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Coaching Skills for Nurses

By Claire Westwood RGN, RSCN, BA Health Studies, Dip Life Coaching, founder of www.happynurses.co.uk

Coaching is an individualised, action-based way to help clients set goals for their future. A coach will work with a client for a number of weeks or months, and will explore the client’s beliefs, values and current reality. The coach then helps them to move forward in life by teaching them to set specific goals, and holding them accountable to take action. The sessions can be held over the phone, or face to face.

As a coach I enable my clients to discover their own answers through the use of questions. I explore their values, their beliefs about themselves and where they feel they are now in relation to where they would like to be. We then establish a written action plan, built around small, manageable actions, which helps them to achieve their goals. They are the ones who decide what they are going to do, not me.

This article will explore some of the communication skills taught as part of my Life Coaching Diploma, and how they can be applied to nursing. These skills are allied to Neuro-linguistic programming (NLP) and can be used in any communication between individuals. They can deepen relationships between client and nurse, lead to greater understanding between health professionals and also improve intimate relationships.

Neuro Linguistic Programming – NLP

Rapport

Creating rapport is extremely important in any relationship. Rapport is the feeling of warmth and trust between two people, allowing effective communication to take place. Some people find this easier to do naturally than others, but there are ways to establish rapport easily with almost anyone.

It is generally easier to create a feeling of connection with ‘people who are like us’. This makes it easier to relate to individuals of the same gender, physical appearance or values. This is a natural and instinctive type of connection, and can be observed between two people. They may be smiling at each other, or ‘mirroring’ each other’s movements and behaviour. This happens when two people are connected in their communication – they will sometimes be standing in the same way, with postures that are the exact opposite of each other. You may notice them moving their hands or changing position at the same time without noticing it themselves. Watch couples when they are out, or old friends or colleagues at work and look for positions that show ‘mirroring’.

This can be used by you to make clients or patients feel more relaxed and establish a connection. When you are sitting opposite a patient or client you can observe how they are sitting and alter your posture slightly to ‘mirror’ them. Your fear may be that ‘they will notice what I am doing’. This may be the case, but as this all happens subconsciously they should respond positively to your positioning without knowing why. If you generally find it easy to establish rapport with your patients, you may notice that you do this automatically. Leaning slightly forward, establishing eye contact and smiling, if appropriate, are simple ways to increase the connection with them.

Using a similar voice pattern, tone and pitch can also create a link with your client or colleague. A patient that is angry or stressed can be made to relax slightly if you match their pace and tone initially, then slow the pace and reduce the volume of your voice so that when they answer they may echo your tone and volume. Their responses are automatic and instinctive.

Questioning

You can use great questions to discover what the patient or client wants for themselves – allow your client/ patient to state their own aims and goals. Theirs may be different to yours, but they are more likely to follow their own plan than one you give them. What do they want, and when? Be realistic, but allow for a degree of challenge. What actions have they tried before? What worked, and what didn’t? What stopped them? Do others around them help or hinder their progress?

The art of asking better questions is one of the most valuable skills I have learnt as a coach. Examples of incisive and powerful questions: How do you feel about….?
What might stop you?
How could I help you….?
What else could you do….?
What would you do if you knew you would succeed?
How would you love to feel when you woke up in the morning?

Listening

Listening is one of the most important yet under-taught skills we can use to improve our communication in any situation. The skill is in listening closely to the speaker’s words, really focusing on them, maintaining eye contact, and listening to the emotion behind what they are saying. Using similar phrases, and echoing their exact words when responding to them makes them feel you are on the same ‘wavelength’ and truly listening to them. If you use their exact phrase in your questioning, you will get a more accurate answer of what they mean than if you ‘paraphrase’ it into your own words. Some communication books advocate repeating exactly what they have said to ensure you understand them, but this can be interpreted as patronising. You can echo their words within a question, in order to elicit more information, but actually listening to the true meaning of the phrase can be more positive.

Goal setting

Health promotion plans often have specific goals that are set by the health professional, rather than the patient or client. Within coaching the goals used are always those of the client. The coach is there to help and encourage the client, and ensure the goals are congruent with the client’s beliefs and lifestyle. The standard template for goal setting is that they should be SMART (Specific, Measurable, Achievable, Realistic, Timed). Some coaches advocate going much further than this and creating goals that make you go ‘Wow!’ (Neill, 2006). If it doesn’t excite you, why would you want to do it?

A goal has to have a ‘what’ and a ‘when’ so you know when you have got there, but should have an element of excitement, inspiration and fun as well. It should be stated in positive terms, so that the client is moving ‘towards’ something. A visual image and emotional picture of ‘why’ they want it will also help.

What will the benefits be to their health, self esteem or lifestyle? This can help considerably in motivating them if you can create a really positive future vision with them. eg “I will lose a stone this week” (very popular with magazines!) – negative, based on loss, measurable, but unrealistic.

Better – “I will weigh 12 stone on October 3rd. I will be wearing my black trousers that I bought last year, and will be going out to the cinema with friends. They will remark on how well I look and I will feel happy and healthy.” “I will be a non-smoker by November 12th. I will enjoy breathing fresh air, my clothes and hair will have a fresh smell. I will be able to walk round the park easily without coughing. I will have £25 more money each week to save, or to spend on my family.”

Action Plan

The next stage is to agree on a plan for them to follow, using their goals. The action plan should be simple and easy, taking small steps at first, building up as they develop more confidence and fitness. The actions must be agreed by the client, and clearly understandable.

How will they be accountable, and to whom? While coaching clients we follow them up every week or fortnight, usually by phone. We keep a copy of their plan, so they feel accountable to us as well as themselves. The clients can also email us between sessions to tell us what they have done. Could they use a health professional, family member or friend to keep them on track?

The coaching process iincludes checking the actions taken by the client against the action plan and measuring progress against the goal. The action plan should be refined in order to help the client to move closer to their goal, exploring ways that they can become more pro-active in their lives. This is one of the most powerful outcomes of coaching, and could help a number of patients dealing with chronic issues.

Giving feedback

One of the most rewarding parts of being a coach is the ‘permission’ I have to congratulate my clients and praise them when they have achieved their goals, or carried out each action on their action plan. I have started to be more complimentary in my work life, and personal life too. Most people are embarrassed at first, but, as I am sure you have experienced yourself, a genuine compliment can stay with you for ever. Look for ways to praise your colleagues and patients, start small. It does get easier to do, and the emotional rewards for the person giving the compliment are as great as those for the receiver.

The patient/ client should feel a sense of achievement as well as increased confidence and better health as they move towards their goal. Most people like positive external feedback so tell them when you are pleased with their progress. Have rewards built in to the programme, to further encourage motivation. Which of your patients are great at sticking to their treatment plan? Tell them how pleased you are. Who has lost weight/ improved their peak flow readings/ can walk an agreed distance? Celebrate each step.

Summary

Working with clients using a coaching approach could be rewarding for both parties. Use rapport, listening and questioning skills, and agree an action plan. Give rewards and praise and celebrate even minor achievements. Let me know any successes you have.

For more information about being a happy nurse visit www.happynurses.co.uk or join the happynurses group here on ProNurse, or just connect with Claire and say hello!

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