Becoming an Integrative Health Coach can provide new career opportunities for nurses and other healthcare providers. It also can equip providers in their current roles with the tools to better engage patients in hospital, home healthcare, or ambulatory settings in making the important lifestyle changes that underlie chronic disease.
Unhealthy habits are notoriously difficult to break and healthy ones can be just as difficult to develop and maintain. As nurses and physicians know well, educating patients about why smoking, physical inactivity, drinking, or overeating are detrimental to well-being is often not enough to change their behavior.
Nurses, nurse practitioners, physicians, and physician assistants rarely have the time to sit down with patients and tease out through careful questioning what would motivate them to quit unhealthy behaviors. Yet neuroscience has shown that it takes time, planning, repetition, and persistence to change unhealthy habits and to form new healthy patterns in the brain’s neural pathways.
In addition, today’s rapidly changing healthcare system is tilting toward providers spending less time with patients, not more. This time conundrum has helped create a new role in health care that is gaining traction as more people struggle with chronic diseases—the Integrative Health Coach. Integrative Health Coaches are trained to support people in successfully making the difficult lifestyle habit changes that are the cornerstone of health and well-being.
Health coaches can be highly effective in helping patients make needed changes. For example, a systematic review published in 2014 in Patient Education and Counseling found that health coaching improves the management of chronic diseases as well as improves lifestyle habits such as increased physical activity and weight management. Studies focused on integrative health coaching also have found significant improvements in patients with chronic diseases such as diabetes and heart disease. Given these results, it’s not surprising that health coaches are being hired by healthcare organizations, employee wellness programs in non-healthcare organizations, wellness centers, and insurance companies. Some coaches have created private practices, while others have simply integrated their knowledge into their current roles.
In this article, you’ll learn more about integrative health coaching through the eyes of those who fill the role.
Health coaching blends two worlds
Chad Sanders was frustrated at his inability to partner with the patients he cared for as a hospital RN. “The heart of nursing is caring—coaching patients towards greater health, healing, and well-being,” he says. “But sometimes the way hospitals and roles are structured prevents you from doing that. I was able to give patients education, but I didn’t have time to assist patients in discovering the best personalized ways to apply this education to make changes in their lives.”
Sanders enrolled in Duke Integrative Medicine’s (IM’s) Integrative Health Coach Professional Training (IHCPT). As an Integrative Health Coach, he uses his advanced training in two roles: one as a health coach in his own private wellness business and the other as a hospital psychiatric nurse, where he applies his coaching skills frequently with individuals and groups.
“I am called to both nursing and health coaching,” Sanders says. “Both worlds blend perfectly and ultimately can help our patients achieve better health, healing, and well-being.”
Finding the best educational option
Many health coaching programs are springing up across the country, but health coaching is still a relatively new role that is not well defined or regulated. Nurses interested in becoming health coaches should investigate whether they are enrolling in a legitimate and reputable health coaching program, such as Duke IM’s IHCPT. (See Overview of Integrative Health Coach training.)
It’s not necessary to be a nurse or another type of healthcare professional to become an Integrative Health Coach, but nursing and coaching make for a powerful combination, says Linda L. Smith, Director of Educational Programs for Duke Integrative Medicine. Smith also is a physician assistant, and the founder and director of Duke IM’s IHCPT.
Nurses learn anatomy, physiology, pharmacology, nursing science, and much more in their basic education programs, and in their practice, they physically care for, educate, and advocate for patients. Coaching is a very natural extension of that role.
“Coaches have a different skill set,” says Smith, who is part of the leadership team for the National Consortium for Credentialing Health & Wellness Coaches (NCCHWC). In 2016, NCCHWC and the National Board of Medical Examiners signed an agreement to launch a national certification for individual health and wellness coaches in the United States, which is expected to start in 2017. A national certification will help build the emerging profession of health coaching.
Educating is not enough
Smith recalls a gentleman who had been referred by his physician for health coaching for smoking cessation. On the first visit, the man told the coach, “I’m not going to discuss smoking cessation. I’m sick of people telling me to stop. I know what to do, but I’m not going to stop smoking.”
The health coach didn’t press the issue. Instead, using Duke IM’s Wheel of Health, she asked him if there were other areas of his health, such as diet, movement and exercise, or relationships that he was concerned about. The man said he wanted to exercise again and was willing to start a simple walking program, Smith says. As he achieved one small goal, such as walking 10 minutes a day, he was able to strive for other goals.
A year later, he was walking more, eating better, and feeling good, but he couldn’t reach his new goal of walking 3 miles at a time because he was short of breath, Smith says. Finally, he had the confidence and motivation to stop smoking and to continue to develop in his health and well-being.
Several years later the man is still an ex-smoker. “If the coach had continued to talk with him about smoking cessation, it wouldn’t have worked,” Smith says. “He wasn’t yet ready to make that change but he was ready to get started in another area.”
Coaching through life’s obstacles
Integrative Health Coach Janet Stolp was an experienced RN in various specialties and was already working as a wellness coach for employees of Duke University Medical Center when she decided to take Duke IM’s IHCPT. She completed both the Foundation and Certification Courses.
“I was curious as to why some clients could move forward and make changes and others felt stuck,” she says. “I knew it wasn’t because of a lack of information.”
Mary Jones* was one of the first people Stolp worked with as a coach. She helped Jones through a crisis that led to better emotional well-being and eventually the energy and motivation to improve her health habits. At the time, Jones was overwhelmed by being a married, working mother of a small child. “Sometimes I would come home late and I didn’t know what would be waiting for me on the other side of the door,” she says. “Would my toddler be crying, my husband exasperated, or the house in disarray?”
Jones says she was familiar with different ways to reduce stress, such as with meditation, but she didn’t know how to incorporate them into an already busy and frantic life. That is what she learned from Stolp. “She helped me figure out how to weave these skills into the fabric of my life.”
Stolp has learned that coaches sometimes work with patients who will never be well or those whose wellness is blocked by unforeseen and seemingly impossible obstacles. For example, she coached one elderly man with Stage IV heart failure who was told by his physicians that he did not have long to live and should consider palliative/hospice care. He had been caring for his wife who had Alzheimer’s disease at home for many years.
“He was in the hospital when I met him,” Stolp says. “I went in and listened to what was on his mind and how he was grappling with the decision about palliative care.”
The patient said he had little energy but that he was not yet ready to curl up and die; he wanted to go to the beach one last time.
Says Stolp, “We explored his vision for the remainder of his life and how important it was to accomplish a few things before he went to a palliative care center. I asked him what would happen if he didn’t try to plan for a beach trip. He said he would be sad if he didn’t make that effort. So he made the difficult decision to enter his wife in a long-term care facility and go to the beach before entering a palliative/hospice care center himself.
“He explored that possibility without feeling guilty; maybe he was seeking permission from himself. Maybe through my compassion he gained compassion for himself.”
Tools of the coaching trade
Sanders finds good communication skills are essential to building therapeutic relationships for both health coaching and psychiatric nursing. Effective communication is client centered and uses empathy, reflective listening, and open-ended questions to help patients reflect on their own lives. This type of communication elicits core values that patients can link to their health habits and supports their self-efficacy.
“It is not me forcing information on them or trying to make them do what they aren’t ready to do, but rather me partnering with them so they can discover their own intrinsic motivation and readiness for change” Sanders says.
Stolp also uses effective communication as a stress management clinician working with inpatients at Duke University Medical Center and in her own private health-coaching practice.
Other coaching techniques the Integrative Health Coach training taught Sanders and Stolp include realistic goal setting and mindfulness practice.
Nurse heal thyself
Deborah Lee walked away from a 25-year career in nursing that left her physically and mentally depleted before she discovered health coaching.
“I was in my late 40s; I had numerous stress-related illnesses; I was taking multiple medications; I was 50 pounds overweight; and I was depressed,” she says. “I didn’t know what I was going to do. But once I had that space, I started reclaiming my health.”
A former colleague who was studying to be a life coach asked Lee to work with her. “I discovered I wanted to get back to the roots of why I became a nurse—to help people be their best self—and realized I did not want to throw away my nursing education and skills,” she says.
After researching various health coaching programs, she enrolled in Duke IM’s Foundation Course. Lee is now a Certified Integrative Health Coach, an instructor in both the Foundation and Certification Courses at Duke IM, and a research specialist at Western Kentucky University in Bowling Green.
Lee’s passion is coaching other RNs to deal with the stress that affects their health and well-being so they don’t end up depleted as she did. One example of her work as an Integrative Health Coach was helping a nurse leader who was stressed by a difficult work relationship with a physician—something most nurses can relate to. The physician had tirades that would turn the staff upside down, negatively affecting the nurse leader’s day. “He was controlling everybody’s moods,” Lee says.
When the physician was on a tirade, the nurse leader’s anxiety would build and she would become upset or cry in front of him, which was not how she wanted to react. Knowing she couldn’t change him, she wanted to respond differently but didn’t know how to do that when gripped by anxiety.
Lee helped the nurse learn to become mindful to her experience in the moment so she could choose how she wanted to react: She could continue to do what she was doing or react in a way that gave her a sense of control. Lee encouraged her in exploring options to change her mental dialogue in a way that supported her ability to respond differently.
The strategy worked, as the nurse leader continued to practice listening to her strong inner voice and reacting differently to the physician’s tirades. It changed both the nurse leader’s and the physician’s approach to one of cooperation instead of antagonism.
Says Lee, “My contribution was to support her to develop her own best answers to the problem; to change the dialogue within herself.”
For more information about Duke Integrative Medicine’s Integrative Health Coach Professional Training or to sign up for an information session visit https://www.dukeintegrativemedicine.org/integrative-health-coach-training/.
Kivelä K, Elo S, Kyngäs H, et al. The effects of health coaching on adult patients with chronic diseases: a systematic review. Patient Educ Couns. 2014;97(2):147-57.
Wolever RQ, Dreusicke M, Fikkan J, et al. Integrative health coaching for patients with type 2 diabetes: a randomized clinical trial. Diabetes Educ. 2010;36(4):629-39.
*Name has been changed to protect privacy.
This article is sponsored by Duke Integrative Medicine.