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

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. Overview of the Model Ethical decision-making 3. 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. Overview of the Model 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/). Referred to as the Naylor model (Naylor etal., 2004). 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). 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. 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. This report offers insight into strategies of coaching that would be useful in a variety of health care settings to promote the advancement of nurse leaders. including direct clinical practice, guidance and coaching, consultation, evidence-based practice (EBP), leadership, collaboration, and . In identifying these elements, the model of APN guidance and coaching breaks down what is really a holistic, flexible, and often indescribable process. Unauthorized use of these marks is strictly prohibited. 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. View Guidance and Coaching Competency.docx from NUR 5081 at William Paterson University. Reflection in action is the ability to pay attention to phenomena as they are occurring, giving free rein to ones intuitive understanding of the situation as it is unfolding; individuals respond with a varied repertoire of exploratory and transforming actions best characterized as strategic improvisation. Personal communication. Adapted from Prochaska, J.O., DiClemente, C.C., & Norcross, J.C. [1992]. Actions may be small (e.g., walking 15 minutes/day) but are clearly stated and oriented toward change; individuals are more open to the APNs advice. Graduate programs deepen students inherent coaching skills by incorporating evidence-based coaching practices into curricula. 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). Making lifestyle or behavior changes are transitions; the stages of change are consistent with the characteristics of transition phases (Chick and Meleis, 1986). These ideas are consistent with elements of the TTM and offer useful ideas for assessment. The teaching-coaching role of the APN The demand for well-educated and skilled healthcare providers has never been greater. Log In or Register to continue APNs bring their reflections-in-action to their post-encounter reflections on action. APNs bring their reflections-in-action to their post-encounter reflections on action. 239-240). 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. Clinical Nurse Specialist<br>Direct clinical practice--includes expertise in advanced assessment, implementing nursing care, and evaluating outcomes.<br>Expert coaching and guidance encompassing . Hamric & Hanson's Advanced Practice Nursing: An Integrative Approach: 9780323777117: Medicine & Health Science Books @ Amazon.com . 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). The growth in programs has led to a corresponding increased demand for clinical 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. APNs are likely to move between guidance and coaching in response to their assessments of patients. JS would review the common side effects, what could be done pharmacologically and nonpharmacologically to minimize the effects, and what other patients had done to manage their time and activities during the period receiving chemotherapy. Strategies for Developing and Applying the Coaching Competency Let's partner to . Patients know that, if and when they are ready to change, the APN will collaborate with them. Experienced APNs are more likely than inexperienced APNs to pay attention to feelings and intuitions. It may involve more than one person and is embedded in the context and the situation (Chick & Meleis, 1986, pp. Even so, relapse is always possible in the action or maintenance stage and may be a response to stressful situations. 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. 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. Does it differentiate advanced practice registered nursing from floor RN nursing for you? Definitions: Teaching, Guidance, and Coaching Leadership For a schematic illustration of the model, see Fig. Topeka, KS. Care Transition Models Using Advanced Practice Nurses, *Referred to as the Coleman model (Coleman etal., 2004). 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. (2011). Furthermore, many APNs will have responsibilities for coaching teams to deliver patient-centered care. 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. 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). Patient Education 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. Professional coaching now is recognized within and outside of nursing as a particular intervention, distinct from guidance, mentoring and counseling. Transitional Care Model Referred to as the GRACE model (Counsell etal., 2006). Offering specific advice in this stage is counterproductive and can increase resistance and hamper progression through the stages of change. Over the last decade, the importance of interprofessional teamwork to achieve high-quality, patient-centered care has been increasingly recognized. Advanced practice nurses use role modelling, teaching, clinical problem solving and change facilitation to promote evidence-based practice among . 2. 3. Method: The APN can utilize both mentoring and coaching as leadership skills in practice. In practice, APNs remain aware of the possibility of multiple transitions occurring as a result of one salient transition. These ideas are consistent with elements of the TTM and offer useful ideas for assessment. 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. Guidance and coaching are part of the advance practice registered nurse (APRN) competencies, and it leads the change to a patient's healthier life. Patient education may include information about cognitive and behavioral changes but these changes cannot occur by teaching alone. 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). Preparation 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. 2020 Jan 1;51(1):12-14. doi: 10.3928/00220124-20191217-04. is directly linked to the competencies of direct clinical practice, coaching, and guidance, complemented by the other components and competencies.9 Regulatory. 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. New graduates entering a professional field of practice as well as established nurses moving into a new practice setting or a new role may receive mentoring as part of the role transition process. 2022 Jul 15;8:23779608221113864. doi: 10.1177/23779608221113864. Epub 2015 Feb 9. Are there certain elements of this competency that are more important than others? Conflict Negotiation and Resolution 8-2). (2010). 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. Log In or, Click to share on Twitter (Opens in new window), Click to share on Facebook (Opens in new window), Click to share on Google+ (Opens in new window), The competency of guidance and coaching is a well-established expectation of the advanced practice nurse (APN). 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. Skill in establishing therapeutic relationships and being able to coach patients based on discipline-related content and skills will be important in achieving interprofessional, patient-centered care. 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. Interprofessional Teams The APN uses self-reflection during and after interactions with patients, classically described as reflection-in-action and reflection-on-action (Schn, 1983, 1987). Murray LA, Buckley K. Using simulation to improve communication skills in nurse practitioner preceptors. The purpose of this report is to describe the current literature related to coaching among APNs and the results of this coaching experience. 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. 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. Data sources: Review of coaching literature in psychology, sports, business, and nursing. With experience, APNs develop their own strategies for integrating specialty-related anticipatory guidance into their coaching activities. 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. 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). In 2008, worldwide, over 36 million people died from conditions such as heart disease, cancers, and diabetes (World Health Organization [WHO], 2011, 2012). Advanced practice is a level of practice, rather than a type or specialty of practice. These ideas are consistent with elements of the TTM and offer useful ideas for assessment. Patient education involves helping patients become better informed about their condition, medical procedures, and choices they have regarding treatment. Advanced practitioners are educated at masters level in advanced practice and are assessed as competent in practice, using expert knowledge and skills. APNs also attend to patterns, consciously and subconsciously, that develop intuition and contribute to their clinical acumen. 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; National Center for Quality Assurance [NCQA], 2011. Care Transitions Intervention Model This bestselling textbook provides a clear, comprehensive, and contemporary introduction to advanced practice . Evidence That Advanced Practice Nurses Guide and Coach The APN coaching process can best be understood as an intervention. Does it differentiate advanced practice registered nursing from floor RN nursing for you? The purpose of this paper was to describe evidenced-based interventions as implemented by advanced practice nurses (APNs) conducting intervention research with a vulnerable population of blood and marrow transplant patients. 2019 May/Jun;35(3):152-159. doi: 10.1097/NND.0000000000000534. 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. 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). Transitions in Health and Illness Guidance can be seen as a preliminary, less comprehensive form of coaching. Contemplation is not a commitment, and the patient is often uncertain. Transition Situations That Require Coaching. eCollection 2022 Jan-Dec. Reshaping Nursing Workforce Development by Strengthening the Leadership Skills of Advanced Practice Nurses. 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 Education 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. 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). What is a nurse coach? As with other APN core competencies, the coaching competency develops over time, during and after graduate education. Chapter Contents 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. Offering specific advice in this stage is counterproductive and can increase resistance and hamper progression through the stages of change. Mentoring is used in a variety of professional settings. 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 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. TABLE 8-2 Tran AN, Nevidjon B, Derouin A, Weaver S, Bzdak M. J Nurses Prof Dev. Careers. Making lifestyle or behavior changes are transitions; the stages of change are consistent with the characteristics of transition phases (, 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 (, Brooten, Youngblut, Deatrick, etal., 2003, Advanced Practice Nurses and Models of Transitional Care, 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. Direct clinical practice 2. However, all APNs must be skilled in dealing with organizational transitions, because they tend to affect structural and contextual aspects of providing care. 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. This is the stage in which people are ready to take action within 1 month. 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. Self-Reflection Wise APNs pay attention to all four types of transitions in their personal and professional lives. Self-reflection is the deliberate internal examination of experience so as to learn from it. 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. Adapted from Parry, C. & Coleman, E. A. There is no federal regulation of APNs across the Key Features The evolving criteria and requirements for certification of professional coaches are not premised on APN coaching skills. 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/). (2011). For example, Chick and Meleis (1986) have characterized the process of transition as having phases during which individuals go through five phases (see earlier). 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). 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. American Holistic Nurses Association. Eight core competency domains are delineated in the Caring advanced practice nursing model: 1. 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. 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.