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