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

Share this: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) 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. (From R. W. Scholl. Coaching and guidance 4. 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). Evidence-based care transitions models side-by-side March 2011 (adrc-tae.org/tiki-download_file.php?fileId=30310). In medically complex patients, APNs may be preferred and less expensive coaches, in part because of their competencies and scopes of practice. The competency related to teams and teamwork emphasizes relationship building as an important element of patient-centered care (see Chapter 12). Leadership For a schematic illustration of the model, see Fig. Following a critical content analysis, the roles and responsibilities of the forensic nurses were described and compared with the seven core competencies of advanced nursing practice as outlined . 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 Chapter 22). 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). 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) Personal communication. Health and illness transitions were primarily viewed as illness-related and ranged from adapting to a chronic illness to returning home after a stay in the hospital (Schumacher and Meleis, 1994). The purposes of this chapter are to do the following: offer a conceptualization of APN guidance and coaching that can be applied across settings and patients health states and transitions; integrate findings from the nursing literature and the field of professional coaching into this conceptualization; offer strategies for developing this competency; and differentiate professional coaching from APN guidance and coaching. In 2008, worldwide, over 36 million people died from conditions such as heart disease, cancers, and diabetes (World Health Organization [WHO], 2011, 2012). (2010). 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). To help the reader begin to discern the subtle differences among coaching actions, the terms that inform this model are defined here, in particular, patient education, APN guidance, including anticipatory guidance, and a revised definition of APN coaching (to distinguish it from professional coaching). J Contin Educ Nurs. These competencies are the following: direct clinical practice, expert coaching and advice, consultation, research skills, clinical and professional leadership, collaboration, and ethical decision making. Graduate programs deepen students inherent coaching skills by incorporating evidence-based coaching practices into curricula. Back to Balance LLC, Psychiatric Nurse Practitioner, Cheshire, CT, 06410, (203) 403-6232, Are you struggling with anxiety, panic, depression, mood swings, difficulty focusing, poor motivation . A nurse coach is a nurse that focuses on whole body wellness - body and mind. TABLE 8-2 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. This article chronicles a typical patient's journey through a post-hospital discharge nursing research study involving APNs as "intervention . The APN uses self-reflection during and after interactions with patients, classically described as reflection-in-action and reflection-on-action (Schn, 1983, 1987). Anticipatory guidance is a particular type of guidance aimed at helping patients and families know what to expect. The advantages of coaching are numerous. 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). The APN coaching process can best be understood as an intervention. Patient teaching and education (see Chapter 7) directly relates to APN 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. 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). Why or why not? 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). In this chapter, health and illness transitions are defined as transitions driven by an individuals experience of the body in a holistic sense. Note: The situations are categorized according to the initiating change. 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. Action 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. Parry and Coleman (2010) have offered useful distinctions among different strategies for helping patients: coaching, doing for patients, educating, and guiding along five dimensions (Table 8-1). 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). Overview of the Model D eliberations in the UK on regu-lating advanced nursing prac-tice have been long and com-plex, spanning over 20 years. Data sources: Review of coaching literature in psychology, sports, business, and nursing. Advanced practice competencies are discussed in relation to all advanced practice nursing and blended CNS-NP roles (case manager, acute . Only gold members can continue reading. Transitional care has been defined as a set of actions designed to ensure the coordination and continuity of health care as patients transfer between different locations or different levels of care within the same location (Coleman & Boult, 2003, p. 556). To qualify as a medical or health care home or ACO, practices must engage patients and develop communication strategies. Teaching is an important intervention in the self-management of chronic illness and is often incorporated into guidance and coaching. Silver Spring, MD: Nursebooks.org Beginnings, December 2019. Strategies for Developing and Applying the Coaching Competency 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. Open Longevity Science, 4, 4350. It is important to understand that APN guidance and coaching are not synonymous with professional coaching. 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. Advanced Practice Nurse Guidance and Coaching Competency: Theoretical and Empirical Perspectives 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; Prochaskas stages of change: The five stages of change. 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. The three components share similarities but increase gradually in terms of involvement and participation for further management of the patient's condition. For example, Chick and Meleis (1986) have characterized the process of transition as having phases during which individuals go through five phases (see earlier). 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/). 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. APNs interpret these multiple sources of information to arrive at possible explanations and interventions. Referred to as the GRACE model (Counsell etal., 2006). With experience, APNs develop their own strategies for integrating specialty-related anticipatory guidance into their coaching activities. 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. They reflect changes in structures and resources at a system level. 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 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).