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. 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. The term is also used to refer to advising others, especially in matters of behavior or belief. Studies of the transitional care model (TCM) and care transitions intervention (CTI) have used APNs as the primary intervener. 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. Patient education involves helping patients become better informed about their condition, medical procedures, and choices they have regarding treatment. 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. Since the last edition, developments in public health and health policy within nursing and across disciplines have influenced the conceptualization of the APN guidance and coaching competency. With contemplators, the focus of APN coaching is to try to tip the decisional balance. 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. Care Transition Models Using Advanced Practice Nurses, *Referred to as the Coleman model (Coleman etal., 2004). Distinctions Among Coaching and Other Processes. Several assumptions underlie this model: Guidance and coaching by advanced practice nurse (APNs) have been conceptualized as a complex, dynamic, collaborative, and holistic interpersonal process mediated by the APN-patient relationship and the APN's self-reflective skills (Clarke & Spross, 1996; Spross, Clarke, & Beauregard, 2000; Spross, 2009). Patient teaching and education (see Chapter 7) directly relates to APN coaching. 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. J Am Assoc Nurse Pract. The development of all major competencies of advanced practice nursing is discussed: direct clinical practice, consultation, coaching/guidance, research, leadership, collaboration, and ethical decision-making. Expert Answer Transitions can also be characterized according to type, conditions, and universal properties. 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. Understanding patients perceptions of transition experiences is essential to effective coaching. 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. 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). However, all APNs must be skilled in dealing with organizational transitions, because they tend to affect structural and contextual aspects of providing care. Advanced Practice Nurses and Models of Transitional Care According to these authors, a commitment and ability to adopt a coaching role and foster empowerment and confidence in the patient is more important than a disciplinary background. 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). 1. 8-1), in which change can be hastened with skillful guidance and coaching. American Psychologist, 47, 1102.). 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. It may involve more than one person and is embedded in the context and the situation (Chick & Meleis, 1986, pp. 2017;33(1):33-9. The APN coaching process can best be understood as an intervention. Judith A. Spross and Rhonda L. Babine 10.1111/jocn.14636. 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). Transtheoretical Model of Behavior Change This definition is necessarily broad and can inform standards for patient education materials and programs targeting common health and illness topics. 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. 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. Topeka, KS. Offering advice or education at this stage can also impede progress toward successful behavior change. Advanced Practice Nursing: An Integrative Approach ISBN 9781455739806 1455739804 by Ann B. Hamric; Charlene M. Hanson; Mary Fran Tracy; Eileen T. O'Grady - buy, sell or rent this book for the best price. In todays health care system, transitions are not just about illness. Relapse can occur over time (e.g., several just this once, I can occasions), but even one slip can initiate a return to the old behavior. American Holistic Nurses Association. 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; Parry and Coleman (2010) have offered useful distinctions among different strategies for helping patients: coaching, doing for patients, educating, and guiding along five dimensions (, Patient teaching and education (see Chapter 7) directly relates to APN coaching. 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). Hill LA, Sawatzky JA. 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. Guidance and Coaching Competency and Outcomes 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. Table 8-2 lists some transitions, based on this typology, that might require APN coaching. Advanced Practice Nurse Guidance and Coaching and Coach Certification 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. All nurses and APNs should be familiar with the patient education resources in their specialty because these resources can facilitate guidance and coaching. 2015 Jun;24(11-12):1576-84. doi: 10.1111/jocn.12757. In practice, APNs remain aware of the possibility of multiple transitions occurring as a result of one salient transition. Debates started in the late 1980s and early 1990s as service and strategic interest in advanced nurse roles grew (Kaufman, 1996; Key Features Furthermore, many APNs will have responsibilities for coaching teams to deliver patient-centered care. Aging and Disability Resource Center, 2011; Administration on Aging, 2012). 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 APN uses self-reflection during and after interactions with patients, classically described as reflection-in-action and reflection-on-action (Schn, 1983, 1987). 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). (From R. W. Scholl. Based on studies of smokers, Prochaska and associates (2008) learned that behavior change unfolds through stages. Graduate programs deepen students inherent coaching skills by incorporating evidence-based coaching practices into curricula. The term encompasses four commonly identified role . As with other APN core competencies, the coaching competency develops over time, during and after graduate education. National Library of Medicine 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. Precontemplation 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. 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. When patient-centered approaches are integrated into the mission, values, and activities of organizations, better outcomes for patients and institutions, including safer care, fewer errors, improved patient satisfaction, and reduced costs, should ensue. Adapted from the U.S. The site is secure. A subtle distinction is that guidance is done by the nurse, whereas coachings focus is on empowering patients to manage their care needs. Are there certain elements of this competency that are more important than others? 8600 Rockville Pike Federal government websites often end in .gov or .mil. Thoroughly revised and updated, the 7th edition of this bestselling text covers topics ranging from the evolution of advanced practice nursing to evidence-based practice, leadership, ethical decision-making, and health policy. Personal communication. Note: The situations are categorized according to the initiating change. 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). 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. They are acutely aware of the hazards of the behavior and are also more aware of the advantages of changing the behavior. View Guidance and Coaching Competency.docx from NUR 5081 at William Paterson University. With experience, APNs develop their own strategies for integrating specialty-related anticipatory guidance into their coaching activities. Many of these transitions have reciprocal impacts across categories. Situational transitions are most likely to include changes in educational, work, and family roles. 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. 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). HHS Vulnerability Disclosure, Help 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. APNs also apply their guidance and coaching skills in interactions with colleagues, interprofessional team members, students, and others. 2004). 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. This is the stage in which people are ready to take action within 1 month. In identifying these elements, the model of APN guidance and coaching breaks down what is really a holistic, flexible, and often indescribable process. In addition, each of the 6 core competencies of the APN role identified by Method: Accessibility Bethesda, MD 20894, Web Policies 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. Developmental, health and illness, and situational transitions are the most likely to lead to clinical encounters requiring guidance and coaching. In a clinical case study. There are several reasons for this: The foundational importance of the therapeutic APN-patient (client) relationship is not consistent with professional coaching principles. 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. Mentoring up: A grounded theory of nurse-to-nurse mentoring. Teaching is an important intervention in the self-management of chronic illness and is often incorporated into guidance and coaching. APNs must be able to explain their nursing contributions, including their relational, communication, and coaching skills, to team members. Graduate programs deepen students inherent coaching skills by incorporating evidence-based coaching practices into curricula. Individual elements of the model include clinical, technical, and interpersonal competence mediated by self-reflection. 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. These core competency domains are as follows: values and ethics for interprofessional practice; roles and responsibilities; interprofessional communication; and teams and teamwork. 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 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). 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. Oct 19, 2016 | Posted by admin in NURSING | Comments Off on Guidance and Coaching, Imperatives for Advanced Practice Nurse Guidance and Coaching, Definitions: Teaching, Guidance, and Coaching, Advanced Practice Nurse Guidance and Coaching Competency: Theoretical and Empirical Perspectives, Transtheoretical Model of Behavior Change, Evidence That Advanced Practice Nurses Guide and Coach, Model of Advanced Practice Nurse Guidance and Coaching, Individual and Contextual Factors That Influence Advanced Practice Nurse Guidance and Coaching, Guidance and Coaching Competency and Outcomes, Development of Advanced Practice Nurses Coaching Competence, Graduate Nursing Education: Influence of Faculty and Preceptors, Strategies for Developing and Applying the Coaching Competency, Advanced Practice Nurse Guidance and Coaching and Coach Certification. Advanced Practice Nurse Guidance and Coaching Competency: Theoretical and Empirical Perspectives 2020 Jan 1;51(1):12-14. doi: 10.3928/00220124-20191217-04. 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. Nationally and internationally, chronic illnesses are leading causes of morbidity and mortality. Assumptions Developmental transitions are those that reflect life cycle transitions, such as adolescence, parenthood, and aging. Assumptions In 2008, 107 million Americans had at least one of six chronic illnessescardiovascular disease, arthritis, diabetes, asthma, cancer, and chronic obstructive pulmonary disease (U.S. Department of Health and Human Services [HSS], 2012); this number is expected to grow to 157 million by 2020 (Bodenheimer, Chen, & Bennett, 2009). Patients know that, if and when they are ready to change, the APN will collaborate with them. 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). Discuss practical ways the APRN provides guidance and coaching to patients in his or her daily APRN role. 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. Log In or Register to continue Contemplation J Nurses Prof Dev. 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. These nurses can spend most of their time teaching and counseling patients; nursing students also practice this skill. 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. Accountable care initiatives are an opportunity to implement these findings and evaluate and strengthen the guidance and coaching competency of APNs. 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). 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. 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. Addressing all major advanced practice nursing competencies, roles, and issues, Advanced Practice Nursing: An Integrative Approach, 5th Edition provides a clear, comprehensive, and current introduction to APN today. 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. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). 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. 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. Advanced practice nurses use role modelling, teaching, clinical problem solving and change facilitation to promote evidence-based practice among . Primary Care Understanding patients perceptions of transition experiences is essential to effective coaching. 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. Situational transitions are most likely to include changes in educational, work, and family roles. 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; IOM, 2001; National Center for Quality Assurance [NCQA], 2011). 1. Leadership For a schematic illustration of the model, see Fig. Earlier work on transitions by Meleis and others is consistent with and affirms the concepts of the TTM. 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.
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