Answer the following:
� Coaching and mentoring should be a core competency of nurses prepared at the graduate level. Do you agree or disagree with this statement? Defend your response.
-Yes, I agree
� Based on your graduate specialization, identify one coaching activity that you can do in this advanced practice role. What strategies would you employ for this activity?
-As a Nurse Practitioner I would do and focus on teaching patients about the effects of alcohol.
-My strategy would be Storytelling. (Refer to the text for this strategy)
� Describe one mentoring activity you might complete with a mentor that would help you to acclimate to your new advance practice role. Should this activity be structured or unstructured?
�
Reading:
The competency of guidance and coaching is a well-established expectation of the advanced practice nurse (APN). For example, the ability to establish therapeutic relationships and guide patients through transitions is incorporated into the DNP Essentials (American Association of Colleges of Nursing [AACN], 2006). Although there is variability in how this aspect of APN practice is described, standards that specifically address therapeutic relationships and partnerships, coaching, communication, patient-family�centered 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).
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. Professional coaching now is recognized within and outside of nursing as a particular intervention, distinct from guidance, mentoring and counseling. 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. 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. It is important to understand that APN guidance and coaching are not synonymous with professional coaching. There are several reasons for this:�The foundational importance of the therapeutic APN-patient (client) relationship is not consistent with professional coaching principles.�The evolving criteria and requirements for certification of professional coaches are not premised on APN coaching skills.�Empirical research findings that predate contemporary professional coaching have affirmed that guidance and coaching are characteristics of APN-patient relationships.
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. The goals of APN guidance are to raise awareness, contemplate, implement, and sustain a behavior change, manage a health or illness situation, or prepare for transitions, including birth and end of life. The deliberate use of guidance in situations that are acute, uncertain, or time-constrained, offers patients and families ideas for examining alternatives or identifying likely responses. 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
Strategies for Developing and Applying the Coaching Competency
Storytelling is another expressive strategy in which stories, the products of reflection, are relayed orally (Charon, 2006; Mattingly, 2001). Sharing stories about guidance and coaching from practica enables APN students to establish a shared history and provides a means of offering and receiving support while learning about coaching situations and strategies. Done well, the process promotes community, collegiality, critical thinking and risk taking and fosters self-esteem and confidence. Through these expressive methods, cues and strategies for coaching used by different APN students and preceptors become available to a larger group of learners. APNs can encourage storytelling among patients and families. In fact, APNs in palliative care often ask family members, whose loved one is not able to communicate, to tell them about the loved one�for example, memories, personality characteristics, and interests.
In 2008, 107 million Americans had at least one of six chronic illnesses�cardiovascular disease, arthritis, diabetes, asthma, cancer, and chronic obstructive pulmonary disease (U.S. Department of Health and Human Services [HSS], 2012); this number is expected to grow to 157 million by 2020 (Bodenheimer, Chen, & Bennett, 2009). These diseases share four common risk factors that lend themselves to APN guidance and coaching�tobacco use, physical inactivity, the harmful use of alcohol, and poor diet.
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). 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.
Patient teaching and education (see Chapter 7) directly relates to APN coaching. Teaching is an important intervention in the self-management of chronic illness and is often incorporated into guidance and coaching. �Patient education involves helping patients become better informed about their condition, medical procedures, and choices they have regarding treatment. Nurses typically have opportunities to educate patients during bedside conversations or by providing prepared pamphlets or handouts. Patient education is important to enable individuals to better care for themselves and make informed decisions regarding medical care� (Martin, eNotes, 2002, https://www.enotes.com/patient-education-reference/patient-education). This definition is necessarily broad and can inform standards for patient education materials and programs targeting common health and illness topics. Patient education may include information about cognitive and behavioral changes but these changes cannot occur by teaching alone. All nurses and APNs should be familiar with the patient education resources in their specialty because these resources can facilitate guidance and coaching.
Guidance
Guidance can be seen as a preliminary, less comprehensive form of coaching. A subtle distinction is that guidance is done by the nurse, whereas coaching’s focus is on empowering patients to manage their care needs. This definition of guidance draws on dictionary definitions of the word and the use of the term in motivational interviewing (MI). To guide is to advise or show the way to others, so guidance can be considered the act of providing counsel by leading, directing, or advising. To guide also means to assist a person to travel through, or reach a destination in, an unfamiliar area, such as by accompanying or giving directions to the person.
Quantitative studies, qualitative studies, and anecdotal reports have suggested that coaching patients and staff through transitions is embedded in the practices of nurses.
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