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The Synergy Model maintains that when a nurse’s competencies are driven by the needs and characteristics of the patient and family, improved outcomes will result for the patient, the family, and the healthcare system itself.
Eight identified need s and characteristics can describe a holistic picture of the patient and family. Each characteristic is conceptualized on a continuum so that the patient can be described as existing at a particular point on the continuum at any given time. These characteristics are the following1:
Stability—The ability to maintain a steady state
Complexity—The entanglement of 2 or more systems (body, family, therapies)
Predictability—Expecting a certain illness trajectory or outcome
Resiliency—Capacity to return to previous level of functioning
Vulnerability—Susceptibility to stressors that may effect outcomes
Participationin Decision Making—How much the patient and family participate in decision making
Participation in Care—How much the patient and family can participate in care
Resource Availability —Resources (personal , financial , social, etc) the patient and family bring to the current situation
As patients’ needs are ever changing, the need for specific nursing competencies may vary over time. The nurse competencies are described on a continuum from the novice or competent nurse to the expert nurse. Each individual nurse may be stronger in 1 or more particular competencies. The essence of the Synergy Model is that the patient is matched with a nurse who is strong in the particular competencies that will facilitate the patient obtaining optimal out-comes . These competencies are the following1:
Clinical Judgment—Clinical reasoning and critical thinking skills
Caring Practices—Creating a therapeutic environment based on the unique needs of the patient and family
Advocacy and Moral Agency—Working on another’s behalf; resolving ethical concerns
Collaboration—Working with others in a way that encourages each person’s contribution toward patient goals
Systems Thinking — Recognizing the interrelationships of healthcare systems
Response to Diversity—Recognizing and incorporating differences into care
Clinical Inquiry—The ongoing questioning and evaluation of practice
Facilitator of Learning —Using self to facilitate patient and family learning
CASE STUDY
R.P., a 16-year-old girl, was admitted to the pediatric intensive care unit (PICU) for ascending weakness and paralysis. She had been otherwise healthy except for a virus-like illness 3 weeks before admission. The suspected diagnosis was Guillain-Barré syndrome (GBS). Two days after admission, R.P.’s nurse, Karen, presented this case during nursing rounds, using the Synergy Model as a framework.
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R.P. was experiencing ascending paralysis that was still progressing. Her respiratory muscles were being affected and she was beginning to have difficulty breathing and coughing. Her voice was weak and she was having difficulty swallowing. She was also experiencing autonomic dysfunction and hypertension.
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Physiologically, R.P.’s respiratory, neurologic, and cardiovascular systems were affected by her illness. A central venous catheter was placed so that R.P. could undergo plasmapheresis therapy. Emotionally, she was anxious about her condition. From a family system perspective, R.P. primarily resided with her mother in another state and had been visiting her father when she became ill. Her mother was experiencing financial difficulties as a result of being off from her job and in another state with her daughter.
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There was a certain trajectory of illness that could be expected for this patient with GBS. What was unknown at the present was whether R.P.’s paralysis would continue to the point that she would need mechanical ventilation.
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R.P. had no other underlying healthcare problems. The recovery period for GBS can be from months to years ; there fore , it would be challenging for her to return to her previous level of functioning.
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R.P. was at risk for respiratory failure, complications from plasmapheresis, pain, anxiety, and poor nutritional intake. All of these could adversely impact her outcomes.
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R.P. and her parents were fully involved in decision making and were participating in medical rounds daily as integral members of the healthcare team.
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Because of R.P.’s paralysis she could not provide her own care, but her mother participated fully in her care with assistance from the nurses. Her mother expressed the desire to learn techniques that would be needed for R.P.’s long-term rehabilitation.
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R.P.’s mother had financial concerns because she was from out of state and was away from her job. She had extended family members, but they were unable to travel to be with her. R.P.’s father was remarried and received emotional support from his wife. As R.P.’s rehabilitation needs became clearer, additional community and fiscal resources would be needed for her care.
Nurse Competencies
The nurse facilitator helped the staff nurses identify which nurse competencies would be important to match with R.P.’s needs and characteristics to promote optimal outcomes.
Clinical Judgment.
Because R.P. was minimally stable, highly complex, and moderately vulnerable, she needed a nurse who excelled in clinical reasoning, had sound decision-making skills, and could grasp the global situation. Karen was a seasoned PICU nurse and was frequently monitoring R.P.’s vital signs, respiratory effort, and oxygen saturation. She was able to prioritize R.P.’s care needs and could articulate a plan should intubation and mechanical ventilation become necessary.
Advocacy and Moral Agency.
R.P. needed a nurse who would be able to work on her behalf and represent her concerns. Karen was helping R.P. and her parents identify and articulate their personal values and concerns . For instance, R.P.’s mother wished to be with in close proximity to her daughter at all times. Karen assisted her with finding a room at the Ronald McDonald House directly across from the hospital and agreed to phone her with any changes in R.P.’s condition. R.P.’s mother was able to take breaks for meals confident that Karen would anticipate and meets her daughter’s needs in her absence.
Caring Practices.
Karen was using vigilance to anticipate and recognize subtle changes in R.P.’s condition. She was conscious of the need to institute plans to prevent such complications as aspiration, central catheter infection, and skin breakdown. In addition, she had a plan to ensure adequate pain relief and anxiety relief for R.P.
Facilitator of Learning.
Karen assessed that R.P.’s family had little understanding of GBS and of mechanical ventilation. Karen asked for the group’s suggestions for facilitating this family’s learning about these immediate needs. The nurse facilitator also guided the nurses in a discussion about R.P. and her family’s anticipated future learning needs.
Outcomes
The nurse facilitator helped Karen identify potential outcomes for R.P . She reminded all the nurses that outcomes must be identified as important not only to the nurse , but also to the patient and family. Karen planned to discuss outcomes with R.P. and her family at the conclusion of nursing rounds. She identified comfort, relief from anxiety, family satisfaction with care, and prevention of complications from respiratory failure as outcomes.
CONCLUSION
The Synergy Model provides staff nurses with the ability to articulate their patients’ needs and their own unique competencies that impact patients’ outcomes. This case study illustrates how the Synergy Model can be incorporated into nursing rounds in the critical care unit . The Synergy Model will take on more meaning to nurses and their patients as it permeates every aspect of nursing practice.
Reference
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