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The new paradigm of medicine and health - what’s in it for nurses? Let’s explore Nurse Coaching!

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In England, the 5 Year Forward View  sets out clearly that we need a radical upgrade in prevention and public health; people using health services need to have far greater control of their own care and the NHS should take decisive steps to break down the barriers in how care is provided.

Viv Bennett, Chief Nurse at Public Health England, echoed these statements in her recent keynote address at the Royal College of Nursing Congress in Bournemouth.

In order to realise these aspirations, health care professionals need to reframe their assumptions from a deficit to an asset based model of health and care. Reframing disease from an entity to a process and from viewing the ‘patient’ or individual as dependent to, dare I say, empowered?

This is all wrapped up in the philosophy of Health and Wellness or more recently, Nurse Coaching (a form of health coaching).

You may recognise terms such as health trainer, life coaching, peer coaching, behaviour change, health goals, self-care, change counselling, chronic disease management, self management… the list goes on.

Health coaching flips our idea of health and care provision from reactive to proactive, disease management to health and wellbeing under the ultimate public health goals of reducing inequalities and preventing illness in the first place.

It could be seen as an extension of making every contact count (MECC). MECC is an important public health intervention but MECC is more concerned with making that initial step to consider behaviour change, have a conversation and often signposting onwards. Readiness to change is another matter altogether and is very complex.

Health coaching is ultimately about us supporting an individual to realise their potential, enabling them to develop the knowledge, skills, tools and confidence to become an active participant so that they can reach their own goals, not ours.

It acts to reduce mortality and morbidity, reduce the prevalence of long term conditions, improves decision making and in due course patient or user satisfaction. What’s not to love?!

The more I say health coaching out loud, the more I like this term. It sounds positive, facilitative. It suggests a partnership, co-production, aiming for a goal.

Health coaching, which is usually undertaken by a diverse range of health and care professionals  (HCPs) involves a mixture of behaviour change interventions, including motivational interviewing, which is recommended by NICE as part of a suite of behaviour change interventions.

The more I say health coaching out loud, the more I like this term. It sounds positive, facilitative. It suggests a partnership, co-production, aiming for a goal.

The next step is for us to explore Nurse Coaching. Nurses and midwives constitute the largest professional group of HCPs and are uniquely positioned to undertake this role.

Montgomery and colleagues in their book Nurse Coaching: Integrative Approaches for Health and Wellbeing state that in the US, ‘nurse coaches are addressing the bio-psycho-social-spiritual-cultural-environmental dimensions of health’.

They use ‘mindfulness, presence, deep listening, and skillful questioning'. Once qualified, Nurse Coaches undertake lifelong learning which includes reflective supervision which enhances their competencies.

In the US, Nurse Coaches practice in a variety of specialisms including researchers, educators, Advanced Nurse Practitioners, Nurse Consultants and are located in areas such as end of life care, diabetes, cardiac rehabilitation, multiple and complex long term conditions. So what are we waiting for?

We cannot afford to watch and wait to see what happens. We have to take action now and by that I mean collective action. Not a paternalistic ‘we know best’ approach, where each symptom is treated in a silo and the conversation goes one way; from the health care professional (HCP) to the ‘patient’, telling them what they need to do.

We need to let go of our power and ‘sanctimonious lecturing’ (as mentioned by a close friend of mine when referring to previous conversations to address his weight gain with his HCP).

Reducing avoidable demand will be crucial over the next phase of health and care reform. We all need to work together, do together, not be done to. As health and care professionals, we need to reframe our philosophy. We cannot afford to keep doing what we’ve always done.

The trick to living well for longer is to put lots of things in place at an individual, community and population level.

Ultimately, we need to try and reduce avoidable premature mortality. By that I am referring to tackling non-communicable diseases or more commonly known as long-term conditions such as obesity, diabetes, heart and liver disease, hypertension. The list goes on I'm afraid, but these are the most common.

It is happening and it’s happening in pockets all over the country. Populations, however large or small, are working in partnership with their local health and care providers and making joint decisions.

We also need to look a lot more closely at the interrelationship between physical and mental health and wellbeing too. Individual behaviours too need attention. These include alcohol, diet, physical activity, sex and smoking. All pleasures of life, so very challenging to adapt.

It is happening and it’s happening in pockets all over the country. Populations, however large or small, are working in partnership with their local health and care providers and making joint decisions.

Professionals are undergoing a transformation. Health Education East of England has partnered up with The Performance Coach to provide an opportunity for professionals to explore health coaching and put their learning into practice.

Over 800 doctors, nurses, allied health professionals from across the system have undertaken the training so far, as well as a ‘train the trainers’ component.

It will not take much to develop this further and to focus on Nurse Coaching as a specialism of the nursing profession in the UK. This is my vision. Join me!

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  1. Comment by Mark Doughty posted on

    A great article, thank you Joanne. As a patient who has lived with a number of LTCs since my early 20's I have personal experience of when the medical model (and its associated mindset and diagnostic processes) has worked for me. Unfortunately I also have personal experience when because of my chronic condition which cannot be solved, cured or 'fixed' it hasn't worked.

    I think health care professionals (HCPs) can learn a lot from sitting with and listening to those of us who had to find our own way to live well with our health conditions precisely because we were not able to find the answers within a system which generally had a tendency to disempower us, act paternalistically and viewed me as "the Arthritic in bed 4". And I am not denying all those HCPs who have been modelling the behaviours and attitudes associated with the new paradigm described in this article. However from my personal experience of spending over 30 years in relationship on a monthly basis with the NHS it has often felt like I have been negotiating a system fundamentally designed to treat those conditions that can be cured or 'fixed' using a hierarchical, bureaucratic set of structures, systems and processes with a rational diagnostic mindset that seems at its core to simplify me to a set of throughputs, and data to be collected, analysed and fed back to improve the efficiency of the system.

    When my physical symptoms are seen as a problem to be fixed, when different parts of my illness are treated as separate problems then its very easy for it to be communicated to a young man trying to make sense of the changes going on in his life that he is the problem and that he is fragmented and no longer whole.

    So for some of us we have looked outside the medical model for our answers and we have found those answers in a a new health care model (or paradigm as described in this article) that is a more holistic, integrated approach to health care. Here the diagnostic model rather than being dominant is just one way (albeit a very powerful and useful one) of making sense and helping me to manage my health.

    What this one model and paradigm supports is a set of new relationships between myself and my health and wellbeing and myself and those health and social care professionals I partner with and collaborate with to ensure that I can live a well and fulfilling life with my RA.

    This new paradigm is at the heart of the patient as leader. A person who self leads themselves and their care whilst also being an agent of change supporting HCPs to design and implement services that truly meet our needs.

    The patient as leader works as a self coach and uses the facilitative and coaching model when partnering with their HCPs.

    The patient as leader could be a powerful ally working in partnership with the nurse coach. We are both operating from the same paradigm. We both view the world through the same lens and we can both really support an NHS to work and be different if it is truly to embrace the challenges posed by the Five Year Forward View.

    To help understand where i am coming from in my thinking, I offer three short blogs that have been post of the NHS Leadership Academy website. The first is "The Patient as Leader" the second is "Can patients influence how the system engages with us? The patient leader can"
    and the third is "The power of those small acts of Kindness"

    I hope you find these helpful and please lets try and not continue that old way of separate groups believing that they have discovered something new and special when what many of us are simply doing is rediscovering and uncovering ways of being and acting that have been around for hundred (probably thousands) of years but that our current fixation on a particular way or working has some how excluded from mainstream medical health care thinking and practice.

    I agree patient leaders and nurse coaches share a vision lets practice what we preach and collaborate, partner and share this with others.

  2. Comment by Maneesh Juneja posted on

    This is brilliant - what a refreshing read.

  3. Comment by Diana Robinson posted on

    I'd be interested to know where patient and carer voices (and experiences) fit into "nurse coaching"

  4. Comment by Joanne Bosanquet posted on

    Hi Diana, thank you for your post. The very heart of nurse coaching evolves around the individual. It is the individual's personal goals and aspirations that are explored in depth. I agree with the need to involve carers too. We need to move from a deficit model to an asset model and carers have a vital role to play.
    I am intending to publish a more in depth piece in the near future but in the mean time, please do have a look at the embedded links in the blog. Very best wishes. Joanne

  5. Comment by Angela Perrett posted on

    Really like this. I agree we need a paradigm shift and a move towards asset based, partnership and co-production feels like the way forward to me. Worth exploring further particularly in line with Mark's thoughts around patient leaders and similar vision around

  6. Comment by Kym posted on

    @MrsBosanquet : great article and so true! We have spent so much time focusing on illness - now is the time to work with the low to rising risk population! Turning off the nurse brain " I can fix you- just do as I say" is an adjustment- but what a difference. Empowering the patient to focus on their goals- things they intrinsically know - is incredibly rewarding! I love what I do- every day! Check out the work of Barbara Dossey, Ph.D. , RN as a pioneer in the world of nurse coaching!!

  7. Comment by Kathryn posted on

    It's one of those things, that, once you've used it you realise what absolute sense it makes! It's a refreshing approach with both the professional and the service user having conversations about how the service user can manage the issues with the support of the professional, rather than the old school 'I'm the nurse, I know best'. It's a different way of thinking and takes a little practice and adjustment but once you see the positive impact, you won't go back!

  8. Comment by Jane Lopez posted on

    It is about time that nurses are seen as leaders in a new healthcare paradigm. This article brings together a unique nursing perspective and expanded the role of all nurses.

  9. Comment by Nicole Vienneau posted on

    Excellent article and very relevant today as Nurse Coaching becomes more and more main stream- to shift the reactive healthcare system to a more proactive system- where the patient and their family are truly the center of all decisions- instead of just saying they are.

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