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The Art of Coaching in Primary Care

By

Maureen Ryan DNP, NP, CHWC, CST

April 10, 2014

Attendees at this presentation will learn to utilize coaching strategies to facilitate sustainable change

leading patients to health and wellness:

1. Explore the differences between the approach of a health and wellness coach and the approach of expert health care provider

2. Describe the core coaching skills

3. Identify strategies to assess patients readiness to change

No Conflict of Interest to Disclose

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Health and Wellness Coach

!  Assists individuals to become personally responsible, autonomous, and motivated to change

!  Establishes a relationship designed to promote growth and change

Why coaches? !   Chronic diseases are responsible for 84% of all

health care costs.

!   In 2009, 145 million people — almost half the U.S. population — had a chronic condition.

!   Approximately 67% of the workforce is overweight or obese and, in recent years, there has been a 36% hike in health care spending associated with obesity.

Robert Wood Johnson Foundation, 2010

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Nurse Coach !  Assesses client readiness for change

!  Provides a nonjudgmental safe, space for structured coaching conversations

!  Implements client-centered coaching interventions that assist clients in identifying goals and selecting action steps

!  Evaluates progress, addresses challenges and celebrates wins

Nurse Coaches are passionately committed to life-long personal development and learning

We teach unconsciously that which we are, whether this be good, indifferent, bad. We do not teach what we preach,

but what we are.

Florence Nightingale

Lets walk our talk!

Contrast

Expert HCP !   Authoritarian, educator

!   Defines agenda

!   Defines plan

!   Solves problems

!   Told what to do

Coach !   Facilitator, partner

!   Client comes up with agenda

!   Promotes growth and change

!   Client is in charge

!   Fosters possibilities

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Foundation: Trust and Rapport

!  Unconditional positive regard

!  Empathy

!  Humble role model

!  Presence

!  Client finds the answers

Coaching Presence

!  Empathy

!  Affirmation

!  Warmth

!  Curiosity

!  Playfulness

!  Authenticity

Core Coaching Skills

!  Mindful Listening

!  Open-Ended Inquiry

!  Offers Perceptive, Insightful Reflections

!  Identifies and Asks Powerful Questions

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Lasting Change

!  Essentials – Robust motivator – Capacity and confidence

– Optimistic view of future – Future-oriented reasons

Capacity to change

!  Confidence

!  Resilience

!  Hope

!  Belief

Mindfulness

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Mindfulness: It’s time to lead by example

!  Intention

!  Attention

!  Attitude

Mental & Emotional Resources

!  Mindfulness

!  Self-awareness

!  Motivation

!  Self-efficacy

!  Optimism

The greatest achievement in life is to have the ability to create the world around you, so that it matches the

dreams in your mind.

Mike Dillard

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Vision/Goal

“Vision is a target that beckons” Drawing to rather than running from

Bennis & Nanus, 1985

Transtheoretical Model of Behavior Change

Five stages of change: 1. Precontemplation (Not ready for change)

2. Contemplation (Thinking about change) 3. Preparation (Preparing for Action) 4. Action (Taking action) 5. Maintenance (Maintaining a good behavior) Dr. James Prochaska

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Assess Readiness to Change

!  Are you willing to work on making a change? (no = I won't)

!  Do you feel overwhelmed? (yes = I may)

!  Are you thinking about it? (yes = I may)

!  Are you making some plans? (Yes = I will)

!  Are you taking action? (yes = I am) !  For how long (if > 6 months = I still am) Wellcoaches, 2012

Motivation

!   Emotion is Energy in Motion!

!   Emotion or feeling that will be experienced once goal is met

!   Motivation –  Intrinsic –  Extrinsic

!   Creates the energy needed to change behaviors or beliefs

!   The why behind the why

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Positive Emotions Improve thinking processes !   Flexible !   Creative !   Open minded

!   See bigger picture !   3 to 1 ratio predicts thriving ! www.positivityratio.com

!   www.viacharacter.org ! www.authentichappiness.org

Decisional Balance

Benefits of change

!  What would your life be like if you achieve this goal?

Barriers to changing

!  What would your life be like if you don’t achieve this goal?

Barriers !  Identify barriers or roadblocks

!  Be aware and prepared

!  Can be physical, mental, emotional or spiritual

!  Create space of safety and trust

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Appreciative Inquiry

!  By identifying, appreciating and amplifying strengths, people go beyond problem solving to bold shifts forward.

!  Actions become positively charged and positive outcomes are evoked.

Frederickson, 2003

Appreciative Inquiry !   Intention

positive anticipation of future, positive actions and outcomes

!   Attention

positive attention in present

positive questions, reflections, conversations

!   Attitude positive energy and emotion

Motivational Interviewing

Myrebirth.com

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Motivational Interviewing Principles

!  AREDS – Avoid Arguing – Roll with Resistance – Express Empathy – Develop Discrepancy – Support Self Efficacy Rollnick & Miller, 2008

Well-being Assessment !   Life satisfaction !   Energy !   Exercise !   Nutrition !   Weight !   Mental and Emotional Fitness !   Health !   Overall Well-Being Score

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Wellness Vision !  My wellness vision is . . .

!  My motivators are . . .

!  The strengths I can draw on . . .

!  My challenges are . . .

!  Strategies that will help me realize vision and meet the challenges are . . .

Wellcoaches, 2012

Preparing for session !   What have I accomplished since our last session? !   What did I learn about myself? !   What didn’t I get done, but intended to do? !   What challenges am I currently exploring? !   What opportunities are available to me right now? !   This is how I want to use my coach during this call:

__________________________________. !   Three things that I have been grateful for this

week: _________________________________.

Trust the Body

!  Innate wisdom of body

!  Symptoms as teachers

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