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Coaching
Function
One of Benner’s Seven Domains of Nursing Practice
Expert Nurse: I had a very satisfying teaching experience with a patient today because I
was able to stop everything and spend an hour and a half with him, teaching him at the
precise moment that he was most ready to learn. It was a tough decision, because it
entailed stopping all other responsibilities and telling everybody that I was going to be
gone.
Expert Nurse: He made it very clear that he was ready. He was asking a lot of questions.
He had had a regular ileostomy a couple of years ago and had finally been persuaded
that a continent ileostomy was going to be the greatest thing for him. Earlier I thought he
was feeling helpless about he operation he had just had. He looked as though he felt
crummy. Physically, he was sort of stressed looking, nervous looking. Furthermore, he
was treating the whole thing physically very gingerly. He didn’t need to be that gentle with
it. So by the time he started asking questions he was feeling better physically, feeling like
there was some hope that he would learn how to deal with this. (Benner, 2001, pp. 79-80)
Personal Example
● Patient had too much to drink and passed out not remembering
much
● But remembered: car was stolen, ex tried to poison her, locked out
of apartment, cat in apartment with no food and water, and debit
card being used
● Patient only interested in taking care of these issues
● Used discretion in realizing not the best time to do any teaching
● Involved Case Management
● Resolved the issues I could
● Reevaluated the proper time to implement patient education
● Patient more receptive to learning after at home situations dealt
with
Assisting Patients to Integrate the
Implications of Illness and Recovery into
Their Lifestyles
● Helping patients improve their quality and meaning of life, by incorporating temporary or permanent
illness into essential life activities
● Both exemplars discussed in the book the nurses talked about looking at the patient as a whole
○ How can they help these patients who have debilitating illnesses adjust to life?
○ What options do the patients have at returning to a semi-normal life, after their illness?
○ “First approaching it from the fact of what is this disease, and what is being done for this child.
To see if everything possible was being done (p 83).”
○ “She was a marvelous lady who was dying because she was being treated like an invalid, and
she felt useless and hopeless (p 81).”
Eliciting and Understanding the Patient’s
Interpretation of His or Her Illness
● Nurses must take the time to listen to the patients interpretation of how they feel emotionally,socially and
physically during their illness (time in the hospital), this creates a better relationship between patient and care
provider.
● Taking the time to understand the patients mindset the nurse is able to build a better understanding and create a
better plan to improve the recovery of the patient.
● Understanding when to be stern, offer encouragement or be passive based on the patient (pg. 78).
● Example: Primary problem for the patient might not be pain or the diagnosis at that moment it could be the sun
in their eyes, or feeling of loneliness of discomfort from being in a hospital environment. Understanding
physical pain from emotional pain.
Benner’s Exemplar of Understanding Patient's
Interpretation
Benner spoke about a female patient with ulcerative colitis who had undergone surgery and would have to
live with an ileostomy for several months.
The patient verbalized how “disgusting and ugly” her ileostomy made her feel. The nurse understood the
patient’s emotion towards her ileostomy and rather than trying to change the mindset of how she felt
towards an ileostomy, the nurse focused on the required care and teaching.
Interviewer Note: “Patient verbalized that the teaching had been particularly helpful” (pg. 86).
Personal Example
During 331 clinical I had the opportunity to care for a patient that was blaming her Diabetes on her
husbands cooking.
As a student nurse I took the time to listen to what she was thinking and saying and realized that,
though her husbands cooking may have played factors for her Diabetes, other variables also play a
role. I chose to focus her attention towards her ability to control her diabetes through exercise,
watching for signs and symptoms and creating a daily routine to better manage her diabetes.
I was able to realize that as soon as a nurse or a doctor brought up food or her husband she became
irritated and unproductive. I was able to gear my teaching plan towards exercise, symptoms and
creating a routine.
Significance to Nursing Practice
https://www.youtube.com/watch?v=GRzpXY
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