Developmental transitions are those that reflect life cycle transitions, such as adolescence, parenthood, and aging. Many of these transitions have reciprocal impacts across categories. Interprofessional Teams Studies of the transitional care model (TCM) and care transitions intervention (CTI) have used APNs as the primary intervener. 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. Hill LA, Sawatzky JA. 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. Personal communication. 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). 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). Transition Situations That Require Coaching 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. Chapter 8 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). Bookshelf Individual elements of the model include clinical, technical, and interpersonal competence mediated by self-reflection. This bestselling textbook provides a clear, comprehensive, and contemporary introduction to advanced practice nursing today, addressing all major APRN competencies, roles, and issues. As with other APN core competencies, the coaching competency develops over time, during and after graduate education. 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). Developmental, health and illness, and situational transitions are the most likely to lead to clinical encounters requiring guidance and coaching. Evidence in the literature related to the use of coaching specifically among APNs is limited. Nurses typically have opportunities to educate patients during bedside conversations or by providing prepared pamphlets or handouts. Aging and Disability Resource Center, 2011; Administration on Aging, 2012). Anticipatory guidance is a particular type of guidance aimed at helping patients and families know what to expect. 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. These ideas are consistent with elements of the TTM and offer useful ideas for assessment. It is mediated by the APN-patient relationship and the APNs self-reflective skills and interpersonal, clinical, and technical skills. Murray LA, Buckley K. Using simulation to improve communication skills in nurse practitioner preceptors. Clinical and Technical Competence Early work by Schumacher and Meleis (1994) remains relevant to the APN coaching competency and contemporary interventions, often delivered by APNs, designed to ensure smooth transitions for patients as they move across settings (e.g., Coleman & Boult, 2003; Coleman & Berenson, 2004; U.S. 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; Over the last decade, the importance of interprofessional teamwork to achieve high-quality, patient-centered care has been increasingly recognized. These factors are further influenced by individual and contextual factors. FIG 8-2 Coaching competency of the advanced practice nurse. Using coaching as a leadership skill assists the APN in making a significant contribution to the health care field and to employee growth and . 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. (2011). 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). 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. Stages of Change Tags: Advanced Practice Nursing An Integrative Approach 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). Guidance and coaching in the nursing practice are part of the work of nursing midwives, clinical specialist nurses, and nurse practitioners. 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. 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. Coaching and guidance are structured approaches that can be used within or alongside patient decision aids (PtDAs) to facilitate the process of decision making. Health Care Policy Initiatives Patient education involves helping patients become better informed about their condition, medical procedures, and choices they have regarding treatment. 5. Abstract Purpose: The purposes of this study were to explore coaching as a nurse practitioner (NP) strategy for improving patient health outcomes and to lay a foundation for validating coaching benefits. Situational transitions are most likely to include changes in educational, work, and family roles. 8-2). The definition speaks to the fact that others are affected by, or can influence, transitions. 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). The Caring advanced practice nursing model is composed of eight core competency domains: direct clinical practice, ethical decision-making, coaching and guidance, consultation, cooperation, case management, research and development, and leadership (Fagerstrm 2011, 2019a). Professional coaching now is recognized within and outside of nursing as a particular intervention, distinct from guidance, mentoring and counseling. These diseases share four common risk factors that lend themselves to APN guidance and coachingtobacco use, physical inactivity, the harmful use of alcohol, and poor diet. 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). 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 is the stage in which people are ready to take action within 1 month. 3. Although a number of "coaching" types and modalities exist, for example, health, wellness, personal, and life coaching, health coaching . This definition is necessarily broad and can inform standards for patient education materials and programs targeting common health and illness topics. Its purpose was to inspire hospitals to integrate concepts from the communication, cultural competence, and patient- and family-centered care fields into their organizations (TJC, 2010, p. 11). Interpersonal Competence Why or why not? All that is changing as nurse coaches are becoming more common and helping nurses achieve success. There are a number of issues that must be considered by both students and preceptors when negotiating a clinical experienceandragological, curricular, credentialing, and legal . 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 to facilitate completion of a transformational project. National Library of Medicine In practice, APNs remain aware of the possibility of multiple transitions occurring as a result of one salient transition. 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. 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. The preceptors and sites must meet standards established by the academic institution, advanced practice nurse certification organizations, and state legislatures. Do you agree that guidance and coaching is a core competency of advanced practice registered nursing? Addressing all major advanced practice nursing competencies, roles, and issues, Advanced Practice Nursing: An Integrative Approach, 5th Edition provides a clear, comprehensive, and . The APN uses self-reflection during and after interactions with patients, classically described as reflection-in-action and reflection-on-action (Schn, 1983, Health Policy Issues in Changing Environments, Integrative Review of Outcomes and Performance Improvement Research on Advanced Practice Nursing, Conceptualizations of Advanced Practice Nursing, Understanding Regulatory, Legal, and Credentialing Requirements, Role Development of the Advanced Practice Nurse, Advanced Practice Nursing An Integrative Approach. Extensive research on the TCM has documented improved patient and institutional outcomes and led to better understanding of the nature of APN interventions. 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). 8-2). 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. 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). 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. Patient education is important to enable individuals to better care for themselves and make informed decisions regarding medical care (Martin, eNotes, 2002, www.enotes.com/patient-education-reference/patient-education). HHS Vulnerability Disclosure, Help Individual elements of the model include clinical, technical, and interpersonal competence mediated by self-reflection. Leadership For a schematic illustration of the model, see Fig. Over the last decade, the importance of interprofessional teamwork to achieve high-quality, patient-centered care has been increasingly recognized. Making lifestyle or behavior changes are transitions; the stages of change are consistent with the characteristics of transition phases (, 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 (, Brooten, Youngblut, Deatrick, etal., 2003, Advanced Practice Nurses and Models of Transitional Care, 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. Even so, relapse is always possible in the action or maintenance stage and may be a response to stressful situations. APNs integrate self-reflection and the competencies they have acquired through experience and graduate education with their assessment of the patients situationthat is, patients understandings, vulnerabilities, motivations, goals, and experiences. Hamric & Hanson's Advanced Practice Nursing: An Integrative Approach: 9780323777117: Medicine & Health Science Books @ Amazon.com . 6. Referred to as the GRACE model (Counsell etal., 2006). They compare a guiding style of communication to tutoring; the emphasis is on being a resource to support a persons autonomy and self-directed learning and 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). Transitions are paradigms for life and living. Advanced practice is a level of practice, rather than a type or specialty of practice. Mentoring is used in a variety of professional settings. The competency of guidance and coaching is a well-established expectation of the advanced practice nurse (APN). 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). 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). The growth in programs has led to a corresponding increased demand for clinical Direct clinical practice -- Coaching and guidance -- Consultation -- Evidence-based practice -- Leadership -- Collaboration -- Ethical decision making -- The clinical nurse specialist -- The primary care nurse practitioner -- The . Guidance is directing, advising and counseling patients, and it is closely related to coaching, but less comprehensive and while nurses offer guidance, they empower the patients to manage the care needs through coaching. 2017;33(1):33-9. 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. 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. They have a detailed action plan and may have already taken some action in the past year. Empirical research findings that predate contemporary professional coaching have affirmed that guidance and coaching are characteristics of APN-patient relationships. Patient teaching and education (see Chapter 7) directly relates to APN coaching. 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. 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. Currently, the TCM is a set of activities aimed at pro, 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 (, 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. 2004). Federal government websites often end in .gov or .mil. 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. 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. 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). They conduct client visits, use motivational interviewing techniques, and model correct strategies necessary to help patients reach self-management goals. 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. Change is conceptualized as a five-stage process (Fig. This section reviews selected literature reports, including the following: (1) conceptual and empirical work on transitions as a major focus of APN guidance and coaching; (2) the transtheoretical model of behavior change (also known as the stages of change theory) and its associated interventions; and (3) evidence that APNs incorporate expert guidance and coaching as they deliver care. Experienced APNs are more likely than inexperienced APNs to pay attention to feelings and intuitions. Review Methods Quality . 8-1), in which change can be hastened with skillful guidance and coaching. J Am Assoc Nurse Pract. 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. 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). 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. Studies of the transitional care model (TCM) and care transitions intervention (CTI) have used APNs as the primary intervener. Guidance and Coaching Foundations of the APN competency are established when nurses learn about therapeutic relationships and communication in their undergraduate and graduate programs, together with growing technical and clinical expertise. This definition is necessarily broad and can inform standards for patient education materials and programs targeting common health and illness topics. Graduate programs deepen students inherent coaching skills by incorporating evidence-based coaching practices into curricula. Skill in establishing therapeutic relationships and being able to coach patients based on discipline-related content and skills will be important in achieving interprofessional, patient-centered care. and transmitted securely. There is no federal regulation of APNs across the Understanding patients perceptions of transition experiences is essential to effective coaching. Precontemplators are not interested in learning more, thinking about, or discussing their high-risk behaviors. According to Hamric, guidance is typically done by a nurse while coaching is something done by an advanced practice nurse (APN) because it is resolute, multipart, and collective process in which the APN works with the patient and their families to achieve attainable goals which are thought of together (2014). 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. 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). Many of these transitions have reciprocal impacts across categories. Does it differentiate advanced practice registered nursing from floor RN nursing for you? Development of Advanced Practice Nurses Coaching Competence In medically complex patients, APNs may be preferred and less expensive coaches, in part because of their competencies and scopes of practice. In 2008, worldwide, over 36 million people died from conditions such as heart disease, cancers, and diabetes (World Health Organization [WHO], 2011, 2012). For example, in the Adverse Childhood Experiences (ACE) Study (Centers for Disease Control and Prevention, 2010), adverse experiences in childhood, such as abuse and trauma, had strong relationships with health concerns, such as smoking and obesity. eCollection 2022 Jan-Dec. Reshaping Nursing Workforce Development by Strengthening the Leadership Skills of Advanced Practice Nurses. 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). Change is conceptualized as a five-stage process (Fig. Consultation 5. 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. 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 evolving criteria and requirements for certification of professional coaches are not premised on APN coaching skills. PMC 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. 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). American Holistic Nurses Association. 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). Bethesda, MD 20894, Web Policies Transitions in Health and Illness 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). A serial cross-sectional survey design was used to evaluate the coaching circle experience of four cohorts of Fellows from 2013-2017. APNs also attend to patterns, consciously and subconsciously, that develop intuition and contribute to their clinical acumen. Its purpose was to inspire hospitals to integrate concepts from the communication, cultural competence, and patient- and family-centered care fields into their organizations (TJC, 2010, p. 11). 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. Wise APNs pay attention to all four types of transitions in their personal and professional lives. Data sources: Review of coaching literature in psychology, sports, business, and nursing. Extensive research on the TCM has documented improved patient and institutional outcomes and led to better understanding of the nature of APN interventions.
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