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Discussion

Discussion

Reply to the following discussion by supporting the post.  You will want to focus on their point of view, asking pertinent questions, adding to the responses by including information from other sources. Be objective, clear, and concise. 

It is important to support what you say with relevant citations in the APA format from both the course materials and outside resources. 

CB Discussion:

Population:  The group of patients for this proposal will include patients presenting to a nurse practitioner-run specialty clinic in Tulsa, OK for musculoskeletal pain.  Because this clinic does not take insurance and is cash pay only; this group of patients is anticipated to be of higher economic status than average.  Also, this group of patients will most likely demonstrate high self-awareness and high health literacy since they are seeking specialty care outside of normal health care networks.  Patients with musculoskeletal pain benefit from consistent exercise (Lindsay et al., 2020; Mehri et al., 2020).

Intervention: The intervention of interest is one that would increase patient adherence to a physical conditioning program.  The specific conditioning exercises the patient chooses are not the focus of this proposal.  The more important aspect is what action by the nurse practitioner is most beneficial to improving adherence to an exercise plan.  Health coaching in various patient populations has a positive effect on lifestyle changes such as increasing physical activity.  Health coaching is a patient-centered interaction that facilitates a change in behavior.  The nurse practitioner and the patient set goals and map out an action plan.  As a coach, the nurse practitioner listens, holds space for the patient, facilitates, motivates, provides feedback, and encourages the patient as they make progress along the action plan (Kivelä et al., 2014; Oikarinen et al., 2017).  An initial in-person coaching session and weekly telephone calls with the patient by the nurse practitioner is the intervention.

Comparison: the comparison group will be a similar group of patients from the nurse practitioner specialty practice who do not receive the initial or weekly telephone coaching sessions.

Outcome:  The outcome of interest is whether or not the patients who participate in health coaching sessions with the nurse practitioner will have better adherence to an exercise plan.

Timeframe:  Lifestyle modifications are not easy endeavors to undertake.  Habits are hard to break.  Therefore, the patients will be evaluated for the outcome at the end of twelve months.

PICOT Question:  In patients with musculoskeletal pain seeking care from a nurse practitioner specialty clinic (P), does health coaching and weekly telephone coaching calls by the nurse practitioner (I) compared to no coaching (C) increase adherence to a physical exercise plan (O) over the period of one year (T).

References

Kivelä, K., Elo, S., Kyngäs, H., & Kääriäinen, M. (2014). The effects of health coaching on adult patients with chronic diseases: A systematic review. Patient Education and Counseling97(2), 147–157. https://doi.org/10.1016/j.pec.2014.07.026

Lindsay, K., Caplan, N., Weber, T., Salomoni, S., De Martino, E., Winnard, A., Scott, J., Young, E., Hides, J., Hodges, P., & Debuse, D. (2020). Effects of a six-week exercise intervention on function, pain and lumbar multifidus muscle cross-sectional area in chronic low back pain: A proof-of-concept study. Musculoskeletal Science and Practice49, 102190. https://doi.org/10.1016/j.msksp.2020.102190

Mehri, A., Letafatkar, A., & Khosrokiani, Z. (2020). Effects of corrective exercises on posture, pain, and muscle activation of patients with chronic neck pain exposed to anterior-posterior perturbation. Journal of Manipulative and Physiological Therapeutics43(4), 311–324. https://doi.org/10.1016/j.jmpt.2018.11.032

Oikarinen, A., Engblom, J., Kyngäs, H., & Kääriäinen, M. (2017). A study of the relationship between the quality of lifestyle counseling and later adherence to the lifestyle changes based on patients with stroke and tia. Clinical Rehabilitation32(4), 557–567. https://doi.org/10.1177/0269215517733794


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