guidance and coaching in advanced practice nursing

In this stage, people intend to make a change within the next 6 months. Guidance Thorne (2005) has analyzed findings from a decade of qualitative research on nurse-patient relationships and communication in chronic illness care in the context of the health policy emphasis on accountable care; many findings were associated with better outcomes. The teaching-coaching role of the APN The demand for well-educated and skilled healthcare providers has never been greater. They include adapting to the physiologic and psychological demands of pregnancy, reducing risk factors to prevent illness, changing unhealthy lifestyle behaviors, and numerous other clinical phenomena. Graduate Nursing Education: Influence of Faculty and Preceptors 2019;50(4):170-175.]. Advanced practitioners are educated at masters level in advanced practice and are assessed as competent in practice, using expert knowledge and skills. They have a detailed action plan and may have already taken some action in the past year. In search of how people change. Advanced practice nurses use role modelling, teaching, clinical problem solving and change facilitation to promote evidence-based practice among . 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). 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. The most frequent intervention was surveillance; health teaching was the second or third most frequent intervention, depending on the patient population. These core competency domains are as follows: values and ethics for interprofessional practice; roles and responsibilities; interprofessional communication; and teams and teamwork. 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. 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. Following a critical content analysis, the roles and responsibilities of the forensic nurses were described and compared with the seven core competencies of advanced nursing practice as outlined . 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. Adapted from Prochaska, J.O., DiClemente, C.C., & Norcross, J.C. [1992]. 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). They are acutely aware of the hazards of the behavior and are also more aware of the advantages of changing the behavior. 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). Running Head: GUIDANCE AND COACHING FOR THE ADVANCED PRACTICE NURSE 1 Guidance and Coaching for the Advanced Expert Help Because the GRACE model is similar to the TCM and CTI models, it will not be discussed further here. Empirical research findings that predate contemporary professional coaching have affirmed that guidance and coaching are characteristics of APN-patient relationships. (From R. W. Scholl. Personal communication. 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. Assumptions Using coaching as a leadership skill assists the APN in making a significant contribution to the health care field and to employee growth and . APRNs are nurses who have met advanced educational and clinical practice requirements, and often provide services in community-based settings. Nrgaard B, Ammentorp J, Ohm Kyvik K . Rollnick and colleagues (2008) have described guiding as one of three styles of doing MI. Extensive research on the TCM has documented improved patient and institutional outcomes and led to better understanding of the nature of APN interventions. Transtheoretical Model of Behavior Change Transition Situations That Require Coaching. 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. 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. Health Care Policy Initiatives Only gold members can continue reading. 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. In practice, APNs remain aware of the possibility of multiple transitions occurring as a result of one salient transition. Making lifestyle or behavior changes are transitions; the stages of change are consistent with the characteristics of transition phases (Chick and Meleis, 1986). American Holistic Nurses Association. Our Service Charter. Topeka, KS. MeSH The most frequent intervention was surveillance; health teaching was the second or third most frequent intervention, depending on the patient population. Empirical research findings that predate contemporary professional coaching have affirmed that guidance and coaching are characteristics of APN-patient relationships. 239-240). 5. Building on findings from studies of the TCM, the CTI program supports older adults with complex medical needs as they move throughout the health care system (Parry and Coleman, 2010). 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. These factors are further influenced by individual and contextual factors. Situational transitions are most likely to include changes in educational, work, and family roles. APNs used a holistic focus that required clinical expertise, including sufficient patient contact, interpersonal competence, and systems leadership skills to improve outcomes (Brooten, Youngblut, Deatrick, etal., 2003). 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). Does it differentiate advanced practice registered nursing from floor RN nursing for you? 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). 2020 Sep;115(6):466-476. doi: 10.1007/s00063-020-00716-w. Epub 2020 Sep 1. Schumacher and Meleis (1994) have proposed four types of transitionsdevelopmental, health and illness, situational, and organizational. 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/). International Council of Nurses (ICN) | ICN - International Council of . The art and science of nurse coaching: A provider's guide to coaching, scope and competencies. 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). 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). In todays health care system, transitions are not just about illness. Guidance and Coaching Competency and Outcomes The three components share similarities but increase gradually in terms of involvement and participation for further management of the patient's condition. 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. Subsequent studies of CTI have demonstrated significant reductions in 30-, 90-, and 180-day hospital readmissions (Coleman, Parry, Chalmers & Min, 2006). J Contin Educ Nurs. future of advanced practice and how it may shape the career structure of nursing. APNs used a holistic focus that required clinical expertise, including sufficient patient contact, interpersonal competence, and systems leadership skills to improve outcomes (Brooten, Youngblut, Deatrick, etal., 2003). Our writers are specially selected and recruited, after which they undergo further training to perfect their skills for specialization purposes. 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. Evidence in the literature related to the use of coaching specifically among APNs is limited. APNs interpret these multiple sources of information to arrive at possible explanations and interventions. 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). 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. 2015 Jun;24(11-12):1576-84. doi: 10.1111/jocn.12757. Patient-Centered Care, Culturally Competent and Safe Health Care, and Meaningful Provider-Patient Communication 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. To help the reader begin to discern the subtle differences among coaching actions, the terms that inform this model are defined here, in particular, patient education, APN guidance, including anticipatory guidance, and a revised definition of APN coaching (to distinguish it from professional coaching). These ideas are consistent with elements of the TTM and offer useful ideas for assessment. 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. 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/). A nurse coach is a nurse that focuses on whole body wellness - body and mind. (From R. W. Scholl. Coaching Difficult Patients In this stage, people intend to make a change within the next 6 months. Coaching deals with empowering the sick to cope their health needs and guidance raise attentiveness, envisage, execute and maintain a compartment variation, manage illness situation and prepare patients for transitions. 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. Table 8-2 lists some transitions, based on this typology, that might require APN coaching. 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. 2004). 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. 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. 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. 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. Transitions in Health and Illness Over the last decade, the importance of interprofessional teamwork to achieve high-quality, patient-centered care has been increasingly recognized. Developmental transitions are those that reflect life cycle transitions, such as adolescence, parenthood, and aging. Epub 2015 Feb 9. Evidence-based care transitions models side-by-side March 2011 (adrc-tae.org/tiki-download_file.php?fileId=30310). 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. 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. Regular self-reflection helps APNs develop skills to describe clinical phenomena and express that which is hard to name. Accessibility National Library of Medicine Attending to the possibility of multiple transitions enables the APN to tailor coaching to the individuals particular needs and concerns. 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. 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). eCollection 2022 Jan-Dec. Reshaping Nursing Workforce Development by Strengthening the Leadership Skills of Advanced Practice Nurses. 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). 1. This site needs JavaScript to work properly. HHS Vulnerability Disclosure, Help Conflict Negotiation and Resolution Expert Answer Mentoring up: A grounded theory of nurse-to-nurse mentoring. 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). 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. The growth in programs has led to a corresponding increased demand for clinical Commentary on: Hale RL, Phillips CA. All nurses and APNs should be familiar with the patient education resources in their specialty because these resources can facilitate guidance and coaching. 8-1), in which change can be hastened with skillful guidance and coaching. 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). Rather than directing or lecturing, she asked the woman if she knew about the effects of alcohol on the body; the woman said no. The NP then asked if the woman would like to learn about the effects, to which the patient replied yes. The visit proceeded with a brief overview of the effects of alcohol and provision of more resources. Beginnings, October 2019. But nurses traditionally haven't used coaches in the same way. APNs must be able to explain their nursing contributions, including their relational, communication, and coaching skills, to team members. For example, the ability to establish therapeutic relationships and guide patients through transitions is incorporated into the DNP Essentials (American Association of Colleges of Nursing [AACN], 2006). It. Based on studies of smokers, Prochaska and associates (2008) learned that behavior change unfolds through stages. Research and development 8. Patient education involves helping patients become better informed about their condition, medical procedures, and choices they have regarding treatment. 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. Interprofessional Teams Discuss practical ways the APRN provides guidance and coaching to patients in his or her daily APRN role. 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. It applies APN core competencies to the major APN roles - including the burgeoning Nurse Practitioner role - and covers topics ranging from the evolution of APN to evidence-based . Offering advice or education at this stage can also impede progress toward successful behavior change. Nationally and internationally, chronic illnesses are leading causes of morbidity and mortality. The APN uses self-reflection during and after interactions with patients, classically described as reflection-in-action and reflection-on-action (Schn, 1983, 1987). Advanced practice competencies are discussed in relation to all advanced practice nursing and blended CNS-NP roles (case manager, acute . The physical, emotional, social, and economic burdens of chronic illness are enormous but, until recently, investing in resources to promote healthy lifestyles and prevent chronic illnesses has not been a policy priority. Referred to as the GRACE model (Counsell etal., 2006). Professional coaching now is recognized within and outside of nursing as a particular intervention, distinct from guidance, mentoring and counseling. A subtle distinction is that guidance is done by the nurse, whereas coachings focus is on empowering patients to manage their care needs. Nurse health coaches focus on chronic disease prevention through lifestyle and integrative healthcare techniques. After multiple experiences with cancer patients, one of the authors (JS) incorporated anticipatory guidance at the start of cancer chemotherapy, using the following approach. 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). Int J Nurs Stud. As a result, enrollment is expanding in academic settings that prepare advanced practice nurses for primary care and acute care roles. (2011). 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. Accountable Care Organizations and Patient-Centered Medical Homes 6. 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. 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). The competency related to teams and teamwork emphasizes relationship building as an important element of patient-centered care (see Chapter 12). Mentoring is used in a variety of professional settings. APNs are likely to move between guidance and coaching in response to their assessments of patients. [J Contin Educ Nurs. Leadership For a schematic illustration of the model, see Fig. Interprofessional Teams Based on transitional care research, the provision of transitional care is now regarded as essential to preventing error and costly readmissions to hospitals and is recognized and recommended in current U.S. health care policies (Naylor etal., 2011). Imperatives for Advanced Practice Nurse Guidance and Coaching Organizational transitions are those that occur in the environment; within agencies, between agencies, or in society. 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). Guidance can be seen as a preliminary, less comprehensive form of coaching. These initiatives suggest that APNs, administrators, and researchers need to identify those clinical populations for whom APN coaching is necessary. Design Systematic review and narrative synthesis. 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. "Organization and system-focused leadership" included the following seven leadership capability domains: 1) improving the quality of care provided; 2) enhancing professional nursing practice; 3) being an expert clinician; 4) communicating effectively; 5) mentoring and coaching; 6) providing leadership on internal and external committees and 7) 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).

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