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. HHS Vulnerability Disclosure, Help Table 8-3 compares the three models of care transitions that used APNs. 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 advantages of coaching are numerous. 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. Adapted from the U.S. Transtheoretical Model of Behavior Change Developmental, health and illness, and situational transitions are the most likely to lead to clinical encounters requiring guidance and coaching. In this chapter, health and illness transitions are defined as transitions driven by an individuals experience of the body in a holistic sense. The purpose of this report is to describe the current literature related to coaching among APNs and the results of this coaching experience. 4. 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. 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. [J Contin Educ Nurs. 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. 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. The purpose of this paper was to describe evidenced-based interventions as implemented by advanced practice nurses (APNs) conducting intervention research with a vulnerable population of blood and marrow transplant patients. Definitions: Teaching, Guidance, and Coaching 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. Only gold members can continue reading. Developing clinical leaders: the impact of an action learning mentoring programme for advanced practice nurses. 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. 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. 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. 1. Earlier work on transitions by Meleis and others is consistent with and affirms the concepts of the TTM. Model of Advanced Practice Nurse Guidance and Coaching Early studies documented the nature, focus, content, and amount of time that APNs spent in teaching, guiding and coaching, and counseling, as well as the outcomes of these interventions (Brooten, Youngblut, Deatrick, etal., 2003; see Chapter 23). The Resource Hamric & Hanson's advanced practice nursing : an integrative approach, [edited by] Mary Fran Tracy, . APN students need to be taught that the feelings arising in clinical experiences are often clues to their developing expertise or indicate something that may require personal attention (e.g., a patient who repeatedly comes to clinic intoxicated elicits memories and feelings of a parent who was alcoholic). Because the GRACE model is similar to the TCM and CTI models, it will not be discussed further here. 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). 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. 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. Advanced Nursing Roles-guidance and coaching - Nursing Papers Online Our nursing papers online writers will handle all assignments including the Advanced Nursing Roles-guidance and coaching Manage Orders Place Order + 1 (917) 341-1923 support@nursingpapersonline.com Home Get Nursing Papers Help How It Works Pricing Order Now Contact Us APNs can use the TTM model to tailor interactions and interventions to the patients specific stage of change to maximize the likelihood that they will progress through the stages of behavioral change. Key Features Exemplar 8-1Anticipatory Guidance in Primary and Acute Care. (2010). With contemplators, the focus of APN coaching is to try to tip the decisional balance. Because the GRACE model is similar to the TCM and CTI models, it will not be discussed further here. APNs involve the patients significant other or patients proxy, as appropriate. 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 (Coleman, Smith, Frank, etal. 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. APN coaching is analogous to the flexible and inventive playing of a jazz musician. Mentoring is used in a variety of professional settings. 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). This definition is necessarily broad and can inform standards for patient education materials and programs targeting common health and illness topics. As with other APN core competencies, the coaching competency develops over time, during and after graduate education. APN-led patient education and monitoring programs for specific clinical populations have demonstrated that coaching is central to their effectiveness (Crowther, 2003; Brooten, Naylor, York, etal., 2002; Marineau, 2007). 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. The site is secure. Thus, guidance and coaching by APNs represent an interaction of four factors: the APNs interpersonal, clinical, and technical competence and the APNs self-reflection (Fig. Interprofessional Teams The growth in programs has led to a corresponding increased demand for clinical Dossey and Hess (2013) state that the purpose of coaching in nursing is "to advocate, identify, and focus on factors that promote health, healthy people, and healthy communities" (p. 10). Discuss practical ways the APRN provides guidance and coaching to patients in his or her daily APRN role. 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. 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. Imperatives for Advanced Practice Nurse Guidance and Coaching Offering advice or education at this stage can also impede progress toward successful behavior change. Does it differentiate advanced practice registered nursing from floor RN nursing for you? Guidance and coaching are essential components of work for an advanced practice nurse (APN). 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. 2021 Jun;118:103759. doi: 10.1016/j.ijnurstu.2020.103759. government site. Clinical coaching is a relationship for the purpose of building skills. 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). According to Hamric, guidance is typically done by a nurse while coaching is something done by an advanced practice nurse (APN) because it is resolute, multipart, and collective process in which the APN works with the patient and their families to achieve attainable goals which are thought of together (2014). APNs must be able to explain their nursing contributions, including their relational, communication, and coaching skills, to team members. Guidance and coaching require that APNs be self-aware and self-reflective as an interpersonal transaction is unfolding so that they can shape communications and behaviors to maximize the therapeutic goals of the clinical encounter. Findings were sustained for as long as 6 months after the program ended. Care Transition Models Using Advanced Practice Nurses This bestselling textbook provides a clear, comprehensive, and contemporary introduction to advanced practice . future of advanced practice and how it may shape the career structure of nursing. Advanced practice nursing is more a concept than a defined role and cannot be described as a specific set of skills or regu- . 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 . Model of Advanced Practice Nurse Guidance and Coaching FIG 8-2 Coaching competency of the advanced practice nurse. 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. is directly linked to the competencies of direct clinical practice, coaching, and guidance, complemented by the other components and competencies.9 Regulatory. Many of these transitions have reciprocal impacts across categories. 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. 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). Patient education involves helping patients become better informed about their condition, medical procedures, and choices they have regarding treatment. Click to learn more today. But nurses traditionally haven't used coaches in the same way. 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. Many of these transitions have reciprocal impacts across categories. 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. 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. The https:// ensures that you are connecting to the 8-2). The APN coaching process can best be understood as an intervention. TABLE 8-3 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; Prochaska, Redding, & Evers, 2008). Health Care Policy Initiatives 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. Developmental, health and illness, and situational transitions are the most likely to lead to clinical encounters requiring guidance and coaching. Studies have suggested that prior embodied experiences may play a role in the expression or the trajectory of a patients health/illness experience. 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. 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. Transitioning into the nurse practitioner role through mentorship. Currently, the TCM process is focused on older adults and consists of screening, engaging the older adult and caregiver, managing symptoms, educating and promoting self-management, collaborating, ensuring continuity, coordinating care, and maintaining the relationship (www.transitionalcare.info/). 239-240). Some health and illness changes are self-limiting (e.g., the physiologic changes of pregnancy), whereas others are long term and may be reversible or irreversible. In search of how people change. APRNs are nurses who have met advanced educational and clinical practice requirements, and often provide services in community-based settings. There are a number of issues that must be considered by both students and preceptors when negotiating a clinical experienceandragological, curricular, credentialing, and legal . 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). Debates started in the late 1980s and early 1990s as service and strategic interest in advanced nurse roles grew (Kaufman, 1996; The preceptors and sites must meet standards established by the academic institution, advanced practice nurse certification organizations, and state legislatures. 1. 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. This site needs JavaScript to work properly. 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. Transitions in Health and Illness Schumacher and Meleis (1994) have proposed four types of transitionsdevelopmental, health and illness, situational, and organizational. Subsequent studies of CTI have demonstrated significant reductions in 30-, 90-, and 180-day hospital readmissions (Coleman, Parry, Chalmers & Min, 2006). 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. J Clin Nurs. TABLE 8-1 including direct clinical practice, guidance and coaching, consultation, evidence-based practice (EBP), leadership, collaboration, and . 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. 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). Patient education may include information about cognitive and behavioral changes but these changes cannot occur by teaching alone. For example, TCM programs have begun to use baccalaureate-prepared nurses to provide transitional care; Parry and Coleman (2010) have reported on the use of other providers in CTI interventions, including social workers. Burden of Chronic Illness Using coaching as a leadership skill assists the APN in making a significant contribution to the health care field and to employee growth and . 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. 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 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). 6. Are there certain elements of this competency that are more important than others? Unauthorized use of these marks is strictly prohibited. Subsequent studies of CTI have demonstrated significant reductions in 30-, 90-, and 180-day hospital readmissions (Coleman, Parry, Chalmers & Min, 2006). View Guidance and Coaching Competency.docx from NUR 5081 at William Paterson University. 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). 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). and transmitted securely. Aging and Disability Resource Center, 2011, Schumacher and Meleis (1994) have defined the term. Nurses typically have opportunities to educate patients during bedside conversations or by providing prepared pamphlets or handouts. The competency of guidance and coaching is a well-established expectation of the advanced practice nurse (APN). Controlled trials of this model have found that APN coaching, counseling, and other activities demonstrate statistically significant differences in patient outcomes and resource utilization (e.g., Brooten, Roncoli, Finkler, etal., 1994; Naylor, Brooten, Campbell, etal., 1999). 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. Related They have a detailed action plan and may have already taken some action in the past year. 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. Transitions in Health and Illness Even so, relapse is always possible in the action or maintenance stage and may be a response to stressful situations. Patient teaching and education (see Chapter 7) directly relates to APN coaching. 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. APNs can use nurses theoretical work on transitions to inform assessments and interventions during each of the TTM stages of change and tailor their guiding and coaching interventions to the stage of readiness. Maintenance Distinctions Among Coaching and Other Processes 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. Background: 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. Nationally and internationally, chronic illnesses are leading causes of morbidity and mortality. In addition, patient-centered communication and interprofessional team communication are important quality and safety education for nurses (QSEN) competencies for APNs (Cronenwett, Sherwood, Pohl, etal., 2009; qsen.org/competencies/graduate-ksas/). 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. 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). To qualify as a medical or health care home or ACO, practices must engage patients and develop communication strategies. APNs develop additional competencies in direct practice and in the guidance and coaching of individuals and families through developmental, health- illness, and situational transitions . These distinctions are reflected in the definitions that follow. Bookshelf This is the stage in which people are ready to take action within 1 month. Clinical nurse specialists (CNSs) typically have more involvement in planning and implementing organizational transitions. 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. There are several reasons for this: The teaching-coaching role of the APN The demand for well-educated and skilled healthcare providers has never been greater. Adapted from Parry, C. & Coleman, E. A. 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.
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