The Teaching-

Coaching
Function
One of Benner’s Seven Domains of Nursing Practice

By: Brian Monteiro, Precious White, and Melissa

Zong
 Objectives
1. Examine Benner’s Teaching-Coaching Function
Domain and three of its competencies
2. Discuss personal experiences relating to each
competency
3. Analyze the significance when applied to the
many aspects of nursing practice
 Competencies of the
Domain
● Timing: Capturing a Patient’s Readiness to Learn
● Assisting Patients to Integrate the Implications of
Illness and Recovery into Their Lifestyles
● Eliciting and Understanding the Patient’s
Interpretation of His or Her Illness
● Providing and Interpretation of the Patient’s
Condition and Giving a Rationale for Procedures
● The Coaching Function: Making Culturally Avoided
Aspects of an Illness Approachable and
Understandable
 Timing: Capturing a Patient’s
Readiness to Learn

● Discretion is important in deciding when to deviate from

normal scheduled nursing care
● Should teaching be implemented at this time?
● Where is the patient mentally?
● Are there any barriers?
● How much and what does the patient know already?
 Exemplar Example

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.

Interviewer: How did you know the patient was ready?

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

● Patients may interpret body responses to illness

○ Nurse’s role to teach them what to expect, correct any
misinterpretations made by the patient, and to offer
explanations for any other questions
● Benner (2001) states, “Patients frequently check out their
questions with the nurse before asking the doctor. Thus, nurses
become experts in coaching a patient through illness” (p. 77).
● Benner (2001) also states, “These expert nurses not only offer
information, they offer ways of being, ways of coping, and even
new possibilities for the patient by means of the perspectives and
the practices that are embedded in good nursing care” (p. 78).
 Significance Relating to
Interdisciplinary Teamwork
Every patient is different and will interpret things differently
even if they have the same illness. It is up to the nurses who
spend the majority of the time with the patients to express to
the interdisciplinary team of what the patient is feeling.

All health care providers should be on the same page

keeping the patients well informed.

Ultimately all decisions are made by the patients.

Transparency amongst everyone will create a better mileu.
 Significance Relating to Patient
Safety and Patient Care
● Coaching a patient through a high anxiety situation increases patient safety, by grounding
them to reality
○ Nurses are able to use different tactics to communicate to patients in high stress
emergent situations
● Nurses act as a coach for patients that are dealing with new acute illnesses
○ They guide the patient through the process of the disease, what to expect, answer any
questions, and help the patient cope
■ Thus making the experience in a whole less daunting
● Coaching-teaching a patient that has been diagnosed with a new illness offers patients a
new perspective on the possibilities at hand and new ways of living
○ Increasing their quality of life and function of daily living
And Here’s a Short Clip on the Power of the
Teaching-Coaching Function from other
nurses!

https://www.youtube.com/watch?v=GRzpXY
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