In todays health care system, transitions are not just about illness. 2. [J Contin Educ Nurs. 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. Discuss practical ways the APRN provides guidance and coaching to patients in his or her daily APRN role. Tran AN, Nevidjon B, Derouin A, Weaver S, Bzdak M. J Nurses Prof Dev. Adapted from Prochaska, J.O., DiClemente, C.C., & Norcross, J.C. [1992]. Currently, the TCM is a set of activities aimed at providing comprehensive in-hospital planning and home follow-up for chronically ill high risk older adults hospitalized for common medical and surgical conditions (Transitional Care Model, 2008-2009; www.transitionalcare.info/). 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. Table 8-3 compares the three models of care transitions that used APNs. Note: The situations are categorized according to the initiating change. Based on studies of smokers, Prochaska and associates (2008) learned that behavior change unfolds through stages. 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 (. When patient-centered approaches are integrated into the mission, values, and activities of organizations, better outcomes for patients and institutions, including safer care, fewer errors, improved patient satisfaction, and reduced costs, should ensue. These competencies are the following: direct clinical practice, expert coaching and advice, consultation, research skills, clinical and professional leadership, collaboration, and ethical decision making. 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). 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). [2012]. In search of how people change. When the risks of not changing the behavior are approximately equivalent to the advantages of changing, people can become stuck in ambivalence. Guidance and Coaching A subtle distinction is that guidance is done by the nurse, whereas coachings focus is on empowering patients to manage their care needs. 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). Ethical decision-making 3. 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. Noting that everyone responds to this type of chemotherapy differently, JS would ask what they had heard about the drugs they would be taking. Disclaimer. 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). 1. Adapted from the U.S. 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). Anticipatory guidance is a particular type of guidance aimed at helping patients and families know what to expect. Patient teaching and education (see Chapter 7) directly relates to APN coaching. This is the stage in which people are not yet contemplating change; specifically, they do not intend to take any action within the next 6 months. The PPACA has led payers to adopt innovative approaches to financing health care, including accountable care organizations (ACOs) and patient-centered medical homes (PCMHs; see, Patient-Centered Care, Culturally Competent and Safe Health Care, and Meaningful Provider-Patient Communication. Definitions: Teaching, Guidance, and Coaching Offering specific advice in this stage is counterproductive and can increase resistance and hamper progression through the stages of change. The aim in offering this model is not only to help APNs understand what coaching is but to give them language by which to explain their interpersonal effectiveness. Coaching is a relatively new application to promote the development of leadership skills in health care and nursing. The evolving criteria and requirements for certification of professional coaches are not premised on APN coaching skills. Exemplar 8-1Anticipatory Guidance in Primary and Acute Care FIG 8-2 Coaching competency of the advanced practice nurse. Self-reflection is the deliberate internal examination of experience so as to learn from it. 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. Building on findings from studies of the TCM, the CTI program supports older adults with complex medical needs as they move throughout the health care system (Parry and Coleman, 2010). This is the stage in which people are ready to take action within 1 month. 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. 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. FIG 8-2 Coaching competency of the advanced practice nurse. 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. Personal communication. 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. Schumacher and Meleis (1994) have proposed four types of transitionsdevelopmental, health and illness, situational, and organizational. American College of Nurse Midwives [ACNM, 2012]; National Association of Clinical Nurse Specialists [NACNS], 2013, National Organization of Nurse Practitioner Faculties [NONPF], 2012. Accountable care initiatives are an opportunity to implement these findings and evaluate and strengthen the guidance and coaching competency of APNs. In a clinical case study, Felitti (2002) proposed that, although diabetes and hypertension were the presenting concerns in a 70-year-old woman, the first priority on her problem list should be the childhood sexual abuse she had experienced; effective treatment of the presenting illnesses would depend on acknowledging the abuse and referring the patient to appropriate therapy. Organizational transitions are those that occur in the environment; within agencies, between agencies, or in society. Making lifestyle or behavior changes are transitions; the stages of change are consistent with the characteristics of transition phases (Chick and Meleis, 1986). 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). Evidence-based care transitions models side-by-side March 2011 (adrc-tae.org/tiki-download_file.php?fileId=30310). 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). 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). As with other APN core competencies, the coaching competency develops over time, during and after graduate education. The PPACA has led payers to adopt innovative approaches to financing health care, including accountable care organizations (ACOs) and patient-centered medical homes (PCMHs; see Chapter 22). official website and that any information you provide is encrypted 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. Teaching is an important intervention in the self-management of chronic illness and is often incorporated into guidance and coaching. eCollection 2022 Jan-Dec. Reshaping Nursing Workforce Development by Strengthening the Leadership Skills of Advanced Practice Nurses. Distinctions Among Coaching and Other Processes. Precontemplators are not interested in learning more, thinking about, or discussing their high-risk behaviors. Click to learn more today. FIG 8-1 Prochaskas stages of change: The five stages of change. 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. Developmental transitions are those that reflect life cycle transitions, such as adolescence, parenthood, and aging. Studies have suggested that prior embodied experiences may play a role in the expression or the trajectory of a patients health/illness experience. Results: Adapted from the U.S. Patient education may include information about cognitive and behavioral changes but these changes cannot occur by teaching alone. This definition is necessarily broad and can inform standards for patient education materials and programs targeting common health and illness topics. 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. Currently, the TCM is a set of activities aimed at providing comprehensive in-hospital planning and home follow-up for chronically ill high risk older adults hospitalized for common medical and surgical conditions (Transitional Care Model, 2008-2009; www.transitionalcare.info/). The foundational importance of the therapeutic APN-patient (client) relationship is not consistent with professional coaching principles. International Council of Nurses (ICN) | ICN - International Council of . APRNs are nurses who have met advanced educational and clinical practice requirements, and often provide services in community-based settings. Precontemplators are not interested in learning more, thinking about, or discussing their high-risk behaviors. APNs also attend to patterns, consciously and subconsciously, that develop intuition and contribute to their clinical acumen. 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. The competency of guidance and coaching is a well-established expectation of the advanced practice nurse (APN). 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. Assumptions Many of these transitions have reciprocal impacts across categories. The purpose of this report is to describe the current literature related to coaching among APNs and the results of this coaching experience. Health coaching and group visits are emerging as 2 effective strategies to improve patients' behavior in chronic care management. 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). Only gold members can continue reading. 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. 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. 2020 Jan 1;51(1):12-14. doi: 10.3928/00220124-20191217-04. PMC Wise APNs pay attention to all four types of transitions in their personal and professional lives.
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