guidance and coaching in advanced practice nursing

Advanced Practice Nursing: Essential Knowledge for the Profession, Third Edition is a core advanced practice text used i. Anmelden; Registrierung; . 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). Anticipatory guidance is a particular type of guidance aimed at helping patients and families know what to expect. Interprofessional Teams Advanced practitioners are educated at masters level in advanced practice and are assessed as competent in practice, using expert knowledge and skills. In todays health care system, transitions are not just about illness. (From R. W. Scholl. These distinctions are reflected in the definitions that follow. Contemplation is not a commitment, and the patient is often uncertain. The APN uses self-reflection during and after interactions with patients, classically described as reflection-in-action and reflection-on-action (Schn, 1983, 1987). Organizational transitions are those that occur in the environment; within agencies, between agencies, or in society. [2012]. 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. Transition Situations That Require Coaching. 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). eCollection 2022 Jan-Dec. Reshaping Nursing Workforce Development by Strengthening the Leadership Skills of Advanced Practice Nurses. 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. 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 Adapted from the U.S. Self-reflection is the deliberate internal examination of experience so as to learn from it. 1. 1. including direct clinical practice, guidance and coaching, consultation, evidence-based practice (EBP), leadership, collaboration, and . 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. Studies have suggested that prior embodied experiences may play a role in the expression or the trajectory of a patients health/illness experience. These can also result from changes in intangible or tangible structures or resources (e.g., loss of a relationship or financial reversals; Schumacher & Meleis, 1994). Rather than directing or lecturing, she asked the woman if she knew about the effects of alcohol on the body; the woman said no. The NP then asked if the woman would like to learn about the effects, to which the patient replied yes. The visit proceeded with a brief overview of the effects of alcohol and provision of more resources. 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. 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. Evidence-based care transitions models side-by-side March 2011 (adrc-tae.org/tiki-download_file.php?fileId=30310). 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). Are there certain elements of this competency that are more important than others? Key Features 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. 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). APNs involve the patients significant other or patients proxy, as appropriate. (2010). 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. TABLE 8-2 Advanced Practice Nurse Guidance and Coaching and Coach Certification Extensive research on the TCM has documented improved patient and institutional outcomes and led to better understanding of the nature of APN interventions. Clinical Nurse Specialist<br>Direct clinical practice--includes expertise in advanced assessment, implementing nursing care, and evaluating outcomes.<br>Expert coaching and guidance encompassing . 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. Mentoring up: A grounded theory of nurse-to-nurse mentoring. APN coaching is defined as a purposeful, complex, dynamic, collaborative, and holistic interpersonal process aimed at supporting and facilitating patients and families through health-related experiences and transitions to achieve health-related goals, mutually determined, whenever possible. Individual elements of the model include clinical, technical, and interpersonal competence mediated by self-reflection. 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). 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. 2. Evidence That Advanced Practice Nurses Guide and Coach 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. 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. Referred to as the Naylor model (Naylor etal., 2004). They reflect changes in structures and resources at a system level. 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). 2004). Many of these transitions have reciprocal impacts across categories. 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). 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. 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. Eight core competency domains are delineated in the Caring advanced practice nursing model: 1. Adapted from Prochaska, J.O., DiClemente, C.C., & Norcross, J.C. [1992]. Noting that everyone responds to this type of chemotherapy differently, JS would ask what they had heard about the drugs they would be taking. Guidance and coaching are part of the advance practice registered nurse (APRN) competencies, and it leads the change to a patient's healthier life. Discuss practical ways the APRN provides guidance and coaching to patients in his or her daily APRN role. They are acutely aware of the hazards of the behavior and are also more aware of the advantages of changing the behavior. Empirical research findings that predate contemporary professional coaching have affirmed that guidance and coaching are characteristics of APN-patient relationships. This is the stage in which people are ready to take action within 1 month. Personal communication. The APN coaching process can best be understood as an intervention. 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). APN coaching is defined as a purposeful, complex, dynamic, collaborative, and holistic interpersonal process aimed at supporting and facilitating patients and families through health-related experiences and transitions to achieve health-related goals, mutually determined, whenever possible. Patient education is important to enable individuals to better care for themselves and make informed decisions regarding medical care (, www.enotes.com/patient-education-reference/patient-education, 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). 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). Cooperation 6. APNs must be able to explain their nursing contributions, including their relational, communication, and coaching skills, to team members. 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. 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). Many of these transitions have reciprocal impacts across categories. Teaching and counseling are significant clinical activities in nurse-midwifery (Holland & Holland, 2007) and CNS practice (Lewandoski & Adamle, 2009). 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. TABLE 8-3 Guidance and coaching are essential components of work for an advanced practice nurse (APN). The ability to self-reflect and focus on the process of coaching as it is occurring implies that APNs are capable of the simultaneous execution of other skills. 2011;27(3):161-7. The Institute for Healthcare Improvement [IHI] has asserted that patient-centered care is central to driving improvement in health care Johnson, Abraham, Conway, etal., 2008). In medically complex patients, APNs may be preferred and less expensive coaches, in part because of their competencies and scopes of practice. Epub 2020 Aug 26. 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. Commentary on: Hale RL, Phillips CA. Transitions in Health and Illness 2022 Jul 15;8:23779608221113864. doi: 10.1177/23779608221113864. 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. 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. Participants evaluated the structure and function, as well as the value, of the coaching circle. Hamric created a conceptual definition model for advanced practice nursing (APN) with defining characteristics that identify several core competencies, Guidance and coaching,Consultation,Evidence-based practice, Leadership, Collaboration,Ethical decision making.Hamric 's (APN) core competencies are an umbrella for the additional role-specific . 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. Distinctions Among Coaching and Other Processes APNs should also be alert to expressions of emotions about the unhealthy behavior because these are often opportunities to raise a patients awareness of the impact of the unhealthy behavior, an important precursor to committing to change. The definition speaks to the fact that others are affected by, or can influence, transitions. 1. Advanced practice nurses use role modelling, teaching, clinical problem solving and change facilitation to promote evidence-based practice among . Definitions: Teaching, Guidance, and Coaching Assumptions 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. There are several reasons for this: 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 . It is important to note that all elements of the model work synergistically to create this competency; separating them for the sake of discussion is somewhat artificial. Care Transitions Intervention Model 8-2). Model of Advanced Practice Nurse Guidance and Coaching 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. 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). 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). 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). Because the GRACE model is similar to the TCM and CTI models, it will not be discussed further here. 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. For example, Chick and Meleis (1986) have characterized the process of transition as having phases during which individuals go through five phases (see earlier). Expert Answer 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 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. In medically complex patients, APNs may be preferred and less expensive coaches, in part because of their competencies and scopes of practice. Aging and Disability Resource Center, 2011; Administration on Aging, 2012). 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. Data sources: Review of coaching literature in psychology, sports, business, and nursing. 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. In identifying these elements, the model of APN guidance and coaching breaks down what is really a holistic, flexible, and often indescribable process. Direct clinical practice 2. APRNs are nurses who have met advanced educational and clinical practice requirements, and often provide services in community-based settings. Teaching is an important intervention in the self-management of chronic illness and is often incorporated into guidance and coaching. Interprofessional Teams Note: The situations are categorized according to the initiating change. Among the studies of APN care are those in which APNs provide care coordination for patients as they move from one setting to the other, such as hospital to home. Active roles for older adults in navigating care transitions: Lessons learned from the care transitions intervention. In practice, APNs remain aware of the possibility of multiple transitions occurring as a result of one salient transition. 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). 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. Wise APNs pay attention to all four types of transitions in their personal and professional lives. Furthermore, many APNs will have responsibilities for coaching teams to deliver patient-centered care. Developmental, health and illness, and situational transitions are the most likely to lead to clinical encounters requiring guidance and coaching. Over the last decade, the importance of interprofessional teamwork to achieve high-quality, patient-centered care has been increasingly recognized. Attending to the possibility of multiple transitions enables the APN to tailor coaching to the individuals particular needs and concerns. 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). 5. Chapter Contents 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. Personal communication. Making lifestyle or behavior changes are transitions; the stages of change are consistent with the characteristics of transition phases (Chick and Meleis, 1986). Transtheoretical Model of Behavior Change Rollnick and colleagues (2008) have described guiding as one of three styles of doing MI. Self-Reflection Nurses typically have opportunities to educate patients during bedside conversations or by providing prepared pamphlets or handouts. Discuss practical ways the APRN provides guidance and coaching to patients in his or her daily APRN role. Adapted from Prochaska, J.O., DiClemente, C.C., & Norcross, J.C. [1992]. 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/). Referred to as the GRACE model (Counsell etal., 2006). 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). Referred to as the Naylor model (Naylor etal., 2004). 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. [Clinical leadership competencies in advanced nursing practice : Scoping review]. Overview of the Model Table 8-3 compares the three models of care transitions that used APNs. The art and science of nurse coaching: A provider's guide to coaching, scope and competencies. American Holistic Nurses Association. It may involve more than one person and is embedded in the context and the situation (Chick & Meleis, 1986, pp. Purposeful sampling was used to select advanced practice nurses who met the following inclusion criteria: employed as a master's pre - pared advanced practice nurse with at least 1year of experience in the APN role. Rather than directing or lecturing, she asked the woman if she knew about the effects of alcohol on the body; the woman said no. The NP then asked if the woman would like to learn about the effects, to which the patient replied yes. The visit proceeded with a brief overview of the effects of alcohol and provision of more resources. Clinical nurse specialists (CNSs) typically have more involvement in planning and implementing organizational transitions. American Psychologist, 47, 1102.). Coaching competency of the advanced practice nurse. In 2008, worldwide, over 36 million people died from conditions such as heart disease, cancers, and diabetes (World Health Organization [WHO], 2011, 2012). Data sources Articles were identified through a search of CINAHL, Medline, Scopus, and PsychINFO databases. 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. Offering specific advice in this stage is counterproductive and can increase resistance and hamper progression through the stages of change. Review Methods Quality . 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). 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). Transitions can also be characterized according to type, conditions, and universal properties. [2012]. Aging and Disability Resource Center. Studies have suggested that prior embodied experiences may play a role in the expression or the trajectory of a patients health/illness experience. Topeka, KS. Situational transitions are most likely to include changes in educational, work, and family roles. 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/). 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). 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). Several assumptions underlie this model: Int J Nurs Stud. 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. 4. 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. Patient-Centered Care, Culturally Competent and Safe Health Care, and Meaningful Provider-Patient Communication 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. Guidance and coaching is a core competency of advanced practice nursing. 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. Professional Coaching and Health Care Consultation 5. J Am Assoc Nurse Pract. This article chronicles a typical patient's journey through a post-hospital discharge nursing research study involving APNs as "intervention .

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