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

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). Examine the advanced nursing practice role for which you are being prepared (NP, Executive Leader, or Nurse Educator) and briefly describe the role including the history of the role, education and certification, and major functions of this role. Teaching and counseling are significant clinical activities in nurse-midwifery (Holland & Holland, 2007) and CNS practice (Lewandoski & Adamle, 2009). 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). 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). Offering advice or education at this stage can also impede progress toward successful behavior change. Some form of coaching is inherent in nursing practice, and developing professional nurse coaching certifications should build on these skills. 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. 4. In addition, each of the 6 core competencies of the APN role identified by 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). Epub 2015 Feb 9. The competency of guidance and coaching is a well-established expectation of the advanced practice nurse (APN). 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). Teaching and counseling are significant clinical activities in nurse-midwifery (Holland & Holland, 2007) and CNS practice (Lewandoski & Adamle, 2009). Care Transitions Intervention Model Advanced Practice Nurse Guidance and Coaching Competency: Theoretical and Empirical Perspectives Eight core competency domains are delineated in the Caring advanced practice nursing model: 1. 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. This definition is necessarily broad and can inform standards for patient education materials and programs targeting common health and illness topics. 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. There are a number of issues that must be considered by both students and preceptors when negotiating a clinical experienceandragological, curricular, credentialing, and legal . Registered nurses, including APNs, are central to a redesigned health system that emphasizes prevention and early intervention to promote healthy lifestyles, prevent chronic diseases, and reduce the personal, community, organizational, and economic burdens of chronic illness (Hess, Dossey, Southard, etal., 2012; Institute of Medicine [IOM], 2010; Thorne, 2005). Mentoring is used in a variety of professional settings. 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). sharing sensitive information, make sure youre on a federal APNs involve the patients significant other or patients proxy, as appropriate. 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. 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). 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. . 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). Transitions can also be characterized according to type, conditions, and universal properties. Table 8-3 compares the three models of care transitions that used APNs. Guidance is directing, advising and counseling patients, and it is closely related to coaching, but less comprehensive and while nurses offer guidance, they empower the patients to manage the care needs through coaching. Back to Balance LLC, Psychiatric Nurse Practitioner, Cheshire, CT, 06410, (203) 403-6232, Are you struggling with anxiety, panic, depression, mood swings, difficulty focusing, poor motivation . These factors are further influenced by individual and contextual factors. 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). APNs can usually coach patients independent of setting, cognitive capacity, and stage of illness; it can be done at a distance or face to face. The art and science of nurse coaching: A provider's guide to coaching, scope and competencies. APNs must be able to explain their nursing contributions, including their relational, communication, and coaching skills, to team members. Key Features 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. In this stage, the focus of APN coaching is to make the patient feel understood, avoid giving advice, keep lines of communication open, and convey a willingness to be available when the patient is ready to make a change. 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; Over the last decade, the importance of interprofessional teamwork to achieve high-quality, patient-centered care has been increasingly recognized. 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. The growth in programs has led to a corresponding increased demand for clinical 2020 Sep;115(6):466-476. doi: 10.1007/s00063-020-00716-w. Epub 2020 Sep 1. Development of Advanced Practice Nurses Coaching Competence These distinctions are reflected in the definitions that follow. APNs are likely to move between guidance and coaching in response to their assessments of patients. 8-1), in which change can be hastened with skillful guidance and coaching. Abstract Purpose: The purposes of this study were to explore coaching as a nurse practitioner (NP) strategy for improving patient health outcomes and to lay a foundation for validating coaching benefits. Studies of the transitional care model (TCM) and care transitions intervention (CTI) have used APNs as the primary intervener. 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. Debates started in the late 1980s and early 1990s as service and strategic interest in advanced nurse roles grew (Kaufman, 1996; 3. 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. 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. Evidence-based care transitions models side-by-side March 2011 (adrc-tae.org/tiki-download_file.php?fileId=30310). 8600 Rockville Pike . Extensive research on the TCM has documented improved patient and institutional outcomes and led to better understanding of the nature of APN interventions. In identifying these elements, the model of APN guidance and coaching breaks down what is really a holistic, flexible, and often indescribable process. 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. 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 . Offering specific advice in this stage is counterproductive and can increase resistance and hamper progression through the stages of change. 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, Patient-Centered Care, Culturally Competent and Safe Health Care, and Meaningful Provider-Patient Communication. 10.1111/jocn.14636. Distinctions Among Coaching and Other Processes. Parry and Coleman (2010) have offered useful distinctions among different strategies for helping patients: coaching, doing for patients, educating, and guiding along five dimensions (Table 8-1). The APN uses self-reflection during and after interactions with patients, classically described as reflection-in-action and reflection-on-action (Schn, 1983, 1987). adrc-tae.org/tiki-download_file.php?fileId=30310, Extensive research on the TCM has documented improved patient and institutional outcomes and led to better understanding of the nature of APN interventions. 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). Preparation 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. 2017;29(1):26-34. 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. This is the stage in which people are ready to take action within 1 month. FIG 8-2 Coaching competency of the advanced practice nurse. Graduate programs deepen students inherent coaching skills by incorporating evidence-based coaching practices into curricula. Adapted from Parry, C. & Coleman, E. A. Nurses typically have opportunities to educate patients during bedside conversations or by providing prepared pamphlets or handouts. A serial cross-sectional survey design was used to evaluate the coaching circle experience of four cohorts of Fellows from 2013-2017. The APN guidance and coaching competency reflects an integration of the characteristics of the direct clinical practice competency (see Chapter 7) but is particularly dependent on the formation of therapeutic partnerships with patients, use of a holistic perspective and reflective practice, and interpersonal interventions. With experience, APNs develop their own strategies for integrating specialty-related anticipatory guidance into their coaching activities. 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. 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. Precontemplators are not interested in learning more, thinking about, or discussing their high-risk behaviors. These ideas are consistent with elements of the TTM and offer useful ideas for assessment. For example, Chick and Meleis (1986) have characterized the process of transition as having phases during which individuals go through five phases (see earlier). (From R. W. Scholl. 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. Throughout the process, the APN is aware of the individual and contextual factors that may affect the coaching encounter and these factors also shape interactionsfirst to elicit and negotiate patient goals and outcomes and then to collaborate with the patient and others to produce those outcomes. More often, one is likely to ruminate on negative experiences because the feeling of failure is more uncomfortable than the feeling of satisfaction or success. 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. Advanced Practice Nurses and Models of Transitional Care Parry and Coleman (2010) have offered useful distinctions among different strategies for helping patients: coaching, doing for patients, educating, and guiding along five dimensions (Table 8-1). Extensive research on the TCM has documented improved patient and institutional outcomes and led to better understanding of the nature of APN interventions. The advantages of coaching are numerous. APRNs are nurses who have met advanced educational and clinical practice requirements, and often provide services in community-based settings. Findings were sustained for as long as 6 months after the program ended. They conduct client visits, use motivational interviewing techniques, and model correct strategies necessary to help patients reach self-management goals. 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). Acute Care In this stage, people intend to make a change within the next 6 months. Over the last decade, the importance of interprofessional teamwork to achieve high-quality, patient-centered care has been increasingly recognized. 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. The competency related to teams and teamwork emphasizes relationship building as an important element of patient-centered care (see Chapter 12). Attending to the possibility of multiple transitions enables the APN to tailor coaching to the individuals particular needs and concerns. 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. Developmental transitions are those that reflect life cycle transitions, such as adolescence, parenthood, and aging. Experienced APNs are more likely than inexperienced APNs to pay attention to feelings and intuitions. Edited and written by a Who's Who of internationally known advanced practice nursing experts, Hamric and Hanson's Advanced Practice Nursing: An Integrative Approach, 6th Edition helps you develop an understanding of the various advanced practice registered nursing (APRN) roles. Adapted from Prochaska, J.O., DiClemente, C.C., & Norcross, J.C. [1992]. Distinctions Among Coaching and Other Processes APNs are likely to move between guidance and coaching in response to their assessments of patients.