The AACN Synergy Model

As a nurse working for many years, I have come across many instances where there has been difficult situations in decision making by patients, families and patient care team. One evening, I received an admission from the emergency department for a patient aged 101 year old, who had a fall and fractured her right pelvis and hip and also diagnosed with pneumonia. The patient has a history of Diabetes Mellitus type 2, Congestive Heart failure, and previous fall resulting in compression fracture at T1-T2, which is not treated surgically, blind in both eyes, and Full Code. Patient is alert and disoriented to situation, time and place. She was in severe pain, agitated and restless and being confused trying to get out of bed. After receiving the

(2007), “the AACN Synergy Model matches the patient characteristics with the nurses’ competencies to optimize outcomes”. This systems model was used to analyze the dilemma and to provide the best care to the patient. Even though she recovered for the pneumonia, the patient’s ability to return to her previous state of health was compromised by her multiple co-morbid conditions and her advanced age. The patient was not in a position to make decisions for herself and the patient’s daughter was in denial that her mother was dying and needed some educational resources such as palliative and hospice, chaplain to make informed decision. Initially the daughter was hesitant to talk about the code status and once she was provided the information she was more responsive to the course of events, participated in the decision making process leading to end of

Even though, the patient did not want to have the surgery, it was due to the pressure from her daughter that she wanted to go for it. My goal was to provide compassionate and therapeutic care, looking at the patient holistically, providing comfort to the patient, and analyzing patient response to treatment. Once I recognized that the family needs help in making informed decision, I provided them with resources who can help them, and communicated with our health care provider about the family’s willingness to see palliative care team.

The other theoretical frame work used is the comfort theory by Katherine Kolcaba. According to Kolcaba (as cited in currentnursing.com, 2011) describes comfort as existing in three forms: relief, ease and transcendence. The patient was in severe pain and the nurse provided comfort by administration pain medications to relieve pain. The patient also was experiencing anxiety as to whether she has to have surgery and that was advocated by the nurse to the family and no surgery was