guidance and coaching in advanced practice nursing

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. Course Hero uses AI to attempt to automatically extract content from documents to surface to you and others so you can study better, e.g., in search results, to enrich docs, and more. 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). J Clin Nurs 2018. Epub 2015 Feb 9. Thorne (2005) has analyzed findings from a decade of qualitative research on nurse-patient relationships and communication in chronic illness care in the context of the health policy emphasis on accountable care; many findings were associated with better outcomes. 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. 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. Adapted from the U.S. Tran AN, Nevidjon B, Derouin A, Weaver S, Bzdak M. J Nurses Prof Dev. Situational transitions are most likely to include changes in educational, work, and family roles. 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). 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). After multiple experiences with cancer patients, one of the authors (JS) incorporated anticipatory guidance at the start of cancer chemotherapy, using the following approach. 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). Guidance and coaching require that APNs be self-aware and self-reflective as an interpersonal transaction is unfolding so that they can shape communications and behaviors to maximize the therapeutic goals of the clinical encounter. 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). 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. Does it differentiate advanced practice registered nursing from floor RN nursing for you? 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). 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. Reflection-in-action requires astute awareness of context and investing in the present moment with full concentration, capabilities that take time to master and require regular practice. 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. A nurse coach is a nurse that focuses on whole body wellness - body and mind. 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. As interprofessional teamwork becomes more integrated into health care, guidance and coaching will likely be seen as a transdisciplinary, patient-centered approach to helping patients but will be expressed differently, based on the discipline and experience of the provider. Eight core competency domains are delineated in the Caring advanced practice nursing model: 1. In this chapter, health and illness transitions are defined as transitions driven by an individuals experience of the body in a holistic sense. Even so, relapse is always possible in the action or maintenance stage and may be a response to stressful situations. J Contin Educ Nurs. 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. They reflect changes in structures and resources at a system level. Transitions are paradigms for life and living. 2019;50(4):170-175.]. Attending to the possibility of multiple transitions enables the APN to tailor coaching to the individuals particular needs and concerns. Commentary on: Hale RL, Phillips CA. Currently, the TCM is a set of activities aimed at pro, 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 (, 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. Aging and Disability Resource Center. Design Systematic review and narrative synthesis. 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. TABLE 8-2 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. There are a number of issues that must be considered by both students and preceptors when negotiating a clinical experienceandragological, curricular, credentialing, and legal matters must be satisfied . Related Imperatives for Advanced Practice Nurse Guidance and Coaching Transitions in Health and Illness J Prof Nurs. The competency related to teams and teamwork emphasizes relationship building as an important element of patient-centered care (see Chapter 12). As with other APN core competencies, the coaching competency develops over time, during and after graduate education. 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). 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). For example, Chick and Meleis (1986) have characterized the process of transition as having phases during which individuals go through five phases (see earlier). Evidence in the literature related to the use of coaching specifically among APNs is limited. 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. 2021 Jun;118:103759. doi: 10.1016/j.ijnurstu.2020.103759. Because the GRACE model is similar to the TCM and CTI models, it will not be discussed further here. 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. Offering advice or education at this stage can also impede progress toward successful behavior change. Imperatives for Advanced Practice Nurse Guidance and Coaching These distinctions are reflected in the definitions that follow. 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). To guide also means to assist a person to travel through, or reach a destination in, an unfamiliar area, such as by accompanying or giving directions to the person. The foundational importance of the therapeutic APN-patient (client) relationship is not consistent with professional coaching principles. Log In or Register to continue 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. Key Features 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. Early work by, U.S. The teaching-coaching role of the APN The demand for well-educated and skilled healthcare providers has never been greater. Direct clinical practice 2. The growth in programs has led to a corresponding increased demand for clinical The definition speaks to the fact that others are affected by, or can influence, transitions. 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. 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/). 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 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). Guidance and coaching are essential components of work for an advanced practice nurse (APN). 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 goals may include higher levels of wellness, risk reduction, reduced morbidity and suffering from chronic illness, and improved quality of life, including palliative care. 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). 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. American Psychologist, 47, 1102.). Change is conceptualized as a five-stage process (Fig. Contemplation is not a commitment, and the patient is often uncertain. 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. 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. They conduct client visits, use motivational interviewing techniques, and model correct strategies necessary to help patients reach self-management goals. 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 . 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). 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. 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 Burden of Chronic Illness TABLE 8-1 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. 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. Studies have suggested that prior embodied experiences may play a role in the expression or the trajectory of a patients health/illness experience. 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. When the risks of not changing the behavior are approximately equivalent to the advantages of changing, people can become stuck in ambivalence. FOIA Transition Situations That Require 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). Aging and Disability Resource Center, 2011; Administration on Aging, 2012). Accountable care initiatives are an opportunity to implement these findings and evaluate and strengthen the guidance and coaching competency of APNs. Over the last decade, the importance of interprofessional teamwork to achieve high-quality, patient-centered care has been increasingly recognized. Kreisberg (2015) distinguished health coaching from . APNs also apply their guidance and coaching skills in interactions with colleagues, interprofessional team members, students, and others. Guidance and Coaching Competency and Outcomes 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. Consultation 5. 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). Offering advice or education at this stage can also impede progress toward successful behavior change. 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. 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. 2022 Jul 15;8:23779608221113864. doi: 10.1177/23779608221113864. 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). Adapted from Parry, C. & Coleman, E. A. It may involve more than one person and is embedded in the context and the situation (Chick & Meleis, 1986, pp. Coaching and guidance are structured approaches that can be used within or alongside patient decision aids (PtDAs) to facilitate the process of decision making. Teaching is an important intervention in the self-management of chronic illness and is often incorporated into guidance and coaching. is directly linked to the competencies of direct clinical practice, coaching, and guidance, complemented by the other components and competencies.9 Regulatory. In todays health care system, transitions are not just about illness. The evolving criteria and requirements for certification of professional coaches are not premised on APN coaching skills. Teaching and counseling are significant clinical activities in nurse-midwifery (Holland & Holland, 2007) and CNS practice (Lewandoski & Adamle, 2009). 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. 4. 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. Outcomes of successful transitions include subjective well-being, role mastery, and well-being of relationships (Schumacher and Meleis, 1994), all components of quality of life. Anticipatory guidance is a particular type of guidance aimed at helping patients and families know what to expect. As interprofessional teamwork becomes more integrated into health care, guidance and coaching will likely be seen as a transdisciplinary, patient-centered approach to helping patients but will be expressed differently, based on the discipline and experience of the provider. Patient teaching and education (see Chapter 7) directly relates to APN coaching. 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. 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). Action 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). 6. Definitions: Teaching, Guidance, and Coaching 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. A serial cross-sectional survey design was used to evaluate the coaching circle experience of four cohorts of Fellows from 2013-2017. Examination Level Eligibility Criteria ; NC-BC (Nurse Coach Board Certified) HWNC-BC (Health and Wellness Nurse Coach Board Certified) - same exam as NC-BC - must hold AHNCC Holistic Certification: Unrestricted, current U.S. RN license* Active practice as an RN for a minimum of 2 years full-time or 4,000 hours part-time within the past 5 years if you have a Baccalaureate Degree in . Patient education involves helping patients become better informed about their condition, medical procedures, and choices they have regarding treatment. These factors are further influenced by individual and contextual factors. Tags: Advanced Practice Nursing An Integrative Approach Guidance in the advanced practice nurse (APN) 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" (Hamric, 2014, p. 186). 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. Conflict Negotiation and Resolution Adapted from Parry, C. & Coleman, E. A. Bookshelf Making lifestyle or behavior changes are transitions; the stages of change are consistent with the characteristics of transition phases (Chick and Meleis, 1986). Similar to life, they may be predictable or unpredictable, joyous or painful, obvious or barely perceptible, chosen and welcomed, or unexpected and feared. 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/). At least 1year of APN experience is needed to define and implement all APN role dimensions, including leadership (Baker, Patient education involves helping patients become better informed about their condition, medical procedures, and choices they have regarding treatment. Even so, relapse is always possible in the action or maintenance stage and may be a response to stressful situations. Active roles for older adults in navigating care transitions: Lessons learned from the care transitions intervention. Transitions can also be characterized according to type, conditions, and universal properties. . Referred to as the GRACE model (Counsell etal., 2006). For example, the ability to establish therapeutic relationships and guide patients through transitions is incorporated into the. Data sources: Review of coaching literature in psychology, sports, business, and nursing. 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. 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. 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). (2010). Discuss practical ways the APRN provides guidance and coaching to patients in his or her daily APRN role. 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. Model of Advanced Practice Nurse Guidance and Coaching As a result, enrollment is expanding in academic settings that prepare advanced practice nurses for primary care and acute care roles. "Organization and system-focused leadership" included the following seven leadership capability domains: 1) improving the quality of care provided; 2) enhancing professional nursing practice; 3) being an expert clinician; 4) communicating effectively; 5) mentoring and coaching; 6) providing leadership on internal and external committees and 7) Using coaching as a leadership skill assists the APN in making a significant contribution to the health care field and to employee growth and . International Council of Nurses (ICN) | ICN - International Council of . In search of how people change. Empirical research findings that predate contemporary professional coaching have affirmed that guidance and coaching are characteristics of APN-patient relationships. 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). 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. How do you think guidance and coaching in the advanced practice role is different from the RN role of teaching/coaching? Regular self-reflection helps APNs develop skills to describe clinical phenomena and express that which is hard to name. Our writers are specially selected and recruited, after which they undergo further training to perfect their skills for specialization purposes. In identifying these elements, the model of APN guidance and coaching breaks down what is really a holistic, flexible, and often indescribable process. Rollnick and colleagues (2008) have described guiding as one of three styles of doing MI. Several assumptions underlie this model: 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. In todays health care system, transitions are not just about illness. Nurses typically have opportunities to educate patients during bedside conversations or by providing prepared pamphlets or handouts. PMC Addressing all major advanced practice nursing competencies, roles, and issues, Advanced Practice Nursing: An Integrative Approach, 5th Edition provides a clear, comprehensive, and . Clinical nurse specialists (CNSs) typically have more involvement in planning and implementing organizational transitions. Data sources Articles were identified through a search of CINAHL, Medline, Scopus, and PsychINFO databases. The APN uses self-reflection during and after interactions with patients, classically described as reflection-in-action and reflection-on-action (Schn, 1983, Health Policy Issues in Changing Environments, Integrative Review of Outcomes and Performance Improvement Research on Advanced Practice Nursing, Conceptualizations of Advanced Practice Nursing, Understanding Regulatory, Legal, and Credentialing Requirements, Role Development of the Advanced Practice Nurse, Advanced Practice Nursing An Integrative Approach.