Coaching Skills for nurses
The long term goal of this program is to assist patients with debilitating illnesses to change their behavior by learning to more easily make choices that support rather than challenge their health.
Coaching is seen as an effective way to do this. It is a widely used communication tool that has been shown to improve other people’s ability to change their behavior. The principles of coaching have long been applied to health related behaviors and are successful in allowing people to change behaviors ranging from heroin addiction to smoking cessation and insomnia, (Prochaska & DiClemente (1994). However nurses are not currently receiving formal training in these skills.
The specific objective of this program is to develop coaching skills for the clinical nurse educators (or other allied health professionals) to apply in to their education follow up and review sessions with patients.
The program also aims to increase the work satisfaction of clinical nurse educators by developing skills that can make their challenging and important role a little easier and more satisfying.
This objective is achieved by conducting a three month learning journey to develop the educator’s coaching skills. It focuses on their role in the patient support team and involves an initial three day workshop supported by action learning projects, individual and review sessions.
The journey develops communication skills required to coach, the ability to use different conversation structures to create change and the attitudes that are essential to inspiring people to change their behavior.
The application of coaching techniques to the patient education program has the potential to improve compliance significantly.
Studies outside of healthcare show the significant impact coaching can have. In 1997 a study by Olivero showed a 22.4% increase in productivity after a management training program but an 88% increase after internal coaching was provide as an adjunct to the training. Developing coaching capacity in clinical specialists (nurses) is a way to further increase their success in improving therapy retention rates by assisting patients to comply with therapy.
Health outcome measurements related to the specific illness can be expected to improve as a result.
Science to support the approach
Despite the long associations of some of the principles of coaching in healthcare, the application of these principles is generally in isolated skills sets and formal training in coaching skills for health care practitioners is rare.
Recently there has been an increased interest in the potential for improving health outcomes in many disease states with the use of coaching techniques by health care practitioners. This interest is indicated by the rapid increase in published articles on the subject.
Grant (2005) notes that there have been 200 citations regarding coaching published in the medical literature since 1935 and that 173 of them have been in the last year.
Despite the increased interest in this subject there are few empirical studies that look to understand the impact that developing coaching expertise in nurses has on their effectiveness, their wellbeing and their patient’s health.
One study that does do this looked at the use of coaching interventions in diabetes and indicates that coaching diabetes patients leads to enhanced self management and subsequently improved metabolic control, (Whittemore, 2005).
Literature specifically related to nurse-patient communication highlights a common view that nurses communication skills and the training they receive in this area are inadequate, (Bowles, et al 2001).
A few recent studies have looked at the impact of training nurse’s in specific skills that are subsets of the broader ability to coach. These studies have shown positive impacts on patient wellbeing.
Such studies include an evaluation of the use of a solution focused approach, (Bowles et al, 2001) and a patient centered approach by nurses (McCabe, 2004).
One of the challenges associated with these studies is the lack of a reliable measurement tool to quantify either communication or coaching skill level.
The literature shows some recent attention to the development of measurement tools for communication expertise in nurses (Klakovich, 2006) but not specifically their coaching capacity.
Guidance can be found on this issue from management literature. Grant and Cavanagh (2005) report on a goal focused coaching skills questionnaire that was found to have good “convergent, concurrent, face validity and test – retest reliability”. The questionnaire was able to distinguish between professional and non professional coaches. This work formed the foundation for the evaluation tool used to measure the outcome of the Metta Healthcare programs.
Case study: Results from a Meta Healthcare programsshow significant increases in work life satisfaction and self-assessed coaching skills.