Chapter 4 Coaching and Counseling of Patients Flashcards
Competency Definition for Coaching and Counseling:
Coaching and Counseling of patents and their families involves developing a relationship that emphasizes communication, teamwork, and skill development.
The 1st thing to do in Coaching and Counseling of Patients and Families is what?
Develop a relationship with the patients and families
Should you include the family members and community partners in the care team?
Yes, but not until shared goals, resources, and limitations are known
What are some of the barriers to coping and participating in the care plan?
- readiness to change may not be present (guide them through the stages of change, provide resources)
- limited resources
- physical, mental and educational limitations to include low health literacy
What is DiClemente and Prochaska transtheoretical model re stages of change readiness first stage?
a. Pre-contemplation - pt not aware of need to change behavior
What is the next stage of readiness to change after pre-contemplation?
a. Pre-contemplation - pt not aware of need to change behavior
b. Contemplation - the intention to take actions is in the next 6 months
What is the next step in readiness for change?
a. Pre-contemplation - pt not aware of need to change behavior
b. Contemplation - the intention to take actions is in the next 6 months
a. Pre-contemplation - pt not aware of need to change behavior
b. Contemplation - the intention to take actions is in the next 6 months
c. Preparation: the intent is to take action in next month with some new behaviors tried in the last 12 months
What is the next step in readiness for change?
a. Pre-contemplation - pt not aware of need to change behavior
b. Contemplation - the intention to take actions is in the next 6 months
c. Preparation: the intent is to take action in next month with some new behaviors tried in the last 12 months
a. Pre-contemplation - pt not aware of need to change behavior
b. Contemplation - the intention to take actions is in the next 6 months
c. Preparation: the intent is to take action in next month with some new behaviors tried in the last 12 months
d. Action: initiation of behavioral modification
What is the next step in readiness for change?
a. Pre-contemplation - pt not aware of need to change behavior
b. Contemplation - the intention to take actions is in the next 6 months
c. Preparation: the intent is to take action in next month with some new behaviors tried in the last 12 months
d. Action: initiation of behavioral modification
a. Pre-contemplation - pt not aware of need to change behavior
b. Contemplation - the intention to take actions is in the next 6 months
c. Preparation: the intent is to take action in next month with some new behaviors tried in the last 12 months
d. Action: initiation of behavioral modification
e. Maintenance: continuation of the behavior for more than 6 months
Should you identify what stage of readiness the pt is in before initiating interventions as a nurse coach?
YES!
Build the relationship on trust, not coercion. Health outcomes for pt may not mesh with health team, reflect on best care to find a shared goal
Do you need to determine education level of pt before making a care plan?
Yes, medical jargon and low health literacy - pt doesn’t hear the message you are trying to deliver
- individualize to the pt’s chronic disease mgmt needs, reading and health literacy levels
What is an effective behavior change tool that will help guide pts towards talking about change in their own words?
Motivational interviewing
Is empathy and listening at the heart of the interview process?
Yes
Is the pt a valued member of the interdisciplinary team?
Yes, pt is a co-laborer in the health goals
If the practice is pt-centered, will it look the same for all pts?
No, you need to communicate that to other team members
Should you incorporate reflective practice after initiating goals?
Yes, relational support and the art of caring is a nursing coaching skill
True or false
You should identify which faily member can most effectively provide the necessary level of support required by the pt
True, value active partnerships with patients in planning, implementation and evaluation of care
How does motivational interviewing promote trust between care team, pt, and family?
It promotes an atmosphere of safety and acceptance to explore and modify health related behavior
When utilizing Motivational Interviewing, consider what 4 general principles in your approach to collaborating with the family?
- Honesty regarding matters of health, empathetic to pt’s challenges relative to recovery
- Have a structured path to recovery
- Manage expectations, expant pt’s understanding regarding condition
- Consistent feedback, recognize progress
- Acknowledge role of family i progress
- Recognize ambivalence is normal and often inherent in longer recoveries
What are potential discrepancies in desired outcomes and behaviors that are inconsistent with the recovery plan?
a. Relationship between clinician, pts, families and caregivers should address the benefits of changing behaviors that will facilitate desired outcomes
b. It’s important to help pts recognize contradictions between what they want and what they are doing
Should you acknowledge resistance and frustration by pt and caregivers?
Yes, confront the problem, not the person, resistance is a signal to reinforce goals and refresh the care plan.
- Care and recovery must include alternative care options that will accomplish the same goals and outcomes. Resistance often stems from fear of change and fear of failure.
- Encourage and recognize pt efforts and family contributions, this is critical to pt’s progress, recovery and positive outcomes.
- Support self-efficacy- need to understand value of changed behavior and have a solid belief in ability to accomplish the desired change.
- Appreciate shared decision making with empowered pts and families, even when conflict occurs.
What is the definition of health coaching?
A practice that educates patients while promoting self-management of individualized health goals.
What are the 5 A’s Behavior Change Model Adapted for Self-Management Support Improvement?
It is an interactive closed loop model for implementing self-management strategies.
- Assess
- Advise
- Agree
- Assist
- Arrange
What is included in #1 Assess?
Assess: beliefs, behavior, and knowledge
a. Assess pt’s knowledge about his/her health status.
b. Elicit pt values, preference, and expressed needs
c. Assess levels of physical and emotional comfort
d. Assess pt’s confidence in dealing with his/her health goals and barriers
e. Assess pt’s knowledge, skills, and beliefs related to perceived health status.
What is included in #2 Advise?
Advise: provide specific info about health risks and benefits of change.
a. Provide pt-centered recommendations to promote health.
b. Relate all health info to health behaviors
c. Stress the importance of behavior changes.
What is included in #3 Agree?
Agree: collaboratively set goals based on patients’ interests and confidence in ability to change behaviors.
a. Set collaborative goals
b. Make SMART goals: specific, measurable, attainable, realistic, and timely
c. Incorporate family into plan to support and accomplish goals.
d. Communicate goals to all team members
e. Consider both short and long-term goals
f. Discuss risks and benefits of proposed behavior changes.
What is included #4 Assist?
Assist: Identify personal barriers, strategies, problem-solving techniques, and social/environmental support.
a. Promote creative strategies to lead to planned change
b. Collaboratively design patient-centered plants to address pt concerns
c. Provide evidence-based care strategies
d. Develop strategies and self-monitoring skills to address barriers to changes
What is included in #5 Arrange?
Arrange: specify plan for f/u.
a. Continually monitor and f/u action plans that facilitate open communication
b. Utilize strategies to monitor progress (email, phone calls, visits) as outlined in plan.
Personal Action Plan: what are the elements?
a. Identify specific goals
b. List anticipated barriers
c. Create strategies to minimize barriers
d. Develop f/u plan
e. Communicate plan to pt/family and entire health team.
What are the benefits to use of Self-Management Model?
- Shared decision making
- Prompts behavior changes
- Relevant strategies and interventions
- Knowledge of treatment
- Pt partnership with health care team
Importance of maintaining relationship with the pt and family
Establishing strong nurse/pt relationship determines the quality of outcomes. Prerequisite for pt trust is the sense that the nurse is genuinely caring, compassionate and competent and a knowledgeable expert re pt’s health care needs.
Building a relationship of trust between the nurse and pt can be categorized in 6 phases.
- Reaching out
- Removing the mask of anonymity
-remove stereotypes
-each is essential to pt’s progress
-open discussion, nurse can express
interest and understanding of the
broader dimension of pt’s life - Acknowledgment of connection
-pt realizes nurse responds to him as
whole person
-Verbal, nonverbal and body language
indicate strong caring
-nurse provides consistent eye-to-eye
contact with the pt using dialogue
assuring she is listening and focused on
pt’s concerns. - Reaching a level of truthfulness
-pt now feels safe in nurse’s care
-pt will honestly share inner feelings,
concerns, level of knowledge and skill. - Reaching a level of solidarity
-pt more confident nurse is on his side
and they are equal in the partnership.
-feelings of mistrust disappear, nurse has
demonstrated genuine care about pt
and understands his personal life
situation, goals,and expectations for
recovery. - True negotiation of care
-the nurse and pt work equally to
develop the plan of care and goals
-the nurse is supportive but not creating
a dependency, understands pt’s world
and pt has a better sense of well-being.
Evaluations and outcomes:
- Pt’s utilize RN with increased phone,
email, home and office visits. - Patients understand resources available
to meeting their self-management goals - Pt can seek help prior to escalation of
symptoms - Pt is better able to be self-efficient and
cope.
