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Synergy Model for Patient Care

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The AACN Synergy Model for Patient Care The AACN Synergy Model for Patient Care Basic Information About the AACN Synergy Model for Patient Care The core concept of the reconceptualized model of certified practice - the AACN Synergy Model for Patient Care - is that the needs or characteristics of patients and families influence and drive the characteristics or competencies of nurses. Synergy results when the needs and characteristics of a patient, clinical unit or system are matched with a nurse
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  The AACN Synergy Model for Patient Care 1 The AACN Synergy Model for Patient Care Basic Information About the AACN Synergy Model for Patient Care The core concept of the reconceptualized model of certified practice - the AACNSynergy Model for Patient Care - is that the needs or characteristics of patients andfamilies influence and drive the characteristics or competencies of nurses. Synergyresults when the needs and characteristics of a patient, clinical unit or system arematched with a nurse's competencies.  All patients have similar needs and experience these needs across wide ranges orcontinuums from health to illness. Logically, the more compromised patients are, themore severe or complex are their needs. The dimensions of a nurse's practice are drivenby the needs of a patient and family. This requires nurses to be proficient in the multipledimensions of the nursing continuums. When nurse competencies stem from patientneeds and the characteristics of the nurse and patient synergize, optimal patientoutcomes can result. Characteristics of Patients, Clinical Units and Systems of Concern toNurses Each patient and family, clinical unit and system is unique, with a varying capacity forhealth and vulnerability to illness. Each one brings a set of unique characteristics to thecare situation. These characteristics span the health-illness continuum.Resiliency The capacity to return to a restorative level offunctioning using compensatory/copingmechanisms; the ability to bounce back quicklyafter an insult.Level 1 - Minimally resilient Unable to mount a response; failure ofcompensatory/coping mechanisms; minimalreserves; brittleLevel 3 - Moderately resilient Able to mount a moderate response; able to initiatesome degree of compensation; moderate reservesLevel 5 - Highly resilient Able to mount and maintain a response; intactcompensatory/coping mechanisms; strongreserves; enduranceVulnerability Susceptibility to actual or potential stressors thatmay adversely affect patient outcomes.Level 1 - Highly vulnerable Susceptible; unprotected, fragileLevel 3 - Moderately vulnerable Somewhat susceptible; somewhat protected  The AACN Synergy Model for Patient Care 2 Level 5 - Minimally vulnerable Safe; out of the woods; protected, not fragileStability The ability to maintain steady-state equilibrium.Level 1 - Minimally stable Labile; unstable; unresponsive to therapies; highrisk of deathLevel 3 - Moderately stable Able to maintain steady state for limited period oftime; some responsiveness to therapiesLevel 5 - Highly stable Constant; responsive to therapies; low risk of death Complexity The intricate entanglement of two or more systems(e.g., body, family, therapies).Level 1 - Highly complex Intricate; complex patient/family dynamics;ambiguous/vague; atypical presentationLevel 3 - Moderately complex Moderately involved patient/family dynamicsLevel 5 - Minimally complex Straightforward; routine patient/family dynamics;simple/clear cut; typical presentationResource availability Extent of resources (e.g., technical, fiscal,personal, psychological, and social) thepatient/family/community bring to the situation.Level 1 - Few resources Necessary knowledge and skills not available;necessary financial support not available; minimalpersonal/psychological supportive resources; fewsocial systems resourcesLevel 3 - Moderate resources Limited knowledge and skills available; limitedfinancial support available; limitedpersonal/psychological supportive resources;limited social systems resourcesLevel 5 - Many resources Extensive knowledge and skills available andaccessible; financial resources readily available;strong personal/psychological supportiveresources; strong social systems resources  The AACN Synergy Model for Patient Care 3 Participation in care Extent to which patient/family engages in aspectsof care.Level 1 - No participation Patient and family unable or unwilling to participatein careLevel 3 - Moderate level ofparticipationPatient and family need assistance in careLevel 5 - Full participation Patient and family fully able to participate in careParticipation in decision-making Extent to which patient/family engages in decision-making.Level 1 - No participation Patient and family have no capacity for decision-making; requires surrogacyLevel 3 - Moderate level ofparticipationPatient and family have limited capacity; seeksinput/advice from others in decision-makingLevel 5 - Full participation Patient and family have capacity, and makesdecision for selfPredictability A characteristic that allows one to expect a certaincourse of events or course of illness.Level 1 - Not predictable Uncertain; uncommon patient population/illness;unusual or unexpected course; does not followcritical pathway, or no critical pathway developedLevel 3 - Moderately predictable Wavering; occasionally-noted patientpopulation/illnessLevel 5 - Highly predictable Certain; common patient population/illness; usualand expected course; follows critical pathway For example: A healthy, uninsured, 40-year-old woman undergoing a pre-employment physical is likelyto be: (a) stable (b) not complex (c) very predictable (d) resilient (e) not vulnerable (f)able to participate in decision-making and care, but (g) has inadequate resourceavailability.A critically ill infant with multisystem organ failure is likely to be: (a) unstable (b) highlycomplex (c) unpredictable (d) highly resilient (e) vulnerable (f) unable to becomeinvolved in decision-making and care, but (g) has adequate resource availability.  The AACN Synergy Model for Patient Care 4 Nurse Competencies of Concern to Patients, Clinical Units and Systems Nursing care reflects an integration of knowledge, skills, experience, and attitudesneeded to meet the needs of patients and families. Thus, continuums of nursecharacteristics are derived from patient needs. The following are levels of expertiseranging from competent (1) to expert (5):Clinical Judgment Clinical reasoning, which includes clinical decision-making,critical thinking, and a global grasp of the situation, coupledwith nursing skills acquired through a process of integratingformal and informal experiential knowledge and evidence-based guidelines.Level 1 Collects basic-level data; follows algorithms, decision trees,and protocols with all populations and is uncomfortabledeviating from them; matches formal knowledge with clinicalevents to makedecisions; questions the limits of one's abilityto make clinical decisions and delegates the decision-making to other clinicians; includes extraneous detailLevel 3 Collects and interprets complex patient data; makes clinical judgments based on an immediate grasp of the wholepicture for common or routine patient populations;recognizes patterns and trends that may predict the directionof illness; recognizes limits and seeks appropriate help;focuses on key elements of case, while shorting outextraneous detailsLevel 5 Synthesizes and interprets multiple, sometimes conflicting,sources of data; makes judgment based on an immediategrasp of the whole picture, unless working with new patientpopulations; uses past experiences to anticipate problems;helps patient and family see the big picture; recognizes thelimits of clinical judgment and seeks multi-disciplinarycollaboration and consultation with comfort; recognizes andresponds to the dynamic situationAdvocacy and MoralAgencyWorking on another's behalf and representing the concernsof the patient/family and nursing staff; serving as a moralagent in identifying and helping to resolve ethical and clinicalconcerns within and outside the clinical setting.Level 1 Works on behalf of patient; self assesses personal values;aware of ethical conflicts/issues that may surface in clinicalsetting; makes ethical/moral decisions based on rules;represents patient when patient cannot represent self; awareof patients' rights
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