guidance and coaching in advanced practice nursing

A nurse practitioner (NP), doing a health history on a young woman, elicited information about binge drinking that was a concern. Empirical research findings that predate contemporary professional coaching have affirmed that guidance and coaching are characteristics of APN-patient relationships. The teaching-coaching role of the APN The demand for well-educated and skilled healthcare providers has never been greater. 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). With experience, APNs develop their own strategies for integrating specialty-related anticipatory guidance into their coaching activities. Nurses typically have opportunities to educate patients during bedside conversations or by providing prepared pamphlets or handouts. Experienced APNs are more likely than inexperienced APNs to pay attention to feelings and intuitions. Patient Education Guidance and coaching are essential components of work for an advanced practice nurse (APN). 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). APNs also attend to patterns, consciously and subconsciously, that develop intuition and contribute to their clinical acumen. These ideas are consistent with elements of the TTM and offer useful ideas for assessment. 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). Many of these transitions have reciprocal impacts across categories. The purposes of this chapter are to do the following: offer a conceptualization of APN guidance and coaching that can be applied across settings and patients health states and transitions; integrate findings from the nursing literature and the field of professional coaching into this conceptualization; offer strategies for developing this competency; and differentiate professional coaching from APN guidance and coaching. Guidance can be seen as a preliminary, less comprehensive form of coaching. Patient education may include information about cognitive and behavioral changes but these changes cannot occur by teaching alone. Findings were sustained for as long as 6 months after the program ended. 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. 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). 1. When patient-centered approaches are integrated into the mission, values, and activities of organizations, better outcomes for patients and institutions, including safer care, fewer errors, improved patient satisfaction, and reduced costs, should ensue. Primary Care 2021 Jun;118:103759. doi: 10.1016/j.ijnurstu.2020.103759. 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). PMC Professional coaching now is recognized within and outside of nursing as a particular intervention, distinct from guidance, mentoring and counseling. 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. Developing clinical leaders: the impact of an action learning mentoring programme for advanced practice nurses. 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. 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. For example, Chick and Meleis (1986) have characterized the process of transition as having phases during which individuals go through five phases (see earlier). 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. Unauthorized use of these marks is strictly prohibited. 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. Bookshelf Schumacher and Meleis (1994) have proposed four types of transitionsdevelopmental, health and illness, situational, and organizational. 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. Preparation These nurses can spend most of their time teaching and counseling patients; nursing students also practice this skill. Both guidance and coaching competencies are equally important elements that help in the treatment of a patient. In addition, each of the 6 core competencies of the APN role identified by Adapted from Parry, C. & Coleman, E. A. Int J Nurs Stud. They conduct client visits, use motivational interviewing techniques, and model correct strategies necessary to help patients reach self-management goals. 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). In practice, APNs remain aware of the possibility of multiple transitions occurring as a result of one salient transition. 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). Distinctions Among Coaching and Other Processes Precontemplators are not interested in learning more, thinking about, or discussing their high-risk behaviors. Active roles for older adults in navigating care transitions: Lessons learned from the care transitions intervention. Individual and Contextual Factors That Influence Advanced Practice Nurse Guidance and Coaching 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. 4. 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. This article chronicles a typical patient's journey through a post-hospital discharge nursing research study involving APNs as "intervention . Table 8-2 lists some transitions, based on this typology, that might require APN coaching. The most frequent intervention was surveillance; health teaching was the second or third most frequent intervention, depending on the patient population. All that is changing as nurse coaches are becoming more common and helping nurses achieve success. HHS Vulnerability Disclosure, Help 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. The art and science of nurse coaching: A provider's guide to coaching, scope and competencies. Advanced Practice Nurse Guidance and Coaching Competency: Theoretical and Empirical Perspectives Nurse health coaches focus on chronic disease prevention through lifestyle and integrative healthcare techniques. 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 Adapted from the U.S. Patient education involves helping patients become better informed about their condition, medical procedures, and choices they have regarding treatment. The APN coaching process can best be understood as an intervention. Because the GRACE model is similar to the TCM and CTI models, it will not be discussed further here. 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). As APN-based transitional care programs evolve, researchers are examining whether other, sometimes less expensive providers can offer similar services and achieve the same outcome. APNs involve the patients significant other or patients proxy, as appropriate. Patient teaching and education (see Chapter 7) directly relates to APN coaching. Referred to as the GRACE model (Counsell etal., 2006). Participants evaluated the structure and function, as well as the value, of the coaching circle. How do you think guidance and coaching in the advanced practice role is different from the RN role of teaching/coaching? In this stage, people intend to make a change within the next 6 months. Coaching is a relatively new application to promote the development of leadership skills in health care and nursing. The most frequent intervention was surveillance; health teaching was the second or third most frequent intervention, depending on the patient population. Method: Consultation 5. Transitions are paradigms for life and living. Hill LA, Sawatzky JA. The APN uses self-reflection during and after interactions with patients, classically described as reflection-in-action and reflection-on-action (Schn, 1983, 1987). Table 8-2 lists some transitions, based on this typology, that might require APN coaching. 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). 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. 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. The APN coaching process can best be understood as an intervention. 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). Contemplation is not a commitment, and the patient is often uncertain. Bethesda, MD 20894, Web Policies Open Longevity Science, 4, 4350. Developmental, health and illness, and situational transitions are the most likely to lead to clinical encounters requiring guidance and coaching. A subtle distinction is that guidance is done by the nurse, whereas coachings focus is on empowering patients to manage their care needs. Referred to as the Naylor model (Naylor etal., 2004). Active roles for older adults in navigating care transitions: Lessons learned from the care transitions intervention. *Referred to as the Coleman model (Coleman etal., 2004) The site is secure. Empirical research findings that predate contemporary professional coaching have affirmed that guidance and coaching are characteristics of APN-patient relationships. Evidence-based care transitions models side-by-side March 2011 (adrc-tae.org/tiki-download_file.php?fileId=30310). However, all APNs must be skilled in dealing with organizational transitions, because they tend to affect structural and contextual aspects of providing care. APNs also apply their guidance and coaching skills in interactions with colleagues, interprofessional team members, students, and others. 3. Guidance and Coaching Instead of providing the patient with the answers, the coach supports the patient and provides the tools needed to manage the illness and navigate the health care system. The definition speaks to the fact that others are affected by, or can influence, transitions. 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. At least 1year of APN experience is needed to define and implement all APN role dimensions, including leadership (Baker, Advanced Practice Nurse Guidance and Coaching and Coach Certification Guidance and coaching by advanced practice nurse (APNs) have been conceptualized as a complex, dynamic, collaborative, and holistic interpersonal process mediated by the APN-patient relationship and the APN's self-reflective skills (Clarke & Spross, 1996; Spross, Clarke, & Beauregard, 2000; Spross, 2009). A nurse practitioner (NP), doing a health history on a young woman, elicited information about binge drinking that was a concern. Evidence That Advanced Practice Nurses Guide and Coach Would you like email updates of new search results? Many of these transitions have reciprocal impacts across categories. 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. This is the stage in which people are ready to take action within 1 month. 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. The aging population, increases in chronic illness, and the emphasis on preventing medical errors has led to calls for care that is more patient-centered (Devore & Champion, 2011; IOM, 2001; National Center for Quality Assurance [NCQA], 2011). 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. International Council of Nurses (ICN) | ICN - International Council of . 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 (. 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). Table 8-3 compares the three models of care transitions that used APNs. 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. Patients know that, if and when they are ready to change, the APN will collaborate with them. The advantages of coaching are numerous. Aging and Disability Resource Center, 2011; Administration on Aging, 2012). As with other APN core competencies, the coaching competency develops over time, during and after graduate education. APNs involve the patients significant other or patients proxy, as appropriate. Articles published in English between 2010 and 2021 were included. 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. Some form of coaching is inherent in nursing practice, and developing professional nurse coaching certifications should build on these skills. 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. The competency of guidance and coaching is a well-established expectation of the advanced practice nurse (APN). Guidance and coaching are part of the advance practice registered nurse (APRN) competencies, and it leads the change to a patient's healthier life. 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. 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. 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. 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. Back to Balance LLC, Psychiatric Nurse Practitioner, Cheshire, CT, 06410, (203) 403-6232, Are you struggling with anxiety, panic, depression, mood swings, difficulty focusing, poor motivation . Stages of Change 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. Situational transitions are most likely to include changes in educational, work, and family roles. This bestselling textbook provides a clear, comprehensive, and contemporary introduction to advanced practice . 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). 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. Parry and Coleman (2010) have offered useful distinctions among different strategies for helping patients: coaching, doing for patients, educating, and guiding along five dimensions (Table 8-1). These core competency domains are as follows: values and ethics for interprofessional practice; roles and responsibilities; interprofessional communication; and teams and teamwork. 8-2). Subsequent studies of CTI have demonstrated significant reductions in 30-, 90-, and 180-day hospital readmissions (Coleman, Parry, Chalmers & Min, 2006). Based on studies of smokers, Prochaska and associates (2008) learned that behavior change unfolds through stages. Coleman and colleagues have found results similar to those of TCM, a decreased likelihood of being readmitted and an increased likelihood of achieving self-identified personal goals around symptom management and functional recovery (Coleman, Smith, Frank, etal. Let's partner to . Although a number of "coaching" types and modalities exist, for example, health, wellness, personal, and life coaching, health coaching . The term is also used to refer to advising others, especially in matters of behavior or belief. (2010). Offering specific advice in this stage is counterproductive and can increase resistance and hamper progression through the stages of change. 2. 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. Studies have suggested that prior embodied experiences may play a role in the expression or the trajectory of a patients health/illness experience. Studies of the transitional care model (TCM) and care transitions intervention (CTI) have used APNs as the primary intervener. APNs must be able to explain their nursing contributions, including their relational, communication, and coaching skills, to team members. Topeka, KS. 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. 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. 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. 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. Similar to life, they may be predictable or unpredictable, joyous or painful, obvious or barely perceptible, chosen and welcomed, or unexpected and feared.

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