Expert coaching and guidance refers to a learning relationship entered into by the nurse and the patient or client (Sparacino, 2005). The learning activities and content are directed towards providing skills and knowledge required to meet a patient’s health care needs. This is a vital function and responsibility for medical practitioners at all levels. Expert coaching and guidance is aimed at allowing patients have a better comprehension of various aspects of their health condition, health care and needs. This APN competency is, therefore, essential in guaranteeing that the patient is informed and knowledgeable about his or her health, facilitating improved health.
One technique of implementing expert guidance and coaching is using the family approach. The family is viewed as a unit of care. This enables the APN to provide effective patient teaching. Family members adjust and cope with a patient’s illness in various ways, depending on several factors. Family members have different emotional states, different knowledge levels, and different concerns. Expert coaching and guidance will be more successful if health care professionals are able to recognize the effect that illnesses have on the family. This will enable them take the necessary steps in individualizing and incorporating this information as they involve the family in patient teaching. By considering the circumstances and needs of family members when conducting expert coaching and guidance the APN can begin to enlist the family as a system of support. This should be aimed at helping the patient adhere to recommendations and achieve his or her health goals (Berry, 2007). Gathering information about family structure, interactions and reactions is not necessarily time-consuming as commonly presumed. Much of information about the family can be gathered through simple observation. Who appears most interested and concerned about the patient? Who talks to whom and in what way? What types of interactions are observed among the family members? What activities appear salient to them? What is their general lifestyle?
The APN should also be alert to family reactions to learning about the patient’s condition and treatment. Do the family members appear anxious about learning skills to be used in caring for the patient at home? Is there essentially no response from family members in patient guidance and coaching interactions? Is the family presently stressed? How has the family handled stress in the past? How is the family coping with stress now? When conducting expert guidance and coaching that includes the family, the APN should identify conceptual problems through appropriate data collection techniques. The health care professional should also develop sensitivity to behaviors and reactions associated with different areas of coaching by observing non-verbal and verbal indications. Is the family responsive to patient teaching? Is one family member dominating the conversation? Are there disruptions of patient guidance and coaching from the family?
Health professionals, in general, facilitate the effectiveness the effectiveness of patient teaching by fostering discussion among family members. If the health professional has continued contact with the family, and the patient, he or she can check on the patient’s progress with the recommendations. In addition, he or she can also identify any new problems or strains with interfere with adherence. This, in the long run, enables the patients and their families find new resources and solutions to maximize compliance potential. Another method of implementing expert coaching and guidance is using the individual needs of the patient in setting goals and objectives to guide learning interventions. The impact of the learning process is optimized if the goals and objectives are stated at the beginning.
The main purpose of coaching through transitions is increasing patient compliance, reducing anxiety for both patient and family, build trust, and minimize the risk of lawsuits against health care providers and hospital systems. Theories that explain human behavioral change act as guidelines for expert coaching, and guidance. Theories that are applicable to patient education are derived from various disciplines, including; communication, sociology, organizational development, adult education and psychology. Theories that are used for expert coaching and guidance include the self-efficacy theory, Health Belief theory, locus of control theory, diffusion theory, stress and coping theory, cognitive dissonance theory and, adult learning theory.
Coaching through transitions refers to the steps followed in providing education and measuring learning in patients (Donnelly, 2006). The steps include assessing learning, evolving learning objectives, planning and implementing patient coaching, evaluation of patient learning and documentation of patient coaching and learning. Coaching through transition involves three main foundations: diagnosing the patient’s situation; discovering the strategies and approaches that were used in the past and then developing a customized approach to the situation.
Hamric, A., Sprouse, L, & Hanson, C., (2009) identify three critical competencies for the coaching role of the APN. First, the coach or preceptor must possess clinical competence. Documentation of clinical competence can be achieved by one’s resume or curriculum vitae; evidence of continuing education; attainment and maintenance of the national board certification; employer evaluations; institutional peer review; and letters of recommendation from former students, colleagues, learned societies, professional organizations and the faculty. The APN preceptor should also have examples of publications and presentations, in addition, to maintaining a professional portfolio with this documentation.
The second attribute that a coach or clinical preceptor must have is technical competence. This refers to demonstrating skill and expertise in the performance of necessary tasks related to your practice area. Certificates of completion for different skills, trainings or workshops or the professional portfolio is also another applicable method of accomplishing documentation of technical competency. A log of different procedures performed, and their outcome data can also be used.
However, Hamric, A., Sprouse, L, & Hanson, C., (2009) further argue that clinical and technical expertise, although necessary, are not sufficient characteristics of a qualified coach or preceptor in expert coaching and guidance. They propose that an effective clinical coach should also regularly engage in self-reflection and exhibit interpersonal competence, in addition. Preceptors who demonstrate interpersonal competence are usually in a position to recognize and accept the distinctive attributes of each student. They also respond empathetically better to student’s concerns and encourage feedback and information sharing from students. Interpersonally competent preceptors mollify the power differential between expert and novice through judicious use of self-disclosure. In addition, they also discuss care processes in the clinic as they unfold (reflection in action) and after a healthcare episode is completed (reflection on action). Emphasis is placed on the assessment of both negative and positive experiences so that both the mentor and mentee can get to learn from them.
Although, technical and clinical competence might be sufficient to coach a novice through transition preceptors need all three competencies. A well-implemented one-to-one relationship between a novice and an experienced practitioner has various benefits. First, it provides students with the experience much needed in the real world. Second, it provides a safety net for both the student and the patient to build their confidence. Moreover, it allows the APN to model the role for students with patients and other healthcare professionals.
Self-reflection, according to Fawcett, Newman, & McAllister (2004) refers to self-awareness of one’s own repertoire of knowledge and skills in combination with present circumstances to form new understandings. It is viewed as vital for professional problem-solving, promoting better client outcomes and clinical reasoning. Methods of self-reflection include use of journals, discussions with colleagues and feedback. The use of journals as an educational strategy enables APNs to experience transformative learning by increasing their self-awareness combined with interactive feedback from mentors and patients. Considering the changing paradigms of the medical profession, the importance of self-reflection to career competency cannot be overemphasized.
In my practicum to develop expert coaching and guidance skills, I would apply the following strategies to achieve a successful outcome: communicate clearly and simply, create a positive environment for the patient and limit my coaching and guidance objectives. In addition, I will divide the information gathered over a period of time, use multiple teaching methods to pass my message and build on previous information from each session. Finally, I will ensure comprehension and/or clarification of misinterpretations that may come up.
To meet the current and future healthcare needs of society, academic institutions that prepare APNs will continue to rely on expert nurses’ responsibility in providing supervised clinical experiences. The APNs are in turn expected to reciprocate by providing quality expert coaching and guidance to their patients in their future careers.