Post on 14-Jul-2015
The Synergy Model in Family-Centered Care
Assistant Professor Besey Ören
besey_oren@yahoo.com
In the last decade, nurses have been incentivized to use more
contemporary methods due to;
Limited sources,
Constant changes,
Expansion of information
Global lack of manpower
Diekelmann N. "Too much content…", epistemologies' grasp and nursing education. J Nurs Educ
2002;41(11):469-70.
.
This process of change also affects the nursing profession.
Therefore, nurses feel compelled to adapt to this process by
improving their professional capacity through new methods.
Özer S. Fadıloğlu Ç. Application of the synergy model: A case study on leukemia. Journal of Ege
University Nursing School, 24(2):103-111,2008.
Various studies are being conducted in order to implement these changes in
appropriate ways.
Among these studies, those involving the development scientifically-based
nursing models are the most valuable ones.
The use of nursing models make it easy to practically apply systematized
theoretical information.
Beytut D, Gerçekler G.Ö, Deniz P, Yardımcı F. Turkish Clinics J Nurs Sci 2013;5(1):49-54.)
Development of the Synergy Model
Dr. Curley supervised a team of experts in order to
develop the "Synergy Model for Critical Care", which is supported by the American Association of Critical Care Nurses.With Dr. Curley’s creativity and vision, the "Synergy Model" became a model that is used in school curricula, in certification exams, and in designing programs for numerous hospitals.
Innovation and Leadership in Clinical Practice, Research and Education. (2009) 4th International Congress on Innovations in
Nursing..
Synergy
The word synergy is of French origin.
Synergy means that a number of organs work together in order to
perform a task or that a number of responsibles cooperate in
order to obtaining a result.
Synergy means “görevdeşlik” in Turkish and it basically means
the whole being more than the sum of its parts.
The whole-part relationship in syergy
In the formation of synergy, the relationship between parts that
generate the whole is of crucial importance.
In this context, the parts act as catalysts and provide that the
result is more than their sum.
2+2=5Kuğuoğlu S, Çövener Ç, Aktaş E, M Tanır MK. Use of the synergy model in the family-centered care of the child who is
confined to bed. Maltepe University Journal of the Science and Art of Nursing, Cilt:2,Sayı:1.2009:59-64.
The synergy model requires patients and nurses to act
together.
Within this model, the patient and his/her family have the
role of an active participant in means of the nurse-patient
interaction.
Relationships within the synergy model
SynergyModel
Nurse-SystemNurse-
Nurse
Nurse-
Patient/Patient’s
family
Curley MAQ. Patient-nurse synergy: optimizing patients' outcomes. Am J Crit Care. 1998;7: 64-72.
Patient characteristics
and needsDemands of the health
care environment
Nursing application
In the synergy model, which can be easily applied to intensive
care,
Patient characteristics
Matching nursing competencies
Result in synergy
The best patient
outcomes are
achieved
The main concepts of synergy as a model for patient care
Basic needs and characteristics of the patient
and his/her family
• 1
Synergy
• 2
Active participation
• 3
In the model, there are 8 characteristics that reflect the health status of the patient.
1. Resiliency
2. Vulnerability
3. Stability
4. Complexity
5. Resource availability
6. Participation in care
7. Participation in decision making
8. Predictability.
The synergy model in practice: The synergy model as a framework for nursing rounds. Crıtıcal Care Nurse . 2002; 22(6): 66-68.
Özer S. Fadıloğlu Ç. Application of the synergy model: A case study on leukemia. Journal of Ege University Nursing School, 24(2):103-
111,2008.
Patients are assessed according to their status of featuring these characteristics as
follows.
1. Very poor
2. Poor
3. Moderate
4. Good
5. Very good
Swickard S, Swickard W, ReimerA, Lindell D, Winkelman C. Adaptation of the AACN Synergy model for patient care to critical
care transport. Critical Care Nurse 2014; 34(1):16-29.
Use of the synergy model in the family-centered care of the child who is confined to bed. Maltepe University Journal of the
Science and Art of Nursing, 2 (1).2009:59-64.
Resiliency
It is the ability to recapture premorbid functional status.
For example, if a patient who broke his foot can walk
again, it means that he/she is resilient.
Vulnerability
It means being vulnerable to stressors that can influence the
expected disease outcomes.
Stability
It is the ability to have a stable health condition.
Complexity
The term corresponds to the complexity of two or more systems
such as the body, family, and treatments.
For example, more than one system being affected by a disease is a
complex condition.
Resource availability
It is the availability and level of technical, financial,
physiological, and social resources. In this context, the patient’s
support systems are determined.
Participation in care
It is the participating patient’s or his /her family’s degree of taking
responsibilities.
Predictability
These are the common characteristics that enable the nurse to
understand disease prognosis.
It is a characteristic that provides the prediction of possible
disease- or event-related problems.
Participation in decision making
It refers to the patient’s and his/her family’s process of
participation in decision making with regard to the treatment
options. In this process, counseling should be provided for the
patient or family.
Nursing Competencies
Nurse competencies that should be used for solving patients'
problems change according to the needs of the patient and
his/her family.
These competencies include a combination of information,
skills, and experiences that will improve the outcomes expected
by the patient and his/her family.
Nursing Competencies
* Clinical judgment
* Caring practices
* Advocacy and moral agency
* Collaboration
* Systems thinking
* Response to diversity
* Clinical inquiry
* Learning convenience
Nursing Competencies
Each nursing competency is evaluated on a Likert-type scale that
ranges from 1 (rookie) to 5 (expert).
Use of the synergy model in the family-centered care of the child who is confined to bed. Maltepe University Journal of the Science
and Art of Nursing, 2 (1).2009:59-64.
The synergy model in practice: The synergy model as a framework for nursing rounds. Crıtıcal Care Nurse . 2002; 22(6): 66-68.
Özer S. Fadıloğlu Ç. Application of the synergy model: A case study on leukemia. Journal of Ege University Nursing School
24(2):103-111,2008.
Clinical Judgment
It involves the nurse’s ability to make clinical judgments
through critical thinking and understanding of the condition.
Caring Practices
It involves the formation of a therapeutic environment based on
family and patient specific needs.
Such as actively listening to the patient.
Advocacy and Moral Agency
Working on behalf of the individual involves solving ethical
concerns.
Such as the nurse talking to the doctor about the patient’s wish
to remove an urinary catheter.
Collaboration
Supporting every individual’s contribution that promote patient
goals and working with them.
Such as the nurse talking to the dietitian about the nutrition of a
patient who looses weight.
Systems Thinking
It refers to the information and tools that enable the nurse to accept
relationships within and against health care systems.
Such as the nurse talking to the patient who should maintain a salt-
free diet and to the patient’s family who try to bring food to the
patient and activating application systems.
Response to Diversity
It requires the recognition and acceptation of
diversity in care and the sensitivity to include
those in care.
Clinical Inquiry
Constant inquiry and evaluation of
applications.
Learning Convenience
It involves making the necessary efforts for
facilitating the learning process of the patient and
his/her family.
Participating parents
Personnel, finances
social
Maintaining stable
health conditions
Family members
that participate
in decisions
Vulnerability to stressors
that can affect
disease outcomes
Characteristics that
determine
disease prognosis
Complexity of two
or more systems
Patient and family
characteristics
Stability
ComplexityPredictability
Vulnerabilit
y
Participation in decision making
Participati
on in care
Resource
availability
The synergy model
The best outcomes are obtained when patient
characteristics match well with nursing competencies.
Outcomes should be evaluated according to the
perspectives of the patient, the nurse, and the system.
Intensive Care
Very
complicated
An unknown environment
Loud
The effect of intensive care on the patient and the family
Crisis
Depression
Stress
Post-traumatic stress disorder(PTSD)
Weakness
Separation anxiety
Sensory deprivation
Social isolation
Changes in bodily perceptions
Fear
Helplessness
Pain
Can be present 1 year after discharge Renrick J E, Rashotte 2009
Factors that intensify the problems experienced by the patient and the family
Disallowance of visits Limited visit duration Family not being able to participate in patient care Ambiguity of prognosis Absence of a waiting room Financial concerns Loss of control Worrying about other family members who are at home The family feeling unimportant in means of patient care
The personnel does not prefer family participation when the level of intervention
increases!
The most preferred one is injury dressing The least preferred one is resuscitation and
entubation
Sarıkaya Karabudak S, et al.
Reasons for not preferring the family to be present during an application
The negative psychological impact on the family
Limitation of work space
Patient care being negatively effected
Limitation of other patients’ privacy
The negative impact on the staff’s technical skills
Family members pressing charges when an adversity occurs
Akşit & Cimete 2001; Baker 1996; Balluffi et al.2004; Çavuşoğlu 2004
It can be assumed that providing care for intensive care
patients using the synergy model will lead to improved
outcomes both for the patient and the family.
Particularly in countries like Turkey, where family bonds are
quite strong, the model can be used more effectively.
Also, receiving support from the patient and the family when
the number of available nurses is insufficient, can reduce the
workload of nurses.
A CASE REPORT ACCORDING TO THE SYNERGY MODEL
R.B. is a 92 year old male patient. He lives alone in his own house and his
daughter assists him since she lives nearby. The patient was admitted to the
emergency service with a history of somnolence and frequent loss of footing.
He was admitted to the neurological intensive care unit due to somnolence,
respiratory stress, general deterioration of his condition, and cerebrovascular
events (CVE). The patient had a myocardial infarction 5 years ago and stayed
at the intensive care unit for 4 days and a stent was placed in two veins. The
patient had a history of hypertension, coronary artery disease, and type II
diabetes mellitus.
According to the examinations we conducted, fasting blood sugar was 177
mg/dl, glycolized hemoglobin was 11.2 g/dl, and hematocrit was 32.4%. In
radiological examinations, 78% stenosis was determined in the carotid
vertebral ultrasound and acute infarctions in 6-7 focal points within the right
occipital and right temporal regions were detected via brain MR. The
patient, who continued to receive treatment in intensive care, was evaluated
in means of nursing care using the synergy model.
Patient characteristics
Stability: The patient is stabilized at the moment. Body
temperature and pulse is within normal limits, respiration is
irregular and may worsen.
Complexity: The patient’s condition was complex, 4 of the
systems were deteriorated (nervous system, respiratory
system, circulatory system, endocrine system), and his family
is aware of the condition.
Predictability: The patient’s prognosis can be mostly
predicted. Probably, there will be a limitation of movement
ability.
Resiliency: He has chronic diseases and quite elderly . He hasn't resilience
Vulnerability: The patient’s family was stressful.
Participation in decisions: The patient could not participate in
decision making since he could not communicate with others, the
family participated in decision making, the patient’s son and
daughter were willing to ask questions and they asked appropriate
questions.
Participation in care: The patient’s participation was poor.
The children’s participation was good. The patient’s daughter
was occasionally accepted into the unit while the patient’s
self-care needs were attended to. She participated in his care
and provided support by holding his hand and talking to him.
Availability of sources: The patient had social security and the
family’s economic status was at moderate levels and they
were having economic hardships. The patient was receiving
support from his family but his family experienced difficulty
when the patient needed help in means of home care.
Istanbul