Coaching, in recent decades, has gained considerable impetus, as a highly motivating, self-directed, goal-centred approach to achieving personal success (Arnold, 2016). Through coaching, people are empowered to uncover their own solutions; foster their own skills, and change firmly held attitudes and behaviours; the aim of which ‘is to close the gap’ between one's potential and present state (Rogers, 2016).
The coaching process
‘is a conversation, or series of conversations, that one person has with another’.
The emphasis being on the coachee to take personal responsibility for creating sustainable change (Whitmore, 2017). Furthermore, coaching is considered a journey; one through which people are able to unlock their potential and maximise their own performance (Whitmore, 2017).
With the coach being:
‘a sounding board, a facilitator, an awareness raiser and a supporter’.
Moreover, coaching, argues Jones (2021), supports coachees to explore and make sense of the information available, and through guidance, apply such information to their own situation. For the coachee to be successful requires the coach to have the capacity to enable personal insight and to facilitate the concept of learning through reflection (Jones, 2021).
Coaching, with its emphasis on collaboration, empathy, unconditional positive regard and authenticity, asserts Stober (2006), is part of a humanistic approach, through which a productive relationship can be nurtured and potential achieved.
Coaching types
There exists a plethora of coaching types, which can be used in differing situations and environments based on individual need. Examples of which can be found in Table 1. The emphasis of this paper is on ‘health coaching’, a concept which focuses on evidence-based clinical interventions, such as motivational interviewing, goal setting, active listening and change management theory (Huffman, 2016).
Table 1. Types of coaching
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Disappointingly, however, despite strong evidence demonstrating the effectiveness of health coaching within international studies, there is limited evidence of its impact within the NHS (Gray, 2019). It is therefore difficult, as Gray (2019) argues, to determine whether an investment in health coaching offers a sound return on investment in comparison with other forms of health intervention.
Nonetheless, the aim of Health Education England (HEE) is to ensure that, through a clearly defined framework, health coaching becomes firmly embedded within healthcare delivery (HEE, n.d.). This process is enabling patients to be supported to self-manage their own health; with education and training opportunities aimed at developing the coaching skills of health professionals being accessible (HEE, n.d.).
What is health coaching?
A plethora of definitions exist that aim to create an understanding of health coaching and its application.
Olsen (2014) defines health coaching as:
‘a goal oriented, client-centred partnership that is health-focused and occurs through a process of client enlightenment and empowerment’.
While Rogers and Maini (2016) define health coaching as:
‘the art of facilitating the patient's active participation in managing their own health. Coaching raises self-awareness and identifies choices. Through using a coaching approach, patients are able to find their own solutions to enhancing health-related quality of life.’
Whereas Huffman and Miller (2019) define health coaching as:
‘the use of evidence-based skilful conversation, clinical strategies, and interventions to actively and safely engage clients in health behaviour change to better self-manage their health, health risk(s), and acute or chronic health conditions resulting in optimal wellness, improved health outcomes, lowered health risk, and decreased health care costs’.
Coaching – a person-centred approach
Health coaching is considered a partnership between healthcare practitioners and individuals; one which guides and prompts behaviour change, empowering individuals to make healthcare choices based on what personally matters to them (NHS, 2020).
This emphasis on patient involvement has created a paradigm shift, from the traditional expert-focused care models, to one that is person-centred, with the individual being seen as the expert in their own care (Davies et al, 2020). The interface between patient and health professional being one of collaboration and patient focus (Singh et al, 2020).
Delivering health coaching
Health coaching can take place in a variety of settings (May and Russell, 2013) using an array of multi-faceted interventions, with Singh et al (2020) exploring a number of approaches to delivery, which can, as required, be combined. These include, telephone and face-to-face coaching, as well as the use of a number of electronic approaches including e-mail and texts, applications, videos and online links.
Fundamental to the success of the coaching partnership, is the coach having the skills and attributes necessary to undertake the coaching process (Table 2).
Table 2. Professional attributes of the coach
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Why is health coaching needed?
The pervasiveness of chronic disease and its impact on both quality of life and the economy as a whole, requires a sea change, through which a variety of interventions can emerge, including argues Olsen (2014), the use of an effective health behavioural change model and the undertaking of quality research.
With behavioural risk factors, including tobacco smoking, poor diet, alcohol consumption and low levels of physical activity, being attributed to 34% of all deaths in the UK (Organisation for Economic Co-operation and Development, 2019), and with 70% of the total health and care expenditure in England attributed to those with long-term conditions (Department of Health, 2012), it is clear that action is necessary.
Action that requires the intervention of a new model for public health, one ‘that is built on a sophisticated and nuanced understanding of complex systems’ from microbiological to global (Sniehotta et al, 2017).
However, despite the significant time, effort and intervention spent in supporting positive health outcomes, it is well known that patients often ignore the advice of health professionals (Martin et al, 2005). Furthermore, despite the importance of a strong collaborative approach to decision making, as evidenced by the National Institute for Health and Care Excellence (NICE, 2019), a recent report published by the Care Quality Commission (2020) determined that only 55% of people responded ‘yes definitely’ when asked if they had been involved as much as they would have liked, when making decisions in relation to their treatment and care.
With the leading causes of death in the UK attributed to non-communicable diseases and approximately 22% of all deaths considered avoidable (Office for National Statistics [ONS], 2018), nurses, it can be argued, have a crucial role to play in supporting patients to make healthy choices in regards to lifestyle behaviours (Thompson, 2019). This is supported by Fu et al (2016), who demonstrated through their research that a good patient–professional collaboration has a positive effect on a patient's ability to self-care.
The nurse's role
With a greater emphasis now being placed on the importance of patients developing effective self-management strategies (Wood, 2018), one approach that could be used is health coaching (NHS, 2020). With many nurses understanding the complexities of their patients' lives, and the possibility of working towards improved health (Mitchell et al, 2013), nurses are in a strong position to utilise their skills, many of which can be attributed to the role of a health coach.
Disappointingly, however, there is evidence that some nurses shy away from this important aspect of their professional role with some typically failing to transfer this knowledge to their personal health and lifestyle behaviours (Malik et al, 2011), with Kelly et al (2017) further advocating that nurses can often fail to offer healthy lifestyle advice depending on their perceived abilities, training and work environment. Moreover, Heidke et al (2020) argue that some nurses who smoke or are overweight were less confident in their ability to provide information to promote positive lifestyle behaviours and felt hypocritical and therefore avoided discussing such issues with patients.
There is grave concern, therefore, that nurses, although often assumed to be knowledgeable in health-promoting behaviours (Keele, 2019), are failing to convert this knowledge into sustainable change (Ross et al, 2017). While historically it has been expected that nurses will role model the behaviour they endorse, of late, the capacity to meet this expectation has been frequently questioned (Keele, 2019). As evidence suggests that patients are influenced by nurses own health behaviours and willingness to act as health promoters (Hurley et al, 2018), this requires urgent attention.
Although supporting patients to make health behaviour changes is considered a fundamental aspect of the nursing role (Olsen, 2014), failing to be role models means that patients may be less likely to follow the health advice of nurses who do not personally engage in the behaviours they are seen to promote (Ross et al, 2017).
Furthermore, research undertaken by Blake and Harrison (2013) into the health behaviours of pre-registration nurses found that the behaviour of participants was ‘less than exemplary’ and inconsistent with personally held beliefs of the importance of nurses being role models.
An important point to consider, however, is that of Keele (2019) who argues that, rather than victim blaming nurses for not presenting a perfect picture of health, a more realistic approach may be to hold nurses to the same standard of expectation as the rest of the general population, and to provide a variety of effective workplace strategies to support their needs. This is supported by Wills et al (2020), who argue that if nurses are considered best placed to integrate health coaching into everyday professional practice and to act as role models for the population, then developing strategies to support the health of the nursing workforce must be recognised as a global priority.
With the global nursing literature indicating that frontline nurses are at increased risk of mental health problems as a result of the COVID-19 pandemic (Bao et al, 2020; Kang et al, 2020), perhaps now, more than ever, nurses need an increased level of support.
Conclusion
The interest in the use of coaching skills to guide optimal health and improve the health of the nation has increased significantly in recent years. This has become evident with the drive to integrate health coaching roles into the everyday lives of nurses and the need to support nurses to become effective role models.
It should not, however, be the responsibility of nurses to become role models for a population, after all nurses are only human too. However, as a profession, nurses can help motivate patients, taking them from a sense of hopelessness that their lives can be any different – this sense of hopelessness is often ingrained in decades of lost opportunities – to one of taking active responsibility. But nurses cannot do this alone; they too need support.
As the pendulum swings steadily between the burden of health and health improvement, nurses are in a unique position to step forward and take on the challenge of making health coaching work. But with nurses being increasingly at risk of mental health problems themselves, with many being fearful for their lives and those of their families as the pandemic fails to abate, is taking on an additional perceived, or indeed, actual, burden, simply too much to bear at this current time?
Only time will tell and… the clock is ticking!
KEY POINTS
- Health coaching is a concept which focuses on evidence-based clinical interventions, such as motivational interviewing, goal setting, active listening and change management theory
- Health coaching is considered a partnership between healthcare practitioners and individuals
- Nurses are in a strong position to utilise their skills, many of which can be attributed to the role of a health coach
- Supporting patients to make health behaviour changes is considered a fundamental aspect of the nursing role