Application and Integration of Aacn Synergy Care Model in Clinical Practice

Application and Integration of AACN Synergy Care

Model In Clinical Practice

Application and Integration of AACN Synergy Care model in Clinical Practice

Objective of this paper is to discuss the integration and application of AACN Synergy Care model in Clinical Practice. The paper discusses the background of the model, philosophical underpinning the model is based and strategic knowledge used to formulate the model to enhance greater understanding on the application of the model in clinical practice.

Synopsis of the Theory's Background

American Association of Critical Care's (AACN) is based on the mutual advantages that patients and families would drive from the nurse's competencies. The core concept of AACN is that the needs and characteristics of patients and the family will be influenced by the competencies and characteristics of nurses. In early 1990s, leaders of AACN embarked on journey to define a new model that would guide nursing practice and ultimately confer certification for nursing care. A task force led by Dr. Martha A.Q. Curley constructed an organizational framework that would enhance the value of the nursing practice. The task orientation also enhanced essential relationship between patients and nurses with relation to healthcare. The formulation of the model is based on the premises that patient's outcome could be optimized when the nurses' competencies are able to match patient's characteristics. (Brewer et al. 2007).

The historical evolution of the AACN model started in 1993, when a think tank convened to develop a conceptual framework that would enhance certified nursing practice. The think tank consisted of nationally recognized experts and scholars including Martha A. Q Curley, Patricia Hooper, and Mairead Hickey. The philosophical thinking underlying the formulation of AACN model is based on the believe of think tank members who decide that certified practice should be based on meting the needs of patients. (Kaplow & Reed 2008).The AACN model rests on the premises that "optimal outcomes result from the synergy of a nurse's competencies matching the needs of patients and their families." (Hamrick, 2010 P. 2).

The AACN model describes eight characteristics of patient and measures them as high, medium, and low-acute patients. The eight patient characteristics include vulnerability, resiliency, complexity, stability, availability, resource participation in care, predictability, and participation in decision-making. The model also describes eight nurse competencies, which include caring practices, advocacy and moral agency, clinical judgment, systems thinking, collaboration, response to diversity, clinical inquiry and facilitation of learning. According to AACN model, when patient characteristics and nurse competencies are able to match patients' outcome, there would be a satisfaction for patient and family.

Brewer et al. (2007) contribute to the argument by pointing out the philosophy underpinning guiding the birth of AACN synergy model rests on the believe that there is a need for an ultimate certification in nursing practice that would measure value within the nursing practice and the measurement will move nursing practice towards essential relationship between nurses and patients. The AACN model is based on the premises that patient outcome could be optimized when patients characteristics match nurse competencies. The strategies employed in formulating the model are to define the specific characteristics of patients and specific knowledge and competencies that nurses must possess. Table 1 reveals eight patient's characteristics and eight nurse's competencies that would bring out patient's outcome.

Characteristics of Patients

Competencies of Nurse

Resiliency

Ability to rebound after an injury. Patient's capacity to return into a restorative level using a compensatory coping mechanism.

Clinical judgment -- Clinical reasoning should be employed by healthcare providers to enhance healthcare delivery. Critical reasoning includes nursing skills, critical thinking acquired through experiential knowledge, integrating education, and evidence-based guidelines. The knowledge integration will enhance the clinical decisions when delivering care to patients.

Vulnerability

Vulnerability could be affected through patient's physiological makeup as well as health behaviors exhibited by the patient. Moreover, patient's ability to maintain a stability and steady state of equilibrium. Thus, response to intervention of nurses could affect patient's stability.

Advocacy -- Working on other's behalf when other is not capable of advocating for him- or herself. The nurse needs to serve as a moral agent in helping to resolve and identify clinical and ethical concerns within the clinical setting.

Stability

Patient's ability to respond to therapies by maintaining a steady state of equilibrium. Response to nursing interventions and therapies could affect patient's stability.

Caring practices -- Nursing interventions could create a supportive, therapeutic and compassionate environment for patients and staff. The aim is to promote healing and comfort as well as preventing unnecessary suffering for patients. Caring should include vigilance, compassion, responsiveness and engagement to patient and family.

Complexity

This involves emotional and physiological state of body. Complexity also refers to either physiological or emotional, and environmental interactions with the patient. The more the systems manifested in patients, the more the complex pattern displayed in patients.

Collaboration -- Nurses need to work with others to promote the optimal outcomes. Patient, family of patients, and healthcare providers should work towards promoting realistic and optimal goals for patients.

Resource availability

Extent of resources, which include psychological, ?scal, personal, technical, supportive or social in nature. The more resources a patient brings, the more the positive outcome.

Systems thinking -- Tools and knowledge that nurses use to identify the interconnected nature across and within the healthcare and non-healthcare system. Ability to understand how one decision making could affect the whole systems thinking. Typically, Nurses should use a global perspective to negotiate patients' needs and make effective clinical decision that would enhance patients' health outcome.

Participation in care

Patient and family participation in the care delivery could be influenced by the resource availability, educational background and cultural background.

Response to diversity -- Sensitivity to appreciate. Recognize, and incorporate differences into healthcare provision. Nurses should recognize the individuality of each patient as well as observing patterns that could assist in responding to nursing interventions.

Participation in decision making

Level of patient and the patient's family in understanding the information delivered by healthcare providers will assist in executing the informed decisions. Patient's knowledge will determine whether to engage patient's family in clinical decision, which includes patient's capacity to make decision on beliefs and values, and the injury.

Clinical inquiry -- This is an ongoing process of evaluating practice and questioning the informed practice, and innovating through experiential and research learning. At the expert level, nurse should deviate from individualized standards and follow the guidelines to meet patients' needs.

Predictability

Characteristics that allow one to expect a certain course of illness or course of events. This include uncertain such as uncommon patient illness or population. Certain which include common patient illness or population. ( Brewer, et al. 2007 ).

Facilitation of learning -- Nurse should facilitate learning for patients, patients' families, and workers in other healthcare disciplines. The learning should be through both formal and informal methods.

"Education based on individual strengths and weaknesses of the patient and the patient's family should be provided. The educational level of the patient should be considered in the design of the plan for educating the patient and the patient's family to ensure informed decisions. Creative methods should be developed to ensure that the patient and the patient's family understand the situation." ( Brewer, et al. 2007 P. 160).

Unique focus of the Model

Hamrick (2010) argues that the focus of AACN model is the integration of AACN Certification and Synergy Model, which put emphasis on patients by speaking out to the world that patients come first. Unique focus of the model is to link the clinical practice to achieve patient's outcome. The model also attempts to link AACN Certification Corporation credentialing programs into the Synergy Model in order to put emphasis on the patients. AACN is also representing the nurse's interest in the world to assist nurses to charge with the responsibilities of caring for critically ill patients. Moreover, AACN is dedicated to provide resources and knowledge for nurses in order to deliver quality healthcare for patients. The AACN model is also to illuminate the contemporary nursing practice by providing innovative solutions to nursing expertise. Typically, patients and patients' family are most vulnerable during patient's acute illness. Thus, nurses should rely on their expertise to provide the acute and critical care for patients. Thus, AACN intends to provide the expert knowledge for nurses to deliver their promises to patients and their families.

Organized Overview of the Model

The basic concept of AACN certification is to enhance and promote consumer health by maintaining and establishing high standard and professional excellence for nurses through certification. (AACN Certification Corporation, 2012). Moreover, the model defines patients as psychological, biological, social, and spiritual entities who manifest different characteristics at a particular developmental stage. The whole patient (mind, body and spirit) must be considered when a nurse is delivering a critical healthcare. Patients could be described in the context of their characteristics and these characteristics are connected and not working in isolation. Patients are also described as holistic, dynamic, open system and continuum of health and illness. Similarly, nurses are described in various dimension and the interrelated of nurses paints overall nurse's profiles. The goal of a nurse is to restore patient's optimal level of wellness as being defined by patient. Although, death could be an acceptable outcome for a patient, however, the goal of patient is to move a patient towards a peaceful death. According to ACCN model, there are eight characteristics of patient measured as high, medium, and low-acute characteristics. The model discusses nurse's competencies. The eight patient characteristics and eight nurse competencies should be linked to bring out better outcome for patients. (AACN, 2012).

ACCN model describes health as synergy contributing to patient outcome. Combination of patient's need and nurse competencies could bring wellness in patient. Typically, patient's health will be observed by functional change, behavioral change, comfort, quality of life, ratings, trust and satisfaction. The physiological changes are observed by absence of complication revealing the extent the treatment objective has been achieved. ACCN model also differentiates wellness and illness. Illness refers to presence of complication in patients. Wellness refers to the absence of complication in patients and when wellness is observed in patient, there would be a functional, physiological and behavioral changes leading to high quality of life.

AACN model categorized environment as psychosocial environment, health work environment, physical environment and personal health practice. To establish a sustainable health work environment, nurses must be proficient in skilled communication. To establish health work environment, there should be true collaboration, effective decision making, authentic leadership, meaningful recognition within health organization. On the other hand, psychosocial environment refers to the climate and culture of the workplace while physical environment refers to component of tangible workplace, which includes employee working condition. Personal health practice refers to the resources nurses bring to workplace and the resources include hereditary predisposition, personal resources and attitude. (AACN (2012).

Theories Generated from the Model

Nursing Theory Synergy Model is one of the important theories generated from the model. The nursing theory of synergy model designed to pair the patient's needs with nurse's competencies. Typically, the nurses should be able to integrate the cultural differences and alternative therapies in the culture of care. The theory points out that there is a need to establish working relationships with patient and nurses to enhance clinical patient's outcome.

Watson's Theory of Caring is another theory generated from the model. Watson's theory argues that caring is an endorsement of identity and nursing role is to establish a caring relationship with patients to enhance patient's well-being. Nurse's role is also to treat patients mind, body, and spirit as holistic beings. Moreover, a nurse should treat patients with a positive regard as well as promoting patient's health through knowledge and intervention.

One of the contributions of Synergy Model and Watson's Theory of Caring is that they enhance a greater understanding of nurses on the strategy to integrate their knowledge to enhance patient's caring. Moreover, the application of the models has assisted the patient's to reach harmony (body, mind, spirit) with nurses through caring and holistic and caring modalities. Despite the elegant argument of Nursing Theory Synergy Model, and Watson's Theory of Caring, the two models may be difficult to be put into practice with increasing tight staffing ratio and nursing shortage in the United States.

Research or Clinical Study Tested an Aspect of the Model

One of the clinical studies tested on AACN Synergy Model is the application of the model for a patient with CHF (chronic heart failure). CHF is a major public health problem in the United States, and the disease is common with people aged above 65. The CHF is a chronic disease that limits patient's functional status, which severely lower the quality of life. In the United States, the treatment of CHF costs between $10 and $30 Billion annually. Although, there are significant advance in pathophysiology and therapeutic treatment for CHF, however, there has been a little change in the mortality rates of patients suffering from CHF within the past 4 decades.

However, Sophie's Story reveals how the Synergy Model is implemented to enhance Sophie's well-being. Sophie, an 82-year-old African-American woman who was suffering from class III CHF, and was hospitalized twice within past 18 months. She had a stroke and she walked on cane after ambulation. Sophie took the following medication:

potassium, digoxin, an angiotensin-converting enzyme inhibitor, fosinopril sodium, furosemide and Coumadin,

The costs of overall medication were $350 per month. One morning, Sophie complaint of slight shortness of breath and after she was rushed to hospital, Nurses discovered that:

Sophie's blood pressure elevated to 176/94 mm

Her pulse was irregular 106 beats/min

Her random blood glucose level was measured 13.6 mmol/L (245 mg/dL).

"Upon questioning Sophie, the advanced practice nurse found that Sophie had not taken any of her medications for the past 3 days…. because she did not have the money to pay for them." (Hardin, & Hussey 2003 P. 75).

The Synergy model was applied to treat the patient and based on the application of Synergy model, the eight patient's characteristics was identified and eight nursing competencies were applied to Sophie's case. The Synergy model discusses the patient's characteristics and nursing competencies applied to Sophie's case in Table 2.

Table 2: Patient's Characteristics and Nurse Competencies applied to Sophie's Case

Patient's Characteristics

Nurse Competencies

Stability (decreasing)

Pulse blood pressure, presence of dyspnea pedal and edema.

Clinical judgment -- Analysis of patient's data to make decisions based on the needs of patient.

Complexity (increasing)

Two or more of her body systems became entangle. Her cardiopulmonary systems were compromised because the patient was affected by lack of resource availability.