Synergy [horizontal ellipsis] The Unique Relationship Between Nurses and Patients (The AACN Synergy Model for Patient Care), Martha A.Q. Curley. Sigma Theta Tau in collaboration with the American Association of Critical-Care Nurses, 2007. Soft cover, 290 pages, $39.95.
This book has 22 contributing authors, providing a diverse look at the American Association of Critical-Care Nurses Synergy Model. Simply stated, "the Synergy Model is a conceptual framework describing a patient-nurse relationship that acknowledges the primary importance of nursing care based on the needs of patients and their families. The fundamental premise of the Synergy Model is that patient's characteristics drive nurse competencies" (page 2). Originally designed for critical care nurses, the model has now been applied across clinical practice specialties. What the Synergy model does is place decision making around patient care to a whole new level of thinking, beyond just patient care delivery models or acuity systems but to what appears to be the essence of nursing, assisting the patient and meeting their needs in synergy with the patient.
The Synergy Model has 8 patient characteristics:
1. stability,
2. complexity,
3. vulnerability,
4. predictability,
5. resiliency,
6. participation in decision making,
7. participation in care, and
8. resource availability.
The Synergy Model identifies 8 dimensions of nursing practice:
1. clinical judgment,
2. clinical inquiry,
3. caring practices,
4. response to diversity,
5. advocacy/moral agency,
6. facilitation of learning,
7. collaboration, and
8. systems thinking.
At first glance the model appears to be much more predictable of resource management than acuity systems, but unfortunately, Barbara Brewer's research in the final chapter indicates they cannot stand alone as an acuity system. Measurements need to be tested and validated to do so. But the sheer logic of the model demands that researchers not give up and find appropriate measures to make the model contribute to the daunting task of resource management in a resource challenged system. Synergy is a better predictor of resource management from the perspective of nurse competencies need on a unit. Acuity systems do not tell us what types of nurses we need, that is, specific skill sets, but how many we need. Synergy does not tell us how many. They do in fact complement each other. Acuity systems tell you how many staff members you need and Synergy provides a framework for assigning them to individual patients.
While better measurements are researched, the application of the model in multiple ways is quite legitimate. As the chapters indicate, the model is helpful in peer review, progressive levels of care, certification, multihospital systems, ambulatory care systems, professional practice models, staff development, nursing school curriculum, and professional development.
This book does not just present another framework for model of care but, in so doing, creates a forum for professional dialogue that goes back to the history of nursing. What is nursing? What does it do? How does it contribute? I can remember having these discussions with classmates in nursing school more than 30 years ago. What makes this dialogue so critical now is that we are facing a perfect storm of sorts in healthcare. More demands (aging baby boomers) with fewer resources (limits of Medicare and Social Security) and rising healthcare costs. This powerful model provides a context with which a nurse leader can bring nursing to the ultimate bargaining table. So whether you use the book to implement the Synergy Model or read the book to better position your negotiating language, the book will be helpful. Integrating patient characteristics (vs diagnosis) with nurse competencies (vs a nurse is a nurse) strengthens any nurse resource negotiation. The American Association of Critical-Care Nurses has made a significant contribution to our profession through this model.