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. 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 . Based on studies of smokers, Prochaska and associates (2008) learned that behavior change unfolds through stages. 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. Graduate programs deepen students inherent coaching skills by incorporating evidence-based coaching practices into curricula. 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. 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. 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 . 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. They have a detailed action plan and may have already taken some action in the past year. Aging and Disability Resource Center. Situational transitions are most likely to include changes in educational, work, and family roles. In 2008, worldwide, over 36 million people died from conditions such as heart disease, cancers, and diabetes (World Health Organization [WHO], 2011, 2012). 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). Patients know that, if and when they are ready to change, the APN will collaborate with them. Federal government websites often end in .gov or .mil. Data sources: Review of coaching literature in psychology, sports, business, and nursing. 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. Topeka, KS. Consultation 5. 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 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. In this chapter, health and illness transitions are defined as transitions driven by an individuals experience of the body in a holistic sense. Advanced practice competencies are discussed in relation to all advanced practice nursing and blended CNS-NP roles (case manager, acute . 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 Nurses Prof Dev. A nurse practitioner (NP), doing a health history on a young woman, elicited information about binge drinking that was a concern. This is the stage in which people are ready to take action within 1 month. 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 is a level of practice, rather than a type or specialty of practice. 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. It may involve more than one person and is embedded in the context and the situation (Chick & Meleis, 1986, pp. They have the freedom and authority to act, making autonomous decisions in the assessment, diagnosis and . To qualify as a medical or health care home or ACO, practices must engage patients and develop communication strategies. Although technical competence and clinical competence may be sufficient for teaching a task, they are insufficient for coaching patients through transitions, including chronic illness experiences or behavioral and lifestyle changes. 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. Aging and Disability Resource Center, 2011, Schumacher and Meleis (1994) have defined the term. Participants evaluated the structure and function, as well as the value, of the coaching circle. 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. The publication of these competencies, together with research on interprofessional work in the health professions (e.g., Reeves, Zwarenstein, Goldman, etal., 2010), are helping educators determine how best to incorporate interprofessional competencies into APN education. Acute Care Offering specific advice in this stage is counterproductive and can increase resistance and hamper progression through the stages of change. 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. APN coaching is analogous to the flexible and inventive playing of a jazz musician. 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. They have a detailed action plan and may have already taken some action in the past year. 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). JS would review the common side effects, what could be done pharmacologically and nonpharmacologically to minimize the effects, and what other patients had done to manage their time and activities during the period receiving chemotherapy. Referred to as the GRACE model (Counsell etal., 2006). Using coaching as a leadership skill assists the APN in making a significant contribution to the health care field and to employee growth and . As a result, enrollment is expanding in academic settings that prepare advanced practice nurses for primary care and acute care roles. Care Transition Models Using Advanced Practice Nurses 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. Experienced APNs are more likely than inexperienced APNs to pay attention to feelings and intuitions. Nationally and internationally, chronic illnesses are leading causes of morbidity and mortality. Adapted from Parry, C. & Coleman, E. A. Exemplar 8-1Anticipatory Guidance in Primary and Acute Care. Coaching circles are a technique used in the Duke-Johnson & Johnson Nurse Leadership Program to provide guidance and expertise to small groups of advanced practice nurse (APN) Fellows to facilitate completion of a transformational project. 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. Guidance and coaching is a core competency of advanced practice nursing. Bookshelf 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. The Joint Commission (TJC) published the Roadmap for Hospitals in 2010. ANP is an umbrella term that refers to "an advanced level of nursing practice that maximizes the use of in-depth nursing knowledge and skill in meeting the health needs of clients (individuals, families, groups, populations or entire communities)" ( Canadian Nurses Association, 2006: p. 1). 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. Graduate programs deepen students inherent coaching skills by incorporating evidence-based coaching practices into curricula. However, reflecting on satisfying and successful experiences and discerning why they were effective contributes to developing competence and expertise and reveals knowledge about assessments and interventions that will be useful in future interactions. 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. 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). Costeira C, Dixe MA, Querido A, Vitorino J, Laranjeira C. SAGE Open Nurs. Although technical competence and clinical competence may be sufficient for teaching a task, they are insufficient for coaching patients through transitions, including chronic illness experiences or behavioral and lifestyle changes. 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. 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. The APN uses self-reflection during and after interactions with patients, classically described as reflection-in-action and reflection-on-action (Schn, 1983, 1987). 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. APNs interpret these multiple sources of information to arrive at possible explanations and interventions. These factors are further influenced by individual and contextual factors. Patient Education 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). Because the GRACE model is similar to the TCM and CTI models, it will not be discussed further here. Hamric & Hanson's Advanced Practice Nursing: An Integrative Approach: 9780323777117: Medicine & Health Science Books @ Amazon.com . Nurses typically have opportunities to educate patients during bedside conversations or by providing prepared pamphlets or handouts. Teaching is an important intervention in the self-management of chronic illness and is often incorporated into guidance and coaching. The deliberate use of guidance in situations that are acute, uncertain, or time-constrained, offers patients and families ideas for examining alternatives or identifying likely responses. In medically complex patients, APNs may be preferred and less expensive coaches, in part because of their competencies and scopes of practice. The evolving criteria and requirements for certification of professional coaches are not premised on APN coaching skills. 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.
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