1. Crane, Patricia A. MSN, RNC, NP

Article Content


Sonya R. Hardin, Roberta Kaplow. Sudbury. MA:Jones & Bartlett. 2005.


The synergy model for clinical excellence is based on nursing competencies and patient characteristics within a comprehensible clinical framework to improve patient outcomes. Theoretical models are often confusing, and their application to practice often escapes the understanding of new and seasoned nurses. The usefulness of the American Association of Critical-Care Nurses (AACN) Synergy Model as a comprehensive framework for clinical care is made clear with definitions of concepts and appropriate explanations and application to the lived experiences of nursing practice.


Following the introductory chapter, half of the text is composed of 2 expanded sections that present the patient characteristics (resiliency, vulnerability, stability, complexity, resource availability, participation in care, participation in decision making, and predictability) and nurse characteristics or competencies (clinical judgment, advocacy/moral agency, caring practices, collaboration, systems thinking, response to diversity, clinical inquiry, and facilitator of learning). Each of the chapters presents an introductory background and a definition of the characteristic, followed by a presentation of a case study and its application to the synergy model, using level descriptors.


The fourth section is composed of chapters with scenarios and sample questions, with an answer key, on various types of patient care situations in different areas of critical care. Scenarios are also included for the advanced practice clinicians.


The unique contribution made by nurses to clinical patient care outcomes may best be conceptualized by this model's clarification of the synergistic relationships among patient and nurse characteristics with level descriptors. In addition, nurses can view practice through competency levels as they progress to excellence.


Expanding the understanding of the framework beyond critical care situations would be a valuable next step in validating the usefulness of the model. What is needed for full appreciation of the functional effectiveness of the synergistic framework is further evaluation and presentation of scenarios in other patient care settings such as family nursing care, chronic illness, long-term care, or reproductive health.


Educators who use the book to incorporate the synergy framework into nursing theory courses are finding it beneficial and relevant when applied in educational settings. Nurses can focus on characteristics and level descriptors that pertain to the situation being addressed. Clinical experts and educators who use the model find that the book provides the basic understanding of the model in limited patient care situations. There is a need for further publications that expand the relational understanding of the model particularly for nurses in early levels of competency.


A solid presentation of the model and its benefits, this book demonstrates the usefulness to clinicians, educators, and students in a manner that validates nurse-patient relationships and can help direct competency-based learning.


Reviewed by


Patricia A. Crane, MSN, RNC, NP


University of Pittsburgh, School of Nursing, Pittsburgh, PA


Ms Crane also serves as a reviewer of manuscripts for DCCN