Introduction
Guidance is nurse-patient communication to aid patients and relatives in evaluating their resources and motivations to achieve specific treatment goals. Coaching supports patients in managing their care needs by providing direction and ongoing support. Coaching is a novel application in nursing practice and healthcare to develop leadership skills. Although guiding is a type of coaching, it is less comprehensive and more preliminary.
An advanced practice nurse’s (APN) job requires regular supervision and coaching to achieve better patient outcomes. The key aspect of both is interaction in the patient care setting, which is critical for APNs to educate patients and their families on their health status (Cable & Graham, 2018). Therefore, guidance and coaching have been incorporated as an interpersonal process within the APN-patient relationship to enhance collaborative, holistic care.
Guidance in APN
In APNs, guidance involves helping patients find solutions to their issues and pursue a course that aligns with their skills and goals. It is informed by the APN’s personal experiences, assessments, and information to help patients and families best use their resources and motivations to improve patient outcomes(Cable & Graham, 2018). For instance, anticipatory guidance teaches the patient what to expect regarding a specific disease process or other health-related problems. The primary purpose of guidance includes: providing the necessary information and assistance to patients, helping patients and families make the right choices, improving self-understanding, facilitating adjustments, and making patients self-sufficient and independent.
Patient education and teaching are fundamental in APN guidance and should be conducted with patients in the care setting. Patient education, for instance, aims to provide patients with direct knowledge about their disease, medical procedures, and options they should consider to change their health-related behaviors and improve their health. Guidance can be provided verbally or through informational pamphlets issued to patients or caregivers. The guidance informs patients about their well-being and enables them to choose the best self-care strategies while hospitalized or after discharge (Cable & Graham, 2018). Therefore, APN guidance focuses on suggesting a collaborative treatment plan based on the available information and discussions between the patient and the nurse.
Coaching in APN
Coaching aims to equip patients with the fundamental knowledge to manage their health needs. It helps patients achieve autonomy by empowering them as primary decision-makers and providing tools for informed decision-making, problem-solving, and the development of self-care confidence. The nurse practitioner’s technical, clinical, self-reflective, and social skills influence the coaching process to enhance the patient’s wellness goals and health-related experiences (Cable & Graham, 2018). Therefore, coaching influences the palliative care sector’s healthcare environment, suggesting that practitioners must be self-aware and act as multidisciplinary team members (Costeira et al., 2022). It might be the beginning, or just a small portion, of a mentoring relationship that grows through time and lasts beyond fulfilling a specific objective.
Coaching aims to reach mutually agreed-upon health-related goals to enhance function and health. It can be viewed as an intentional, intricate, comprehensive, and dynamic interpersonal process that supports patients and families. So, the nurse coaching role entails interaction with intention, purpose, skills, and expertise to co-create a care plan with their clients (Cable & Graham, 2018). The purpose of co-creating care plans is to promote and facilitate clients’ achievement of their goals. Therefore, nurse coaching skills include building relationships, supporting and encouraging, challenging and motivating, observing and analyzing, active and open listening, deep and curious questioning, motivational interviewing, appreciative inquiry, and providing instruction and feedback.
Coaching typically entails brief, one-on-one learning sessions grounded in insight, reflection, choice-making, and goal pursuit. The coaching process fosters self-knowledge and goal-setting through extensive individual evaluation, promoting reflection on perspective, mentality, beliefs, and techniques that may lead to more sustainable behavior (Costeira et al., 2022). Coaching supports nurses in dialogues and exchanges to enhance professional development, career dedication, practice, and client advantages (Costeira et al., 2022).
It can also assist nurses in implementing a person-centered approach while preventing illness and lessening the effects of chronic diseases. For instance, nurse practitioners primarily instructed patients, handed prescriptions, and provided primary care. However, APNs use their expertise differently and sparingly in the coaching relationship. The coaching model is akin to an excavation project: patients possess the answers, and nurses uncover their deepest desires and needs to help them achieve their goals.
Comparison of Guidance and Coaching
Patient education frequently occurs through guidance and coaching, as both involve APN-patient interaction and provide necessary details about patients’ health. However, guidance is perceived as a less comprehensive approach to coaching. While the APN has an active role in providing direction and guidance, coaching centers on patient-centered empowerment (Cable & Graham, 2018).
For instance, coaching focuses on direct, patient-centered interaction and involvement to support adherence to a treatment plan and the behaviors necessary for wellness. Similarly, the guidance provides guidance and support in selecting the appropriate course of care. Therefore, guidance occupies a middle ground where APNs and patients have equal influence over the agenda and maintain high engagement levels.
The nurse’s role and level of patient engagement vary between guidance and coaching. For instance, while patients are urged to seek information and make individual choices, the APN nurse sets the agenda and acts as a teacher in guidance with moderate patient interaction (Cable & Graham, 2018). On the contrary, patients maintain control over the agenda because coaching promotes involvement and empowerment, with the nurse practitioner taking on a supportive role.
Theory on Guidance and Coaching
The Zone of Proximal Development (ZPD) theory describes the aspects of guidance and coaching in APN work. According to Kamarudin et al. (2020), ZPD is the distance between what people can achieve on their own and what they can accomplish with expert assistance. The support provided by APNs goes beyond patients’ present competence to advance their knowledge and health.
In practice, APNs always consider the minimum intervention necessary to get the patient from one point to the next. For instance, APNs frequently need to assess patients’ knowledge gaps and determine how much guidance and coaching are required for each situation. Therefore, nurses do not have to do everything for the patient if it is unnecessary; rather, they guide patients to make informed decisions, which is the primary goal of ZPD theory.
Current Healthcare System
The changing landscape of healthcare and the changing profile of the U.S. population require a fundamental shift in the delivery of care. Emerging problems in healthcare delivery include the shortage of primary healthcare practitioners and the large patient base resulting from increased affordable insurance coverage (Anderlini, 2018). Although APNs are trained and able to deliver various services, like guidance and coaching, they are limited by state laws, federal policies, institutional practices, and culture (Waldrop & Derouin, 2019). APNs, if allowed to fully exercise their knowledge and training, may help grow the workforce needed to meet the nation’s primary care needs and add their unique skills to patient-centered, community-based health care.
Recommendations for Change
Information on cognitive and behavioral changes is often included in patient education, but changes may never be effective through teaching alone. Therefore, APN experts should be familiar with patient education resources in their specialty to facilitate education. It implies that the healthcare sector should invest in training resources to achieve the highest level of competency and address APN shortages (Anderlini, 2018). Similarly, mentoring new APNs should involve a long-term relationship and comprehensive skill transfer from a more experienced mentor to a less experienced mentee, to improve performance and support professional development and career advancement in the industry. In this way, the nation shall have the experience and skills to satisfy the care needs of the growing patient population.
Conclusion
The paper provides guidance on coaching for Advanced Practice Nurses (APNs), the Zone of Proximal Development (ZPD) theory, and the modern healthcare system. Guidance is the assistance APNs provide to patients and families to help them manage their health choices, develop their perspectives, and make informed decisions. Coaching entails supporting the patient to achieve specific health or performance goals by providing direction and ongoing support. Guidance and coaching practice centers on wellness, healing, and health through APN-patient interaction.
The nurse coach role is increasingly important as a partner and team in health care delivery. The rising trend of chronic illnesses and lifestyle diseases has made guidance and coaching essential for preserving and restoring patient health. Accordingly, nurses should consider going into the APN guidance and coaching specialty to gain additional training in health and wellness, lifestyle medicine, and the science of human change.
References
Anderlini, D. (2018). The United States health care system is sick: From Adam Smith to overspecialization. Cureus, 10(5), 1–9.
Cable, S., & Graham, E. (2018). “Leading better care”: An evaluation of an accelerated coaching intervention for clinical nursing leadership development. Journal of Nursing Management, 26(5), 605–612.
Costeira, C., Dixe, M. A., Querido, A., Vitorino, J., & Laranjeira, C. (2022). Coaching as a model for facilitating the performance, learning, and development of palliative care nurses. SAGE Open Nursing, 8, 1–7.
Kamarudin, M. binti, Kamarudin, A. Y. binti, Darmi, R. binti, & Saad, N. S. binti M. (2020). A review of coaching and mentoring theories and models. International Journal of Academic Research in Progressive Education and Development, 9(2), 289–298.
Waldrop, J., & Derouin, A. (2019). The coaching experience of advanced practice nurses in a national leadership program. The Journal of Continuing Education in Nursing, 50(4), 170–175.
