Advanced Practice Nursing: An Integrative Approach ISBN 9781455739806 1455739804 by Ann B. Hamric; Charlene M. Hanson; Mary Fran Tracy; Eileen T. O'Grady - buy, sell or rent this book for the best price. Making lifestyle or behavior changes are transitions; the stages of change are consistent with the characteristics of transition phases (Chick and Meleis, 1986). 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. They conduct client visits, use motivational interviewing techniques, and model correct strategies necessary to help patients reach self-management goals. 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/). 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. 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. But nurses traditionally haven't used coaches in the same way. New to this edition NEW! 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. In 2008, worldwide, over 36 million people died from conditions such as heart disease, cancers, and diabetes (World Health Organization [WHO], 2011, 2012). The Joint Commission (TJC) published the Roadmap for Hospitals in 2010. While interacting with patients, APNs integrate observations and information gleaned from physical examinations and interviews with their own theoretical understanding, noncognitive intuitive reactions, and the observations, intuitions, and theories that they elicit from patients. The Joint Commission (TJC) published the Roadmap for Hospitals in 2010. FIG 8-1 Prochaskas stages of change: The five stages of change. Anticipatory guidance is a particular type of guidance aimed at helping patients and families know what to expect. The preceptors and sites must meet standards established by the academic institution, advanced practice nurse certification organizations, and state legislatures. 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. The Resource Hamric & Hanson's advanced practice nursing : an integrative approach, [edited by] Mary Fran Tracy, . 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. In identifying these elements, the model of APN guidance and coaching breaks down what is really a holistic, flexible, and often indescribable process. Noting that everyone responds to this type of chemotherapy differently, JS would ask what they had heard about the drugs they would be taking. 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). Contemplation is not a commitment, and the patient is often uncertain. Distinctions Among Coaching and Other Processes 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). 2020 Jan 1;51(1):12-14. doi: 10.3928/00220124-20191217-04. Hill LA, Sawatzky JA. J Clin Nurs 2018. Furthermore, many APNs will have responsibilities for coaching teams to deliver patient-centered care. 8-2). How do you think guidance and coaching in the advanced practice role is different from the RN role of teaching/coaching? APNs also apply their guidance and coaching skills in interactions with colleagues, interprofessional team members, students, and others. APNs bring their reflections-in-action to their post-encounter reflections on action. The foundational importance of the therapeutic APN-patient (client) relationship is not consistent with professional coaching principles. Clinical Nurse Specialist<br>Direct clinical practice--includes expertise in advanced assessment, implementing nursing care, and evaluating outcomes.<br>Expert coaching and guidance encompassing . Developmental transitions are those that reflect life cycle transitions, such as adolescence, parenthood, and aging. 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). Guidance can be seen as a preliminary, less comprehensive form of coaching. 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). As with other APN core competencies, the coaching competency develops over time, during and after graduate education. Many of these transitions have reciprocal impacts across categories. They have the freedom and authority to act, making autonomous decisions in the assessment, diagnosis and . Active roles for older adults in navigating care transitions: Lessons learned from the care transitions intervention. Table 8-3 compares the three models of care transitions that used APNs. Distinctions Among Coaching and Other Processes. Because motivational interviewing (MI) has been part of CTI training, these findings suggest that integration of TTM key principles into APN practice, such as helping patients identify their own goals and having support (coaching) in achieving them, contributes to successful coaching outcomes. These initiatives suggest that APNs, administrators, and researchers need to identify those clinical populations for whom APN coaching is necessary. Why or why not? Topeka, KS. 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. 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). APNs used a holistic focus that required clinical expertise, including sufficient patient contact, interpersonal competence, and systems leadership skills to improve outcomes (Brooten, Youngblut, Deatrick, etal., 2003). 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. As health care reform in the United States steadily moves the pendulum from sickness and disease to wellness and prevention, new interventions have arisen in the name of coaching to guide and thus improve the life, health, and health risk of individuals. The APN uses self-reflection during and after interactions with patients, classically described as reflection-in-action and reflection-on-action (Schn, 1983, 1987). Mentoring is used in a variety of professional settings. Adapted from the U.S. Extensive research on the TCM has documented improved patient and institutional outcomes and led to better understanding of the nature of APN interventions. 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. The most frequent intervention was surveillance; health teaching was the second or third most frequent intervention, depending on the patient population. Teaching is an important intervention in the self-management of chronic illness and is often incorporated into guidance and coaching. 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. 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). Tags: Advanced Practice Nursing An Integrative Approach
Although we believe that guidance is distinct from coaching, more work is needed to illuminate the differences and relationships between the two. The term is also used to refer to advising others, especially in matters of behavior or belief. Transition Situations That Require Coaching. Both guidance and coaching competencies are equally important elements that help in the treatment of a patient. . Imperatives for Advanced Practice Nurse Guidance and Coaching Precontemplation J Prof Nurs. 8600 Rockville Pike A serial cross-sectional survey design was used to evaluate the coaching circle experience of four cohorts of Fellows from 2013-2017. Rollnick and colleagues (2008) have described guiding as one of three styles of doing MI. Based on studies of smokers, Prochaska and associates (2008) learned that behavior change unfolds through stages. It is mediated by the APN-patient relationship and the APNs self-reflective skills and interpersonal, clinical, and technical skills. Self-Reflection It may involve more than one person and is embedded in the context and the situation (Chick & Meleis, 1986, pp. 2022 Jul 15;8:23779608221113864. doi: 10.1177/23779608221113864. 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; National Center for Quality Assurance [NCQA], 2011. Federal government websites often end in .gov or .mil. As with other APN core competencies, the coaching competency develops over time, during and after graduate education. These distinctions are reflected in the definitions that follow. Bethesda, MD 20894, Web Policies The competency related to teams and teamwork emphasizes relationship building as an important element of patient-centered care (see Chapter 12).
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