guidance and coaching in advanced practice nursing

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). 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). An official website of the United States government. J Am Assoc Nurse Pract. Patient-Centered Care, Culturally Competent and Safe Health Care, and Meaningful Provider-Patient Communication 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. The term is also used to refer to advising others, especially in matters of behavior or belief. Mentoring is used in a variety of professional settings. 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 For example, Chick and Meleis (1986) have characterized the process of transition as having phases during which individuals go through five phases (see earlier). 1. Hamric & Hanson's Advanced Practice Nursing: An Integrative Approach: 9780323777117: Medicine & Health Science Books @ Amazon.com . Aging and Disability Resource Center, 2011; Administration on Aging, 2012). Health Coaching in Nurse Practitioner-led Group Visits for Chronic Care APNs also attend to patterns, consciously and subconsciously, that develop intuition and contribute to their clinical acumen. Transtheoretical Model of Behavior Change Extensive research on the TCM has documented improved patient and institutional outcomes and led to better understanding of the nature of APN interventions. Nurse health coaches focus on chronic disease prevention through lifestyle and integrative healthcare techniques. Overview of the Model Guidance and Coaching The evolving criteria and requirements for certification of professional coaches are not premised on APN coaching skills. 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. 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. APN coaching is analogous to the flexible and inventive playing of a jazz musician. 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. Evocation requires close attention to the patients statements and emotions to uncover possible motivations that will move the patient forward; so, interventions in this stage are not directed toward overcoming resistance or increasing adherence or compliance to treatment. A nurse coach is a nurse that focuses on whole body wellness - body and mind. 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). However, reflecting on satisfying and successful experiences and discerning why they were effective contributes to developing competence and expertise and reveals knowledge about assessments and interventions that will be useful in future interactions. 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. In a clinical case study. Health coaching provided by registered nurses described: a systematic 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. J Contin Educ Nurs. In identifying these elements, the model of APN guidance and coaching breaks down what is really a holistic, flexible, and often indescribable process. Bookshelf Noting that everyone responds to this type of chemotherapy differently, JS would ask what they had heard about the drugs they would be taking. 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. Adapted from Prochaska, J.O., DiClemente, C.C., & Norcross, J.C. [1992]. Studies of the transitional care model (TCM) and care transitions intervention (CTI) have used APNs as the primary intervener. 2. These initiatives suggest that APNs, administrators, and researchers need to identify those clinical populations for whom APN coaching is necessary. Findings were sustained for as long as 6 months after the program ended. TTM has been used successfully to increase medication adherence and to modify high-risk lifestyle behaviors, such as substance abuse, eating disorders, sedentary lifestyles, and unsafe sexual practices. These ideas are consistent with elements of the TTM and offer useful ideas for assessment. With contemplators, the focus of APN coaching is to try to tip the decisional balance. Contemplation is not a commitment, and the patient is often uncertain. They are acutely aware of the hazards of the behavior and are also more aware of the advantages of changing the behavior. 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. This chapter explores the complex processes of APN role development, with the objectives of providing the following: (1) an understanding of related concepts and research; (2) anticipatory guidance for APN students; (3) role facilitation strategies for new APNs, APN preceptors, faculty, administrators, and interested colleagues; and (4) J Clin Nurs. The most frequent intervention was surveillance; health teaching was the second or third most frequent intervention, depending on the patient population. 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. 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 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. Offering advice or education at this stage can also impede progress toward successful behavior change. There is also a model of practice-based care coordination that used an NP and social worker, the Geriatric Resources for Assessment and Care of Elders (GRACE) model (Counsell, Callahan, Buttar, etal., 2006). Transtheoretical Model of Behavior Change 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). APNs bring their reflections-in-action to their post-encounter reflections on action. All that is changing as nurse coaches are becoming more common and helping nurses achieve success. 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. APNs interpret these multiple sources of information to arrive at possible explanations and interventions. 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. Teaching is an important intervention in the self-management of chronic illness and is often incorporated into guidance and coaching. Exemplar 8-1Anticipatory Guidance in Primary and Acute Care 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. Empirical research findings that predate contemporary professional coaching have affirmed that guidance and coaching are characteristics of APN-patient relationships. 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. The achievement and maintenance of . 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. FIG 8-1 Prochaskas stages of change: The five stages of 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. The Caring advanced practice nursing model is composed of eight core competency domains: direct clinical practice, ethical decision-making, coaching and guidance, consultation, cooperation, case management, research and development, and leadership (Fagerstrm 2011, 2019a). 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. 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. 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. These ideas are consistent with elements of the TTM and offer useful ideas for assessment. When the risks of not changing the behavior are approximately equivalent to the advantages of changing, people can become stuck in ambivalence. Patients know that, if and when they are ready to change, the APN will collaborate with them. Health coaching can strengthen nurse practitioner-led group visits by enhancing peer . Eight core competency domains are delineated in the Caring advanced practice nursing model: 1. Hamric & Hanson's advanced practice nursing - University of Missouri including direct clinical practice, guidance and coaching, consultation, evidence-based practice (EBP), leadership, collaboration, and . Clipboard, Search History, and several other advanced features are temporarily unavailable. 8-1), in which change can be hastened with skillful guidance and coaching. 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. Change is conceptualized as a five-stage process (Fig. 4. 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. These nurses can spend most of their time teaching and counseling patients; nursing students also practice this skill. Accountable care initiatives are an opportunity to implement these findings and evaluate and strengthen the guidance and coaching competency of APNs. 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. Coaching to promote professional development in nursing practice Discuss practical ways the APRN provides guidance and coaching to patients in his or her daily APRN role. Anticipatory guidance is a particular type of guidance aimed at helping patients and families know what to expect. (2011). In medically complex patients, APNs may be preferred and less expensive coaches, in part because of their competencies and scopes of practice. Conclusion week 4 discussion 4.docx - Hello class, I agree that guidance and 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. 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). 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. 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. Nurse coaches also complete follow-up visits, track progress toward health . 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. Attending to the possibility of multiple transitions enables the APN to tailor coaching to the individuals particular needs and concerns. 2019;50(4):170-175.]. Nurse Coaching: What Can a Coach Do for You? Referred to as the Naylor model (Naylor etal., 2004). Many of these transitions have reciprocal impacts across categories. In medically complex patients, APNs may be preferred and less expensive coaches, in part because of their competencies and scopes of practice. Nurse Coach - American Holistic Nurses Studies have suggested that prior embodied experiences may play a role in the expression or the trajectory of a patients health/illness experience. Coaching and mentoring should be a core competency of nurses prepared Experienced APNs are more likely than inexperienced APNs to pay attention to feelings and intuitions. Topeka, KS. The .gov means its official. Guidance and coaching in the nursing practice are part of the work of nursing midwives, clinical specialist nurses, and nurse practitioners. Graduate Nursing Education: Influence of Faculty and Preceptors Advanced practice role of guidance and coaching - Course Hero Noting that everyone responds to this type of chemotherapy differently, JS would ask what they had heard about the drugs they would be taking. It may involve more than one person and is embedded in the context and the situation (Chick & Meleis, 1986, pp. PDF Get Ebooks Advanced Practice Nursing - E-Book: An Integrative Approach Regular self-reflection helps APNs develop skills to describe clinical phenomena and express that which is hard to name. 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. Coaching competency of the advanced practice nurse. Transitions are paradigms for life and living. 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. 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). 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. 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). Distinctions Among Coaching and Other Processes HHS Vulnerability Disclosure, Help Transitions can also be characterized according to type, conditions, and universal properties. There are a number of issues that must be considered by both students and preceptors when negotiating a clinical experienceandragological, curricular, credentialing, and legal . 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.