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. Advanced practice competencies are discussed in relation to all advanced practice nursing and blended CNS-NP roles (case manager, acute . 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. Our writers are specially selected and recruited, after which they undergo further training to perfect their skills for specialization purposes. Nurses typically have opportunities to educate patients during bedside conversations or by providing prepared pamphlets or handouts. This strategy is aimed at increasing foundational staff nurse knowledge and skills. 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. Aging and Disability Resource Center. 8-1), in which change can be hastened with skillful guidance and coaching. (2011). 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. Nationally and internationally, chronic illnesses are leading causes of morbidity and mortality. 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. 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. Definitions: Teaching, Guidance, and Coaching 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. Advanced practice is a level of practice, rather than a type or specialty of practice. 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. 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. 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). 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. Background: Consultation 5. Active roles for older adults in navigating care transitions: Lessons learned from the care transitions intervention. 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. 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. Guidance can be seen as a preliminary, less comprehensive form of coaching. There are several reasons for this: There are several reasons for this: The foundational importance of the therapeutic APN-patient (client) relationship is not consistent with professional coaching principles. They conduct client visits, use motivational interviewing techniques, and model correct strategies necessary to help patients reach self-management goals. 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, Referred to as the Coleman model (Coleman etal., 2004). To guide is to advise or show the way to others, so guidance can be considered the act of providing counsel by leading, directing, or advising. 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). International Council of Nurses (ICN) | ICN - International Council of . A subtle distinction is that guidance is done by the nurse, whereas coachings focus is on empowering patients to manage their care needs. Studies of the transitional care model (TCM) and care transitions intervention (CTI) have used APNs as the primary intervener. Studies have suggested that prior embodied experiences may play a role in the expression or the trajectory of a patients health/illness experience. 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. 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). Several assumptions underlie this model: Primary Care Definitions: Teaching, Guidance, and Coaching Attending to the possibility of multiple transitions enables the APN to tailor coaching to the individuals particular needs and concerns. FOIA 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. In this stage, the focus of APN coaching is to make the patient feel understood, avoid giving advice, keep lines of communication open, and convey a willingness to be available when the patient is ready to make a change. Offering specific advice in this stage is counterproductive and can increase resistance and hamper progression through the stages of change. Transitions can also be characterized according to type, conditions, and universal properties. Patients know that, if and when they are ready to change, the APN will collaborate with them. The competency related to teams and teamwork emphasizes relationship building as an important element of patient-centered care (see Chapter 12). Guidance Evidence-based care transitions models side-by-side March 2011 (adrc-tae.org/tiki-download_file.php?fileId=30310). 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. Clinical and Technical Competence 1. Patient education involves helping patients become better informed about their condition, medical procedures, and choices they have regarding treatment. The evolving criteria and requirements for certification of professional coaches are not premised on APN coaching skills. Adapted from Prochaska, J.O., DiClemente, C.C., & Norcross, J.C. [1992]. 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. Mentoring up: A grounded theory of nurse-to-nurse mentoring. 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. 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/). Self-Reflection However, all APNs must be skilled in dealing with organizational transitions, because they tend to affect structural and contextual aspects of providing care. Conflict Negotiation and Resolution Adapted from Parry, C. & Coleman, E. A. 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. official website and that any information you provide is encrypted 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). 6. It is mediated by the APN-patient relationship and the APNs self-reflective skills and interpersonal, clinical, and technical skills. Although we believe that guidance is distinct from coaching, more work is needed to illuminate the differences and relationships between the two. Advanced practitioners are educated at masters level in advanced practice and are assessed as competent in practice, using expert knowledge and skills. Model of Advanced Practice Nurse Guidance and Coaching 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). sharing sensitive information, make sure youre on a federal As health care reform in the United States steadily moves the pendulum from sickness and disease to wellness and prevention, new interventions have arisen in the name of coaching to guide and thus improve the life, health, and health risk of individuals. 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. Interpersonal Competence The definition speaks to the fact that others are affected by, or can influence, transitions. Guidance and coaching in the nursing practice are part of the work of nursing midwives, clinical specialist nurses, and nurse practitioners. Coaching is provided by an individual, and guidance is embedded within the decision support materials. Tasks and activities of Advanced Practice Nurses in the psychiatric and mental health care context: A systematic review and thematic analysis. Burden of Chronic Illness 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. 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). 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). Coaching as a Model for Facilitating the Performance, Learning, and Development of Palliative Care Nurses. This is the stage in which people are ready to take action within 1 month. These can also result from changes in intangible or tangible structures or resources (e.g., loss of a relationship or financial reversals; Schumacher & Meleis, 1994). The preceptors and sites must meet standards established by the academic institution, advanced practice nurse certification organizations, and state legislatures. 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). Patient Education Key Features 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. 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. Bookshelf JS pointed out that the first treatment was the hardest because of unknown factors and that if the patient paid attention to his or her own experienceif and when side effects occurredthey would be in a position to work together to make subsequent treatments more tolerable. The APN coaching process can best be understood as an intervention. It applies APN core competencies to the major APN roles - including the burgeoning Nurse Practitioner role - and covers topics ranging from the evolution of APN to evidence-based . 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 . (2011). Transition Situations That Require Coaching. Does it differentiate advanced practice registered nursing from floor RN nursing for you? It may involve more than one person and is embedded in the context and the situation (Chick & Meleis, 1986, pp. Regular self-reflection helps APNs develop skills to describe clinical phenomena and express that which is hard to name. 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. A subtle distinction is that guidance is done by the nurse, whereas coachings focus is on empowering patients to manage their care needs. Maintenance 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. Adapted from the U.S. 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. 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. 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). Table 8-3 compares the three models of care transitions that used APNs. 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. Coaching competency of the advanced practice nurse. 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. Patients know that, if and when they are ready to change, the APN will collaborate with them. The competency of guidance and coaching is a well-established expectation of the advanced practice nurse (APN). Chick and Meleis (1986) have characterized the process of transition as having phases during which individuals experience the following: (1) disconnectedness from their usual social supports; (2) loss of familiar reference points; (3) old needs that remain unmet; (4) new needs; and (5) old expectations that are no longer congruent with the changing situation. Subsequent studies of CTI have demonstrated significant reductions in 30-, 90-, and 180-day hospital readmissions (Coleman, Parry, Chalmers & Min, 2006). 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. Int J Nurs Stud. 2. All nurses and APNs should be familiar with the patient education resources in their specialty because these resources can facilitate guidance and coaching. 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. 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. 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. Many of these transitions have reciprocal impacts across categories. 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. 5. 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. Table 8-3 compares the three models of care transitions that used APNs. Rollnick and colleagues (2008) have described guiding as one of three styles of doing MI. Advanced Practice Nursing: Essential Knowledge for the Profession, Third Edition is a core advanced practice text used i. Anmelden; Registrierung; . Similar to life, they may be predictable or unpredictable, joyous or painful, obvious or barely perceptible, chosen and welcomed, or unexpected and feared. 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. 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. Extensive research on the TCM has documented improved patient and institutional outcomes and led to better understanding of the nature of APN interventions. 5. 8600 Rockville Pike 2004). Nrgaard B, Ammentorp J, Ohm Kyvik K . FIG 8-1 Prochaskas stages of change: The five stages of change. 5.1. Earlier work on transitions by Meleis and others is consistent with and affirms the concepts of the TTM. This chapter considers the core competency of APN guidance and coaching within the context of the nursing professions efforts to extend and advance the coaching functions of nurses. Ethical decision-making 3. The growth in programs has led to a corresponding increased demand for clinical 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. Advanced practice nurses use role modelling, teaching, clinical problem solving and change facilitation to promote evidence-based practice among . 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. Referred to as the Naylor model (Naylor etal., 2004). Anticipatory guidance is a particular type of guidance aimed at helping patients and families know what to expect. Direct clinical practice -- Coaching and guidance -- Consultation -- Evidence-based practice -- Leadership -- Collaboration -- Ethical decision making -- The clinical nurse specialist -- The primary care nurse practitioner -- The . This section reviews selected literature reports, including the following: (1) conceptual and empirical work on transitions as a major focus of APN guidance and coaching; (2) the transtheoretical model of behavior change (also known as the stages of change theory) and its associated interventions; and (3) evidence that APNs incorporate expert guidance and coaching as they deliver care.