guidance and coaching in advanced practice nursing

Change is conceptualized as a five-stage process (Fig. 2004). Related Advanced practice is a level of practice, rather than a type or specialty of practice. In todays health care system, transitions are not just about illness. 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. Model of Advanced Practice Nurse Guidance and Coaching 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. Are there certain elements of this competency that are more important than others? 5.1. The site is secure. 2020 Sep;115(6):466-476. doi: 10.1007/s00063-020-00716-w. Epub 2020 Sep 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). sharing sensitive information, make sure youre on a federal Teaching is an important intervention in the self-management of chronic illness and is often incorporated into guidance and coaching. In search of how people change. Coaching Difficult Patients Epub 2015 Feb 9. Overview of the Model These core competency domains are as follows: values and ethics for interprofessional practice; roles and responsibilities; interprofessional communication; and teams and teamwork. Advanced Practice Nurse Guidance and Coaching Competency: Theoretical and Empirical Perspectives 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). 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). Development of Advanced Practice Nurses Coaching Competence Running Head: GUIDANCE AND COACHING FOR THE ADVANCED PRACTICE NURSE 1 Guidance and Coaching for the Advanced Expert Help Patient Education (From R. W. Scholl. 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. Precontemplation Wise APNs pay attention to all four types of transitions in their personal and professional lives. It is important to understand that APN guidance and coaching are not synonymous with professional coaching. Int J Nurs Stud. J Nurses Prof Dev. 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. In practice, APNs remain aware of the possibility of multiple transitions occurring as a result of one salient transition. In this stage, people intend to make a change within the next 6 months. Hamric & Hanson's Advanced Practice Nursing - E-Book 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 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). Transtheoretical Model of Behavior Change They reflect changes in structures and resources at a system level. I provide guidance and best practices from my 20+ years of acute hospital experience to help create the best nursing experience possible for our nurses and their patients. Experienced APNs are more likely than inexperienced APNs to pay attention to feelings and intuitions. 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. 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. Adapted from Prochaska, J.O., DiClemente, C.C., & Norcross, J.C. [1992]. 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. Developing clinical leaders: the impact of an action learning mentoring programme for advanced practice nurses. 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. 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. 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. Patient-Centered Care, Culturally Competent and Safe Health Care, and Meaningful Provider-Patient Communication 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 and Coaching | Nurse Key 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. 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). This article presents coaching, which facilitates the highest form of learning, as a potential strategy for promoting professional development in nursing. APNs interpret these multiple sources of information to arrive at possible explanations and interventions. In search of how people change. Care Transition Models Using Advanced Practice Nurses, *Referred to as the Coleman model (Coleman etal., 2004). What is a nurse coach? Adapted from the U.S. Advanced practitioners are educated at masters level in advanced practice and are assessed as competent in practice, using expert knowledge and skills. 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). 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. Guidance and Coaching Competency and Outcomes 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. 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. Furthermore, many APNs will have responsibilities for coaching teams to deliver patient-centered care. Active roles for older adults in navigating care transitions: Lessons learned from the care transitions intervention. Commentary on: Hale RL, Phillips CA. Nurses typically have opportunities to educate patients during bedside conversations or by providing prepared pamphlets or handouts. The physical, emotional, social, and economic burdens of chronic illness are enormous but, until recently, investing in resources to promote healthy lifestyles and prevent chronic illnesses has not been a policy priority. 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. Exemplar 8-1Anticipatory Guidance in Primary and Acute Care 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. 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). 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. They are acutely aware of the hazards of the behavior and are also more aware of the advantages of changing the behavior. 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. APNs bring their reflections-in-action to their post-encounter reflections on action. 8-1), in which change can be hastened with skillful guidance and coaching. In practice, APNs remain aware of the possibility of multiple transitions occurring as a result of one salient transition. 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/). 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. Debates started in the late 1980s and early 1990s as service and strategic interest in advanced nurse roles grew (Kaufman, 1996; 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. Topeka, KS. Clinical coaching is a relationship for the purpose of building skills. 2021 Jun;118:103759. doi: 10.1016/j.ijnurstu.2020.103759. FIG 8-2 Coaching competency of the advanced practice nurse. 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). Dossey and Hess (2013) state that the purpose of coaching in nursing is "to advocate, identify, and focus on factors that promote health, healthy people, and healthy communities" (p. 10). Nationally and internationally, chronic illnesses are leading causes of morbidity and mortality. Empirical research findings that predate contemporary professional coaching have affirmed that guidance and coaching are characteristics of APN-patient relationships. 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). 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). Coaching: An essential leadership skill for the advanced practice nurse Coaching and guidance with patient decision aids: A review of Situational transitions are most likely to include changes in educational, work, and family roles. 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. Chapter Contents This definition of guidance draws on dictionary definitions of the word and the use of the term in motivational interviewing (MI). This practice, by nurses and other disciplines, focuses on health, healing, and wellness; as the broad understanding of professional coaching evolves, it will influence the evolution of the APN guidance and coaching competency. Note: The situations are categorized according to the initiating change. The competency related to teams and teamwork emphasizes relationship building as an important element of patient-centered care (see Chapter 12). APNs used a holistic focus that required clinical expertise, including sufficient patient contact, interpersonal competence, and systems leadership skills to improve outcomes (Brooten, Youngblut, Deatrick, etal., 2003). Clinical nurse specialists (CNSs) typically have more involvement in planning and implementing organizational transitions. Hamric & Hanson's advanced practice nursing - University of Missouri Self-Reflection 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). Extensive research on the TCM has documented improved patient and institutional outcomes and led to better understanding of the nature of APN interventions. Addressing all major advanced practice nursing competencies, roles, and issues, Advanced Practice Nursing: An Integrative Approach, 5th Edition provides a clear, comprehensive, and . 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. The competency of guidance and coaching is a well-established expectation of the advanced practice nurse (APN). 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. Self-Reflection A nurse practitioner (NP), doing a health history on a young woman, elicited information about binge drinking that was a concern. Advanced Practice Nursing: Essential Knowledge for the Profession [3 Graduate Nursing Education: Influence of Faculty and Preceptors Teaching is an important intervention in the self-management of chronic illness and is often incorporated into guidance and coaching. Hamric & Hanson's Advanced Practice Nursing, 7th Edition 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). Guidance Following a critical content analysis, the roles and responsibilities of the forensic nurses were described and compared with the seven core competencies of advanced nursing practice as outlined . 10.1111/jocn.14636. Advanced practice role of guidance and coaching - Course Hero Create a marketing plan to support your value to the healthcare team. 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). Health coaching and group visits are emerging as 2 effective strategies to improve patients' behavior in chronic care management. 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 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). 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 uses self-reflection during and after interactions with patients, classically described as reflection-in-action and reflection-on-action (Schn, 1983, 1987). Transitions in Health and Illness Guidance and coaching by APNs have been conceptualized as a complex, dynamic, collaborative, and holistic interpersonal process mediated by the APN-patient relationship and the APNs self-reflective skills (Clarke & Spross, 1996; Spross, Clarke, & Beauregard, 2000; Spross, 2009). These ideas are consistent with elements of the TTM and offer useful ideas for assessment. 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). Guidance and coaching elements have been conceptualized in recent decades as a complex and dynamic interpersonal process in the APN-patient relationship aimed at collaborative and holistic care. These initiatives suggest that APNs, administrators, and researchers need to identify those clinical populations for whom APN coaching is necessary. It is mediated by the APN-patient relationship and the APNs self-reflective skills and interpersonal, clinical, and technical skills. [Clinical leadership competencies in advanced nursing practice : Scoping review]. Murray LA, Buckley K. Using simulation to improve communication skills in nurse practitioner preceptors. 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. Schumacher and Meleis (1994) have proposed four types of transitionsdevelopmental, health and illness, situational, and organizational. All nurses and APNs should be familiar with the patient education resources in their specialty because these resources can facilitate guidance and coaching. Coaching: An essential leadership skill for the advanced practice nurse The APN coaching process can best be understood as an intervention. They include adapting to the physiologic and psychological demands of pregnancy, reducing risk factors to prevent illness, changing unhealthy lifestyle behaviors, and numerous other clinical phenomena. Consultation 5. 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. Contemplation Reflection in action is the ability to pay attention to phenomena as they are occurring, giving free rein to ones intuitive understanding of the situation as it is unfolding; individuals respond with a varied repertoire of exploratory and transforming actions best characterized as strategic improvisation. Guidance and coaching is a core competency of advanced practice nursing. 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).