Gifts in Health Crisis: The Use of Health Coaching to Create Opportunity for a More Meaningful Life

As patients and families navigate the journey through a health crisis, many aspects of normal reality are disrupted. As a result of this disruption, an opening is created in which life choices can be questioned and tended to in ways that are not available during periods of normal health. Health coaching provides unique tools to assist clients as they make meaningful choices about their lives. It is my assertion that nurses can also use skills from a coaching approach to expand what is possible for patients and families during this tender time.

After listening to health coaching students give their annual case reports related to a client living with a clinical condition, a theme arose. All 12 clients reported that before their health crisis and ensuing chronic clinical condition, they didn’t consciously tend to self-care or think about how the daily choices they were making impacted their quality of life. People in normal health often haven’t looked closely at the choices they are making in their lives regarding how they care for their minds, bodies, and spirits. Or if they have been in touch with these choices, they have largely relied on others, consciously or unconsciously, to be the authority of their health. As mentioned before, during periods of health crisis, when a pause in normal health occurs, an opening is created to consider some of these choices, beliefs, and habits. Health coaching is designed to help people tune into their innate inner wisdom for insights and answers and move to a place of greater personal empowerment regarding their health.

Health in the integrative health coaching model is not solely about physical well-being or the lack of disease. In health coaching, the client’s well-being is approached through the lens of wholeness. The following definition by Dr. Mary Jo Kreitzer, an internationally renowned researcher, scholar, teacher, and leader in integrative health and healing, captures perfectly the sentiments of what true health and healing is from a coaching perspective. “Healing is a process or a journey toward wholeness. As people heal, they experience new insights and perspective and feel whole in body, mind and spirit” (Kreitzer, 2017, para. 8). As a health coach working with clients and families who are facing health crisis, I have found that what arises while creating a new normal in response to changes in life conditions is profound. People ask deeper questions of their lives that might otherwise go unnoticed in the more routine and hurried pace of their daily activities and commitments.

Some of the common topics that arise in these conversations include the nature of their relationships, meaning and purpose in their lives, values (what matters most), and self-awareness. Clients work through variations of the following questions and explorations in these coaching conversations: Are there people who drain my energy and cost precious time without a lot of benefit? Are there boundaries that I need to establish or reset related to how I spend time, energy, and resources? Are there conversations I need to have, that are long overdue?

In exploring meaning and purpose in life, people often ask questions about their careers and other life choices. They may suddenly realize that they have been doing work that doesn’t bring them joy or give them a sense of purpose. Or they may remember that they always loved doing something and have failed to make time for the activities that bring them joy. Many identify their values and priorities, and realize that their daily choices are not aligned with these values and priorities, which creates unnecessary suffering. Some clients realize that they don’t know how they are feeling, and don’t have a healthy way to process their emotions. They find themselves forced to be dependent and in a position of receiving care and support, which makes them ask deeper questions about their independence, self-reliance, and self-worth. If they are family members, suddenly turned caregivers, they may deal with feelings of guilt or helplessness as they witness their loved one struggle; they may become hypervigilant (feeling responsible for protecting and advocating for their loved one); and experience other side effects of caring in the midst of a full life. The brush with mortality often creates a sense of urgency to make every minute count. And finally, it is often in this period of health crisis that people awaken to how many choices they are making unconsciously because of who they think they should be instead of who they truly are.

Based on these common questions and explorations, it becomes evident that there is rich and meaningful territory to explore with patients who are in health crisis, as well as the family members who are providing support. The health coach has a tool kit uniquely designed to create space for these deeper questions and to facilitate clients’ capacity to connect to their innate inner wisdom. The health coaching model that I teach is based on Four Pillars described by Lawson (2013).

Mindful Presence is a way of being with another based on mindfulness, using the “process of focused, nonjudgmental awareness in the present moment” (para. 6).

Authentic Communication comprises four components: “deep listening, curious inquiry, perceptive reflections, and therapeutic silence” (para. 6). It is based on a combination of Motivational Interviewing, Appreciative Inquiry, and Nonviolent Communication, as well as other communication techniques that require the coach to listen to and respond to more than just what is being spoken.

Safe and Sacred Space is a “sense of safety” (para. 6) that the coach creates for the client to allow for deeper exploration based on mutual trust and respect.

Self-awareness is a process the coach uses to remain present with the client without bias. This is accomplished by tuning into and managing personal cues from the coach’s body, mind, and spirit that may distract the coach from being fully present with what is arising for the client (para. 6).

In theory, these Four Pillars might sound simple, yet in practice they require a level of discipline and vigilance to use and maintain. For example, I think of a person I coached, who was creating a new normal after a cancer diagnosis. She had moved from a time of surviving the throes of diagnosis and acute treatment into a tender place where the acute phase of treatment had ended, the medical care team of support was no longer needed, and she was left asking, “What’s next?” The emotions that arose for this client around losing what was normal regarding her body and life, as well as losing her acute care team, were overwhelming. As a coach, especially a highly feeling individual, I could have been capsized by these emotions and my desire to make this client feel better. Instead I worked to check those places in myself that could interfere with my ability to stay focused on the client’s capacity to find her own insights and answers from a place of innate inner wisdom. My self-awareness enabled me to maintain a deeply supportive container of grace and presence for this client so that she could connect with a place of innate inner wisdom, talk through painful feelings as needed, open to possibilities and desires, and ask and reflect on deeper questions about life.

What arose was so profound. This client realized that a new care team needed to be assembled to support her ability to navigate the next phase of the healing journey. She realized that the authority for true health resided within her. Deeper questions about meaning, purpose, career, values, priorities, and relationships arose. A desire to reconnect with sources of joy rose to the top of her priority list. All of this territory was explored in the space of a 30-minute focused coaching conversation, which created a safe container for her personal insights to emerge.

This example felt important from the perspective of having more than 20 years of nursing under my belt and knowing firsthand the impulse to fix and heal from a “make it better” perspective. Truly learning and applying the coaching tools that create a container for deeper life questions and perspectives requires unlearning some of our traditional nursing habits that are based on having solutions, thinking quickly on our feet, and making it better for our patients and their families. In truth, at some point, those patients will leave our care, and will need to have the resources to navigate on their own. Trying to make it better in the short term may actually interfere with the personal empowerment they need to navigate in the long term. If we can expand the tools in our kit to allow us to be responsive in new ways, deeper healing and self-efficacy exist for patients. An unspoken side effect is the possibility that the nurse providing care no longer has to have all of the answers. Instead, the nurse partners with patients to help them seek and find their own insights and answers. Finally, the act of being in this expanded space with a patient and/or family member provides healing to all engaged in the interaction.

One of the key principles that has applied to my life and to the lives of health coaching students I teach is the understanding that we cannot take our clients further than we have gone. So, by choosing the profession of health coaching, I have made a lifelong commitment to my ongoing personal growth and development. I must practice self-awareness and be willing to question my own beliefs, habits, and choices on a daily basis. At the same time, I must have deep compassion for my humanity. This process of coaching is not about perfection, but rather a series of practices and choices that help me become more authentic, mindful, self-aware, and present for my own life and the lives of others.

There are key choices and practices that continue to transform my ability to be fully present for the journey of another. Those include daily physical activity; a highly nutritious, individualized diet; meditation; stretching; journaling; spending time processing and exploring my feelings; work that is meaningful; high-quality relationships; thoughtful boundaries; self-reflection; creative expression; mindset work; and spiritual exploration. I also routinely get massages, chiropractic therapy, and energy healing.

I share all my choices and practices as a foundation for those who feel called to expand their reach as nurses. You are a healing tool, and you can profoundly touch the lives of others in deeper ways. My years of experience have shown me that many nurses are so tuned into the needs of others that they are unable to develop and maintain good self-care practices that nurture their highest well-being. Their healing tool gets dull from being overused and undernourished. I have burned out twice in my career, which has led to a passion for teaching health-care workers about resilience. My daily practices and choices are the result of 20 years of tending to my own self-care. What constitutes self-care varies with each individual. My advice to nurses is to start small and be consistent. Choose some actions you can take daily to support your highest health and well-being. Then build as you go, strengthening and transforming your self-care practices over time from something you do, to a way of being and living your life.

Health coaching tools and techniques are uniquely poised to help patients and families find meaning and gifts in the process of facing health crisis. Amid the devastation of a health crisis, there is an opportunity to use the pause in normal life to open up to deeper insights, questions, and possibilities for life. By using the Four Pillars as a foundation for a coaching conversation, a container is created for the client to tap into her or his innate inner wisdom and sense of personal empowerment. Whatever the outcome of the health crisis, a place of healing is available for patients, families, and the nurses caring for them.