Entry Level Baccalaureate Nursing Students as Health Coaches Kim Alexander Decker, PhD, RN, CNS Desiree Hensel PhD, RN, PCNS-BC, CNE.

Entry Level Baccalaureate Nursing Students as Health

Coaches

Kim Alexander Decker, PhD, RN, CNS

Desiree Hensel PhD, RN, PCNS-BC, CNE

Background• Nursing has traditionally focused on:

– Nurses set client health goals– Tell clients what to do– Give out written plans– Set unrealistic timeframes or outcomes – Calling them noncompliant if they did not do it– Considering ourselves failures if we don’t

make change happen

Research

• Health Coaching, i.e.,– Client Initiated Visions and Plans

• Valuable technique for– Helping Clients Achieve Desired Behavior

Goals (Neuner-Jehle, 2013; Olsen, 2010)– Improving client-provider relations (Thom,

2014)

Purpose

• The purpose of this pilot project was to integrate health coaching into a new population-based clinical course for entry level baccalaureate nursing students at a large Midwestern University.

Research Questions• The research questions that guided this

exploratory study where:

1. “How do students enact the role of health coach?”

2. “What are the barriers and facilitators to teaching health coaching in pre- licensure education?”

3. “What are the outcomes of incorporating health coaching in a nursing course?”

Method: Faculty Preparation

• Faculty attended a one-day workshop on the principles of health coaching.

• One faculty member received advanced

training for certification as a health coach and served as the team’s primary resource.

Method: Students

• 60 entry-level nursing BSN attended foundation lectures– Basics of health and wellness– Stages of change– Health coaching

• Students asked to find own client– interested in pursuing a lifestyle change – willing to meet for 6 1-hour coaching sessions

Health Coaching Conversions

• Listen & clarify• Say what is so• Listen more• Readiness for

change• Request action

• Examine commitment

• Identify action• Ensure

accountability• Repeat as

needed

Method: Activity

• Weekly guidelines provided for working with client

• Sessions summarized in coaching notes– Goals– Tools & techniques used – Opportunities & challenges from the session

• Reflections shared during weekly clinical

Method: Data

• IRB approval obtained to analyze all work generated in this course.

• Data sources– Coaching notes– Clinical discussion sessions– Course evaluations– Faculty feedback

Primary Outcome

• Students used health coaching techniques and tools learned in class BUT

• Few students were able to facilitate transformation change where clients assumed more responsibility for their personal health.

• Roles assumed: Educator, Judge, Enabler, Coach

Mostly Functioned as Educators• Most wanted to tell the client what to do• “Suggested to client to have the roommates keep their

food on a specific shelf in the pantry and refrigerator, if that is tempting him have them keep their food in their room, maybe getting a small refrigerator for their room. Advised him to be the primary cook in the home so he knows how the food is prepared. Getting better at using the mobile app on his phone but still not using it to its full potential. Suggested client start exercising to raise his HDL levels.”

Judges and Enablers• Some got angry that the client would not do

what they wanted• “Since suggesting the mobile app but only taking the

advice after being told it was a good idea from his doctor, he seems more willing to take my suggestions more into

consideration.” • Some wanted to do everything for the client• "We have agreed to meet next Monday … and I will

have researched "bursting" activities for her and we will formulate a checklist of her daily exercise needs."

Too Many Goals/Too Much Change

• Many students lacked sufficient understanding of the process of behavior change evidenced by working on too many goals or expecting change too quickly for a six week time period.

• Example: Committed 6-week goals: “Run 3Xs/week, No alcohol Sunday-Thursday, taking more time for herself.” added “experimenting with the MyPlate” week 5

Uneasiness in the Role• Some student’ notes reflected that they had

little idea of how to help their clients or felt inadequate because their client was not ready to make a change.

• Example: One student still wanted to focus on task when a client was mourning loss of a grandfather

• “it was hard to keep my client focused on the conversation because she needed to talk about her grieving”

Barriers: Faculty

• A general discomfort by faculty with being asked to teach this technique with limited training and even littler clinical experience.

Barriers: Client Selection• Some students chose clients:

– With goals that were not about improving health (such as trying to create a perfect body)

– Were very complex and really required counseling (such as needing help revealing they were gay or wanting to lose >100lbs)

– With which they were too emotionally connected (such as an ex-husband, mother or father)

Barriers: Time Frame

• Students were asked to conduct six weekly counseling sessions and turn in paper work resulting in students progressing with the next session without getting complete feedback on the previous one.

Revisions: Project Specific

• Initial project a success but future revisions should at least include:– Giving the students clearer guidance on

selecting a health coaching participant– Spacing project over a different time frame– Providing clearer feedback

Revisions: Long Term Needs

• Ensure adequate faculty development in this behavior change technique

• Plan for how health coaching will manifest in subsequent clinical courses

Conclusion: Addressing Barriers

• Additional Faculty Education:

• Supplemental Health Coaching workshop with an expert in the field who suggested

-Performance Management

-Maximize Potential

Conclusion: Addressing Barriers

Suggested students select fellow non-nursing students who want to stay healthy.

Concentrate on:• Sleeping • Eating• Stress• Balance• Exercise

Conclusion: Addressing Barriers

• Suggested Time Frame over 3 months

• Feedback after every session

• Receive feedback before conducting subsequent session

Conclusion: Addressing Barriers

Baccalaureate Nursing Program/New Concept Based Curriculum integrated Health Coaching:

• Sophomore Year: Community Health Course• Junior Year: Behavioral Health Course• Senior Year: Management Course

References• Arloski, M. (2014). Wellness coaching for Lasting Lifestyle Change. Duluth,

MN: Whole Person Associates, Inc.• Moore, M. & Tschannen-Moran, B. (2010).Coaching: Psychology manual.

Baltimore, MD: Wellcoaches Corporation.• Neuner-Jehle, S., Schmid, M., & Grüninger, U. (2013). The “Health

Coaching” programme: a new patient-centred and visually supported approach for health behaviour change in primary care. BMC Fam Pract, 14, 100.

• Olsen, J. M., & Nesbitt, B. J. (2010). Health coaching to improve healthy lifestyle behaviors: an integrative review. American Journal of Health Promotion, 25(1), e1-e12

• Thom, D. H., Hessler, D., Willard-Grace, R., Bodenheimer, T., Najmabadi, A., Araujo, C., & Chen, E. H. (2014). Does health coaching change patients’ trust in their primary care provider?. Patient education and counseling.

Questions?

[email protected]

[email protected]