This bestselling textbook provides a clear, comprehensive, and contemporary introduction to advanced practice . These core competency domains are as follows: values and ethics for interprofessional practice; roles and responsibilities; interprofessional communication; and teams and teamwork. 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. However, all APNs must be skilled in dealing with organizational transitions, because they tend to affect structural and contextual aspects of providing care. Clinical Nurse Specialist<br>Direct clinical practice--includes expertise in advanced assessment, implementing nursing care, and evaluating outcomes.<br>Expert coaching and guidance encompassing . It is important to note that all elements of the model work synergistically to create this competency; separating them for the sake of discussion is somewhat artificial. 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 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. 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. J Clin Nurs 2018. Guidance and coaching are part of the advance practice registered nurse (APRN) competencies, and it leads the change to a patient's healthier life. 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. Making lifestyle or behavior changes are transitions; the stages of change are consistent with the characteristics of transition phases (, Quantitative studies, qualitative studies, and anecdotal reports have suggested that coaching patients and staff through transitions is embedded in the practices of nurses (Benner, Hooper-Kyriakidis, etal., 1999), and particularly APNs (, Brooten, Youngblut, Deatrick, etal., 2003, Advanced Practice Nurses and Models of Transitional Care, 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. Applications to addictive behaviours. For years, business leaders have relied on the guidance and support of career coaches to help them advance in their professions and to achieve clear personal goals as well. 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. 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 (. 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. Although we believe that guidance is distinct from coaching, more work is needed to illuminate the differences and relationships between the two. 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. This definition is necessarily broad and can inform standards for patient education materials and programs targeting common health and illness topics. Adapted from Prochaska, J.O., DiClemente, C.C., & Norcross, J.C. [1992]. 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). APNs can usually coach patients independent of setting, cognitive capacity, and stage of illness; it can be done at a distance or face to face. In 2008, worldwide, over 36 million people died from conditions such as heart disease, cancers, and diabetes (World Health Organization [WHO], 2011, 2012). 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. Based on studies of smokers, Prochaska and associates (2008) learned that behavior change unfolds through stages. Disclaimer. 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. Model of Advanced Practice Nurse Guidance and Coaching 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). These ideas are consistent with elements of the TTM and offer useful ideas for assessment. Model of Advanced Practice Nurse Guidance and Coaching Beginnings, June 2019. Aging and Disability Resource Center, 2011; Administration on Aging, 2012). Contemplation is not a commitment, and the patient is often uncertain. However, all APNs must be skilled in dealing with organizational transitions, because they tend to affect structural and contextual aspects of providing care. The APN uses self-reflection during and after interactions with patients, classically described as reflection-in-action and reflection-on-action (Schn, 1983, 1987). American Psychologist, 47, 1102.). Over the last decade, the importance of interprofessional teamwork to achieve high-quality, patient-centered care has been increasingly recognized. 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. Nrgaard B, Ammentorp J, Ohm Kyvik K . (2011). Interprofessional Teams Earlier work on transitions by Meleis and others is consistent with and affirms the concepts of the TTM. Graduate programs deepen students inherent coaching skills by incorporating evidence-based coaching practices into curricula. [J Contin Educ Nurs. Guidance is assisting by soliciting advice, education, and filling the gap of knowledge deficit as serving as a knowledge source to simplify the health care decision of a patient. 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. Case management 7. Health Care Policy Initiatives 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). Chapter 8 2019;50(4):170-175.]. A serial cross-sectional survey design was used to evaluate the coaching circle experience of four cohorts of Fellows from 2013-2017. The term is also used to refer to advising others, especially in matters of behavior or belief. 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. 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. [2012]. 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. Referred to as the GRACE model (Counsell etal., 2006). APNs bring their reflections-in-action to their post-encounter reflections on action. TABLE 8-2 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). In this stage, the focus of APN coaching is to make the patient feel understood, avoid giving advice, keep lines of communication open, and convey a willingness to be available when the patient is ready to make a change. Transitions can also be characterized according to type, conditions, and universal properties. Developmental, health and illness, and situational transitions are the most likely to lead to clinical encounters requiring guidance and coaching. Care Transition Models Using Advanced Practice Nurses, *Referred to as the Coleman model (Coleman etal., 2004). eCollection 2022 Jan-Dec. Reshaping Nursing Workforce Development by Strengthening the Leadership Skills of Advanced Practice Nurses. Overview of the Model It. Thoroughly revised and updated, the 7 th edition of this bestselling text covers topics ranging from the evolution of advanced practice nursing to evidence-based practice, leadership, ethical decision-making, and health policy. The evolving criteria and requirements for certification of professional coaches are not premised on APN coaching skills. The physical, emotional, social, and economic burdens of chronic illness are enormous but, until recently, investing in resources to promote healthy lifestyles and prevent chronic illnesses has not been a policy priority. 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. Transitions in Health and Illness They have a detailed action plan and may have already taken some action in the past year. APNs develop additional competencies in direct practice and in the guidance and coaching of individuals and families through developmental, health- illness, and situational transitions . 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). Discuss practical ways the APRN provides guidance and coaching to patients in his or her daily APRN role. 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. 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). Coaching as a Model for Facilitating the Performance, Learning, and Development of Palliative Care Nurses. 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). But nurses traditionally haven't used coaches in the same way. 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). Referred to as the Naylor model (Naylor etal., 2004). Expert Answer The development of all major competencies of advanced practice nursing is discussed: direct clinical practice, consultation, coaching/guidance, research, leadership, collaboration, and ethical decision-making. For example, the ability to establish therapeutic relationships and guide patients through transitions is incorporated into the. APNs can usually coach patients independent of setting, cognitive capacity, and stage of illness; it can be done at a distance or face to face. Preparation 4. These can also result from changes in intangible or tangible structures or resources (e.g., loss of a relationship or financial reversals; Schumacher & Meleis, 1994). 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. The APN uses self-reflection during and after interactions with patients, classically described as reflection-in-action and reflection-on-action (Schn, 1983, Health Policy Issues in Changing Environments, Integrative Review of Outcomes and Performance Improvement Research on Advanced Practice Nursing, Conceptualizations of Advanced Practice Nursing, Understanding Regulatory, Legal, and Credentialing Requirements, Role Development of the Advanced Practice Nurse, Advanced Practice Nursing An Integrative Approach. 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. 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 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. Self-reflection is the deliberate internal examination of experience so as to learn from it. Transtheoretical Model of Behavior Change Guidance is directing, advising and counseling patients, and it is closely related to coaching, but less comprehensive and while nurses offer guidance, they empower the patients to manage the care needs through coaching. As with other APN core competencies, the coaching competency develops over time, during and after graduate education. 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. Precontemplation 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. Understanding patients perceptions of transition experiences is essential to effective coaching. 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. All nurses and APNs should be familiar with the patient education resources in their specialty because these resources can facilitate guidance and coaching. 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). Studies have suggested that prior embodied experiences may play a role in the expression or the trajectory of a patients health/illness experience. Evidence That Advanced Practice Nurses Guide and Coach There are several reasons for this: The foundational importance of the therapeutic APN-patient (client) relationship is not consistent with professional coaching principles. Transitional care has been defined as a set of actions designed to ensure the coordination and continuity of health care as patients transfer between different locations or different levels of care within the same location (Coleman & Boult, 2003, p. 556). Teaching is an important intervention in the self-management of chronic illness and is often incorporated into guidance and coaching. These competencies are the following: direct clinical practice, expert coaching and advice, consultation, research skills, clinical and professional leadership, collaboration, and ethical decision making. Development of Advanced Practice Nurses Coaching Competence Before Adapted from the U.S. In this stage, people intend to make a change within the next 6 months. Edited and written by a Who's Who of internationally known advanced practice nursing experts, Hamric and Hanson's Advanced Practice Nursing: An Integrative Approach, 6th Edition helps you develop an understanding of the various advanced practice registered nursing (APRN) roles. Because the GRACE model is similar to the TCM and CTI models, it will not be discussed further here. Interprofessional Teams Although a number of "coaching" types and modalities exist, for example, health, wellness, personal, and life coaching, health coaching . Adapted from Parry, C. & Coleman, E. A. 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). These factors are further influenced by individual and contextual factors. Guidance and coaching by advanced practice nurse (APNs) have been conceptualized as a complex, dynamic, collaborative, and holistic interpersonal process mediated by the APN-patient relationship and the APN's self-reflective skills (Clarke & Spross, 1996; Spross, Clarke, & Beauregard, 2000; Spross, 2009). This edition draws from literature on professional coaching by nurses and others to inform and build on the model of APN guidance and coaching presented in previous editions. Guidance can be seen as a preliminary, less comprehensive form of coaching. Transtheoretical Model of Behavior Change Guidance and coaching in the nursing practice are part of the work of nursing midwives, clinical specialist nurses, and nurse practitioners. Aging and Disability Resource Center, 2011, Schumacher and Meleis (1994) have defined the term. There is no federal regulation of APNs across the 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). 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. Over the last decade, the importance of interprofessional teamwork to achieve high-quality, patient-centered care has been increasingly recognized. As a member of the nursing leadership team, the advanced practice nurse (APN) is on the front line, involved with staff on a daily basis, and able to coach staff in a variety of different situations. 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/). 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. In this stage, people intend to make a change within the next 6 months. 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. describes all competencies, including direct clinical practice, guidance and coaching, consultation, evidence-based practice (EBP), leadership, collaboration . Individual and Contextual Factors That Influence Advanced Practice Nurse Guidance and Coaching 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. APNs also apply their guidance and coaching skills in interactions with colleagues, interprofessional team members, students, and others. Overview of the Model Teaching and counseling are significant clinical activities in nurse-midwifery (Holland & Holland, 2007) and CNS practice (Lewandoski & Adamle, 2009). This definition of guidance draws on dictionary definitions of the word and the use of the term in motivational interviewing (MI). 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 evolving criteria and requirements for certification of professional coaches are not premised on APN coaching skills. The evolving criteria and requirements for certification of professional coaches are not premised on APN coaching skills. Early work by, U.S. American Holistic Nurses Association. Individual elements of the model include clinical, technical, and interpersonal competence mediated by self-reflection. 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. 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.