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

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. Developmental transitions are those that reflect life cycle transitions, such as adolescence, parenthood, and aging. Transtheoretical Model of Behavior Change 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. In this chapter, health and illness transitions are defined as transitions driven by an individuals experience of the body in a holistic sense. FIG 8-2 Coaching competency of the advanced practice nurse. 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. The competency related to teams and teamwork emphasizes relationship building as an important element of patient-centered care (see Chapter 12). Change is conceptualized as a five-stage process (Fig. Leadership For a schematic illustration of the model, see Fig. Costeira C, Dixe MA, Querido A, Vitorino J, Laranjeira C. SAGE Open Nurs. The purpose of this report is to describe the current literature related to coaching among APNs and the results of this coaching experience. Patient teaching and education (see Chapter 7) directly relates to APN coaching. Transitions can also be characterized according to type, conditions, and universal properties. A subtle distinction is that guidance is done by the nurse, whereas coachings focus is on empowering patients to manage their care needs. 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 . The APN can utilize both mentoring and coaching as leadership skills in practice. 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. sharing sensitive information, make sure youre on a federal 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. APRNs are nurses who have met advanced educational and clinical practice requirements, and often provide services in community-based settings. Guidance and Coaching Competency and Outcomes For example, the ability to establish therapeutic relationships and guide patients through transitions is incorporated into the. The teaching-coaching role of the APN The demand for well-educated and skilled healthcare providers has never been greater. At least 1year of APN experience is needed to define and implement all APN role dimensions, including leadership (Baker, PMC Self-reflection is the deliberate internal examination of experience so as to learn from it. 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. 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). Why or why not? 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. Conclusion APNs are likely to move between guidance and coaching in response to their assessments of patients. The aim in offering this model is not only to help APNs understand what coaching is but to give them language by which to explain their interpersonal effectiveness. Are there certain elements of this competency that are more important than others? Only gold members can continue reading. 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). These distinctions are reflected in the definitions that follow. Active roles for older adults in navigating care transitions: Lessons learned from the care transitions intervention. Evocation requires close attention to the patients statements and emotions to uncover possible motivations that will move the patient forward; so, interventions in this stage are not directed toward overcoming resistance or increasing adherence or compliance to treatment. 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. 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. 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 must be able to explain their nursing contributions, including their relational, communication, and coaching skills, to team members. 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/). Silver Spring, MD: Nursebooks.org Beginnings, December 2019. 1. 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). Referred to as the GRACE model (Counsell etal., 2006). 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. Rollnick and colleagues (2008) have described guiding as one of three styles of doing MI. Precontemplation To qualify as a medical or health care home or ACO, practices must engage patients and develop communication strategies. 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). 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). 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. Let's partner to . Advanced practitioners are educated at masters level in advanced practice and are assessed as competent in practice, using expert knowledge and skills. 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. 3. 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. This article chronicles a typical patient's journey through a post-hospital discharge nursing research study involving APNs as "intervention . 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. Coaching competency of the advanced practice nurse. Definitions: Teaching, Guidance, and Coaching As interprofessional teamwork becomes more integrated into health care, guidance and coaching will likely be seen as a transdisciplinary, patient-centered approach to helping patients but will be expressed differently, based on the discipline and experience of the provider. 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). TABLE 8-3 APNs also apply their guidance and coaching skills in interactions with colleagues, interprofessional team members, students, and others. 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. Open Longevity Science, 4, 4350. Schumacher and Meleis (1994) have proposed four types of transitionsdevelopmental, health and illness, situational, and organizational. 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. Accessibility 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). Applications to addictive behaviours. 239-240). 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. This definition is necessarily broad and can inform standards for patient education materials and programs targeting common health and illness topics. 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. In search of how people change. 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. 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. Adapted from the U.S. In this stage, people intend to make a change within the next 6 months. Referred to as the Naylor model (Naylor etal., 2004). APNs involve the patients significant other or patients proxy, as appropriate. The preceptors and sites must meet standards established by the academic institution, advanced practice nurse certification organizations, and state legislatures. 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. Active roles for older adults in navigating care transitions: Lessons learned from the care transitions intervention. Hill LA, Sawatzky JA. 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. APN-led patient education and monitoring programs for specific clinical populations have demonstrated that coaching is central to their effectiveness (Crowther, 2003; Brooten, Naylor, York, etal., 2002; Marineau, 2007). 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). This strategy is aimed at increasing foundational staff nurse knowledge and skills. 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. Clinical Nurse Specialist<br>Direct clinical practice--includes expertise in advanced assessment, implementing nursing care, and evaluating outcomes.<br>Expert coaching and guidance encompassing . The evolving criteria and requirements for certification of professional coaches are not premised on APN coaching skills. Topeka, KS. As with other APN core competencies, the coaching competency develops over time, during and after graduate education. They are acutely aware of the hazards of the behavior and are also more aware of the advantages of changing the behavior. Guidance Disclaimer. Studies of the transitional care model (TCM) and care transitions intervention (CTI) have used APNs as the primary intervener. Patient teaching and education (see Chapter 7) directly relates to APN coaching. 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. 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). 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. Transition Situations That Require Coaching 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). Before You may also needDirect Clinical PracticeThe Certified Nurse-MidwifeHealth Policy Issues in Changing EnvironmentsLeadershipIntegrative Review of Outcomes and Performance Improvement Research on Advanced Practice NursingConceptualizations of Advanced Practice NursingUnderstanding Regulatory, Legal, and Credentialing RequirementsRole Development of the Advanced Practice Nurse It. New to this edition NEW! 8600 Rockville Pike Wise APNs pay attention to all four types of transitions in their personal and professional lives. Both guidance and coaching competencies are equally important elements that help in the treatment of a patient. It is mediated by the APN-patient relationship and the APNs self-reflective skills and interpersonal, clinical, and technical skills. 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. (2010). Empirical research findings that predate contemporary professional coaching have affirmed that guidance and coaching are characteristics of APN-patient relationships. In identifying these elements, the model of APN guidance and coaching breaks down what is really a holistic, flexible, and often indescribable process. It is mediated by the APN-patient relationship and the APNs self-reflective skills and interpersonal, clinical, and technical skills. 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. 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. Please enable it to take advantage of the complete set of features! Although we believe that guidance is distinct from coaching, more work is needed to illuminate the differences and relationships between the two. Subsequent studies of CTI have demonstrated significant reductions in 30-, 90-, and 180-day hospital readmissions (Coleman, Parry, Chalmers & Min, 2006). Development of Advanced Practice Nurses Coaching Competence 8-2). Contemplation is not a commitment, and the patient is often uncertain. 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. 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. Aging and Disability Resource Center, 2011; Administration on Aging, 2012). Accountable care initiatives are an opportunity to implement these findings and evaluate and strengthen the guidance and coaching competency of APNs. Guidance can be seen as a preliminary, less comprehensive form of coaching. Experienced APNs are more likely than inexperienced APNs to pay attention to feelings and intuitions. 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. The advantages of coaching are numerous. What is a nurse coach? 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. 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). Click to learn more today. Patient Education Adapted from Parry, C. & Coleman, E. A. The Joint Commission (TJC) published the Roadmap for Hospitals in 2010. 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). Adapted from the U.S. 6. International Council of Nurses (ICN) | ICN - International Council of . 2022 Jul 15;8:23779608221113864. doi: 10.1177/23779608221113864. Attending to the possibility of multiple transitions enables the APN to tailor coaching to the individuals particular needs and concerns. The term is also used to refer to advising others, especially in matters of behavior or belief. Epub 2015 Feb 9. Chapter Contents 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. The three components share similarities but increase gradually in terms of involvement and participation for further management of the patient's condition. 1. 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). Instead of providing the patient with the answers, the coach supports the patient and provides the tools needed to manage the illness and navigate the health care system. 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 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 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. Personal communication. Health coaching and group visits are emerging as 2 effective strategies to improve patients' behavior in chronic care management. This article presents coaching, which facilitates the highest form of learning, as a potential strategy for promoting professional development in nursing. They have a detailed action plan and may have already taken some action in the past year. FIG 8-1 Prochaskas stages of change: The five stages of change. 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. 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. Over the last decade, the importance of interprofessional teamwork to achieve high-quality, patient-centered care has been increasingly recognized. 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. D eliberations in the UK on regu-lating advanced nursing prac-tice have been long and com-plex, spanning over 20 years. When the risks of not changing the behavior are approximately equivalent to the advantages of changing, people can become stuck in ambivalence. There are a number of issues that must be considered by both students and preceptors when negotiating a clinical experienceandragological, curricular, credentialing, and legal matters must be satisfied . The competency of guidance and coaching is a well-established expectation of the advanced practice nurse (APN). 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). 2. 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). In identifying these elements, the model of APN guidance and coaching breaks down what is really a holistic, flexible, and often indescribable process. Such guidance needs to be wisely crafted to avoid leading the witness or creating self-fulfilling prophecies (see Exemplar 8-1). 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. . Careers. How do you think guidance and coaching in the advanced practice role is different from the RN role of teaching/coaching?