Nurse Coaching: Bringing Gridiron Principles to Patient Care

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By Megan Krischke, contributor 

January 17, 2013 - Coaching others to better performance is a long-standing role for managers in sports and in the business world.  Nurses are now discovering that coaching is also a role that they can take on with their patients as a way to achieve a number of health goals.

While many nurses have naturally used coaching skills to support their patients over the years, the practice of nurse coaching is just beginning to emerge as a distinct field, with specialized training and broader recognition. Beginning in January 2013, nurses can now obtain a professional certification as a coach. Also this month, the American Nurses Association (ANA) has published a book on the subject entitled The Art and Science of Nurse Coaching: The Provider’s Guide to Coaching Scope and Competencies.

Nurse Coaching
Darlene Hess, co-author of The Art and Science of Nurse Coaching, says that nurse coaches help patients truly address their personal health issues rather than just sending them home with a checklist of things to do.

“The nurse coaching process begins with the ability to become fully present with self and with the patient,” explained Darlene R. Hess, PhD, RN, AHN-BC, PMHNP-BC, ACC, HWNC-BC, director of Brown Mountain Visions and one of the book’s co-authors. “Then the nurse coach uses active listening, powerful questioning and direct communication to assist the client to identify goals, create action steps and evaluate progress.”

“From a patient perspective, coaching is often used to teach patients and facilitate adherence to self-care practices associated with chronic medical diagnoses such as heart failure, osteoarthritis, diabetes and chronic lung disease,” said Nancy M. Albert, PhD, CCNS, CHFN, CCRN, NE-BC, FAHA, FCCM, senior director of the office of research and innovation for the Nursing Institute and clinical nurse specialist for the Kaufman Center for Heart Failure in the Heart and Vascular Institute at The Cleveland Clinic. “Nurses who use coaching principles effectively will be able to have well-balanced communication with patients, families and caregivers that fosters collaborative practice and behavior change support.”

Some of the benefits of coaching may include easing caregiver burden, enhancing patient and caregiver confidence and better preparing patients to complete chronic illness self-care behaviors.

Nurse Coaching
Barbara Dossey, co-author of The Art and Science of Nurse Coaching, explains that nurse coaches don't try to "fix" patients, but to truly listen to them and maximize their strengths.

Barbara M. Dossey, PhD, RN, AHN-BC, FAAN, HWNC-BC, co-director of the International Nurse Coach Association, core faculty for the Integrative Nurse Coach Certificate Program and co-author of the new ANA book, sees nurse coaching as arising out of the tradition of Florence Nightingale who called nurses to improve the health and well-being of humanity.

“We use the expression that we are walking with clients through a discovery process,” she noted. “We all know that we need to eat healthfully, exercise and reduce stress, but we need help to tap into being more creative, more resilient and how to reduce our anxiety and fear of frustration. This is where we use our coaching competencies to connect with patient strengths and what they want to learn and do with their lives.”

According to Dossey, coaching follows the nursing process. In the first stage, the assessment stage, a coach establishes the relationship and identifies readiness to change. In the second stage, a coach doesn’t diagnose, but instead helps patients to remember that they are the authority in their life and that they hold the solutions to changing their lifestyle. From there the nurse coach, through the use of a skill known as powerful questioning, helps patients to identify their opportunities, their concerns and their desired outcomes. In the planning stage, the nurse assists the patient to create a plan and challenges them in positive ways. The implementation stage focuses on empowering and motivating patients to make these changes by returning to their intrinsic motivations.
“As people in the U.S. age, we are more likely to see the rates of common chronic diseases increase over time. Nurses who are skilled in coaching have added tools in their tool belt they can use to improve patient–health care provider communication and enhance clinical outcomes,” remarked Albert. “Coaching is an ideal model to use to understand patients’ desires, constraints and barriers, and then use the knowledge to develop an ongoing plan of care.”

Effective nurse coaches are self-aware, reflective and intuitive. Nurses who desire to work at deeper levels with their patients find coaching especially rewarding.

“Nurse coaching is done anywhere the nurse is and can be used in any setting or specialty,” stated Dossey. “We are focused on facilitating the process of change and helping that person develop his or her potential.”

Nurses who are interested in becoming coaches can pursue continuing education courses in coach training and can achieve certification through the American Holistic Nurses Credentialing Corporation.

“Nurse coaching is effective, rewarding and it is what clients and patients want. It has the potential to revolutionize how health care is delivered. This emerging role offers a whole new way of looking at how health care providers interact with clients. To me, that is one of the most exciting things about it,” reflected Hess. 

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