EVIDENCEBASED CARE SHEET Synergy Model What We Know › According to the American Association of Critical Care Nurses (AACN), synergy occurs when the needs or characteristics of a patient, clinic, unit, or system are matched with a nurse’s competencies(2,3) • AACN developed the Synergy Model for Patient Care (typically shortened to Synergy Model) in 1996as a framework for credentialing in critical care nursing. However, it can be applied to any patient-nurse interaction(2) • The core concept of the Synergy Model is that the needs and characteristics of patients and their family members influence the characteristics and competencies that nurses require for patient care(2,3) –The Synergy Model is used as a professional framework in the clinical setting, academia, and research to define the nursing relationship with the patient. The Synergy Model promotes clinical inquiry, identification and communication of the specific needs of the patient(2) › The Synergy Model is centered around the following nine guiding assumptions:(1,3) • The nurse creates a caring environment for the patient(1) • The nurse works to enhance clinical outcomes for patients and their family members, the healthcare system, and other healthcare providers(1) • The interrelated characteristics contribute to the profile of the nurse(1) • The nurse incorporates his or her education, clinical knowledge, skills, and experience in each patient interaction(1) • The nurse seeks to optimize patient wellness and goals as defined by the patient (1,3) Authors Hillary Mennella, DNP, ANCC-BC Cinahl Information Systems, Glendale, CA Tanja Schub, BS Cinahl Information Systems, Glendale, CA Reviewers Debra Balderrama, RN, MSCIS Clinical Informatics Services, Tujunga, CA Bryan Boling, RN, DNP, CCRN-CSC Cinahl Information Systems, Glendale, CA Nursing Executive Practice Council Glendale Adventist Medical Center, Glendale, CA Editor Diane Pravikoff, RN, PhD, FAAN Cinahl Information Systems, Glendale, CA –If death is defined by the patient as a goal, the nurse should provide care that promotes a peaceful death • Patients are viewed as biologic, social, psychological, and spiritual entities who present at different developmental stages. It is important that the nurse considers and cares for patients’ body, mind, and spirit as a whole(1,3) • The patient, his/her family members, and the community contribute to the nurse-patient relationship(1,3) • Each patient’s distinctive characteristics are interrelated and contribute to one another. It is important that the nurse understands that patient characteristics are not viewed separately but are viewed as an interrelated system(1,3) • Changes in experiences, the setting, and situations are interrelated and can affect the nurse-patient dynamic(1) › The Synergy Model focuses on eight nursing competencies and eight patient characteristics(2,3) • Nursing competencies include patient advocacy and moral agency (i.e., working on another’s behalf), caring practices, collaboration, clinical judgment, response to diversity, facilitation of learning, systems thinking (i.e., using a body of knowledge, strategies, and tools to manage patients), and clinical inquiry. Clinical nursing November 9, 2018 Published by Cinahl Information Systems, a division of EBSCO Information Services. Copyright©2018, Cinahl Information Systems. All rights reserved. No part of this may be reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, or by any information storage and retrieval system, without permission in writing from the publisher. Cinahl Information Systems accepts no liability for advice or information given herein or errors/omissions in the text. It is merely intended as a general informational overview of the subject for the healthcare professional. Cinahl Information Systems, 1509 Wilson Terrace, Glendale, CA 91206 competencies can be appraised by nurse managers, charge nurses, peers, and self-evaluation(3) –Nursing competencies are scored as Level 1, 3, or 5, with higher numbers indicating greater competence - Level 1 indicates competent level - Level 3 indicates moderate level - Level 5 indicates expert level - For example, a nurse clinician who “synthesizes and interprets multiple, sometimes conflicting sources of data and makes a judgment based on an immediate grasp of the whole picture” would be assigned to Level 5 for clinical judgment • Patient characteristics are based on a health-illness continuum and include resiliency, stability, predictability, complexity, resource availability, participation in care, vulnerability, and participation in the decision-making process(3) –Each patient characteristic is scored as Level 1, 3, or 5, with higher levels indicating higher degree of the patient characteristic being measured. For example, - a patient who is fragile and susceptible to actual or potential stressors that could adversely affect identified outcomes would be assigned a Level of 1 for highly vulnerable on the health-illnesscontinuum for vulnerability (e.g., considered “brittle”) - a level of 3 would indicate moderately vulnerable (e.g., somewhat susceptible) - a level of 5 would indicate a patient who is minimally vulnerable (e.g., considered “safe”) • Patient and nurse competency scores can be input into a Synergy Grid to help determine patient assignments(4) –Cross-checking the patient’s characteristics according to the Synergy Grid with available nursing staff resources makes it possible to assign a nurse with appropriate nursing competencies that is matched with patient characteristics - It is recommended that the unit have at least one expert level nurse per shift in order to appropriately match nurses with patients › The Synergy Model has been used in a variety of clinical settings to match nursing competencies and patient characteristics when determining staffing assignments(4,5,6,8) • Nurses a medical-surgical setting found that use of the Synergy Model contributed to(4) –an 11% increase in overall nursing engagement –a 27% increase in nurses’ belief that coworkers demonstrated skill competencies –an increase to 19% in 2008 from 3% in 2007 in nurses obtaining national certification –a decrease in total patient falls per 1,000 patient days –overall improved patient satisfaction on the medical-surgicalunit –overall improved physician satisfaction with the medical-surgical unit –exceeding the national benchmark of 90–100% screening for methicillin-resistant Staphylococcus aureus (MRSA) on the unit • Use of the Synergy Model to determine work assignments in an ICU resulted in can a decrease in rates of catheter-associated urinary infection (CAUTI), central catheter-associated bloodstream infection (CLABSI), pressure injuries, falls, and ventilator-associatedpneumonia (VAP)(6) • Following application of the Synergy Model in a hematology unit, the percentage of nurses that reported that their competencies were well matched with patient acuity increased from 48% (before model implementation) to 87%. Implementation of the model was also associated with improvements in nurse satisfaction regarding workload, engagement, involvement in work assignments, and level of support for novice nurses(5) • The Synergy Model has also been adapted for use in determining the level of care necessary for transport of critically ill patients between facilities(8) › The Joint Commission (TJC) mandates performing a spiritual assessment as a standard for care of a patient and/or family members. Addressing spirituality contributes to patient satisfaction and a healing environment. The Synergy Model can be applied to spiritual care in critical care settings by addressing two characteristics of the patient (resiliency and resource availability) and two nursing competencies (caring practices and response to diversity)(7) • The AACN defines patient resiliency as the “capacity to return to a restorative level of functioning using compensatory or coping mechanisms; the ability to bounce back quickly after an injury”(2) –Nursing interventions to strengthen patient resiliency can include communication through prayer if appropriate and desired by the patient and/or family members(7) • The AACN defines patient resource availability as “the extent of resources brought to the situation by the patient, family, and community.” Resources can be personal, social, psychological, supportive, technical, or financial(2) –Resources and referrals can be offered by religious congregations, relationships with clergypersons, spiritual relationships with persons who are not part of an organized religious group, and parish nurses; nurses must set time aside for spiritual care of their patients(7) • Caring practices of nurses involve providing comfort and support to promote healing and prevent suffering; interventions should be provided in a compassionate and therapeutic manner(7) –Nurses should accurately identify, assess, and document patient and family member spiritual needs and preferences, provide and encourage access to spiritual resources, and facilitate spiritual practices according to the desires of the patient and family members(7) • The nurse’s response to diversity is the ability to “recognize, appreciate, and incorporate differences in the provision of care.”(2)The nurse’s response to diversity can be intuitive, interpersonal, and altruistic(7) –Differences in spiritual needs and beliefs must be addressed for a congruent nurse-patient relationship(7) –Specialized and targeted education in spirituality can assist nurses in developing sensitivity to the needs of their patients and family members(7) –A nurse with expertise in providing spiritual care can be matched to patients who have spiritual needs; if a nurse with such expertise is not available, appropriate referrals are necessary(7) What We Can Do › Learn about the Synergy Model so you can interconnect your nursing competencies with your patient’s distinctive characteristics; share this information with your colleagues › Refer to the AACN Web site for information regarding Synergy Model scoring of nursing competencies and patient characteristics at https://www.aacn.org/nursing-excellence/aacn-standards/synergy-model › Use a synergy grid to appropriately match nursing competencies with individualized patient needs when making assignments Coding Matrix References are rated using the following codes, listed in order of strength: M Published meta-analysis SR Published systematic or integrative literature review RCT Published research (randomized controlled trial) R Published research (not randomized controlled trial) RV Published review of the literature RU Published research utilization report QI Published quality improvement report L Legislation C Case histories, case studies PGR Published government report G Published guidelines PFR Published funded report PP Policies, procedures, protocols X Practice exemplars, stories, opinions GI General or background information/texts/reports U Unpublished research, reviews, poster presentations or other such materials CP Conference proceedings, abstracts, presentation References 1. Alspach, G. (2006). Expanding the Synergy Model to preceptorship: A preliminary proposal. Critical Care Nurse, 26(2), 10-13. (X) 2. American Association of Critical Care Nurses. (n.d.). The AACN Synergy Model for Patient Care. Retrieved October 13, 2018, from https://www.aacn.org/nursing-excellence/aacn-standards/synergy-model (GI) 3. American Association of Critical Care Nurses. (n.d.). The AACN Synergy Model for Patient Care. Retrieved October 13, 2018, from https://www.aacn.org/~/media/aacn-website/nursing-excellence/standards/aacnsynergymodelforpatientcare.pdf?la=en (GI) 4. Carter, K. F., & Burnette, H. D. (2011). Creating patient-nurse synergy on a medical-surgical unit. MEDSURG Nursing, 20(5), 249-254. (GI) 5. Georgiou, G., Amenudzie, Y., Ho, E., & O’Sullivan, E. (2018). Assessing the application of the Synergy Model in hematology to improve care delivery and the work environment. Canadian Oncology Nursing Journal, 28(1), 13-16. doi:10.5737/236880762811316 (R) 6. Sanderson, S. (2014). EB65 Evidence-based staffing: Using the synergy model to improve patient and nursing outcomes in the intensive care unit. Critical Care Nurse, 34(2), e9. (C) 7. Smith, A. R. (2006). Using the synergy model to provide spiritual nursing care in critical care settings. Critical Care Nurse, 26(4), 41-47. (C) 8. Swickard, S., Swickard, W., Reimer, A., Lindell, D., & Winkelman, C. (2014). Adaptation of the AACN Synergy Model for Patient Care to critical care transport. Critical Care Nurse, 34(1), 16-29. doi:10.4037/ccn2014573 (R)
