guidance and coaching in advanced practice nursing

Guidance and coaching in the role of a registered nurse (RN) Murray LA, Buckley K. Using simulation to improve communication skills in nurse practitioner preceptors. Because the GRACE model is similar to the TCM and CTI models, it will not be discussed further here. Unable to load your collection due to an error, Unable to load your delegates due to an error. 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). Table 8-3 compares the three models of care transitions that used APNs. J Prof Nurs. The evolving criteria and requirements for certification of professional coaches are not premised on APN coaching skills. 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. Offering advice or education at this stage can also impede progress toward successful behavior change. 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). 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). Running Head: GUIDANCE AND COACHING FOR THE ADVANCED PRACTICE NURSE 1 Guidance and Coaching for the Advanced Expert Help . Mary Lowisz - Clinical Nurse Specialist - UW Health | LinkedIn In todays health care system, transitions are not just about illness. Aging and Disability Resource Center, 2011; Administration on Aging, 2012). Guidance and coaching is a core competency of advanced practice nursing Similar to life, they may be predictable or unpredictable, joyous or painful, obvious or barely perceptible, chosen and welcomed, or unexpected and feared. 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. Definitions: Teaching, Guidance, and Coaching Beginnings, October 2019. Create a marketing plan to support your value to the healthcare team. 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. Nationally and internationally, chronic illnesses are lead, U.S. Department of Health and Human Services [HSS], 2012, Centers for Disease Control and Prevention [CDC], 2010, Accountable Care Organizations and Patient-Centered Medical Homes, The Patient Protection and Affordable Care Act (PPACA; HHS, 2011) in the United States and other policy initiatives nationally and internationally are aimed at lowering health costs and making health care more effective. These ideas are consistent with elements of the TTM and offer useful ideas for assessment. Bethesda, MD 20894, Web Policies Teaching is an important intervention in the self-management of chronic illness and is often incorporated into guidance and coaching. Action Research and development 8. Interpersonal Competence For example, Chick and Meleis (1986) have characterized the process of transition as having phases during which individuals go through five phases (see earlier). Distinctions Among Coaching and Other Processes and transmitted securely. The definition speaks to the fact that others are affected by, or can influence, transitions. As with other APN core competencies, the coaching competency develops over time, during and after graduate education. With contemplators, the focus of APN coaching is to try to tip the decisional balance. 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. Commentary on: Hale RL, Phillips CA. 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). Evidence-based care transitions models side-by-side March 2011 (adrc-tae.org/tiki-download_file.php?fileId=30310). 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. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Individual and Contextual Factors That Influence Advanced Practice Nurse Guidance and Coaching 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). 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. In a clinical case study. Participants evaluated the structure and function, as well as the value, of the coaching circle. Similar to life, they may be predictable or unpredictable, joyous or painful, obvious or barely perceptible, chosen and welcomed, or unexpected and feared. Guidance and coaching are part of the advance practice registered nurse (APRN) competencies, and it leads the change to a patient's healthier life. Guidance and coaching by advanced practice nurse (APNs) have been conceptualized as a complex, dynamic, collaborative, and holistic interpersonal process mediated by the APN-patient relationship and the APN's self-reflective skills (Clarke & Spross, 1996; Spross, Clarke, & Beauregard, 2000; Spross, 2009). 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). Hamric & Hanson's Advanced Practice Nursing: An Integrative Approach Our writers are specially selected and recruited, after which they undergo further training to perfect their skills for specialization purposes. 8-1), in which change can be hastened with skillful guidance and coaching. Nurse Coach - American Holistic Nurses Advancing the Practice of Health Coaching - SAGE Journals In this chapter, health and illness transitions are defined as transitions driven by an individuals experience of the body in a holistic sense. Studies have suggested that prior embodied experiences may play a role in the expression or the trajectory of a patients health/illness experience. The term is also used to refer to advising others, especially in matters of behavior or belief. 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. APNs must be able to explain their nursing contributions, including their relational, communication, and coaching skills, to team members. Tags: Advanced Practice Nursing An Integrative Approach Graduate Nursing Education: Influence of Faculty and Preceptors Attending to the possibility of multiple transitions enables the APN to tailor coaching to the individuals particular needs and concerns. As a result, enrollment is expanding in academic settings that prepare advanced practice nurses for primary care and acute care roles. Experienced APNs are more likely than inexperienced APNs to pay attention to feelings and intuitions. In search of how people change. APN coaching is defined as a purposeful, complex, dynamic, collaborative, and holistic interpersonal process aimed at supporting and facilitating patients and families through health-related experiences and transitions to achieve health-related goals, mutually determined, whenever possible. 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. Topeka, KS. 2004). [Clinical leadership competencies in advanced nursing practice : Scoping review]. This strategy is aimed at increasing foundational staff nurse knowledge and skills. Referred to as the GRACE model (Counsell etal., 2006). APRNs' services range from primary and preventive care to mental health to birthing to anesthesia. Self-reflection is the deliberate internal examination of experience so as to learn from it. Studies have suggested that prior embodied experiences may play a role in the expression or the trajectory of a patients health/illness experience. The evolving criteria and requirements for certification of professional coaches are not premised on APN coaching skills. 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. 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. 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). Guidance can be seen as a preliminary, less comprehensive form of coaching. In doing so, it sets out what coaching is and highlights its benefits . Schumacher and Meleis (1994) have proposed four types of transitionsdevelopmental, health and illness, situational, and organizational. 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) The APN uses self-reflection during and after interactions with patients, classically described as reflection-in-action and reflection-on-action (Schn, 1983, 1987). 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. The development of all major competencies of advanced practice nursing is discussed: direct clinical practice, consultation, coaching/guidance, research, leadership, collaboration, and ethical decision-making. Precontemplation Unauthorized use of these marks is strictly prohibited. FIG 8-2 Coaching competency of the advanced practice nurse. Furthermore, many APNs will have responsibilities for coaching teams to deliver patient-centered care. Contemplation is not a commitment, and the patient is often uncertain. Assumptions [PDF] The TeachingCoaching Role of the APN | Semantic Scholar Accountable care initiatives are an opportunity to implement these findings and evaluate and strengthen the guidance and coaching competency of APNs. Care Transitions Intervention Model Care Transition Models Using Advanced Practice Nurses Eight core competency domains are delineated in the Caring advanced practice nursing model: 1. 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. 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. APNs can usually coach patients independent of setting, cognitive capacity, and stage of illness; it can be done at a distance or face to face. It is important to understand that APN guidance and coaching are not synonymous with professional coaching. 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. In 2008, worldwide, over 36 million people died from conditions such as heart disease, cancers, and diabetes (World Health Organization [WHO], 2011, 2012). Advanced practice competencies are discussed in relation to all advanced practice nursing and blended CNS-NP roles (case manager, acute . It is mediated by the APN-patient relationship and the APNs self-reflective skills and interpersonal, clinical, and technical skills. The competency related to teams and teamwork emphasizes relationship building as an important element of patient-centered care (see Chapter 12). Although technical competence and clinical competence may be sufficient for teaching a task, they are insufficient for coaching patients through transitions, including chronic illness experiences or behavioral and lifestyle changes. Exemplar 8-1Anticipatory Guidance in Primary and Acute Care. Ethical decision-making 3. Self-Reflection These competencies are the following: direct clinical practice, expert coaching and advice, consultation, research skills, clinical and professional leadership, collaboration, and ethical decision making. 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). 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. 8-2). The foundational importance of the therapeutic APN-patient (client) relationship is not consistent with professional coaching principles. With experience, APNs develop their own strategies for integrating specialty-related anticipatory guidance into their coaching activities. The APN coaching process can best be understood as an intervention. Such guidance needs to be wisely crafted to avoid leading the witness or creating self-fulfilling prophecies (see Exemplar 8-1). Accountable care initiatives are an opportunity to implement these findings and evaluate and strengthen the guidance and coaching competency of APNs. 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. J Am Assoc Nurse Pract. (From R. W. Scholl. Experienced APNs are more likely than inexperienced APNs to pay attention to feelings and intuitions. 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. Data sources: Review of coaching literature in psychology, sports, business, and nursing. In addition, patient-centered communication and interprofessional team communication are important quality and safety education for nurses (QSEN) competencies for APNs (Cronenwett, Sherwood, Pohl, etal., 2009; qsen.org/competencies/graduate-ksas/). Nurses typically have opportunities to educate patients during bedside conversations or by providing prepared pamphlets or handouts. Leadership For a schematic illustration of the model, see Fig. 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). Making lifestyle or behavior changes are transitions; the stages of change are consistent with the characteristics of transition phases (Chick and Meleis, 1986). The most frequent intervention was surveillance; health teaching was the second or third most frequent intervention, depending on the patient population. With experience, APNs develop their own strategies for integrating specialty-related anticipatory guidance into their coaching activities. TABLE 8-2 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. 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). Offering specific advice in this stage is counterproductive and can increase resistance and hamper progression through the stages of change. Examine the advanced nursing practice role for which you are being prepared (NP, Executive Leader, or Nurse Educator) and briefly describe the role including the history of the role, education and certification, and major functions of this role. Primary Care Patient Education 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). Clinical leadership in nursing practice is recognized when APNs independently control treatment processes in complex nursing situations, exert influence, develop and implement change strategies, consult, coach, train, collaborate, and establish a connection to other health professionals and management. Guidance and coaching Guidance and coaching is a core competency of advanced practice nursing. APNs involve the patients significant other or patients proxy, as appropriate. HHS Vulnerability Disclosure, Help It is mediated by the APN-patient relationship and the APNs self-reflective skills and interpersonal, clinical, and technical skills. 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. including direct clinical practice, guidance and coaching, consultation, evidence-based practice (EBP), leadership, collaboration, and . More often, one is likely to ruminate on negative experiences because the feeling of failure is more uncomfortable than the feeling of satisfaction or success. APNs can use nurses theoretical work on transitions to inform assessments and interventions during each of the TTM stages of change and tailor their guiding and coaching interventions to the stage of readiness. Data sources Articles were identified through a search of CINAHL, Medline, Scopus, and PsychINFO databases. 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). 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 term is also used to refer to advising others, especially in matters of behavior or belief. In this chapter, health and illness transitions are defined as transitions driven by an individuals experience of the body in a holistic sense. An official website of the United States government.