One of the nursing models that I have previously observed is the Synergy Model of Patient Care at the Watertown Regional Medical Center in Wisconsin. It was one of the hospitals that capitalize on the model after it was developed by the American Association of Critical Care Nurses. The hospital utilized the model in providing care for an old patient aged 75. The patient, Stephanie, had been hospitalized twice in two years for various medical conditions, including stroke, hypertension, and diabetes mellitus type 2, which she managed to control with diet. She took oral hypoglycaemics too. The patient had a daughter who cared for her but was unable to provide financial support. She took various medications that cost her approximately $300 on a monthly basis. The APN balanced both the nursing competencies required in dealing with her situation to advance the care. In essence, since they identified patient characteristics and the skills of the most appropriate nurse to deal with her situation, it was easy to identify the model as synergy.
According to Hardin and Hussey (2003), the key to the AACN Synergy Model for Patient Care emanates from the linkage of nurse competencies and patient characteristics in achieving optimal patient outcomes. The authors in their article applied the nursing model to manage a complex client who experienced acute exasperation of their illness, as well as reducing the trajectory of the disease. As such, the purpose of their article was to discuss the application of the model to an ambulatory (chronic heart failure) CHF clinic. As the writers noted, CHF is a major health problem and is commonly diagnosed for people older than 65 years and is progressive and chronic diseases that can limit the functional status of a patient, as well as lowering their quality of life. The patient was named Sophie and was an Africa American aged 82 and had New York Heart Association class III CHF. Being a widow, she lived alone and social security as her main source of financial support. The authors described the patient characteristics based on the Synergy Model, which spanned the continuum of health and illness. The characteristics assisted the nurse to recognize how the patient was vulnerable. Hardin and Hussey (2003) pointed out that the purpose of recognizing and comprehending the features of the patient and how they change by the patient's situation and condition helped them in identifying essential nurse skills that synergize to result in optimal patient outcomes. The skills included clinical judgment, caring practices, collaboration, systems thinking, facilitation of learning, advocacy and moral agency, as well as response to clinical diversity response. They concluded that the synergy model could be applied in a variety of settings, and its application in the ambulatory settings is an example of how the model is flexible.
On the other hand, Gralton and Brett (2012) highlighted how the Synergy Model was used for patient care at a Wisconsin childrens hospital. The researchers in their article pointed out that the model provides a framework for professional nursing practice and emphasizes a unique relationship between clinicians and patients, thereby resulting in optimal outcomes for both. The integration of the model, just as pointed out by Hardin and Hussey (2003), in the hospital was accomplished via backing into the model, as well as facilitating the development of tools that encompass both the clinician competencies and patient characteristics. Also, they pointed out that the synergy model provided the best and safest care based on building unique relationships between caregivers and patients. In essence, with its application in the hospital, the model provided a synergy between patient/family needs and clinician competencies. The patient/family needs included stability, resource availability, vulnerability, participation in decision making, predictability complexity, and participation in care. The clinician competencies involved included response to diversity, systems thinking, facilitation of learning, collaboration, clinical inquiry and judgment, and caring practices. They concluded that through the model, the nursing practice is accentuated by a more comprehensive approach that can enable the nurses to identify the relationship between patient outcomes and care delivery.
Transitional care, as Naylor and Keating (2008) note, encompasses a broad range of services and environments that are designed to promote timely and safe passage of patients across care settings and between levels of health care. They pointed out that there is growing evidence that suggests that there are vulnerabilities to a breakdown in care, which can be solved through transitional care services, especially for older patients. Besides, the researchers also pointed out that poor handoff of older patients and their caregivers from a hospital to their homes is linked to low satisfaction with care and adverse events. Therefore, they recommended increasing older adults access to proven community-based transitional care services, as well as improving transitions within acute hospital settings and patient handoff.
On the other hand, Naylor and Sochalski (2010), pointed out that the transition model is important for the chronically ill patients who experience frequent changes in health status that require transitions among health care settings and providers. In their article, they identified essential elements and facilitators of effective care management critical for the Transitional Care Model (TCM). These included incorporation of a comprehensive in-hospital patient assessment, preparing and developing evidence-based plan of care, ensuring consistency of providers across the entire care episodes, home visits and telephone support, continuity of care between hospital and primary care physician, focussing on each patients needs, engaging the [patients, and emphasizing on the early intervention and response to healthcare risks and symptoms. Besides, the authors also proposed collaboration between nurses and physicians and advocating communication between them, their families and informal caregivers, as well as other healthcare professionals and providers.
Various observations were observed in implementing care APN in accordance to the Synergy Model. Firstly, because she did not have any other insurance except Medicare, she paid for the medications. She visited the hospital complaining of slight shortness of breath. Also, she had gained 3 lb and her blood pressure, which was 130/80 mm/mg, had elevated to 176/94. She had an irregular pulse of 106 beats/minute. Upon questioning, she said that she had not taken her medications for four days because she had no funds. They used the Synergy Model in identifying patient characteristics and the competencies of the nurse. The patient characteristics identified were decreasing stability, increasing complexity of illness, uncertain predictability, increased vulnerability due to limited financial resources, good resiliency to gain stability, participated in decision making and had decreased resource availability. The competencies for the nurse to deal with the situation included clinical judgment, systems thinking, collaboration, facilitation of learning, advocacy and moral agency, as well as response to diversity. The advanced practice nurse (APN) in the situation harmonized these competencies in the model to meet the patient needs. The APN followed up with phone calls to ensure that she took her medications and connected to a local Meals on Wheels program to make sure that she took the right food as she was diabetic.
Another model that can be recommended in Stephanies case is the Transitional Care Model (TCM). In essence, the model, as identified earlier, entails caring for the elderly and involves a smooth transition from hospital to outpatient settings (Foust et al.,2005; Naylor & Keating, 2008; Naylor & Sochalski, 2010). The transition model ensures that there is a positive handoff for the elderly from hospital to their homes. For this reason, using this model entails involving Stephanies daughter in the caregiving process. For this reason, the Transitional Care Nurse (TCN) could use her daughter as a follow up to ensure that Stephanie takes her medications and meals appropriately to prevent further episodes. In essence, the model is appropriate for Stephanie as it ensures that the TCN makes visits to her, and conducts telephone support even after two months after discharge. Besides, it facilitates the active involvement of the patients family through education and support.
In conclusion, the Synergy Model of Patient Care entails the use of an APN where they should balance both the patient characteristics and the nurse competencies. In essence, the model is appropriate for dealing with all types of patients, including the elderly. The patient characteristics have to be analyzed by resiliency, vulnerability, resource availability, participation in care and decision-making, complexity, stability, and predictability. On the other hand, the nurse competencies required to deal with the patient on these aspects include, advocacy and moral agency, caring practices, clinical judgment, systems thinking, facilitation of learning, response to diversity, collaboration, and clinical inquiry. However, in dealing with elderly patients, the transition care model can be used, which entails continuity of medical care between hospital and the TCN, comprehensive in-hospital patient assessment, increases satisfaction and collaboration among hospital staff, and allows communication between the patients family and healthcare professionals.
Foust, J. B., Naylor, M. D., Boling, P. A., & Cappuzzo, K. A. (2005). Opportunities for improving post-hospital home medication management among older adults. Home health care services quarterly, 24(1-2), 101-122.
Gralton, K. S., & Brett, S. A. (2012). Integrating the Synergy Model for Patient Care at Children's Hospital of Wisconsin. Journal of pediatric nursing, 27(1), 74-81.
Hardin, S., & Hussey, L. (2003). AACN synergy model for patient care case study of a CHF patient. Critical care nurse, 23(1), 73-76.
Naylor, M. & Keating, S.A. (2008). Transitional Care: Moving patients from one care setting to another. Am J Nurs, 108(9), 5863.
Naylor, M. D., & Sochalski, J. A. (2010). Scaling up: bringing the transitional care model into the mainstream. Issue Brief (Commonw Fund), 103, 1-12.
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