eCollection 2022 Jan-Dec. Reshaping Nursing Workforce Development by Strengthening the Leadership Skills of Advanced Practice Nurses. Teaching is an important intervention in the self-management of chronic illness and is often incorporated into guidance and coaching. 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; Parry and Coleman (2010) have offered useful distinctions among different strategies for helping patients: coaching, doing for patients, educating, and guiding along five dimensions (, Patient teaching and education (see Chapter 7) directly relates to APN coaching. Skill in establishing therapeutic relationships and being able to coach patients based on discipline-related content and skills will be important in achieving interprofessional, patient-centered care. Adapted from Parry, C. & Coleman, E. A. Referred to as the GRACE model (Counsell etal., 2006). Data sources Articles were identified through a search of CINAHL, Medline, Scopus, and PsychINFO databases. The Joint Commission (TJC) published the Roadmap for Hospitals in 2010. 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). Both guidance and coaching competencies are equally important elements that help in the treatment of a patient. Mentoring is used in a variety of professional settings. Teaching is an important intervention in the self-management of chronic illness and is often incorporated into guidance and coaching. Commentary on: Hale RL, Phillips CA. These initiatives signal increasing recognition by all stakeholders that improving health care depends on a patient-centered orientation in which providers communicate meaningfully and effectively and provide culturally competent and safe care (IOM, 2010; Hobbs, 2009; TJC, 2010; Woods, 2010). Direct clinical practice 2. Empirical research findings that predate contemporary professional coaching have affirmed that guidance and coaching are characteristics of APN-patient relationships. 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. Reflection in action is the ability to pay attention to phenomena as they are occurring, giving free rein to ones intuitive understanding of the situation as it is unfolding; individuals respond with a varied repertoire of exploratory and transforming actions best characterized as strategic improvisation. Chapter 8 MeSH Accountable Care Organizations and Patient-Centered Medical Homes At least 1year of APN experience is needed to define and implement all APN role dimensions, including leadership (Baker, Registered nurses, including APNs, are central to a redesigned health system that emphasizes prevention and early intervention to promote healthy lifestyles, prevent chronic diseases, and reduce the personal, community, organizational, and economic burdens of chronic illness (Hess, Dossey, Southard, etal., 2012; Institute of Medicine [IOM], 2010; Thorne, 2005). In practice, APNs remain aware of the possibility of multiple transitions occurring as a result of one salient transition. 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. New graduates entering a professional field of practice as well as established nurses moving into a new practice setting or a new role may receive mentoring as part of the role transition process. 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. These ideas are consistent with elements of the TTM and offer useful ideas for assessment. The provision of patient-centered care and meaningful patient-provider communication activates and empowers patients and their families to assume responsibility for initiating and maintaining healthy lifestyles and/or adopting effective chronic illness management skills. 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. Developmental transitions are those that reflect life cycle transitions, such as adolescence, parenthood, and aging. However, all APNs must be skilled in dealing with organizational transitions, because they tend to affect structural and contextual aspects of providing care. The ability to self-reflect and focus on the process of coaching as it is occurring implies that APNs are capable of the simultaneous execution of other skills. Subsequent studies of CTI have demonstrated significant reductions in 30-, 90-, and 180-day hospital readmissions (Coleman, Parry, Chalmers & Min, 2006). Guidance can be seen as a preliminary, less comprehensive form of coaching. 2021 Jun;118:103759. doi: 10.1016/j.ijnurstu.2020.103759. As APNs assess, diagnose, and treat a patient, they are attending closely to the meanings that patients ascribe to health and illness experiences; APNs take these meanings into account in working with patients. 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. Schumacher and Meleis (1994) have defined the term transition as a passage from one life phase, condition, or status to another: Transition refers to both the process and outcome of complex person-environment interactions. FIG 8-2 Coaching competency of the advanced practice nurse. Nrgaard B, Ammentorp J, Ohm Kyvik K . 1. These distinctions are reflected in the definitions that follow. The advantages of coaching are numerous. 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. TABLE 8-1 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. Bethesda, MD 20894, Web Policies Clinical and Technical Competence Health Care Policy Initiatives 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). Guidance Imperatives for Advanced Practice Nurse Guidance and Coaching The achievement and maintenance of . Abstract Purpose: The purposes of this study were to explore coaching as a nurse practitioner (NP) strategy for improving patient health outcomes and to lay a foundation for validating coaching benefits. 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). The site is secure. 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 (. Similar to life, they may be predictable or unpredictable, joyous or painful, obvious or barely perceptible, chosen and welcomed, or unexpected and feared. 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. 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). 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. Empirical research findings that predate contemporary professional coaching have affirmed that guidance and coaching are characteristics of APN-patient relationships. 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. 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. 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. There are several reasons for this: Regardless of how difficult life becomes, patients are confident that they can sustain the changes they have achieved and will not return to unhealthy coping mechanisms. Attending to the possibility of multiple transitions enables the APN to tailor coaching to the individuals particular needs and concerns. Referred to as the Naylor model (Naylor etal., 2004). Organizational transitions are those that occur in the environment; within agencies, between agencies, or in society. But nurses traditionally haven't used coaches in the same way. As with other APN core competencies, the coaching competency develops over time, during and after graduate education. 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. 2004). 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. 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). With experience, APNs develop their own strategies for integrating specialty-related anticipatory guidance into their coaching activities. 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 [email protected] Home Get Nursing Papers Help How It Works Pricing Order Now Contact Us Aging and Disability Resource Center. 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). 239-240). 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. Nurse health coaches focus on chronic disease prevention through lifestyle and integrative healthcare techniques. sharing sensitive information, make sure youre on a federal Using coaching as a leadership skill assists the APN in making a significant contribution to the health care field and to employee growth and . There are several reasons for this: The foundational importance of the therapeutic APN-patient (client) relationship is not consistent with professional coaching principles. APNs also apply their guidance and coaching skills in interactions with colleagues, interprofessional team members, students, and others. Earlier work on transitions by Meleis and others is consistent with and affirms the concepts of the TTM. Nurses typically have opportunities to educate patients during bedside conversations or by providing prepared pamphlets or handouts. Transitions in Health and Illness 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 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. Exemplar 8-1Anticipatory Guidance in Primary and Acute Care. 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. Tags: Advanced Practice Nursing An Integrative Approach 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. (2011). 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. 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. Adapted from Prochaska, J.O., DiClemente, C.C., & Norcross, J.C. [1992]. Accountable care initiatives are an opportunity to implement these findings and evaluate and strengthen the guidance and coaching competency of APNs. 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. Nationally and internationally, chronic illnesses are leading causes of morbidity and mortality. Contemplation is not a commitment, and the patient is often uncertain. Definitions: Teaching, Guidance, and Coaching 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. Tran AN, Nevidjon B, Derouin A, Weaver S, Bzdak M. J Nurses Prof Dev. 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. Such guidance needs to be wisely crafted to avoid leading the witness or creating self-fulfilling prophecies (see Exemplar 8-1). Only gold members can continue reading. After multiple experiences with cancer patients, one of the authors (JS) incorporated anticipatory guidance at the start of cancer chemotherapy, using the following approach. 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/).

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