Experienced APNs are more likely than inexperienced APNs to pay attention to feelings and intuitions. Making lifestyle or behavior changes are transitions; the stages of change are consistent with the characteristics of transition phases (Chick and Meleis, 1986). When the risks of not changing the behavior are approximately equivalent to the advantages of changing, people can become stuck in ambivalence. They reflect changes in structures and resources at a system level. Personal communication. As a result, enrollment is expanding in academic settings that prepare advanced practice nurses for primary care and acute care roles. 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. 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 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). It is important to note that all elements of the model work synergistically to create this competency; separating them for the sake of discussion is somewhat artificial. Conclusion For example, Chick and Meleis (1986) have characterized the process of transition as having phases during which individuals go through five phases (see earlier). Nationally and internationally, chronic illnesses are leading causes of morbidity and mortality. Teaching is an important intervention in the self-management of chronic illness and is often incorporated into guidance and coaching. This strategy is aimed at increasing foundational staff nurse knowledge and skills. 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). Individual elements of the model include clinical, technical, and interpersonal competence mediated by self-reflection. Guidance and Coaching Only gold members can continue reading. Guidance and coaching is a core competency of advanced practice nursing. 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. 2. Such guidance needs to be wisely crafted to avoid leading the witness or creating self-fulfilling prophecies (see Exemplar 8-1). 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. Transition Situations That Require Coaching. The competency related to teams and teamwork emphasizes relationship building as an important element of patient-centered care (see Chapter 12). Articles published in English between 2010 and 2021 were included. Clinical nurse specialists (CNSs) typically have more involvement in planning and implementing organizational transitions. Instead of providing the patient with the answers, the coach supports the patient and provides the tools needed to manage the illness and navigate the health care system. Offering advice or education at this stage can also impede progress toward successful behavior change. 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. The term is also used to refer to advising others, especially in matters of behavior or belief. Referred to as the GRACE model (Counsell etal., 2006). A nurse coach is a nurse that focuses on whole body wellness - body and mind. Health coaching and group visits are emerging as 2 effective strategies to improve patients' behavior in chronic care management. Course Hero uses AI to attempt to automatically extract content from documents to surface to you and others so you can study better, e.g., in search results, to enrich docs, and more. 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). Imperatives for Advanced Practice Nurse Guidance and Coaching 2019 May/Jun;35(3):152-159. doi: 10.1097/NND.0000000000000534. The https:// ensures that you are connecting to the Epub 2015 Feb 9. With experience, APNs develop their own strategies for integrating specialty-related anticipatory guidance into their coaching activities. The Resource Hamric & Hanson's advanced practice nursing : an integrative approach, [edited by] Mary Fran Tracy, . Guidance may also occur in situations in which there may be insufficient information for a patient to make an informed choice related to a desired outcome. These factors are further influenced by individual and contextual factors. After multiple experiences with cancer patients, one of the authors (JS) incorporated anticipatory guidance at the start of cancer chemotherapy, using the following approach. The APN uses self-reflection during and after interactions with patients, classically described as reflection-in-action and reflection-on-action (Schn, 1983, 1987). 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 . Coleman and colleagues have found results similar to those of TCM, a decreased likelihood of being readmitted and an increased likelihood of achieving self-identified personal goals around symptom management and functional recovery (. The focus of APN coaching is to work with the patient to avoid relapse by reviewing the stages of change, assessing the stability of the change, assessing for new stressors or reduced capacity to cope with stress, reviewing the patients plans to overcome barriers to change, reminding the patient that vigilance is required, and identifying resources for dealing with new stressors. APNs must be able to explain their nursing contributions, including their relational, communication, and coaching skills, to team members. 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. 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. As with other APN core competencies, the coaching competency develops over time, during and after graduate education. In contrast to mentoring, coaching can specifically be used for guidance related to a specific event, new assignment, or new challenge, with specific objectives in mind. Related Referred to as the GRACE model (Counsell etal., 2006). 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. . However, all APNs must be skilled in dealing with organizational transitions, because they tend to affect structural and contextual aspects of providing care. 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. There are several reasons for this: The foundational importance of the therapeutic APN-patient (client) relationship is not consistent with professional coaching principles. Subsequent studies of CTI have demonstrated significant reductions in 30-, 90-, and 180-day hospital readmissions (Coleman, Parry, Chalmers & Min, 2006). To qualify as a medical or health care home or ACO, practices must engage patients and develop communication strategies. APNs also attend to patterns, consciously and subconsciously, that develop intuition and contribute to their clinical acumen. official website and that any information you provide is encrypted Model of Advanced Practice Nurse Guidance and Coaching Although a number of "coaching" types and modalities exist, for example, health, wellness, personal, and life coaching, health coaching . 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). Guidance and coaching are part of the advance practice registered nurse (APRN) competencies, and it leads the change to a patient's healthier life. 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). It is mediated by the APN-patient relationship and the APNs self-reflective skills and interpersonal, clinical, and technical skills. *Referred to as the Coleman model (Coleman etal., 2004) Stages of Change Care Transition Models Using Advanced Practice Nurses 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). Noting that everyone responds to this type of chemotherapy differently, JS would ask what they had heard about the drugs they would be taking. Developing clinical leaders: the impact of an action learning mentoring programme for advanced practice nurses. 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). 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 is the deliberate internal examination of experience so as to learn from it. 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. Coaching Difficult Patients APNs are likely to move between guidance and coaching in response to their assessments of patients. Running Head: GUIDANCE AND COACHING FOR THE ADVANCED PRACTICE NURSE 1 Guidance and Coaching for the Advanced Expert Help 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. 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). After multiple experiences with cancer patients, one of the authors (JS) incorporated anticipatory guidance at the start of cancer chemotherapy, using the following approach. 3. The Joint Commission (TJC) published the Roadmap for Hospitals in 2010. and transmitted securely. A nurse practitioner (NP), doing a health history on a young woman, elicited information about binge drinking that was a concern. 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. There is no federal regulation of APNs across the Transtheoretical Model of Behavior Change 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. Studies have suggested that prior embodied experiences may play a role in the expression or the trajectory of a patients health/illness experience. 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. 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. Accountable Care Organizations and Patient-Centered Medical Homes 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.
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