AACN Synergy Care Model: Application in Clinical Practice

Introduction and Background of the AACN Synergy Model

The American Association of Critical-Care Nurses (AACN) Synergy Care Model is based on the mutual advantages that patients and families derive from nurse competencies. The core concept of the AACN model is that the needs and characteristics of patients and their families are influenced by the competencies and characteristics of nurses. In the early 1990s, AACN leaders embarked on a 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 designed to enhance the value of nursing practice. The task force also worked to strengthen the essential relationship between patients and nurses within the context of healthcare. The model is founded on the premise that patient outcomes can be optimized when nurse competencies are matched to patient characteristics (Brewer et al., 2007).

The historical evolution of the AACN model began 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 AACN model is based on the belief of these think tank members that certified practice should center on meeting the needs of patients (Kaplow & Reed, 2008). The AACN model rests on the premise 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 patients, measured across high, medium, and low acuity levels. The eight patient characteristics include vulnerability, resiliency, complexity, stability, resource availability, participation in care, predictability, and participation in decision-making. The model also describes eight nurse competencies: caring practices, advocacy and moral agency, clinical judgment, systems thinking, collaboration, response to diversity, clinical inquiry, and facilitation of learning. According to the AACN model, when patient characteristics and nurse competencies are successfully matched, the result is improved outcomes and greater satisfaction for both patients and families.

Brewer et al. (2007) further argue that the philosophy guiding the AACN Synergy Model rests on the belief that an ultimate certification in nursing practice is needed — one that would measure and move nursing practice toward an essential relationship between nurses and patients. The model is based on the premise that patient outcomes can be optimized when patient characteristics match nurse competencies. The strategies employed in formulating the model were to define the specific characteristics of patients and the specific knowledge and competencies that nurses must possess.

The following section presents the eight patient characteristics and the corresponding eight nurse competencies that together produce optimal patient outcomes within the AACN Synergy framework.

Eight Patient Characteristics and Eight Nurse Competencies

Resiliency refers to a patient's ability to rebound after an injury — specifically, the patient's capacity to return to a restorative level using compensatory coping mechanisms. The corresponding nurse competency is clinical judgment, which involves clinical reasoning to enhance healthcare delivery. Critical reasoning encompasses nursing skills, critical thinking derived from experiential knowledge, integration of education, and adherence to evidence-based guidelines. This integration of knowledge enhances clinical decisions when delivering care.

Vulnerability refers to how a patient's physiological makeup and health behaviors affect their ability to maintain a stable equilibrium. A nurse's response to interventions can affect patient stability. The corresponding nurse competency is advocacy and moral agency — working on behalf of patients who cannot advocate for themselves, and serving as a moral agent to help resolve and identify clinical and ethical concerns within the clinical setting.

Stability describes a patient's ability to respond to therapies while maintaining a steady state of equilibrium. Response to nursing interventions and therapies can affect this stability. The corresponding nurse competency is caring practices, which encompasses nursing interventions that create a supportive, therapeutic, and compassionate environment. The aim is to promote healing and comfort while preventing unnecessary suffering. Caring should include vigilance, compassion, responsiveness, and engagement with both patient and family.

Complexity involves the emotional and physiological state of the body and refers to physiological, emotional, and environmental interactions with the patient. The more body systems involved, the more complex the clinical picture. The corresponding nurse competency is collaboration — working with patients, families, and other healthcare providers to promote realistic and optimal goals for patients.

Resource availability refers to the extent of psychological, fiscal, personal, technical, and social resources a patient brings. The more resources available, the more positive the likely outcome. The corresponding nurse competency is systems thinking — using tools and knowledge to understand the interconnected nature of healthcare and non-healthcare systems, and applying a global perspective to negotiate patient needs and make effective clinical decisions.

Participation in care describes how patient and family involvement in care delivery is influenced by resource availability, educational background, and cultural background. The corresponding nurse competency is response to diversity, which involves the sensitivity to recognize and incorporate differences into healthcare provision, acknowledging the individuality of each patient while observing patterns that inform nursing interventions.

Participation in decision-making describes the degree to which patients and families understand information delivered by healthcare providers, enabling informed decisions. A patient's knowledge determines whether and how to engage the family in clinical decisions, including decisions based on beliefs, values, and the nature of the illness. The corresponding nurse competency is clinical inquiry — an ongoing process of evaluating and questioning practice, and innovating through experiential and research-based learning. At the expert level, nurses should move beyond individualized standards and follow evidence-based guidelines to meet patients' needs.

Unique Focus and Organized Overview of the Model

Predictability refers to characteristics that allow one to expect a certain course of illness or events. This may be certain (common patient illness or population) or uncertain (uncommon patient illness or population) (Brewer et al., 2007). The corresponding nurse competency is the facilitation of learning — educating patients, families, and colleagues across healthcare disciplines through both formal and informal methods. As Brewer et al. (2007, p. 160) note: "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."

Hamrick (2010) argues that the unique focus of the AACN model is the integration of AACN Certification and the Synergy Model, which places emphasis on patients by asserting that patients come first. The model's unique purpose is to link clinical practice to patient outcomes and to integrate AACN Certification Corporation credentialing programs into the Synergy Model framework. AACN also represents nurses' interests by supporting those charged with the responsibilities of caring for critically ill patients. The organization is dedicated to providing resources and knowledge to help nurses deliver quality healthcare. The model further aims to illuminate contemporary nursing practice by providing innovative solutions that build nursing expertise. Because patients and their families are most vulnerable during acute illness, nurses must rely on their expertise to provide acute and critical care — and the AACN model is designed to supply that expert knowledge.

The basic concept of AACN certification is to promote consumer health by maintaining and establishing high standards of professional excellence for nurses through certification (AACN Certification Corporation, 2012). The model defines patients as psychological, biological, social, and spiritual entities who manifest different characteristics at particular developmental stages. The whole patient — mind, body, and spirit — must be considered when a nurse is delivering critical healthcare. Patient characteristics are interconnected and do not operate in isolation. Patients are described as holistic, dynamic, open systems existing on a continuum of health and illness. Similarly, nurses are described across multiple dimensions, and the interrelationship of these dimensions forms an overall nurse profile. The goal of a nurse is to restore a patient's optimal level of wellness as defined by the patient. Although death may be an acceptable outcome in some cases, the goal remains to move the patient toward a peaceful death when recovery is not possible (AACN, 2012).

The AACN model describes health as a synergistic contribution to patient outcomes. The combination of patient needs and nurse competencies can produce wellness. Patient health is observed through functional change, behavioral change, comfort, quality of life, patient ratings, trust, and satisfaction. Physiological changes are observed through the absence of complications, which reveals the extent to which treatment objectives have been achieved. The model also distinguishes between wellness and illness: illness refers to the presence of complications, while wellness refers to their absence — a state accompanied by functional, physiological, and behavioral changes that lead to a higher quality of life.

The AACN model categorizes the environment as psychosocial, health work, physical, and personal health practice. To establish a sustainable healthy work environment, nurses must be proficient in skilled communication, true collaboration, effective decision-making, authentic leadership, and meaningful recognition within the health organization. Psychosocial environment refers to the climate and culture of the workplace, while physical environment refers to the tangible components of the workplace, including employee working conditions. Personal health practice refers to the resources nurses bring to the workplace, including hereditary predisposition, personal resources, and professional attitude (AACN, 2012).

Conclusion

Hamrick, E. (2010). The American Association of Critical-Care Nurses Synergy Model for patient care: A critique. [University].

Hardin, S., & Hussey, L. (2003). AACN Synergy Model for patient care: Case study of a CHF patient. Critical Care Nurse, 23(1), 73–76.

Kaplow, R., & Reed, K. D. (2008). The AACN Synergy Model of patient care: A nursing model as a force of magnetism. Nursing Economics, 26(1), 17–25.