Advanced Practice Nursing: Patient Education, Guidance, and Coaching

Introduction

Interaction with patients is a key aspect of APN practice, with one of the main objectives is to provide information and education the individual and their family members on their condition. Guidance and coaching elements have been conceptualized in recent decades as a complex and dynamic interpersonal process in the APN-patient relationship aimed at collaborative and holistic care. The three components share similarities but increase gradually in terms of involvement and participation for further management of the patient’s condition.

Patient Education

Patient education and teaching are the fundamental practices for any nurse and expected to be conducted with all patients to some extent. Patient education is targeted at providing direct information to the patient in order to inform them about their illness, medical procedures, and choices they may have to alter health behaviors and improve their health status. Education can occur in conversational form or by providing informational pamphlets. The objective of patient education is that patients are aware of their condition and care and can make informed decisions regarding medical care or self-management both while in the hospital and post-discharge (Anderson et al., 2017). Patient teaching is a broad spectrum of educational activities which can vary based on specialization of the APN or patient condition.

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APN Guidance

Guidance is a form of nurse-patient communication that aims to help patients and their families to explore their own resources and motivations to achieve certain objectives about their goals. However, to do this, nurses use various assessments, information, and their experience to provide the best direction. True to the definition of the word, APN guidance seeks to advise and show the way by providing counsel. APN guidance is helpful of raising awareness of a health issue, which is then contemplated, and behavior change is implemented and sustained in order to manage the issue in the long-term. Therefore, guidance focuses on providing recommendations based off available information and a discussion between the patient and the APN, to pursue a collaborative care plan (Hamric et al., 2013).

APN Coaching

At its foundation, coaching focuses on empowering patients so that they are able to manage their care needs. It goes a step further than guidance, by making the patient the central decision-maker, and instead, providing them with the tools of problem-solving, making decisions, and building confidence for self-care. It is a highly interpersonal process focused on the healthcare transition to achieve health-associated goals. The APN coaching process is an intervention where the APN uses self-reflective, clinical and technical, and social skills to facilitate the patient health-related experience and achieving set health and wellness goals (Cable & Graham, 2018).

Compare and Contrast

Since patient education is a basis to APN-patient interactions, it is an element which is present in all three of the categories since in either context it is necessary to inform and provide key information to the patient about their condition. Patient teaching resources most often can facilitate guidance and coaching. Meanwhile, guidance is seen as a less comprehensive approach to coaching, but with the primary difference that guidance is conducted by the APN in the active role, while coaching focuses on patient-centered empowerment. In its basics, teaching solely provides information and skill transfer; guidance provides information and assistance in choosing the best direction of care; and coaching focused on direct patient-centered interaction and engagement to adhere to a plan of care and behavior change necessary for wellness.

Another aspect to consider when comparing these is role of the nurse and level of patient engagement. In education, the nurse controls the agenda serving as a teacher, with medium patient engagement since it is encouraged that patients ask questions and also make their own decisions. In coaching, the patient maintains the ownership of the agenda as it is specifically targeted at patient engagement and empowerment, while the APN has a more backend role. Finally, in guidance, it is a medium ground with the patient and the APN controlling the agenda equally, whilst patient engagement is still high as they seek to follow-through on the care plan direction that is best fitting for them individually.

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APN Practice Incorporation

APNs should integrate all three of the elements teaching, guidance, and coaching into practice depending on circumstance, setting, and patient needs. As mentioned, patient education is encouraged in all circumstances, conducted often via bedside conversations or during primary care visits. Meanwhile, deliberate use of guidance may be effective in situations that are acute or time-constrained, offering patients and families with alternatives and recommendations on proceeding with informed choices regarding a desired medical outcome. However, coaching is inherently more complex, and although it can be performed independent of setting, illness or cognitive capacity, it is usually utilized in elements of transition of care. These may be health transitions such as pregnancy or a diabetes diagnosis, developmental transitions such as puberty, or even situational changes that may affect the quality of life. Coaching is central to effectiveness of various APN-led patient education and monitoring programs and with the nursing perspective, a nurse can offer patients complex information specific to their needs, including psychological and social support. Theoretical evidence justifies the use of coaching and guidance for supporting patients in decision-making and communicating their preferences, as both improve patient knowledge and engagement while decreasing mean costs (Stacey et al., 2013).

Conclusion

Patient education, guidance, and coaching are structured approaches used by APNs to inform patients, provide options, and aid in decision-making processes. These processes differ in patient engagement and nursing roles as well as their objectives. APNs should utilize and apply these various concepts of nurse-patient interaction based on medical context to achieve holistic care and optimal healthcare objectives.

References

Anderson, L., Brown, J. P., Clark, A. M., Dalal, H., Rossau, H. K. K., Bridges, C., & Taylor, R. S. (2017). Patient education in the management of coronary heart disease. Cochrane Database of Systematic Reviews, 6. Web.

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. Web.

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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.

Stacey, D., Kryworuchko, J., Belkora, J., Davison, B. J., Durand, M.-A., Eden, K. B., Hoffman, A. S., Koerner, M., Légaré, F., Loiselle, M.-C., & Street, R. L. (2013). Coaching and guidance with patient decision aids: A review of theoretical and empirical evidence. BMC Medical Informatics and Decision Making, 13(S2). Web.

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