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. 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). It is important to understand that APN guidance and coaching are not synonymous with professional coaching. As with other APN core competencies, the coaching competency develops over time, during and after graduate education. This definition is necessarily broad and can inform standards for patient education materials and programs targeting common health and illness topics. J Clin Nurs. It. J Contin Educ Nurs. (2011). 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. 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 Institute for Healthcare Improvement [IHI] has asserted that patient-centered care is central to driving improvement in health care Johnson, Abraham, Conway, etal., 2008). 239-240). In addition, each of the 6 core competencies of the APN role identified by This definition of guidance draws on dictionary definitions of the word and the use of the term in motivational interviewing (MI). 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). 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. There are several reasons for this: The foundational importance of the therapeutic APN-patient (client) relationship is not consistent with professional coaching principles. Clipboard, Search History, and several other advanced features are temporarily unavailable. Guidance Earlier work on transitions by Meleis and others is consistent with and affirms the concepts of the TTM. Topeka, KS. 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. Interpersonal Competence . The term is also used to refer to advising others, especially in matters of behavior or belief. In todays health care system, transitions are not just about illness. 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). For years, business leaders have relied on the guidance and support of career coaches to help them advance in their professions and to achieve clear personal goals as well. 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. Acute Care The competency of guidance and coaching is a well-established expectation of the advanced practice nurse (APN). National Library of Medicine This edition draws from literature on professional coaching by nurses and others to inform and build on the model of APN guidance and coaching presented in previous editions. Offering specific advice in this stage is counterproductive and can increase resistance and hamper progression through the stages of change. Patient teaching and education (see Chapter 7) directly relates to APN coaching. 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. It is important to understand that APN guidance and coaching are not synonymous with professional coaching. 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. In search of how people change. Studies of the transitional care model (TCM) and care transitions intervention (CTI) have used APNs as the primary intervener. Model of Advanced Practice Nurse Guidance and Coaching Furthermore, many APNs will have responsibilities for coaching teams to deliver patient-centered care. Early work by Schumacher and Meleis (1994) remains relevant to the APN coaching competency and contemporary interventions, often delivered by APNs, designed to ensure smooth transitions for patients as they move across settings (e.g., Coleman & Boult, 2003; Coleman & Berenson, 2004; U.S. Noting that everyone responds to this type of chemotherapy differently, JS would ask what they had heard about the drugs they would be taking. 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. 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. Teaching and counseling are significant clinical activities in nurse-midwifery (Holland & Holland, 2007) and CNS practice (Lewandoski & Adamle, 2009). Teaching and counseling are significant clinical activities in nurse-midwifery (Holland & Holland, 2007) and CNS practice (Lewandoski & Adamle, 2009). Patient education may include information about cognitive and behavioral changes but these changes cannot occur by teaching alone. Extensive research on the TCM has documented improved patient and institutional outcomes and led to better understanding of the nature of APN interventions. This is the stage in which people are ready to take action within 1 month. 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. Aging and Disability Resource Center, 2011; Administration on Aging, 2012). Conclusion These distinctions are reflected in the definitions that follow. The most frequent intervention was surveillance; health teaching was the second or third most frequent intervention, depending on the patient population. Note: The situations are categorized according to the initiating change. 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. 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. 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 term is also used to refer to advising others, especially in matters of behavior or belief. Many of these transitions have reciprocal impacts across categories. 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. Nationally and internationally, chronic illnesses are leading causes of morbidity and mortality. Log In or Register to continue 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. 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. Organizational transitions are those that occur in the environment; within agencies, between agencies, or in society. Findings were sustained for as long as 6 months after the program ended. In 2008, worldwide, over 36 million people died from conditions such as heart disease, cancers, and diabetes (World Health Organization [WHO], 2011, 2012). APNs involve the patients significant other or patients proxy, as appropriate. An important assessment prior to the next chemotherapy cycle focused on the patients responses to treatment, and what worked and what didnt work, so that a more appropriate side effect management program could be developed. PMC Click to learn more today. J Nurses Prof Dev. 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. Research and development 8. 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). 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. 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). 6. The purpose of this report is to describe the current literature related to coaching among APNs and the results of this coaching experience. 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. APNs interpret these multiple sources of information to arrive at possible explanations and interventions. 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). 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). Relapse can occur over time (e.g., several just this once, I can occasions), but even one slip can initiate a return to the old behavior. 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. Hamric created a conceptual definition model for advanced practice nursing (APN) with defining characteristics that identify several core competencies, Guidance and coaching,Consultation,Evidence-based practice, Leadership, Collaboration,Ethical decision making.Hamric 's (APN) core competencies are an umbrella for the additional role-specific . Many of these transitions have reciprocal impacts across categories. Nurse health coaches focus on chronic disease prevention through lifestyle and integrative healthcare techniques. 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). 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. 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. Ethical decision-making 3. 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. 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. 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. This article presents coaching, which facilitates the highest form of learning, as a potential strategy for promoting professional development in nursing. 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). 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). Guidance 8600 Rockville Pike When the risks of not changing the behavior are approximately equivalent to the advantages of changing, people can become stuck in ambivalence. Attending to the possibility of multiple transitions enables the APN to tailor coaching to the individuals particular needs and concerns. Health coaching and group visits are emerging as 2 effective strategies to improve patients' behavior in chronic care management. In this stage, the focus of APN coaching is to make the patient feel understood, avoid giving advice, keep lines of communication open, and convey a willingness to be available when the patient is ready to make a change. 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. APNs do this by reinforcing the health benefits of the change, and acknowledging the personal qualities and resources that the patient has tapped to make and sustain this change. *Referred to as the Coleman model (Coleman etal., 2004) future of advanced practice and how it may shape the career structure of nursing. In todays health care system, transitions are not just about illness. Care Transition Models Using Advanced Practice Nurses Teaching is an important intervention in the self-management of chronic illness and is often incorporated into guidance and coaching. 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. These competencies are the following: direct clinical practice, expert coaching and advice, consultation, research skills, clinical and professional leadership, collaboration, and ethical decision making. APNs are likely to move between guidance and coaching in response to their assessments of patients. 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. Discuss practical ways the APRN provides guidance and coaching to patients in his or her daily APRN role. They are acutely aware of the hazards of the behavior and are also more aware of the advantages of changing the behavior. Outcomes of successful transitions include subjective well-being, role mastery, and well-being of relationships (Schumacher and Meleis, 1994), all components of quality of life. Contemplation Hill LA, Sawatzky JA. Table 8-3 compares the three models of care transitions that used APNs. The APN coaching process can best be understood as an intervention. This strategy is aimed at increasing foundational staff nurse knowledge and skills. (2011). 1. Patient education involves helping patients become better informed about their condition, medical procedures, and choices they have regarding treatment. 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. With experience, APNs develop their own strategies for integrating specialty-related anticipatory guidance into their coaching activities. APNs can use the TTM model to tailor interactions and interventions to the patients specific stage of change to maximize the likelihood that they will progress through the stages of behavioral change. This bestselling textbook provides a clear, comprehensive, and contemporary introduction to advanced practice nursing today, addressing all major APRN competencies, roles, and issues. Create a marketing plan to support your value to the healthcare team. 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). 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). The competency related to teams and teamwork emphasizes relationship building as an important element of patient-centered care (see Chapter 12). 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. The APN coaching process can best be understood as an intervention. 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. According to Hamric, guidance is typically done by a nurse while coaching is something done by an advanced practice nurse (APN) because it is resolute, multipart, and collective process in which the APN works with the patient and their families to achieve attainable goals which are thought of together (2014). The growth in programs has led to a corresponding increased demand for clinical Participants evaluated the structure and function, as well as the value, of the coaching circle. Aging and Disability Resource Center, 2011; Administration on Aging, 2012). 2004). Adapted from the U.S. 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. Transtheoretical Model of Behavior Change Disclaimer. Attending to the possibility of multiple transitions enables the APN to tailor coaching to the individuals particular needs and concerns. Clinical coaching is a relationship for the purpose of building skills. FIG 8-2 Coaching competency of the advanced practice nurse. They reflect changes in structures and resources at a system level. 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. Aging and Disability Resource Center. Contemplation is not a commitment, and the patient is often uncertain. 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. Self-reflection is the deliberate internal examination of experience so as to learn from it. 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. Evidence That Advanced Practice Nurses Guide and Coach HHS Vulnerability Disclosure, Help Aging and Disability Resource Center, 2011, Schumacher and Meleis (1994) have defined the term. Nrgaard B, Ammentorp J, Ohm Kyvik K . These initiatives suggest that APNs, administrators, and researchers need to identify those clinical populations for whom APN coaching is necessary. Guidance and coaching are part of the advance practice registered nurse (APRN) competencies, and it leads the change to a patient's healthier life. 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. 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). 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. Patient Education Wise APNs pay attention to all four types of transitions in their personal and professional lives. Debates started in the late 1980s and early 1990s as service and strategic interest in advanced nurse roles grew (Kaufman, 1996; Developmental, health and illness, and situational transitions are the most likely to lead to clinical encounters requiring guidance and coaching. Log In or, 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), The competency of guidance and coaching is a well-established expectation of the advanced practice nurse (APN). Tran AN, Nevidjon B, Derouin A, Weaver S, Bzdak M. J Nurses Prof Dev. Referred to as the GRACE model (Counsell etal., 2006). 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. 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. Self-Reflection 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). International Council of Nurses (ICN) | ICN - International Council of . 2. 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. Data sources: Review of coaching literature in psychology, sports, business, and nursing.
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