guidance and coaching in advanced practice nursing

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. 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. 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). Nationally and internationally, chronic illnesses are leading causes of morbidity and mortality. 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). Empirical research findings that predate contemporary professional coaching have affirmed that guidance and coaching are characteristics of APN-patient relationships. 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, Patient-Centered Care, Culturally Competent and Safe Health Care, and Meaningful Provider-Patient Communication. Coaching and guidance are structured approaches that can be used within or alongside patient decision aids (PtDAs) to facilitate the process of decision making. 10.1111/jocn.14636. Anticipatory guidance is a particular type of guidance aimed at helping patients and families know what to expect. Precontemplators are not interested in learning more, thinking about, or discussing their high-risk behaviors. 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). Teaching and counseling are significant clinical activities in nurse-midwifery (Holland & Holland, 2007) and CNS practice (Lewandoski & Adamle, 2009). 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. The most frequent intervention was surveillance; health teaching was the second or third most frequent intervention, depending on the patient population. Some health and illness changes are self-limiting (e.g., the physiologic changes of pregnancy), whereas others are long term and may be reversible or irreversible. 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). 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. 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. official website and that any information you provide is encrypted 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. In this stage, people intend to make a change within the next 6 months. Empirical research findings that predate contemporary professional coaching have affirmed that guidance and coaching are characteristics of APN-patient relationships. Over the last decade, the importance of interprofessional teamwork to achieve high-quality, patient-centered care has been increasingly recognized. Definitions: Teaching, Guidance, and Coaching Self-Reflection Some form of coaching is inherent in nursing practice, and developing professional nurse coaching certifications should build on these skills. Guidance can be seen as a preliminary, less comprehensive form of coaching. 2004). Teaching is an important intervention in the self-management of chronic illness and is often incorporated into guidance and coaching. Does it differentiate advanced practice registered nursing from floor RN nursing for you? Exemplar 8-1Anticipatory Guidance in Primary and Acute Care. APNs are likely to move between guidance and coaching in response to their assessments of patients. 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). 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. 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). (From R. W. Scholl. Guidance and coaching in the nursing practice are part of the work of nursing midwives, clinical specialist nurses, and nurse practitioners. Transitions can also be characterized according to type, conditions, and universal properties. Key Features 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. Understanding patients perceptions of transition experiences is essential to effective coaching. Although we believe that guidance is distinct from coaching, more work is needed to illuminate the differences and relationships between the two. 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. J Clin Nurs. Aging and Disability Resource Center. Course Hero uses AI to attempt to automatically extract content from documents to surface to you and others so you can study better, e.g., in search results, to enrich docs, and more. Organizational transitions are those that occur in the environment; within agencies, between agencies, or in society. 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 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). Topeka, KS. It is important to understand that APN guidance and coaching are not synonymous with professional coaching. future of advanced practice and how it may shape the career structure of nursing. 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). Some health and illness changes are self-limiting (e.g., the physiologic changes of pregnancy), whereas others are long term and may be reversible or irreversible. With experience, APNs develop their own strategies for integrating specialty-related anticipatory guidance into their coaching activities. 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). Definitions: Teaching, Guidance, and Coaching 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). Design Systematic review and narrative synthesis. APN coaching is analogous to the flexible and inventive playing of a jazz musician. The four pillars of advanced practice are clinical practice, leadership and management, education, and research. 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. Extensive research on the TCM has documented improved patient and institutional outcomes and led to better understanding of the nature of APN interventions. Patient teaching and education (see Chapter 7) directly relates to APN coaching. Data sources Articles were identified through a search of CINAHL, Medline, Scopus, and PsychINFO databases. (2010). This is the stage in which people are ready to take action within 1 month. Advanced practice nursing is more a concept than a defined role and cannot be described as a specific set of skills or regu- . TABLE 8-2 Rollnick and colleagues (2008) have described guiding as one of three styles of doing MI. Patient-Centered Care, Culturally Competent and Safe Health Care, and Meaningful Provider-Patient Communication In 2008, worldwide, over 36 million people died from conditions such as heart disease, cancers, and diabetes (World Health Organization [WHO], 2011, 2012). As health care reform in the United States steadily moves the pendulum from sickness and disease to wellness and prevention, new interventions have arisen in the name of coaching to guide and thus improve the life, health, and health risk of individuals. 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. Adapted from Prochaska, J.O., DiClemente, C.C., & Norcross, J.C. [1992]. Many of these transitions have reciprocal impacts across categories. 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. 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). Strategies for Developing and Applying the Coaching Competency 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). 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. There are a number of issues that must be considered by both students and preceptors when negotiating a clinical experienceandragological, curricular, credentialing, and legal . Exemplar 8-1Anticipatory Guidance in Primary and Acute Care Evidence in the literature related to the use of coaching specifically among APNs is limited. This chapter explores the complex processes of APN role development, with the objectives of providing the following: (1) an understanding of related concepts and research; (2) anticipatory guidance for APN students; (3) role facilitation strategies for new APNs, APN preceptors, faculty, administrators, and interested colleagues; and (4) A nurse practitioner (NP), doing a health history on a young woman, elicited information about binge drinking that was a concern. Based on studies of smokers, Prochaska and associates (2008) learned that behavior change unfolds through stages. The most frequent intervention was surveillance; health teaching was the second or third most frequent intervention, depending on the patient population. Making lifestyle or behavior changes are transitions; the stages of change are consistent with the characteristics of transition phases (Chick and Meleis, 1986). 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. 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. 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). Evidence-based care transitions models side-by-side March 2011 (adrc-tae.org/tiki-download_file.php?fileId=30310). 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. Earlier work on transitions by Meleis and others is consistent with and affirms the concepts of the TTM. Hill LA, Sawatzky JA. 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). Imperatives for Advanced Practice Nurse Guidance and Coaching Furthermore, many APNs will have responsibilities for coaching teams to deliver patient-centered care. 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. In addition, each of the 6 core competencies of the APN role identified by Noting that everyone responds to this type of chemotherapy differently, JS would ask what they had heard about the drugs they would be taking. Addressing all major advanced practice nursing competencies, roles, and issues, Advanced Practice Nursing: An Integrative Approach, 5th Edition provides a clear, comprehensive, and . Quantitative studies, qualitative studies, and anecdotal reports have suggested that coaching patients and staff through transitions is embedded in the practices of nurses (Benner, Hooper-Kyriakidis, etal., 1999), and particularly APNs (Bowles, 2010; Cooke, Gemmill, & Grant, 2008; Dick & Frazier, 2006; Hayes & Kalmakis, 2007; Hayes, McCahon, Panahi, etal., 2008; Link, 2009; Mathews, Secrest, & Muirhead, 2008; Parry & Coleman, 2010). 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. 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 . APNs bring their reflections-in-action to their post-encounter reflections on action. 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. Distinctions Among Coaching and Other Processes 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. Clinical Nurse Specialist<br>Direct clinical practice--includes expertise in advanced assessment, implementing nursing care, and evaluating outcomes.<br>Expert coaching and guidance encompassing . Interpersonal Competence Many of these transitions have reciprocal impacts across categories. 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. APNs interpret these multiple sources of information to arrive at possible explanations and interventions. Create a marketing plan to support your value to the healthcare team. Evidence-based care transitions models side-by-side March 2011 (adrc-tae.org/tiki-download_file.php?fileId=30310). Developmental, health and illness, and situational transitions are the most likely to lead to clinical encounters requiring guidance and coaching. 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 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. Patient Education 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. 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. The APN can utilize both mentoring and coaching as leadership skills in practice. Review Methods Quality . 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). 5. Discuss practical ways the APRN provides guidance and coaching to patients in his or her daily APRN role. 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/). Referred to as the Naylor model (Naylor etal., 2004). For example, Chick and Meleis (1986) have characterized the process of transition as having phases during which individuals go through five phases (see earlier). 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. Advanced Practice Nurses and Models of Transitional Care Earlier work on transitions by Meleis and others is consistent with and affirms the concepts of the TTM. Professional & Expert Writers: Studymonk only hires the best. Ethical decision-making 3. However, reflecting on satisfying and successful experiences and discerning why they were effective contributes to developing competence and expertise and reveals knowledge about assessments and interventions that will be useful in future interactions. 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. They have the freedom and authority to act, making autonomous decisions in the assessment, diagnosis and . 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. Patient education may include information about cognitive and behavioral changes but these changes cannot occur by teaching alone. 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. 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). In this stage, people intend to make a change within the next 6 months. Studies of the transitional care model (TCM) and care transitions intervention (CTI) have used APNs as the primary intervener. Addressing all major advanced practice nursing competencies, roles, and issues, Advanced Practice Nursing: An Integrative Approach, 5th Edition provides a clear, comprehensive, and current introduction to APN today. International Council of Nurses (ICN) | ICN - International Council of . Transtheoretical Model of Behavior Change 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. Adapted from Parry, C. & Coleman, E. A. With contemplators, the focus of APN coaching is to try to tip the decisional balance. Topeka, KS. Such guidance needs to be wisely crafted to avoid leading the witness or creating self-fulfilling prophecies (see Exemplar 8-1). 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 guide is to advise or show the way to others, so guidance can be considered the act of providing counsel by leading, directing, or advising. 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.

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