guidance and coaching in advanced practice nursing guidance and coaching in advanced practice nursing

APNs develop additional competencies in direct practice and in the guidance and coaching of individuals and families through developmental, health- illness, and situational transitions . APNs also apply their guidance and coaching skills in interactions with colleagues, interprofessional team members, students, and others. Both guidance and coaching competencies are equally important elements that help in the treatment of a patient. 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. Guidance Early studies of the model from which TCM evolved have provided substantive evidence of the range and focus of teaching and counseling activities undertaken initially by CNSs, and later NPs, who provided care to varied patient populations. 2019 May/Jun;35(3):152-159. doi: 10.1097/NND.0000000000000534. 8600 Rockville Pike It. 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. Coaching and guidance 4. Imperatives for Advanced Practice Nurse Guidance and Coaching Interprofessional Teams Coaching as a Model for Facilitating the Performance, Learning, and Development of Palliative Care Nurses. Examination Level Eligibility Criteria ; NC-BC (Nurse Coach Board Certified) HWNC-BC (Health and Wellness Nurse Coach Board Certified) - same exam as NC-BC - must hold AHNCC Holistic Certification: Unrestricted, current U.S. RN license* Active practice as an RN for a minimum of 2 years full-time or 4,000 hours part-time within the past 5 years if you have a Baccalaureate Degree in . Bookshelf 1. At least 1year of APN experience is needed to define and implement all APN role dimensions, including leadership (Baker, Self-reflection is the deliberate internal examination of experience so as to learn from it. 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. For example, the ability to establish therapeutic relationships and guide patients through transitions is incorporated into the. Many of these transitions have reciprocal impacts across categories. 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). Advanced practice nurses use role modelling, teaching, clinical problem solving and change facilitation to promote evidence-based practice among . Early studies of the model from which TCM evolved have provided substantive evidence of the range and focus of teaching and counseling activities undertaken initially by CNSs, and later NPs, who provided care to varied patient populations. 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. 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. Overview of the Model FOIA sharing sensitive information, make sure youre on a federal The deliberate use of guidance in situations that are acute, uncertain, or time-constrained, offers patients and families ideas for examining alternatives or identifying likely responses. Disclaimer. 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). Accountable care initiatives are an opportunity to implement these findings and evaluate and strengthen the guidance and coaching competency of APNs. Precontemplation 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. 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. Aging and Disability Resource Center, 2011; Administration on Aging, 2012). 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. Topeka, KS. Definitions: Teaching, Guidance, and Coaching J Contin Educ Nurs. 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). With experience, APNs develop their own strategies for integrating specialty-related anticipatory guidance into their coaching activities. Evidence-based care transitions models side-by-side March 2011 (adrc-tae.org/tiki-download_file.php?fileId=30310). 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). 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). Hill LA, Sawatzky JA. 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. In 2008, worldwide, over 36 million people died from conditions such as heart disease, cancers, and diabetes (World Health Organization [WHO], 2011, 2012). 8-1), in which change can be hastened with skillful guidance and coaching. 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. 8-2). 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. APNs bring their reflections-in-action to their post-encounter reflections on action. A nurse practitioner (NP), doing a health history on a young woman, elicited information about binge drinking that was a concern. Experienced APNs are more likely than inexperienced APNs to pay attention to feelings and intuitions. 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). Transitions can also be characterized according to type, conditions, and universal properties. 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 (. Silver Spring, MD: Nursebooks.org Beginnings, December 2019. International Council of Nurses (ICN) | ICN - International Council of . 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. 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). Developmental transitions are those that reflect life cycle transitions, such as adolescence, parenthood, and aging. 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. Table 8-3 compares the three models of care transitions that used APNs. The publication of these competencies, together with research on interprofessional work in the health professions (e.g., Reeves, Zwarenstein, Goldman, etal., 2010), are helping educators determine how best to incorporate interprofessional competencies into APN education. 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. 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). 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). 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). New to this edition NEW! 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. American Psychologist, 47, 1102.) The deliberate use of guidance in situations that are acute, uncertain, or time-constrained, offers patients and families ideas for examining alternatives or identifying likely responses. 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. Patient education is important to enable individuals to better care for themselves and make informed decisions regarding medical care (, www.enotes.com/patient-education-reference/patient-education, 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). Cooperation 6. Only gold members can continue reading. Over the last decade, the importance of interprofessional teamwork to achieve high-quality, patient-centered care has been increasingly recognized. Developmental, health and illness, and situational transitions are the most likely to lead to clinical encounters requiring guidance and coaching. In this chapter, health and illness transitions are defined as transitions driven by an individuals experience of the body in a holistic sense. This definition is necessarily broad and can inform standards for patient education materials and programs targeting common health and illness topics. The definition speaks to the fact that others are affected by, or can influence, transitions. Share this:Click to share on Twitter (Opens in new window)Click to share on Facebook (Opens in new window)Click to share on Google+ (Opens in new window) Rollnick and colleagues (2008) have described guiding as one of three styles of doing MI. This bestselling textbook provides a clear, comprehensive, and contemporary introduction to advanced practice nursing today, addressing all major APRN competencies, roles, and issues. Our writers are specially selected and recruited, after which they undergo further training to perfect their skills for specialization purposes. 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. 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). Beginnings, June 2019. 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. 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. This description of transitions as a focus for APN coaching underscores the need for and the importance of a holistic orientation to caring for patients. This article presents coaching, which facilitates the highest form of learning, as a potential strategy for promoting professional development in nursing. Precontemplators are not interested in learning more, thinking about, or discussing their high-risk behaviors. 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. 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. 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. Costeira C, Dixe MA, Querido A, Vitorino J, Laranjeira C. SAGE Open Nurs. 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. Referred to as the GRACE model (Counsell etal., 2006). What is a nurse coach? 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. Patient education may include information about cognitive and behavioral changes but these changes cannot occur by teaching alone. "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 Resource Hamric & Hanson's advanced practice nursing : an integrative approach, [edited by] Mary Fran Tracy, . 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. and transmitted securely. Murray LA, Buckley K. Using simulation to improve communication skills in nurse practitioner preceptors. To qualify as a medical or health care home or ACO, practices must engage patients and develop communication strategies. MeSH Kreisberg (2015) distinguished health coaching from . 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. PMC eCollection 2022 Jan-Dec. Reshaping Nursing Workforce Development by Strengthening the Leadership Skills of Advanced Practice Nurses. Personal communication. View Guidance and Coaching Competency.docx from NUR 5081 at William Paterson University. APNs should also be alert to expressions of emotions about the unhealthy behavior because these are often opportunities to raise a patients awareness of the impact of the unhealthy behavior, an important precursor to committing to change. J Nurses Prof Dev. The purpose of this paper was to describe evidenced-based interventions as implemented by advanced practice nurses (APNs) conducting intervention research with a vulnerable population of blood and marrow transplant patients. 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. Strategies for Developing and Applying the Coaching Competency The term is also used to refer to advising others, especially in matters of behavior or belief. Care Transition Models Using Advanced Practice Nurses, *Referred to as the Coleman model (Coleman etal., 2004). They have a detailed action plan and may have already taken some action in the past year. 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. A subtle distinction is that guidance is done by the nurse, whereas coachings focus is on empowering patients to manage their care needs. In contrast to mentoring, coaching can specifically be used for guidance related to a specific event, new assignment, or new challenge, with specific objectives in mind. 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). In search of how people change. 10.1111/jocn.14636. Guidance and Coaching Regular self-reflection helps APNs develop skills to describe clinical phenomena and express that which is hard to name. [2012]. 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. Nationally and internationally, chronic illnesses are leading causes of morbidity and mortality. Burden of Chronic Illness Nurses typically have opportunities to educate patients during bedside conversations or by providing prepared pamphlets or handouts. Conflict Negotiation and Resolution 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. Teaching and counseling are significant clinical activities in nurse-midwifery (Holland & Holland, 2007) and CNS practice (Lewandoski & Adamle, 2009). APNs also attend to patterns, consciously and subconsciously, that develop intuition and contribute to their clinical acumen. Data sources: Review of coaching literature in psychology, sports, business, and nursing. 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. Attending to the possibility of multiple transitions enables the APN to tailor coaching to the individuals particular needs and concerns. Nurses typically have opportunities to educate patients during bedside conversations or by providing prepared pamphlets or handouts. Unauthorized use of these marks is strictly prohibited. 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). Teaching is an important intervention in the self-management of chronic illness and is often incorporated into guidance and coaching. 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. Definitions: Teaching, Guidance, and Coaching 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). For example, Chick and Meleis (1986) have characterized the process of transition as having phases during which individuals go through five phases (see earlier). Coaching is a relatively new application to promote the development of leadership skills in health care and nursing. Let's partner to . Noting that everyone responds to this type of chemotherapy differently, JS would ask what they had heard about the drugs they would be taking. 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. Advanced Practice Nursing: Essential Knowledge for the Profession, Third Edition is a core advanced practice text used i. Anmelden; Registrierung; . Offering specific advice in this stage is counterproductive and can increase resistance and hamper progression through the stages of change. 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. adrc-tae.org/tiki-download_file.php?fileId=30310, Extensive research on the TCM has documented improved patient and institutional outcomes and led to better understanding of the nature of APN interventions. Coverage of the full breadth of APRN core competencies defines and describes all competencies, including direct clinical practice, guidance and coaching, evidence-based practice, leadership, . . 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? 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). Some form of coaching is inherent in nursing practice, and developing professional nurse coaching certifications should build on these skills. Individual and Contextual Factors That Influence Advanced Practice Nurse Guidance and Coaching 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. 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. Topeka, KS. Accountable care initiatives are an opportunity to implement these findings and evaluate and strengthen the guidance and coaching competency of APNs. Click to learn more today. 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. There are several reasons for this: The foundational importance of the therapeutic APN-patient (client) relationship is not consistent with professional coaching principles. 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. Related 2019;50(4):170-175.]. 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. Distinctions Among Coaching and Other Processes Attending to the possibility of multiple transitions enables the APN to tailor coaching to the individuals particular needs and concerns. Earlier work on transitions by Meleis and others is consistent with and affirms the concepts of the TTM. 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). 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 . (2010). The https:// ensures that you are connecting to the 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. 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). 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). 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). (2011). In practice, APNs remain aware of the possibility of multiple transitions occurring as a result of one salient transition. Assumptions 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. 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). 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). Understanding patients perceptions of transition experiences is essential to effective coaching. Advanced Practice Nurse Guidance and Coaching Competency: Theoretical and Empirical Perspectives Med Klin Intensivmed Notfmed. Transtheoretical Model of Behavior Change Self-reflection is the deliberate internal examination of experience so as to learn from it. 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. The competency related to teams and teamwork emphasizes relationship building as an important element of patient-centered care (see Chapter 12). 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). 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. Patients know that, if and when they are ready to change, the APN will collaborate with them.