Introduction
Guidance and coaching are typically used by nurses both in direct and indirect practice. Most importantly, what models and methods of coaching nursing leaders use in the direct practice since, in this case, interaction with staff nurses is more direct (Hamric et al., 2013). Scientists present many models that are used as a framework for guidance and coaching by APRNs. The universal management of models and their application in day-to-day practice can revolutionize the day-to-day work of nursing leaders. If the practice of obligating nurses to apply models of mentoring and coaching is mandatory across the country, performance and quality of care indicators will dramatically improve, as will patient health outcomes. This paper aims to discuss how APRNs implement guidance and coaching as their key role and function.
Definition of Guidance and Coaching
Guidance and coaching are some of the most important elements of the work of nursing leaders that are included in the list of their core competencies and responsibilities. As a rule, the ways of interaction of the APRNs with the staff nurses can be described in statutes that list the requirements and responsibilities of nurses. These formal documents, issued at the state-level jurisdiction, usually provide a detailed list of what the nurse leader or the APRN should and can do.
Importantly, the APRN has a higher level of responsibility than RN and LRN, and many guidance and coaching tasks are its primary and sole responsibility. For example, coaching and guidance activity contributes to the implementation of many functions, procedures, and goals associated with direct clinical practice. As part of this practice, nurses establish a therapeutic relationship with the patient, communicate effectively, clarify and explain health problems to the patient, and set health goals (Hamric et al., 2013). The direct practice also includes monitoring, diagnosis, treatment, education, support, comfort, mentoring, and counseling. As part of the direct practice, the nurse plans further contacts and makes decisions about their own and the patients’ future actions.
Hamric et al. (2013) note that AACN and NACNS recognize guidance and coaching as core competencies. There is a coaching model authored by Demand and colleagues, where coaching is defined as “an interpersonal process that APN uses to engage patients actively in their care” (p. 297). Scientists deliberately differentiate between the concepts of coaching and education, as these concepts define the most important element of the relationship between nurses and patients associated with education.
Theories Regarding Guidance and Coaching
Guidance and coaching in the nursing practice are part of the work of nursing midwives, clinical specialist nurses, and nurse practitioners. These nurses can spend most of their time teaching and counseling patients; nursing students also practice this skill. Training and consultation have a powerful impact on clinical populations, especially when viewed in the context of the Quality-Cost Model. The study found that patients who received nursing education and coaching “achieved better treatment outcomes and resource utilization” than controls (Hamric et al., 2013, p. 298). As a rule, APNs use coaching and guidance tools as part of a holistic approach and nursing practice. Scientists also emphasize that a holistic approach assumes that nurses have clinical knowledge, such as leadership skills.
The use of coaching and guidance is widespread in nursing daily work, including telephone practice and home visits, with two-thirds of interventions being guidance and one-third are “communication, counseling, and referral; encouraging self-care and caring for babies; and reassuring and reinforcing the patient’s actions” (Hamric et al., 2013, p. 300). Another well-known model that includes the use of coaching and guidance tools is called the Care Transition Intervention Model.
This model was developed by scientists Coleman and colleagues, who looked at new ways of caring for patients with chronic diseases. The essence of this model is the use of more limited resources and it defines the transition as “a set of actions aimed at ensuring the coordination and continuity of care when transferring patients from one place to another or different levels of care in one place” (Hamric et al., 2013, p. 302). Conceptually, the Nursing Transition Model uses ideas of self-management of medication, the use of PHR or patient-centered dynamic recording and monitoring of providers, and interaction with a transition coach. It is noteworthy that trainers do not act as providers but act as teachers and facilitators for patients.
Current Healthcare System
Scientists actively discuss the phenomenon of coaching and guidance in nursing practice and analyze several unique models for the implementation of these practices. Hill et al. (2020) developed and tested the CLIP Nursing Learning and Training Model that improved the student-mentor relationship. Boyer et al. (2020) presented a Clinical Transition Framework (CTF) designed to enhance the skills of nurses during their professional reorientation in a new specialty. The model has several advantages that take into account the experience of nursing and is suitable for providers of all backgrounds. The model is based on the findings of scientists based on experience gained from the practice of emergency care, community care, and rural care.
Harvey and Uren (2018) analyzed the 1: 1 model for mentoring student nurses. The essence of the model is that the mentor and the student work together, and the mentor is responsible for completing the training. In the framework of such interaction, some problems may arise, for example, lack of time for training, which led scientists to the decision to introduce a model based on co-mentoring for several students. The model has been successfully implemented in the USA, Australia, and Ireland and has shown success rates.
Herawati et al. (2018) presented another model for the implementation of coaching functions and guidance called the SBAR method, where the abbreviation stands for situation, background, assessment, and recommendation. This model was developed to optimize the shift handover process between nurses. The mentoring method is used to guide the discussion of joint actions to solve daily work problems. The participation of a mentor also helps to form a culture of leadership in medical practice. After initial testing of the presented model, the researchers concluded that its use was associated with senior and shift nurses’ empowerment.
Recommendations for Change
Given the information presented above, it is clear that nurses and senior nurses make extensive use of different models for the implementation of mentoring and coaching functions. However, in the modern health care system, nurses are not always guided by models or apply theory in everyday practice. At the same time, the use of such schemes as the SBAR method or PHR technique allows optimizing daily processes (Herawati et al., 2018; Hamric et al., 2013). These processes may involve mentoring and educating patients or less experienced nurses, and their use has been widely proven to be effective.
Most studies show that the models show immediate positive results for medical institutions where they are introduced into daily practice. Therefore, the modern healthcare system should pay more attention to the implementation of models of mentoring and coaching. The use of such models can be useful in various fields of medicine. For example, these models can greatly benefit nursing leaders in implementing preventive education in the population about cancer risks. In conditions of accelerated and intensive work with patients, for example, in emergency care, nurses will greatly benefit from the use of SBAR models, which significantly saves the time of transferring information between shifts and improves the quality of the information exchanged.
Another example would be nursing work in nursing homes where patients need close communication with nurses. Home visits also involve active mentoring and coaching, and nursing leaders in this specialization will reap many benefits from these models. For example, patients with a certain type of chronic illness may constantly forget to take medication or need to optimize their daily routine, and then the nurses implement the function of mentoring at each visit.
Within the hospital and with fellow nurses, mentoring and coaching models are equally useful. For example, when nurses change their specialization, they may feel insecure about their new responsibilities and make more mistakes. This will result in more stress for nursing mentors and a lot of time correcting mistakes. At the same time, by using the Nurse Transition Model, leaders can find a suitable way for them to train new nurses in the process of direct practice (Hamric et al., 2013). Nursing leaders’ work in mentoring students requires just as much care and is also stressful and risky. Therefore, creating and using a rigorous structure for the daily functions of mentoring and coaching will make the process faster and more efficient. Nurse leaders can also use new concepts of mentoring, such as teaching a group of students at once to improve team performance.
Conclusion
Thus, the ways how APRNs implement guidance and coaching as their key role and function were discussed. The implementation of mentoring and coaching functions is extremely important for nurses since, within the framework of these functions, they establish contact with the patient during the implementation of the procedures of the direct practice. Nurse leaders also provide mentoring and coaching functions through the interaction of more experienced nursing leaders and nursing students or when staff nurses change specialization.
There is a widespread discussion regarding models of mentoring and coaching. Using these models in medical practice will help nursing leaders meet their daily work challenges much more effectively. For example, the use of the Transition Model will optimize the practice of nursing transition from one specialization to another. The Quality-Cost Model allows for better allocation of resources for patients in medical living facilities. The PHR model optimizes medication, diagnosis, and patient education, while the CLIP model aims to improve student-mentor relationships. Finally, the SBAR model is well suited for streamlining day-to-day shift transfer processes between nurses. At the same time, the 1:1 model, optimized in the direction of student enrollment, applies well to nursing mentors’ work with nursing students.
References
Boyer, S. A., Mann-Salinas, E. A., & Valdez-Delgado, K. K. (2018). Clinical transition framework: Integrating coaching plans, sampling, and accountability in clinical practice development. Journal for Nurses in Professional Development, 34(2), 84-91.
Hamric, A. B., Hanson, C. M., Tracy, M. F., & O’Grady, E. T. (2013). Advanced practice nursing-E-Book: An integrative approach. Elsevier Health Sciences.
Harvey, S., & Uren, C. D. (2019). Collaborative learning: Application of the mentorship model for adult nursing students in the acute placement setting. Nurse Education Today, 74, 38-40.
Herawati, V. D., Nurmalia, D., Hartiti, T., & Dwiantoro, L. (2018). The effectiveness of coaching using SBAR (situation, background, assessment, recommendation) communication tool on nursing shift handovers. Belitung Nursing Journal, 4(2), 177-185.
Hill, R., Woodward, M., & Arthur, A. (2020). Collaborative Learning in Practice (CLIP): Evaluation of a new approach to clinical learning. Nurse Education Today, 85, 104295.