 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). Murray LA, Buckley K. Using simulation to improve communication skills in nurse practitioner preceptors. 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 To qualify as a medical or health care home or ACO, practices must engage patients and develop communication strategies. 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. This bestselling textbook provides a clear, comprehensive, and contemporary introduction to advanced practice nursing today, addressing all major APRN competencies, roles, and issues. [2012]. 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. In this stage, people intend to make a change within the next 6 months. Professional coaching now is recognized within and outside of nursing as a particular intervention, distinct from guidance, mentoring and counseling. Although we believe that guidance is distinct from coaching, more work is needed to illuminate the differences and relationships between the two. Aging and Disability Resource Center, 2011; Administration on Aging, 2012). Beginnings, June 2019. Individual elements of the model include clinical, technical, and interpersonal competence mediated by self-reflection. Our Service Charter. 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. This strategy is aimed at increasing foundational staff nurse knowledge and skills. Outcomes of successful transitions include subjective well-being, role mastery, and well-being of relationships (Schumacher and Meleis, 1994), all components of quality of life. and transmitted securely. 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). Advanced practice nursing is more a concept than a defined role and cannot be described as a specific set of skills or regu- . Even so, relapse is always possible in the action or maintenance stage and may be a response to stressful situations. Precontemplation 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 . 2004). It may involve more than one person and is embedded in the context and the situation (Chick & Meleis, 1986, pp. Noting that everyone responds to this type of chemotherapy differently, JS would ask what they had heard about the drugs they would be taking. They are acutely aware of the hazards of the behavior and are also more aware of the advantages of changing the behavior. APNs interpret these multiple sources of information to arrive at possible explanations and interventions. 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. Developing clinical leaders: the impact of an action learning mentoring programme for advanced practice nurses. 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. 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. These core competency domains are as follows: values and ethics for interprofessional practice; roles and responsibilities; interprofessional communication; and teams and teamwork. 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. Direct clinical practice 2. 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. 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. Based on studies of smokers, Prochaska and associates (2008) learned that behavior change unfolds through stages. 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. Med Klin Intensivmed Notfmed. Developmental transitions are those that reflect life cycle transitions, such as adolescence, parenthood, and aging. 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. The Resource Hamric & Hanson's advanced practice nursing : an integrative approach, [edited by] Mary Fran Tracy, . Graduate Nursing Education: Influence of Faculty and Preceptors Some form of coaching is inherent in nursing practice, and developing professional nurse coaching certifications should build on these skills. 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. 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. Nationally and internationally, chronic illnesses are lead, U.S. Department of Health and Human Services [HSS], 2012, Centers for Disease Control and Prevention [CDC], 2010, Accountable Care Organizations and Patient-Centered Medical Homes, 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. Definitions: Teaching, Guidance, and Coaching 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. 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. Transitional Care Model Referred to as the GRACE model (Counsell etal., 2006). Developmental, health and illness, and situational transitions are the most likely to lead to clinical encounters requiring guidance and coaching. Assumptions Interprofessional Teams Transitions are paradigms for life and living. Personal communication. 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). Patient education involves helping patients become better informed about their condition, medical procedures, and choices they have regarding treatment. Transtheoretical Model of Behavior Change
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