guidance and coaching in advanced practice nursing

guidance and coaching in advanced practice nursing

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. This bestselling textbook provides a clear, comprehensive, and contemporary introduction to advanced practice nursing today, addressing all major APRN competencies, roles, and issues. Coaching: An essential leadership skill for the advanced practice nurse Only gold members can continue reading. These ideas are consistent with elements of the TTM and offer useful ideas for assessment. 8-2). official website and that any information you provide is encrypted 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. Studies of the transitional care model (TCM) and care transitions intervention (CTI) have used APNs as the primary intervener. Rollnick and colleagues (2008) have described guiding as one of three styles of doing MI. 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 involve the patients significant other or patients proxy, as appropriate. Clinical nurse specialists (CNSs) typically have more involvement in planning and implementing organizational transitions. The notion of transitions and the concept of transitional care have become central to policies aimed at reducing health care costs and increasing quality of care (Naylor, Aiken, Kurtzman, etal., 2011). 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). [Clinical leadership competencies in advanced nursing practice : Scoping review]. Advanced Nursing Practice - The Royal College of 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/). Aging and Disability Resource Center. 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. Developmental transitions are those that reflect life cycle transitions, such as adolescence, parenthood, and aging. Transitions are paradigms for life and living. Adapted from Prochaska, J.O., DiClemente, C.C., & Norcross, J.C. [1992]. 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. Although we believe that guidance is distinct from coaching, more work is needed to illuminate the differences and relationships between the two. FIG 8-1 Prochaskas stages of change: The five stages of change. 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. When the risks of not changing the behavior are approximately equivalent to the advantages of changing, people can become stuck in ambivalence. 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. 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). Earlier work on transitions by Meleis and others is consistent with and affirms the concepts of the TTM. 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). Currently, the TCM process is focused on older adults and consists of screening, engaging the older adult and caregiver, managing symptoms, educating and promoting self-management, collaborating, ensuring continuity, coordinating care, and maintaining the relationship (www.transitionalcare.info/). 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). Evidence That Advanced Practice Nurses Guide and Coach Guidance can be seen as a preliminary, less comprehensive form of coaching. 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. 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). Even so, relapse is always possible in the action or maintenance stage and may be a response to stressful situations. Case management 7. 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). This site needs JavaScript to work properly. 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). 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). 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. Open Longevity Science, 4, 4350. 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. Back to Balance LLC, Psychiatric Nurse Practitioner, Cheshire, CT This chapter considers the core competency of APN guidance and coaching within the context of the nursing professions efforts to extend and advance the coaching functions of nurses. Chapter Contents Development of Advanced Practice Nurses Coaching Competence Create a marketing plan to support your value to the healthcare team. A nurse practitioner (NP), doing a health history on a young woman, elicited information about binge drinking that was a concern. Hamric & Hanson's Advanced Practice Nursing - 9780323777117 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. As health care reform in the United States steadily moves the pendulum from sickness and disease to wellness and prevention, new interventions have arisen in the name of coaching to guide and thus improve the life, health, and health risk of individuals. Early studies of the model from which TCM evolved have provided substantive evidence of the range and focus of teaching and counseling activities undertaken initially by CNSs, and later NPs, who provided care to varied patient populations. It. 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). Cooperation 6. As APNs assess, diagnose, and treat a patient, they are attending closely to the meanings that patients ascribe to health and illness experiences; APNs take these meanings into account in working with patients. (2011). 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. There are several reasons for this: The foundational importance of the therapeutic APN-patient (client) relationship is not consistent with professional coaching principles. Distinctions Among Coaching and Other Processes. Precontemplation Many of these transitions have reciprocal impacts across categories. 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. For example, Chick and Meleis (1986) have characterized the process of transition as having phases during which individuals go through five phases (see earlier). Maintenance Are there certain elements of this competency that are more important than 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. The purpose of this article is to describe a novel approach for behavior modification that integrates health coaching with group visits facilitated by nurse practitioners. 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. 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. Open Longevity Science, 4, 4350. 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. 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 (. Based on studies of smokers, Prochaska and associates (2008) learned that behavior change unfolds through stages. 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/). Interprofessional Teams 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. Nurses typically have opportunities to educate patients during bedside conversations or by providing prepared pamphlets or handouts. Advanced Practice Nursing: Patient Education, Guidance, and Coaching 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. 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. Schumacher and Meleis (1994) have proposed four types of transitionsdevelopmental, health and illness, situational, and organizational. Let's partner to . At least 1year of APN experience is needed to define and implement all APN role dimensions, including leadership (Baker, Careers. 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. Results: 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). Patient teaching and education (see Chapter 7) directly relates to APN coaching. 239-240). 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). It can therefore be reasoned that wellness coaching is guidance and inspiration provided to otherwise . This section reviews selected literature reports, including the following: (1) conceptual and empirical work on transitions as a major focus of APN guidance and coaching; (2) the transtheoretical model of behavior change (also known as the stages of change theory) and its associated interventions; and (3) evidence that APNs incorporate expert guidance and coaching as they deliver care. Advanced practitioners are educated at masters level in advanced practice and are assessed as competent in practice, using expert knowledge and skills. A Conceptual Definition Model For Advanced Practice Nursing Evidence in the literature related to the use of coaching specifically among APNs is limited. Research and development 8. Clinical coaching: a strategy for enhancing evidence-based nursing practice It applies APN core competencies to the major APN roles - including the burgeoning Nurse Practitioner role - and covers topics ranging from the evolution of APN to evidence-based . 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. As with other APN core competencies, the coaching competency develops over time, during and after graduate education. There are at least three types of evidence-based transitional care programs that have used APNs to support transitions from hospital to home (U.S. Agency on Aging and Disability Resource Center, 2011). Schumacher and Meleis (1994) have proposed four types of transitionsdevelopmental, health and illness, situational, and organizational. There are at least three types of evidence-based transitional care programs that have used APNs to support transitions from hospital to home (, U.S. Agency on Aging and Disability Resource Center, 2011, Referred to as the Coleman model (Coleman etal., 2004). 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. 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. 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. The competency related to teams and teamwork emphasizes relationship building as an important element of patient-centered care (see Chapter 12). Although a number of "coaching" types and modalities exist, for example, health, wellness, personal, and life coaching, health coaching . This is the stage in which patients have changed a behavior for longer than 6 months and strive to avoid relapse; they have more confidence in their ability to sustain the change and are less likely to relapse. Advanced practice nursing is more a concept than a defined role and cannot be described as a specific set of skills or regu- . Advanced Practice Nurses Core Competencies - LWW 1. 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). Health and illness transitions were primarily viewed as illness-related and ranged from adapting to a chronic illness to returning home after a stay in the hospital (Schumacher and Meleis, 1994). Over the last decade, the importance of interprofessional teamwork to achieve high-quality, patient-centered care has been increasingly recognized. 2. 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. Consultation 5. Care Transition Models Using Advanced Practice Nurses, *Referred to as the Coleman model (Coleman etal., 2004). Referred to as the Naylor model (Naylor etal., 2004). After multiple experiences with cancer patients, one of the authors (JS) incorporated anticipatory guidance at the start of cancer chemotherapy, using the following approach. 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. FIG 8-1 Prochaskas stages of change: The five stages of change. 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. Table 8-2 lists some transitions, based on this typology, that might require APN coaching. 2020 Jan 1;51(1):12-14. doi: 10.3928/00220124-20191217-04. 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). These ideas are consistent with elements of the TTM and offer useful ideas for assessment. 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. The site is secure. American Holistic Nurses Association. In 2008, worldwide, over 36 million people died from conditions such as heart disease, cancers, and diabetes (World Health Organization [WHO], 2011, 2012). Health coaching and group visits are emerging as 2 effective strategies to improve patients' behavior in chronic care management. Interpersonal Competence [Clinical leadership competencies in advanced nursing practice - PubMed Noting that everyone responds to this type of chemotherapy differently, JS would ask what they had heard about the drugs they would be taking. 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). Active roles for older adults in navigating care transitions: Lessons learned from the care transitions intervention. 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). Attending to the possibility of multiple transitions enables the APN to tailor coaching to the individuals particular needs and concerns. 4. Judith A. Spross and Rhonda L. Babine HHS Vulnerability Disclosure, Help 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. The APN coaching process can best be understood as an intervention. and transmitted securely. Similarly, in the United States, chronic diseases caused by heart disease result in 7 out of 10 deaths/year; cancer and stroke account for more than 50% of all deaths (Heron, Hoyert, Murphy, etal., 2009). Click to learn more today. 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. Burden of Chronic Illness The APN uses self-reflection during and after interactions with patients, classically described as reflection-in-action and reflection-on-action (Schn, 1983, 1987). 3. Unable to load your collection due to an error, Unable to load your delegates due to an error.

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