According to Hamric, Hanson, Tracy, and O’Grady (2014) guidance is used when a patient or family needs additional information to help make a decision which requires the nurse to lead the patient or family and coaching is when the nurse utilizes open ended questions allowing the patient or family to come to a conclusion on their own. Coaching at APN level differs from the RN level as APNs “coach in situations that are boarder in scope or more complex in nature” (Hamric et al., 2014, p. 193). An APNs clinical and technical competency makes them a better source of information. Patients trust APNs as they trust their physician regarding knowledge of contact and expertise looking to be told what to do however we know that doesn’t work at changing someone’s lifestyle. The patient must want to change and the change must work for their lifestyle and family to make it productive.
I also think interpersonal competency is just as important as clinical and technical. You must have excellent communication skills to and guide and coach a patient to make a change. The patient must trust you and not be made to feel inferior.
The APN is the leader in guidance and coaching where the RN helps support the decision through teaching/coaching. For example, the NP may be providing guidance and coaching to a patient with end stage COPD to decide between palliative care versus continued hospital admission. The RN would in return use teaching and coaching to support the decision through intervention formation and goal setting.
As discussed in past discussions the Affordable Care Act has shifted our health care towards prevention and wellness versus sickness. To decrease cost of health care and increase access to patient care the importance of self-empowering our patients to change their life style is crucial in APN practice. Teaching and patient education paired with coaching can help patient’s self-manage their chronic disease holistically. An interview with the one of the founders of the American College of Nurse Practitioners, Eileen O’Grady, Gardner (2014) discusses the importance of Nurse Practitioners role in wellness coaching to change the direction of health care. Ms. O’Grady discusses how she found acting as the expert and telling her patients what to do wasn’t working so she changed her practice and started utilizing coaching to encourage her patients to take charge of their own health by asking questions and finding what the patient wants (Gardner, 2014). It is more important now than ever to provide patients with the tools to succeed at home.
Narayanasamy and Penney (2014) concluded coaching isn’t only beneficial to patient outcomes but also clinical care and management of nursing staff. The APN can utilize their expertise in coaching for patient care as well as in communication with other health care providers and their staff.
Hamric, A.B., Hanson, C.M., Tracy, M. F., & O’Grady, E. T. (2014). Advanced practice nursing: An integrative approach (5th ed.). St. Louis, MO: Elsevier
Gardner, D. B. (2014). Walking the Talk for Patient-Centered Care: An Interview with Eileen O’Grady, Wellness Coach. Nursing Economic$, 32 (2), 99-100.
Narayanasamy, A., & Penney, V. (2014). Coaching to promote professional development in nursing practice. British Journal of Nursing, 23 (11), 568-573.