guidance and coaching in advanced practice nursing

APN coaching is analogous to the flexible and inventive playing of a jazz musician. Transition Situations That Require Coaching TABLE 8-2 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). 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). 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. 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. 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. Furthermore, many APNs will have responsibilities for coaching teams to deliver patient-centered care. Teaching is an important intervention in the self-management of chronic illness and is often incorporated into guidance and coaching. APNs are likely to move between guidance and coaching in response to their assessments of patients. These ideas are consistent with elements of the TTM and offer useful ideas for assessment. Adapted from Parry, C. & Coleman, E. A. In this chapter, health and illness transitions are defined as transitions driven by an individuals experience of the body in a holistic sense. In search of how people change. Professional coaching now is recognized within and outside of nursing as a particular intervention, distinct from guidance, mentoring and counseling. Coaching Difficult Patients Transitions are paradigms for life and living. Offering advice or education at this stage can also impede progress toward successful behavior change. APNs bring their reflections-in-action to their post-encounter reflections on action. Guidance is assisting by soliciting advice, education, and filling the gap of knowledge deficit as serving as a knowledge source to simplify the health care decision of a patient. Please enable it to take advantage of the complete set of features! 1. This article presents coaching, which facilitates the highest form of learning, as a potential strategy for promoting professional development in nursing. 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). In search of how people change. MeSH 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. 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). Care Transitions Intervention Model 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). Offering advice or education at this stage can also impede progress toward successful behavior change. Preparation Coaching is provided by an individual, and guidance is embedded within the decision support materials. For example, the ability to establish therapeutic relationships and guide patients through transitions is incorporated into the. APNs bring their reflections-in-action to their post-encounter reflections on action. Med Klin Intensivmed Notfmed. In todays health care system, transitions are not just about illness. 5.1. Guidance and coaching in the nursing practice are part of the work of nursing midwives, clinical specialist nurses, and nurse practitioners. Running Head: GUIDANCE AND COACHING FOR THE ADVANCED PRACTICE NURSE 1 Guidance and Coaching for the Advanced Expert Help It may involve more than one person and is embedded in the context and the situation (Chick & Meleis, 1986, pp. The focus of APN coaching is to work with the patient to avoid relapse by reviewing the stages of change, assessing the stability of the change, assessing for new stressors or reduced capacity to cope with stress, reviewing the patients plans to overcome barriers to change, reminding the patient that vigilance is required, and identifying resources for dealing with new stressors. Epub 2015 Feb 9. 239-240). The evolving criteria and requirements for certification of professional coaches are not premised on APN coaching skills. Care Transition Models Using Advanced Practice Nurses Developing clinical leaders: the impact of an action learning mentoring programme for advanced practice nurses. Aging and Disability Resource Center, 2011; Administration on Aging, 2012). 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. Individual and Contextual Factors That Influence Advanced Practice Nurse Guidance and Coaching APNs are likely to move between guidance and coaching in response to their assessments of patients. Advanced Practice Nurse Guidance and Coaching and Coach Certification Effective guidance and coaching of patients, family members, staff, and colleagues depend on the quality of the therapeutic or collegial relationships that APNs establish with them. 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. Coaching and guidance are structured approaches that can be used within or alongside patient decision aids (PtDAs) to facilitate the process of decision making. 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. This definition of guidance draws on dictionary definitions of the word and the use of the term in motivational interviewing (MI). 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. 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). 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. Topeka, KS. Judith A. Spross and Rhonda L. Babine Guidance can be seen as a preliminary, less comprehensive form of coaching. Findings were sustained for as long as 6 months after the program ended. 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 2008, worldwide, over 36 million people died from conditions such as heart disease, cancers, and diabetes (World Health Organization [WHO], 2011, 2012). Studies of the transitional care model (TCM) and care transitions intervention (CTI) have used APNs as the primary intervener. Nurse health coaches focus on chronic disease prevention through lifestyle and integrative healthcare techniques. In practice, APNs remain aware of the possibility of multiple transitions occurring as a result of one salient transition. 2017;33(1):33-9. Distinctions Among Coaching and Other Processes 2004). Extensive research on the TCM has documented improved patient and institutional outcomes and led to better understanding of the nature of APN interventions. Guidance and coaching Guidance and coaching is a core competency of advanced practice nursing. 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. Evidence That Advanced Practice Nurses Guide and Coach Topeka, KS. APNs must be able to explain their nursing contributions, including their relational, communication, and coaching skills, to team members. In medically complex patients, APNs may be preferred and less expensive coaches, in part because of their competencies and scopes of practice. APNs also apply their guidance and coaching skills in interactions with colleagues, interprofessional team members, students, and others. 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. 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). It is concluded that coaching can be a powerful tool in enhancing nurses' and other health professionals' ability to contribute to the success of healthcare organisations. Earlier work on transitions by Meleis and others is consistent with and affirms the concepts of the TTM. Hamric & Hanson's Advanced Practice Nursing, 7th Edition - 9780323777117 ISBN: 9780323777117 Copyright: 2023 Publication Date: 11-04-2022 Page Count: 736 Imprint: Elsevier List Price: $96.99 Hamric & Hanson's Advanced Practice Nursing, 7th Edition Articles published in English between 2010 and 2021 were included. Expert Answer 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. Maintenance Effective guidance and coaching of patients, family members, staff, and colleagues depend on the quality of the therapeutic or collegial relationships that APNs establish with them. Are there certain elements of this competency that are more important than others? The preceptors and sites must meet standards established by the academic institution, advanced practice nurse certification organizations, and state legislatures. The APN coaching process can best be understood as an intervention. Extensive research on the TCM has documented improved patient and institutional outcomes and led to better understanding of the nature of APN interventions. 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. Burden of Chronic Illness Individual elements of the model include clinical, technical, and interpersonal competence mediated by self-reflection. This description of transitions as a focus for APN coaching underscores the need for and the importance of a holistic orientation to caring for patients. Nrgaard B, Ammentorp J, Ohm Kyvik K . There are a number of issues that must be considered by both students and preceptors when negotiating a clinical experienceandragological, curricular, credentialing, and legal . Precontemplation Similar to life, they may be predictable or unpredictable, joyous or painful, obvious or barely perceptible, chosen and welcomed, or unexpected and feared. What is a nurse coach? APNs involve the patients significant other or patients proxy, as appropriate. 1. Tran AN, Nevidjon B, Derouin A, Weaver S, Bzdak M. J Nurses Prof Dev. Table 8-2 lists some transitions, based on this typology, that might require APN coaching. It is important to understand that APN guidance and coaching are not synonymous with professional coaching. Experienced APNs are more likely than inexperienced APNs to pay attention to feelings and intuitions. Assumptions 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). The interaction of self-reflection with these three areas of competence, and clinical experiences with patients, drive the ongoing expansion and refinement of guiding and coaching expertise in advanced practice 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). Thoroughly revised and updated, the 7 th edition of this bestselling text covers topics ranging from the evolution of advanced practice nursing to evidence-based practice, leadership, ethical decision-making, and health policy. 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. In this stage, because ambivalence is not yet completely resolved, the focus of APN coaching is to offer support related to the patients action plan and to determine the strength of the commitment. (2010). It may involve more than one person and is embedded in the context and the situation (Chick & Meleis, 1986, pp. APRNs are nurses who have met advanced educational and clinical practice requirements, and often provide services in community-based settings. 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. 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. Advanced Practice Nurses and Models of Transitional Care Accessibility The APN uses self-reflection during and after interactions with patients, classically described as reflection-in-action and reflection-on-action (Schn, 1983, 1987). Professional & Expert Writers: Studymonk only hires the best. They conduct client visits, use motivational interviewing techniques, and model correct strategies necessary to help patients reach self-management goals. Several assumptions underlie this model: While interacting with patients, APNs integrate observations and information gleaned from physical examinations and interviews with their own theoretical understanding, noncognitive intuitive reactions, and the observations, intuitions, and theories that they elicit from patients. 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). 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. Tags: Advanced Practice Nursing An Integrative Approach Guidance may also occur in situations in which there may be insufficient information for a patient to make an informed choice related to a desired outcome. The purpose of this report is to describe the current literature related to coaching among APNs and the results of this coaching experience. 1. Findings were sustained for as long as 6 months after the program ended. These nurses can spend most of their time teaching and counseling patients; nursing students also practice this skill. Personal communication. Even so, relapse is always possible in the action or maintenance stage and may be a response to stressful situations. Precontemplators are not interested in learning more, thinking about, or discussing their high-risk behaviors. D eliberations in the UK on regu-lating advanced nursing prac-tice have been long and com-plex, spanning over 20 years. Evidence That Advanced Practice Nurses Guide and Coach Change is conceptualized as a five-stage process (Fig. Although we believe that guidance is distinct from coaching, more work is needed to illuminate the differences and relationships between the two. However, all APNs must be skilled in dealing with organizational transitions, because they tend to affect structural and contextual aspects of providing care. The achievement and maintenance of . 8600 Rockville Pike Anticipatory guidance is a particular type of guidance aimed at helping patients and families know what to expect. Clinical and Technical Competence Guidance 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. The site is secure. Noting that everyone responds to this type of chemotherapy differently, JS would ask what they had heard about the drugs they would be taking. 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. 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. 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. 4. While eliciting information on the primary transition that led the patient to seek care, the APN attends to verbal, nonverbal, and intuitive cues to identify other transitions and meanings associated with the primary transition. Ethical decision-making 3. 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. Advanced Practice Nursing: Essential Knowledge for the Profession, Third Edition is a core advanced practice text used i. Anmelden; Registrierung; . 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. In identifying these elements, the model of APN guidance and coaching breaks down what is really a holistic, flexible, and often indescribable process. 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. Wise APNs pay attention to all four types of transitions in their personal and professional lives. Interprofessional Teams 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. The term is also used to refer to advising others, especially in matters of behavior or belief. As a member of the nursing leadership team, the advanced practice nurse (APN) is on the front line, involved with staff on a daily basis, and able to coach staff in a variety of different situations. Action 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). 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). 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. 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. Let's partner to . Currently, the TCM is a set of activities aimed at providing comprehensive in-hospital planning and home follow-up for chronically ill high risk older adults hospitalized for common medical and surgical conditions (Transitional Care Model, 2008-2009; www.transitionalcare.info/). Guidance may also occur in situations in which there may be insufficient information for a patient to make an informed choice related to a desired outcome. 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. Attending to the possibility of multiple transitions enables the APN to tailor coaching to the individuals particular needs and concerns. To qualify as a medical or health care home or ACO, practices must engage patients and develop communication strategies. Mentoring is used in a variety of professional settings. 8-2). J Nurses Prof Dev. TABLE 8-1 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. 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. After multiple experiences with cancer patients, one of the authors (JS) incorporated anticipatory guidance at the start of cancer chemotherapy, using the following approach. American Holistic Nurses Association. 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. Patient education may include information about cognitive and behavioral changes but these changes cannot occur by teaching alone. They have a detailed action plan and may have already taken some action in the past year. Clinical Nurse Specialist<br>Direct clinical practice--includes expertise in advanced assessment, implementing nursing care, and evaluating outcomes.<br>Expert coaching and guidance encompassing . Guidance and coaching are part of the advance practice registered nurse (APRN) competencies, and it leads the change to a patient's healthier life. Development of Advanced Practice Nurses Coaching Competence Clinical coaching is a relationship for the purpose of building skills. The APN uses self-reflection during and after interactions with patients, classically described as reflection-in-action and reflection-on-action (Schn, 1983, 1987). Why or why not? Guidance can be seen as a preliminary, less comprehensive form of coaching. The goals of APN guidance are to raise awareness, contemplate, implement, and sustain a behavior change, manage a health or illness situation, or prepare for transitions, including birth and end of life. 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. cal mentors and preceptors. 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. 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. 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). 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. Regardless of how difficult life becomes, patients are confident that they can sustain the changes they have achieved and will not return to unhealthy coping mechanisms. Patients know that, if and when they are ready to change, the APN will collaborate with them. 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. Hamric & Hanson's Advanced Practice Nursing: An Integrative Approach: 9780323777117: Medicine & Health Science Books @ Amazon.com . 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)

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