Introduction
The nursing profession is one of the chief cornerstones of health care delivery worldwide. The role that nurses play in delivering heath care to populations cannot be overemphasized, which makes the profession such an integral part of the medical sector. One of the basic tenets of the nursing profession is that it comprises an integrated approach to various nursing models that work to ensure the effectiveness of the professionals while ensuring patient safety. This paper explores the models and their importance to the overall health care delivery system. Specifically, it reviews journal articles that examine both the synergy and transitional care nursing models. Furthermore, it recommends the transformational model for professional practice as a nursing model that safeguards patient safety and satisfaction while improving the quality of nursing care.
The Synergy Model of Nursing Care
This model of nursing care was developed by the American Association of Critical Care Nurses, even though it continues to be applied in diverse settings of nursing care (Catrambone, Johnson, Mion, & Minnick, 2009). Apparently, the matching needs and characteristics of a patient/clinical system and a nurse’s competencies is the factor that results in synergy. The model incorporates the following eight patient characteristics, including resilience, where coping mechanisms are used to restore functionality; vulnerability, where nurses identify patient susceptibility to stressors that may affect recovery outcomes; stability, where nurses and patients work toward maintaining a steady state of equilibrium; complexity, where nurses and patients collaborate in uncovering the intricate entanglement of several systems, such as therapies, the family, the body, and so on; resource availability, where the extent of resources that a patient brings to the care system, such as fiscal, psychological, and social, are examined in any particular situation; participation in decision-making, where the input of the patient in the health care decision-making is emphasized; involvement in care, where the extent to which a patient participates in various aspects of care is examined; and predictability, where nurses examine characteristics that enhance certain courses of illnesses or their outcomes (Catrambone, Johnson, Mion, & Minnick, 2009).
As far as the synergy model of patient care is concerned, different articles have investigated diverse clinical settings in which this model plays an important role. The article by Kohr, Hickey, and Curley (2012) explored the initial steps involved in building a nursing productivity measure on the basis of the synergy model. The background of this work was informed by the fact that the synergy model describes the work of nurses based on the individual needs of patients and their families. The researchers’ objective was to generate necessary information for the development of a nursing productivity system using the model as the theoretical framework. On the methodology part, the researchers utilized nurses from three different units of the intensive care section. In the first phase, charge nurses categorized in focus groups described patient and family indicators that were considered when making a nurse-patient assignment. In the second phase, the charge nurses’ information was used in constructing a survey used with their experienced counterparts, who were asked to link the indicators to the three levels of nursing assignments.
According to the results, a total of 30 charge nurses considered all the eight patient characteristics of the synergy model of patient care when making nurse-patient assignments. Additionally, 32 experienced staff nurses completed a total of 79 surveys, which ranked patient stability as the most significant characteristic in nursing care followed by the complexity and predictability characteristics. Furthermore, the respondents linked a common set of unique indicators to each of the synergy model patient care characteristic. In particular, the fluctuation in vital signs was associated with the stability characteristic; the severity and number of diagnoses were linked to predictability; a lack of reserve was associated with the characteristic of resiliency; the invasiveness of clinical procedures was linked to the characteristic of vulnerability; the educational level of family members and their participation style were connected to the characteristic of family participation in decision-making; and the home environment was attributed to the resources.
In their conclusion, Kohr, Hickey, and Curley (2012) indicated that the synergy model of patient care showed promise as a conceptual framework for a nursing productivity system. However, the researchers observed that by utilizing a nursing model that centered a nursing assignment on the needs of a patient may be placed to capture their capacity to quantify resource allocation to nurses.
In another article exploring the synergy model of patient care, Tavangar, Dehghani, Nasiriami, Delavar, & Falahzade (2014) sought to characterize patients with cardiac conditions on the basis of the synergy model. The background of this work was based on the observation that cardiac patients required comprehensive support because of the adverse effects presented by the chronic condition on diverse aspects of their lives. The research sought to determine the importance of the eightfold dimension of cardiac patients in relation to the synergy model that represents their clinical needs.
As far as the methodology was concerned, the researchers utilized 40 randomly selected cardiac patients in the study, who were hospitalized in the cardiac care unit of Yazd Afshar Hospital. The researchers collected data using a two-part checklist that included demographic characteristics and also studied eight dimensions of patients by reviewing their records as well as through interviews. The descriptive statistic approach (frequency) and the analytical statistic approach (Spearman and Mann-Whitney test) were used to analyze the study results.
According to the study results, among the internal characteristics of patients, the dimensions of reversibility, vulnerability, and predictability at level 1, which was the minimum score, showed the highest frequency, while stability and complexity were at level 3, which was the average score. Among the external characteristics, patient participation in decision-making at level 1 showed the highest frequency, while resource and care were at level 3. In their conclusion, Tavangar et al. (2014) observed that ignoring the eightfold dimension on the basis of the synergy model interferes with the comprehensive care of patients with cardiac conditions. Consequently, the researchers argued that it was necessary for health care practitioners, particularly nurses, to consider the eightfold characteristic of patients to provide them with quality care.
Besides the synergy model of patient care, another nursing model utilized in the present-day health care delivery system is the transitional care nursing model. Their importance cannot be overemphasized given that they have reached a point where they have become substitutes for primary care (Finkelman, 2011). In the article by Jackson et al. (2015), the researchers explored the aspect of readmission as well as the effectiveness of transitional care among Medicaid patients diagnosed with medical comorbidity and schizophrenia. The study was informed by the researchers’ observation that patients diagnosed with chronic health comorbidities faced an increased risk of hospital admission. Furthermore, the researchers observed that very little was known about the hospital utilization patterns of these patients or whether the transitional care directed by nurses had any positive impact on their future hospitalization. The researchers used paid Medicaid claims as well as care management databases to examine hospitalization patterns for adults diagnosed with multiple chronic conditions with schizophrenia being one of them. The study population was enrolled in a home program at the Community Care of North Carolina. The researchers examined the readmission rates after psychiatric and non-psychiatric hospital discharges and compared patients who received transitional care directed by nurses and those who received normal care.
According to the results, a total of 980 patients experienced readmission over the course of one year, with 20 percent of readmissions being as a result of reasons other than the primary hospitalization issue, and 36 percent of these readmissions occurring at a different heath care facility. While controlling for clinical and hospital characteristics as well as demographics, those patients who received transitional care were 30 percent less likely to experience readmission within a period of one year after discharge compared to those who received normal care.
In their conclusion, Jackson et al. (2015) observed that regardless of the reason for hospitalization, patients diagnosed with chronic conditions stand to benefit from transitional care support that addresses their medical condition. The researchers observed that this was also true for patients already under intensive outpatient psychiatric care.
In another article, Donald et al. (2015) investigated the cost-effectiveness of hospital versus community transitional care by nurse practitioners. They wanted to determine the cost-effectiveness of transitional care delivered by nurse practitioners. The study utilized a systematic review of randomized controlled trials, where 10 electronic databases, websites, and bibliographies among others were used for data collection. The researchers included randomized controlled tests for the comparison between the usual nursing care and that done by a formally trained nursing practitioner after which they measured the health system outcomes for each. The Cochrane Risk of Bias and the Quality of Health Economic Studies tools were used by the reviewers to screen study articles independently as well as for the assessment of the same. The researchers pooled data for similar outcomes and applied the Grading of Recommendations Assessment Development and Evaluation tool in rating the evidence quality for each outcome with regard to the applied health system.
According to the results, a total of five tests met the determined inclusion criteria. One evaluated one alternative provider nurse practitioner and in the other four, six complementary provider nurse practitioners were tested. Two were found to be at a low risk of bias while the remaining three recorded a high value; however, all of them were showed to have weak economic analysis. The alternative provider nurse practitioner showed similar patterns of patient outcomes and resource utilization by physicians, that is, low quality. In their conclusion, the researchers observed that given the low quality of evidence, the small number of nurse practitioners evaluated for each study, the small sample sizes, and the weak economic analyses, the requisite evidence of the cost-effectiveness of nurse practitioner transitional care was inconclusive and further research was necessary.
Observations about the Implemented Nursing Care Models
Indeed, the application of the synergy model of patient care is a fundamental measure of nurse productivity as far as the needs of patients and their families are concerned. While they are under nursing care, patients and their relations expect that nurses will demonstrate absolute care that safeguards the health requirements of the former in a satisfactory manner. The same is true with regard to the transitional care nursing model, where nurses play a critical role in caring for patients with chronic ailments. Consequently, the sole purpose of transitional care is to ensure that patients continue to receive utmost care in the various settings that they find themselves in. Thus, these two current nursing models continue to play a fundamental role in, for example, caring for patients with cardiac conditions, who require utmost nursing care that synergizes all the patient characteristics of the synergy model, while at the same time capitalizing on transitional care as they move from one setting, for example, a hospital, to another, such as home-based care.
Recommendation of a Different Nursing Model
Another nursing model that has proven to be quite significant in improving nursing quality and ensuring patient safety and satisfaction is the Transformational Model for Professional Practice. This particular model integrates four main components of patient care, including professional practice, process, the primary outcome, and the strategic outcome (Catrambone, Johnson, Mion, & Minnick, 2009).
Conclusion
Without a doubt, the nursing profession is a fundamental component of the overall health care delivery system globally. One aspect that emphasizes the critical role that nurse practitioners play in the health care delivery system concerns the various nursing models that have been developed over the years. In particular, researchers have investigated the critical role that the synergy model of patient care plays in measuring nurses’ productivity with regard to the needs of patients and their families. Similarly, researchers have examined the role that the transitional care nursing model plays in delivering care for patients diagnosed with chronic conditions, such as cardiac ailments. Other models, such as the transformational model for professional practice, plays an important role in integrating various components of the nursing practice with the sole aim of improving the quality of care and ensuring patient safety and satisfaction. On this basis, it is obvious that nursing models are an integral component of the heath care delivery system in the contemporary society.
References
Catrambone, C., Johnson, M., Mion, L., & Minnick, A. (2009). The design of adult acute care units in U.S. hospitals. Journal of Nursing Scholarship, 41(1), 79–86.
Donald, F., Kilptrik, K., Reid, K., Carter, N., Bryant-Lukosius, D., Martin-Misener, R., & DiCenso, A. (2015). Hospital to community transitional care by nurse practitioners: A systematic review of cost-effectiveness. International Journal of Nursing Studies, 52, 436-451.
Finkelman, A. W. (2011). Case management for nurses. Upper Saddle River, NJ: Pearson
Education.
Jackson, C., DuBard, A., Swartz, M., Mahan, A., McKee, J., Pikoulas, T., & Lancaster, M. (2015). Readmission patterns and effectiveness of transitional care among Medicaid patients with schizophrenia and medical comorbidity. North Carolina Medical Journal, 76(4), 219-226.
Kohr, L. M., Hickey, P. A., & Curley, M. A. Q. (2012). Building a nursing productivity measure based on the synergy model: First steps. American Journal of Critical care, 21(6), 420- 430.
Tavangar, H., Dehghani, H., Nasiriami, K., Delavar, S., & Falahzade, M. H. (2014). Characterization of cardiac patients based on the synergy model. Jundishapur Journal of Chronic Disease Care, 3(4), 1-7.
