The main concept of the AACN Synergy Model is
that the needs or characteristics of patients and families influence
and drive the characteristics or competencies of nurses. Synergy
results when the needs and characteristics of a patient, clinical
unit or system are matched with a nurse's competencies.
Generally, all patients have similar needs,
which are experienced along a continuum ranging from health to
illness. The closer to illness patients are on the continuum,
the more complex or severe their needs are. The role of a nurse
is determined by the needs of the patient and family. Since the
nurse's role is determined by the individual patient, he or she
is required to be proficient in a wide range of skills on the
There are five assumptions that guide the AACN Synergy Model of Nursing. They state:
Patients are biological, psychological, social, and spiritual entities who present at a particular developmental stage. The whole patient must be considered.
The patient, family, and community all contribute to providing a context for the nurse-patient relationship.
Patients can be described by a number of characteristics, and all characteristics are connected and contribute to each other. Characteristics cannot be looked at in isolation.
Nurses can be described on a number of dimensions, and the interrelated dimensions create a profile of the nurse.
A goal of nursing is to restore a patient to an optimal level of wellness as defined by the patient. Death can be an acceptable outcome, in which the goal of nursing is to move the patient toward a peaceful death.
The needs of patients are evaluated in levels between one and five, with different
categories. Each level in each category has different characteristics to help the
nurse determine the patient's specific needs. The categories are: resiliency, vulnerability,
stability, complexity, resource availability, participation in care, participation in
decision-making, and predictability.
Resiliency is the capacity to return to a restorative level of functioning using
compensatory or coping mechanisms, as well as the ability to bounce back quickly
after insult. Vulnerability is the susceptibility to actual or potential stressors
that can adversely affect patient outcomes. Stability is the ability to maintain a
steady-state equilibrium. Complexity is the intricate entanglement of two or more
systems, such as body, family, therapies, etc. Resource availability is the extent
of resources the patient brings to the situation, including fiscal, personal, psychological
and social resources. Participation in care is the extent to which the patient is able to
engage in different aspects of care. Participation in decision-making is the extent to
which the patient is able to engage in making decisions regarding his or her care.
Predictability is a characteristic that allows the expectation of a certain course of
events or course of illness. This is determined in part by the commonality of the illness.
In the AACN Synergy Model of Nursing, the care of nurses reflects the integration of
knowledge, skills, experience, and attitudes needed to meet the patient's needs. Nursing
care is also put on a continuum, with skills ranging from competent to expert. The
categories of nursing care are: clinical judgment, advocacy and moral agency, caring
practices, collaboration, systems thinking, response to diversity, facilitation of
learning, and clinical inquiry (innovator/evaluator).
Clinical judgment is clinical reasoning, which includes clinical decision-making,
critical thinking, and a global grasp of the situation. This is coupled with nursing
skills acquired through a process of integrating formal and informal experiental
knowledge and evidence-based guidelines. Advocacy and moral agency represents working
on another's behalf, and representing the concerns of the patient and nursing staff,
and serving as a moral agent in identifying and helping to resolve ethical and clinical
concerns within and outside of the clinical setting. Caring practices are nursing
activities that create a compassionate, supportive and therapeutic environment for
patients and staff, with the aim of promoting comfort and healing and preventing
unnecessary suffering. This includes, but is not limited to, vigilance, engagement
and responsiveness of caregivers, including family and health care professionals.
Collaboration is working with others in a way that promotes and encourages each person's
contributions toward achieving optimal and realistic patient goals. This involves intra-
and inter-disciplinary work with colleagues and community. Systems thinking is a body of
knowledge and tools that allow the nurse to manage the environmental and system resources
that exist for the patient and staff, within or across healthcare and non-healthcare systems.