Guidance and Coaching Competencies

Reply to these three posts separately. Do not judge or be biased.

Post 1:
Guidance and coaching in the advanced practice role differs from the RN role of teaching and coaching. According to Hamric (2014) guidance “is done by the nurse” (p. 185). Guidance by a registered nurse (RN) is defined as “the act of providing counsel by leading, directing, or advising”, also referred to as teaching (Hamric, 2014, p. 186). The RN often teaches “during bedside conversations” and “by providing prepared pamphlets or handouts” (Hamric, 2014, p. 185). Vann (2015) recommends giving the patient a pre-test, then a pamphlet with information in regards to their health concerns, and then a post-test (p. 240). According to Vann (2015) the post-test is significantly higher after the patient receives the information (p. 240). Guidance in the advanced practice nurse (APN) 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” (Hamric, 2014, p. 186). Guidance for the APN includes what the RN does, but it is also more advanced. The main purpose and most important part of guidance in APNs are to “raise awareness, contemplate, implement, and sustain a behavior change, manage a health or illness situation, and prepare for transitions” (Hamric, 2014, p. 186).

Coaching is an act of “empowering patients to manage their care needs” (Hamric, 2014, p. 186). Coaching in the RN role is often referred to as patient education. It is reffered to as “a central and well-documented function of all nurses in any setting” (Hamric, 2014, p. 161). According to Vann (2015) the RN can help the patient “learn to problem solve, make decisions, and build confidence in self-care” (p. 241). APN coaching is an “interpersonal process aimed at supporting and facilitating patients and families through health-related experiences and transitions” in order to “achieve health-related goals” (Hamric, 2014, p. 186). Coaching in APNs is often called an “intervention” in order to distinct it from guidance (Hamric, 2014, p. 186). The most important part of coaching is to help the patient set goals and make decisions that are best for their healthcare.

The teaching and coaching roles fit with the wellness model of care. One example is with The Women’s Wellness after Cancer and Younger Women’s Wellness after Cancer Programs (Porter-Steele, 2015, p. 37). There are “nurse led behavioral interventions” in a “12 week health promotion program” (Porter-Steele, 2015, p. 37). This program consists of an “interactive e-book, website and online health consultations delivered by community based cancer nurses” (Porter-Steele, 2015, p. 37). The coaching aspect of the wellness model of care focuses on “exercise, healthy eating, sleep, and stress management” (Porter-Steele, 2015, p. 37). The teaching aspect of the model focuses on “fatigue, menopausal symptoms, and sexual concerns” (Porter-Steele, 2015, p. 37).

The teaching and coaching roles fit with the sickness model of care. One example is with stroke patients. According to Puhr (2015) the teaching aspects involve “lifestyle changes” and “stroke knowledge” (p. 232). The coaching aspect involves “planning together” in regards to discharge to a rehabilitation facility and “setting goals” for the patient that both the nurse and patient agree upon (Puhr, 2015, p. 223). The goal may be for the patient to be able to have increased strength in the affected extremities by the end of the week. Both the APN and RN play a key role in the teaching and coaching roles of stroke patients. Personally at my current job we incorporate stroke education into daily education for our stroke patients. We have a protocol where all stroke patients receive a stroke handout, daily education, physical therapy, occupational therapy, and speech therapy.

References

Hamric, A. (2014). A definition of advanced practice nursing. In A. Hamric, C. Hanson, M. Tracy & E. O’Grady (Eds.) Advanced Practice Nursing: An Integrative Approach (5th ed). (pp. 161-186). St. Louis, Mo.: Elsevier Saunders.

Porter-Steele, J., McGuire, A., and Anderson, D. (2015). The women’s wellness after cancer program: a nurse led model of care. (2015). Australian Nursing & Midwifery Journal, 23(4), 37-37 2/3p.

Puhr, M. I., & Thompson, H. J. (2015). The use of transitional care models in patients with stroke. Journal of Neuroscience Nursing, (4). 223. doi:10.1097/JNN.0000000000000143.

Vann, J. C. J., Hawley, J., Wegner, S., Falk, R. J., Harward, D. H., and Kshirsagar, A J. (2015). Continuing Nursing Education. Nursing Intervention Aimed at Improving Self-Management for Persons with Chronic Kidney Disease in North Carolina Medicaid: A Pilot Project. (2015). Nephrology Nursing Journal, 42(3), 239-256 18p.

Post 2: Hamric (2014) states that all nurses including APNs are essential to a restructured health system that stresses prevention and early intervention to promote healthy lifestyles, prevent chronic diseases, and reduce the personal, community, organizational, and economic burdens of chronic illness. (pg. 184). Guidance can be described as something the nurse provides such as “counsel by leading, directing or advising with an emphasis on being a resource to support autonomy and self-directed learning and action” (Hamric, 2014).

While guidance is something the nurse does, coaching is about empowering the patient to manage their own health needs. The use of guidance and coaching are central competencies of the APN because nurses are trained from the start to have a holistic view of their patients and society in general. The old adage, “an ounce of prevention is worth a pound of cure” comes to my mind when thinking about guidance and coaching and its effects on chronic illness. This vantage point of prevention is one of the biggest differences between a wellness versus a sickness model of care, it’s more proactive then reactive in approach.

Howard & Ceci (2013) describe that coaching outside of nursing, “embodies the concept of an individual learning by doing alongside a skilled mentor to the realization of one’s full potential” (pg. 225). Howard & Ceci (2013) go on to describe coaching, “In a contemporary healthcare context, coaching is applying skills of listening, questioning and reflecting to support persons with a chronic illness to manage the physical, psychological and social influences of the disease” (pg. 225). Basically, the patient isn’t learning along with the APN but learning from them the best ways to better care for themselves. An example of teaching would be, having the patient learn how to measure their blood pressure, weight and pulse oximetry and keep a diary of this data to be able to recognize when they may need to seek medical care. The nurse may help guide this patient to find more information about how to restrict sodium intake to improve water retention. The APN may coach them by figuring out what exactly improving their health means to them and how to use this information to motivate and encourage their healthy behavior.

I really enjoyed an article by Huffman (2010) in which they compared health teaching versus health coaching. Health teaching would be implemented on the first visit for a specific problem where the patient would be presented with what they need to do to help fix the problem. They might receive some printed material about what they need to do but ultimately leave the office without the motivation to change their behavior. Huffman (2010) goes on to say, “Although individuals may know they should adopt healthful behaviors to address high blood pressure, they may not be motivated to do so. In other words, they are ambivalent to change. By contrast, health coaching engages individuals to actively discover why they are ambivalent about change, integrating health teaching during the process. Throughout this time, it is the individual’s agenda not that of the health care professional, that directs the course for change.” (pg.246).

Guidance and coaching is a complicated and extensive competency of the APN with many different elements. I feel that interpersonal competence is the most important aspect in guidance and coaching. Hamric (2014) lists seven elements that comprise interpersonal competence as; ability to create therapeutic partnerships, person-centered approach, knowing the patient, empathy, cultural competence and cultural safety, advanced communication skills and motivational interviewing (pg.195-198). These are the communication skills necessary to develop a personal relationship with your patients to find out ultimately what their goals are, what they feel are the things holding them back from these goals and techniques that will work for each individual to help them obtain their goals.

References:

Hamric, A.B. (2014). Advanced practice nursing. An integrative approach. St. Louis, Missouri: Elsevier.

Howard, L.M. & Ceci, C. (2013). Problematizing health coaching for chronic illness self-management. Nursing Inquiry 20(3), 223-231. doi: http://dx.doi.org.lib.kaplan.edu/10.1111/nin.12004

Huffman, M.H. (2010). Health coaching: a fresh approach to improving health outcomes and reducing costs. AAOHN Journal 58(6), 245-252. doi: http://dx.doi.org.lib.kaplan.edu/10.3928/08910162-20100526-02

Post 3: Guidance and coaching in advanced practice differ on various grounds with a coaching role of a registered nurse. In advanced practice, guidance and coaching activities aim at equipping the nursing students with skills on delivering quality care to health service consumers. The graduate nurses with adequate experience in working with communities to deliver healthcare take students through a vigorous program in which they learn various concepts of healthcare delivery (Denise, 2009). In this case, the community must have information on the student status before receiving care. The good thing is that nursing students, in this case, do not work alone. The experienced nurses must be present to guide them on what to do and supervise the students on how they deliver healthcare. The main purpose of guidance and coaching in advanced practice is to equip nursing students with practical skills in working with a multidisciplinary team. In other words, it is a form of teaching and learning in a real-world environment.

Registered nurse also plays the teaching/coaching role applies when the nursing professional extends health knowledge to the community. The registered nurse equips members of the community with the necessary skills on how to prevent and manage certain ailment that affects the population (Hamric, 2014). The coaching program takes the form of the community empowerment in matters of healthcare (Luck, 2013). The main difference between the RN’s role in teaching and that of the APN is that one deals with the health service consumers while the other deals with nursing students as part of their academic program. Both roles are equally important and contribute towards achieving healthcare goals in the community.

Denise (2009). The Teaching-Coaching Role of the APN. Wolters Kluwer Health, Health Lippincott Williams & Wilkins, Vol. 23 (3), 279-283.

Hamric, A.B. (2014). Advanced practice nursing: An Integrative Approach. St. Louis, Missouri: Elsevier.

Luck, S. (2013). Changing the Health of our Nation: The Role of Nurse Coaches. INCA faculty and the nurse coach community, pp. 1-16.

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