Crit Care Nurse 2003 Dec; 23(6): 74-80
Using the AACN Synergy Model
An MSN Curriculum in Preparation of CCNSs: A Model for Consideration
Catherine Wilson Cox, RN, PhD, CCRN, CEN, CCNS
Christine M. Galante, RN, PhD, CHE
Catherine Cox is an assistant professor in the School of Nursing & Health Studies at Georgetown University in Washington, DC.
Christine Galante is an associate professor of nursing in the School of Health Professions at Marymount Unviersity in Arlington, Va.
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When invited to teach a 2-semester critical care course at the master’s level several years ago, we were asked to modify the old course syllabi with attention given to realigning the courses in congruence with the American Association of Colleges of Nurses’ recommendation to incorporate curriculum content as advocated by specialty nursing organizations.1 Thus, the courses entitled "Critical Care Nursing I" and "Critical Care Nursing II" were revamped to include the American Association of Critical-Care Nurses (AACN) Synergy Model for Patient Care. Table 1
presents the university’s program of study and Table 2 shows comparisons between both courses. About 64 schools offer the specialty of acute and/or critical care clinical nurse specialist (CCNS) and there is a dearth of information regarding CCNS masters’ programs2; in this article, we propose a successful CCNS curriculum model for consideration.
The 8 nurse dimensions of the Synergy Model serve as the framework for the CCNS certification examination as it describes the relationships between the CCNS and patients and families, nurses, and systems.3 One of the goals of our master’s program is for graduates to successfully complete AACN’s CCNS certification examination; therefore, the revised courses include information on both the nursing characteristics and the physiological conditions reflected in the CCNS examination blueprint (Tables 3 and 4 present the schedule and outline of both courses).
Educational Strategies
The revised courses incorporate various adult learning principles, including Carper’s4 patterns of 4 ways of "knowing": empirical, ethical, personal, and aesthetic. Empirical knowing consists of empirical data or factual knowledge. Ethical knowing assumes that nurses react to moral situations with an ethical framework that guides patient care. Personal knowing incorporates the lived experience that each nurse brings to the situation. Finally, aesthetic knowing employs both intuition and understanding to appreciate the individuality of each patient. Thus, by acknowledging that not all knowing is empirical, both courses allow for discussions regarding simulated and actual patient, family, nurse, and system scenarios that recognize the importance of ethical, personal, and aesthetic knowledge.
The courses also feature "experiental" learning opportunities on the basis of the conviction that not all learning requires a physical presence in the classroom. Taking advantage of the university’s location, and in lieu of actually meeting as a class several days throughout each semester, our students utilize other ways to supplement their learning. For example, students may go to the National Library of Medicine in Bethesda, Md, to learn how to personally navigate one of the best healthcare libraries in the world. By attending a local professional nursing organization meeting, students learn not only to network but also how important group work contributes to the overall mission of an organization. After attending such a meeting, one of our students volunteered for a committee assignment and a year after graduating from the program, she is still an active member of the local chapter of that organization. Finally, attending a Congressional hearing exposes students to their professional obligation to possibly influence public policy.
Boyer5 challenges educators to reconsider scholarship in terms of a variety of academic work: discovery (traditional learning), integration (making connections), application (applying knowledge to real problems), and teaching (conveying knowledge). Introduction of the Synergy Model over a period of 8 weeks, in addition to various other topics related to the role of the CCNS over 2 semesters, supports Boyer’s concept of discovery. Having a clinical component of the course endorses Boyer’s concepts of integration and application (Table 5 presents practicum information). Because teaching conveys a student’s knowledge, both courses provide ample opportunity for students to present material to their classmates. Specifically, students teach all of the physiological conditions reflected in the CCNS examination blueprint to their class colleagues. Because the students are already experienced critical care nurses, they view the topics as nonthreatening. The students become much more comfortable with public speaking, and their presentation styles improve dramatically over the course of 2 semesters when they actually teach the course content.
Several other teaching strategies are employed for these courses. In an effort to expose students to the publication process, they are required to submit a rough draft of a paper the first semester, based on a call for abstracts from selected critical care nursing journals, as well as follow the author guidelines for that periodical. During the second semester, they finalize the papers and submit them for publication (but only after a thorough review by an instructor). Second, the CCNS certification examination tests various patient conditions; therefore, the students are required to complete mock CCRN examinations throughout the semester. Finally, a variety of clinical nurse specialists are booked as guest speakers throughout the second semester; whereby, the students have already acquired more than 120 hours in their practicums as CCNSs and have been exposed to the AACN Synergy Model for Patient Care, which gives them a foundation to ask appropriate questions. The students relish this opportunity to learn firsthand about the variety of roles a CCNS can practice, as well as personally question the guest lecturers.
Recommendations
Because CCNS candidates cannot take AACN’s certification examination until they obtain 500 clinical hours, we recommend incorporating all 500 clinical hours during the MSN program; otherwise, graduates need to obtain the remaining hours once employed. This proves to be a catch-22 situation for some alumnae because certain employers want a graduate to be certified prior to employment yet the graduate needs the employment opportunity to fulfill the clinical practice hours prior to sitting for the examination. Another recommendation would be to dilute the physiological conditions over 3 semesters, rather than 2, in order to focus more discussion on each disease process. Finally, future CCNSs need a true CCNS textbook—the current advanced practice nursing textbooks focus more on the nurse practitioner role, not the CCNS role. The Clinical Nurse Specialist Role in Critical Care, by Gawlinski and Kern,6 provides excellent information about the CCNS role; however, it is more than 10 years old and out of print. To supplement their learning, students are directed to read recent articles, either by obtaining a hard copy or an Internet version, which the instructor finds during frequent literature reviews. As for a textbook regarding individual disease processes, a variety of AACN Core Curriculum and review question books are available but we do not endorse one in particular.
Conclusion
We have proposed a successful curriculum model of a CCNS master’s program for consideration and welcome dialogue from other schools of nursing regarding their programs.
References
- American Association of Colleges of Nursing. The Essentials of Master’s Education for Advanced Practice Nursing. Washington, DC: American Association of Colleges of Nursing; 1996.
- Berlin LE, Stennett J, Bednash GD. 2002–2003 Enrollment and Graduations in Baccalaureate and Graduate Programs in Nursing. Washington, DC: American Association of Colleges of Nursing; 2003.
- Moloney-Harmon PA. The Synergy Model: contemporary practice of the clinical nurse specialist. Crit Care Nurse. April 1999;10:101–104.
- Carper BA. Fundamental patterns of knowing in nursing. Adv Nurs Sci. October 1978;1:13–23.[Medline]
- Boyer EL. Scholarship Reconsidered: Priorities of the Professorate. Princeton, NJ: Carnegie Endowment for the Advancement of Teaching; 1990.
- Gawlinski A, Kern LS. The Clinical Nurse Specialist Role in Critical Care. Philadelphia, Pa: WB Saunders; 1994.
