Faculty of Health Sciences, University of Lethbridge, Canada.
Nurs Inq. 2013 Sep;20(3):223-31. doi: 10.1111/nin.12004. Epub 2012 Sep 17.
To address the growing costs associated with chronic illness care, many countries, both developed and developing, identify increased patient self-management or self-care as a focus of healthcare reform. Health coaching, an implementation strategy to support the shift to self-management, encourages patients to make lifestyle changes to improve the management of chronic illness. This practice differs from traditional models of health education because of the interactional dynamics between nurse and patient, and an orientation to care that ostensibly centres and empowers patients. The theoretical underpinnings of coaching reflect these differences, however in its application, the practices arranged around health coaching for chronic illness self-management reveal the social regulation and professional management of everyday life. This becomes especially problematic in contexts defined by economic constraint and government withdrawal from activities related to the 'care' of citizens. In this paper, we trace the development of health coaching as part of nursing practice and consider the implications of this practice as an emerging element of chronic illness self-management. Our purpose is to highlight health coaching as an approach intended to support patients with chronic illness and at the same time, problematize the tensions contained in (and by) this practice.
为了应对与慢性病护理相关的成本不断增加，许多发达国家和发展中国家都将提高患者的自我管理或自我护理能力作为医疗改革的重点。健康指导作为一种支持向自我管理转变的实施策略，鼓励患者改变生活方式，以改善慢性病的管理。这种做法与传统的健康教育模式不同，因为护士和患者之间存在互动动态，以及以关注和赋予患者权力为中心的护理方向。指导的理论基础反映了这些差异，但在其应用中，围绕慢性病自我管理的健康指导实践揭示了日常生活的社会调节和专业管理。在经济受限和政府从与公民“护理”相关的活动中撤出的背景下，这一点尤其成问题。在本文中，我们追溯了健康指导作为护理实践的一部分的发展，并考虑了这种实践作为慢性病自我管理的一个新出现要素的影响。我们的目的是强调健康指导是一种旨在支持慢性病患者的方法，同时也使这种实践所包含的紧张关系问题化。
