The Synergy Model and the Role of Clinical Nurse Specialists in a Multihospital System

The state of the evidence about the Synergy Model for patient care

AIM

To systematically and critically summarize the state of the evidence about the Synergy Model and its utilization in nursing practice.

BACKGROUND

The Synergy Model emphasizes the importance of alignment between patient needs and nurse competencies in achieving adequate patient- and nurse-related outcomes. It is a relatively new patient-centred care model developed at the end of the 1990s.

INTRODUCTION

Despite the Synergy Model's potential to support patient-centred care, its practical application is still mainly limited. Thus far, literature about the Synergy Model has not yet been synthesized, undermining its broader utilization globally.

METHODS

A systematic search was performed on the following databases: PubMed, CINAHL and Scopus. The authors used the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement and checklist to guide the systematic search; 26 papers were included in this study. A critical interpretative synthesis was adopted to summarize the data extracted from the included papers.

RESULTS

Five interpretative themes emerged: conceptualization, experiences from the field, nursing education, patient-related outcomes and system-related outcomes. Synergy Model shows a precise theoretical definition, and it was implemented in multiple clinical settings, mainly in critical care contexts. It seems to have a positive influence on patient-related, nurse-related and system-related outcomes.

DISCUSSION

Synergy Model seems to be positively associated with specific susceptible outcomes, such as patient satisfaction, reduction of patient's complications, staff satisfaction, empowerment, and engagement of patients and healthcare providers. However, the level of evidence is still limited.

CONCLUSION

Future international research should demonstrate the feasibility of implementing the Synergy Model at an international level. More empirical research is needed to demonstrate the effectiveness of the model on susceptible outcomes.

IMPLICATIONS FOR NURSING AND HEALTH POLICY

This systematic review could support further development of international programmes based on the Synergy Model. The Synergy Model's implementation has the potential to optimize nursing competencies, patient- and nurse-related outcomes.

Activities undertaken by Intensive Care Unit Liaison Nurses in Argentina

BACKGROUND

The Intensive Care Unit Liaison Nurse (ICULN), also known as an outreach nurse, is an advanced practice nursing role that emerged in the late 1990s in Australia and the United Kingdom (UK). Little is known about this role in less developed economies.

OBJECTIVE

To describe the activities undertaken by ICULNs in Argentina.

METHODS

Prospective, descriptive, observational, single site study in an Argentinean metropolitan tertiary referral hospital. Adult patients under ICULN follow up were included in the sample. Data on ICULN activities and patients were collected using an established tool developed by The Australian Intensive Care Unit Liaison Nurse Forum. Descriptive statistics were used to summarise the findings.

RESULTS

Two hundred patients were visited by the ICULNs during the study period. The mean age of patients was 52.5 years (SD 17.7). Cardiovascular disease (n=104, 52%), respiratory disease (n=90, 45%) and diabetes (n=40, 20%) were the most common comorbidities. 110 (55%) patients had surgical procedures. The primary reasons for ICULN visit were follow up post ICU discharge (n=138, 69%) and ward referral (n=46, 23%). 136 (68%) patients received up to 3 visits; the remaining 64 (32%) patients received ≥4 visits. In those patients in need of ≥4 visits ICULNs initiated more non-medical treatments (100%), referred to escalate treatment (35%) and to a higher level of care (13.8%) than in those who were visited up to 3 times.

CONCLUSIONS

This study is the first to document ICULN activity in Argentina using an international framework and data set. These findings can assist with understanding an advanced practice nursing role in Argentina. It may facilitate future comparisons with other contexts and could help managers implementing the role in similar settings. Further investigation will help develop this practice and document its influence on patient outcomes.

An exemplar for evidence-based nursing practice using the Magnet(®) model as the framework for change: oral feeding practice in the neonatal intensive care unit

Implementation of research evidence into practice can be challenging in areas such as the neonatal intensive care unit (NICU), where the environment is complex and rapidly changing and caregiving goals have shifted from simply infant survival to supporting positive long-term neurodevelopmental outcomes. Clinical nurse specialists (CNS) are ideally positioned to use research to obtain new knowledge, innovations, and improvements in care as part of an interdisciplinary team. The authors describe the role of the CNS in changing NICU culture around feeding infants, an important and frequent nursing activity, with the Magnet(®) model as the framework for change.

The Synergy Model at work in a military ICU in Iraq

The Synergy Model for Patient Care, developed by the American Association of Critical-Care Nurses (AACN), demonstrates that positive patient outcomes are achieved when patient characteristics are matched with nurse competencies. Through the vivid realities in the daily journal of a military ICU nurse taking care of patients in Iraq, a virtual triad learning experience provided academic, clinical, and personal support. This article describes how effective nursing practice, whether providing direct patient care in the United States or in a military ICU in Iraq, must be centered around the needs and characteristics of patients. Acute and critically ill patients in a military ICU in Iraq have unique needs and require nurses with competent skills to help promote optimal outcomes.

Activities Performed by Acute and Critical Care Advanced Practice Nurses: American Association of Critical-Care Nurses Study of Practice

• Background Accreditation standards for certification programs require use of a testing mechanism that is job-related and based on the knowledge and skills needed to function in the discipline.

• Objectives To describe critical care advanced practice by revising descriptors to encompass the work of both acute care nurse practitioners and clinical nurse specialists and to explore differences in the practice of clinical nurse specialists and acute care nurse practitioners.

• Methods A national task force of subject matter experts was appointed to create a comprehensive delineation of the work of critical care nurses. A survey was designed to collect validation data on 65 advanced practice activities, organized by the 8 nurse competencies of the American Association of Critical-Care Nurses Synergy Model for Patient Care, and an experience inventory. Activities were rated on how critical they were to optimizing patients’ outcomes, how often they were performed, and toward which sphere of influence they were directed. How much time nurses devoted to specific care problems was analyzed. Frequency ratings were compared between clinical nurse specialists and acute care nurse practitioners.

• Results Both groups of nurses encountered all items on the experience inventory. Clinical nurse specialists were more experienced than acute care nurse practitioners. The largest difference was that clinical nurse specialists rated as more critical activities involving clinical judgment and clinical inquiry whereas acute care nurse practitioners focused primarily on clinical judgment.

• Conclusions Certification initiatives should reflect differences between clinical nurse specialists and acute care nurse practitioners.

Observing the Work of the Clinical Nurse Specialist

The Clinical Nurse Specialist (CNS) is an advanced practice nurse (APN) with graduate preparation as a clinical expert within a specialty area of nursing practice. There is a need for information about the work of the CNS in order to link CNS activities to outcomes and costs of care.

PURPOSE

To describe the work of the CNS in the acute care setting using the National Association of Clinical Nurse Specialists (NACNS) model as an organizing framework.

DESIGN

Descriptive pilot study of the work of the CNS in acute care.

SETTING

A 500-bed academic medical center located in the Midwestern United States.

SAMPLE

Five masters-prepared APNs in a unit-based CNS role.

METHODS

Direct observation and time study were used to record activities and time for 4 hours with each CNS (n = 5) for a total of 20 hours of observation.

FINDINGS

CNS activity and time within each practice domain included patient/client (30%), nursing (44%), organization/system (10%), and other activities (16%). Specific activities observed were linked to possible outcomes in the NACNS framework.

CONCLUSIONS

The NACNS model provided a useful framework for developing a data collection tool that can be used in a larger study that analyzes the work of the acute care CNS.

IMPLICATIONS

Describing the work of the CNS is an important preliminary step to measuring outcomes and costs of care.

Nurse Practitioners in Pediatric Critical Care

The nurse practitioner in pediatric critical care is a distinct advanced practice nursing role that has seen a tremendous increase in development and implementation over the past 10 years. There is a paucity of literature on this unique and valuable role. A total of 74 nurse practitioners practicing in pediatric critical care were surveyed. Part I of the survey solicited descriptive information of the nurse practitioner including background, work environment, reporting structure, and salary. The respondents also identified their role responsibilities that included direct patient management, nursing and medical education, coordination of care, research, and consultation. Part II of the questionnaire addressed skill level and need for supervision for technical procedures and leadership activities. These respondents described expert or proficient skill levels for the majority of technical procedures (ie, lumbar puncture, central line placement) and leadership activities (ie, discharge planning, participation in medical rounds). This is the first published report to delineate the role of the nurse practitioner in pediatric critical care based on responses from a national survey.