Coaching Roles Give Nurses New Avenues to Provide Patient-Centered Care
Nurses don’t always have to venture beyond the bedside for unique career change opportunities. Always innovating and evolving, the profession identifies new roles for clinical practice nurses to meet patients’ needs.
Recognized by the American Nurses Association (ANA) since 2010, nurse coaching opportunities are growing across the United States. In their article in the June 2021 issue of the Clinical Journal of Oncology Nursing, Dermody described the nurse coach role and its application to oncology nursing.
What Is a Nurse Coach?
From technologies that make it all too easy to be sedentary, to busy lifestyles that force us to eat many meals from the drive-through, to seemingly conflicting, confusing, or downright incorrect health information at our fingertips, it’s no wonder patients aren’t living their healthiest life. And with the added stress of a serious health condition like cancer, patients may not know where to turn for help. As trusted experts, nurse coaches help patients overcome those challenges to establish health goals, modify lifestyle habits, manage health conditions, and incorporate integrative practices when appropriate, Dermody said.
Nurse coaches apply coaching principles to holistically address patient goals across the physical, mental, emotional, and spiritual environment, Hess et al. said in ANA’s book on nurse coaching, The Art and Science of Nurse Coaching. The authors outlined six simultaneous steps that nurse coaches use in their patient relationships:
- Establish the relationship and assess patients’ readiness for change.
- Identify their opportunities and issues.
- Guide patients in establishing goals.
- Structure the coaching interaction.
- Empower patients to reach their goals.
- Assist them in evaluating their achievements.
How Patients Benefit From Nurse Coaching
Studies of patients who used nurse coaching for chronic conditions have shown that coaching increased compliance to treatments, decreased hospital readmission rates, and improved clinical biomarkers, Dermody reported. It also increased patients’ awareness of their self-care and self-management. Findings from another study involving patients with chronic obstructive pulmonary disease demonstrated improved dyspnea, fatigue, emotional function, and quality of life.
Some of the strategies nurse coaches use in patient relationships include:
- Affirmation: intentionally declaring a decision or goal
- Cognitive reframing: developing a plan for teaching that incorporates sensitivity to patients’ age, cultural background, motivation, and learning styles
- Deep listening: being present, allowing space, and being focused, with an intention to understand what another person is expressing or not expressing
- Powerful questions: asking open-ended questions that provoke greater insight, clarity, new possibilities, and learning
- Bearing witness: being present for things as they are and using stillness to be present for themselves, patients, and others
- Reflection: engaging in the moment, which guides inner development and permits entry into the flow and dance of wholeness and unity
- Silence or pause: being comfortable with silence and being present and open to what the patient is expressing
- Intuitive knowing: accessing and trusting personal intuition
Why Nurses Make Great Healthcare Coaches
“Nurse coaches concentrate on the whole person and patients’ strengths, knowing that patients are the experts on their desires and decisions, and use tools and strategies that integrate the mind, body, emotions, spirit, and environment to promote health and wellness,” Dermody said. “They create a safe environment for patients to articulate how they feel and to share their desires and goals, dreams for the future, and their hurt, pain, or weaknesses.”
Although they can practice in any setting or specialty, nurse coaches often guide patients through chronic conditions or end of life, Dermody said. Oncology nurses’ experience in caring for patients in those situations makes them well suited for nurse coach roles.
Education, Processes, and Values for Nurse Coaches
Certified nurse coaches are required to maintain an RN license, hold a bachelor’s degree in nursing, and have practiced as a nurse for at least two years.
Dermody explained that the nursing process is also used as the framework for nurse coaching (i.e., assessment, diagnosis, outcomes identification, planning, implementation, and evaluation) and that nurse coaches apply the same ANA scope and standards of practice as clinical nurses. The professional nurse coach role’s five core values are:
- Philosophy, theories, and ethics: incorporating culturally relevant philosophies and paradigms to promote patient-centered goals
- Process: assessing, diagnosing, identifying outcomes, planning, implementing, and evaluating
- Communication and coaching environment: employing skillful communication throughout coaching interactions, considering the impact of self and patient’s internal and external environment when providing nurse coaching services
- Education, research, and leadership: attaining knowledge and competence that reflect current nurse coaching practice and integrating evidence and research into practice
- Self-development: taking personal responsibility for professional development through self-reflection, self-assessment, self-evaluation, and self-care
Nurse coaches integrate nursing theories, change theory, appreciative inquiry, motivational interviewing, coherence theory, and resilience complexity science into their practice, Dermody said. Like all nurses, they follow ethical standards and values, specifically holism, caring, moral insight, dignity, integrity, competence, responsibility, accountability, and legality.
To learn more about nurse coaching roles and read a case study about how a nurse coach helped a patient with advanced metastatic kidney cancer find hope when his treatment transitioned to palliative care, refer to Dermody’s full article in the Clinical Journal of Oncology Nursing.