AACN Synergy Model for Patient Care in Acute Care Transport Analysis

This report critically analyzes the AACN Synergy Model for patient care, focusing on its application within acute care transport. The introduction highlights the model's significance in integrating patient characteristics with nurse competencies to achieve optimal outcomes, particularly in scenarios involving interhospital transfers. The report explores the model's framework, emphasizing the importance of matching patient needs with healthcare provider skills to determine the appropriate level of care during transport. Background information covers the challenges in transferring patients, especially when specialized care or equipment is required. The study reviews existing triage tools, evaluating their limitations in addressing patient-specific needs and the competencies of transport staff. The AACN Synergy Model's eight patient characteristics and nurse competencies are detailed, along with the model's three outcome levels: patient, nurse, and system. The adaptation of the model to acute or critical care transport is discussed, emphasizing the need for a tool that considers both patient needs and nursing expertise. The report concludes by highlighting the potential of the AACN Synergy Model to improve patient outcomes and enhance the efficiency of interfacility transfers by informing the decision-making process on transport methods and staffing levels.

Running Head: AACN SYNERGY MODEL FOR PATIENT CARE
AACN synergy model for patient care in acute care transport
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AACN synergy model for patient care in acute care transport
Introduction
American Association Critical-care Nursing (AACN) synergy model for patient outlines
frameworks for healthcare practice. The significance of the is model is the integration of
characteristics of client with the nurse competencies to realize optimal patient results. The
synergy model is easily adaptable to the critical or acute care context when a nurse who handling
an individual who is critically ill links his or her capabilities to the characteristics of the patient
(Swickard, Swickard, Reimer, Lindell & Winkelman, 2014). Nevertheless, it should be noted
that not all acute or critical care is done within the walls of the healthcare institution context.
Present healthcare setting mandates that individuals having serious illness live in their homes,
creating the need for critical and acute care setting to reach out to their individuals not only to aid
them in the maintaining a quality of life but also to minimize the hospital readmission costs.
Current healthcare delivery depends on the interhospital patient transfer who need higher levels
of care. Even though many algorithms and tools have been designed and utilized for the
determination prehospital means of transport, there has been no accepted tool for the transfer of
individuals between two facilities.
Characteristically, the decision of transfer of individuals between two hospitals is
normally left at the hands of the sending staff, who can or cannot be cognizant of the degree of
care offered or availability of the mode of transfer (Swickard, Swickard, Reimer, Lindell &
Winkelman, 2014). Thus, there is a need to evaluate the suitable degree of care needed to realize
the requirements of individuals during transfer. AACN synergy model of patient care is
described as a model that integrates both the patient and the nurse and focusses on improving

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individual care by incorporating the features of the individual with the abilities of the healthcare
provider. The model offers vital aspect in offering the conceptual support to drive the decision on
the degree of care needed to finish transfers between the hospitals effectively as well as safely.
This paper will critically describe the AACN synergy model for patient care to evaluate the
suitable degree of care needed for transfer between two facilities.
Background information on the study
A basic indicator for transfer between facilities may be a special diagnosis like ST-
segment elevation myocardial infarction. Given the amount of time taken on transferring an
individual with ST-segment elevation myocardial infarction to a hospital, the hospital can
perform the percutaneous coronary medical intervention, numerous healthcare hospitals not
having that capacity have designed or come up with well-rehearsed algorithms. This is done to
enable the movement process to a hitherto determined hospital which does not provide
percutaneous coronary medical strategy to run smoothly and swiftly (Swickard, Swickard,
Reimer, Lindell & Winkelman, 2014). Numerous transfers, nevertheless, usually have not
reached such levels, thus, sending (referring) healthcare provider has to look for a transfer with a
healthcare provider from the targeted receiving facility. The responsibility for looking for the
time as well as means of transfer is mostly given to the referring healthcare staff, with or without
suggestions from the receiving hospital. The healthcare provider has to evaluate factors like
condition of the patient, knowledge of the capabilities of the local transport, travel time, weather,
geographical location, etc. Mode of transport via air is frequently chosen over the terrestrial
mode of transport due to the abilities of the air transport personnel which are frequently viewed
to be greater than those of the terrestrial teams (Swickard, Swickard, Reimer, Lindell &
Winkelman, 2014).

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It should be noted that it is a myth that the degree of the healthcare provider by various
travelling authorities is equal owing to the same means of travelling, nevertheless, there is
empirical report that professional recovery staff from the targeted hospital have minimized the
incidence of negative events like protracted hypoxia and hypotension as well as reduced time to
definitive care and treatment. Skills levels, as well as education, differ broadly within facilities.
The sending staff has to contemplate numerous aspects and vital expanse of information, most of
which he or she may not be cognizant with or have access to.
One aspect vital to triage is the utilization of the tools allowing the process to be more
than arbitrary decision of the referring or receiving provider (Moffat, 2018). Many trials have
been made to design as well as utilize triage tools to the process of management of acute care
transfer. An empirical study examined the use of initial triage tool to evaluate the means of
travelling to tertiary care for individuals with cardiac problems. The study evaluated the impact
of using the terrestrial mode of transfer time as well as four physiological factors in the
evaluation of ground vis-a-vis air transfer of individuals with cardiac problems. Outcomes of the
study showed that the degree of care offered on every means of transfer is the same yet the
degree of care offered is not shown. A different empirical study evaluated a different triage tool,
the transfer evaluation in pediatrics, for utilization in examining the unit terminus of the
transferred pediatric individuals. Nevertheless, tools were not applied in examining the means of
transport or the degree of care needed for the transport (Murray, Williams, Pignataro & Volpe,
2015). Even though the tools operated effectively in the settings where they were designed, all of
them did not solve the features of the patient, as stipulated in the AACN synergy model for
patient care. They did not give solutions to the skills, experience, and knowledge of the transport
nursing staff. Moreover, adapted early warning systems and therapeutic scoring system tools also

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resulted to poor prognostic performance as well as did not variate for the interfacility degree of
care needed to transfer individuals safely (Shuntaro & Shinichi, 2018).
AACN synergy model for patient care
It is important for individuals to base decisions concerning transport degree model which
emphasizes the individual’s needs. The AACN synergy model for patient care, which was
designed by experts on behalf of the AACN, is described as a model that integrates both the
healthcare provider and the patient and is emphasized on the patient's needs, the competencies of
the healthcare provider like a nurse, as well as the synergy, developed when those competencies
and needs match. The initial objective of the model was to offer a conceptual outline for licensed
practice. The model tries to describe nursing practice above tasks, rather describes nursing via
greater-degree competencies and characteristics. The degree of characteristics of the patient as
well as nursing competencies happen on a band and can differ temporal space The model has
been applied in different circumstances as well as for different purposes. Instances of present
uses entail creating a nursing productivity measure, staff development as well as care of
individuals with critical coronary syndromes. The eight features of individuals in the model
entail vulnerability, availability of resources, taking part in care, stability, resilience, taking part
in the decision making, as well as predictability. An individual is examined on every feature in
relation to their capability that level, and given a numeric figure, that is, either one (very low),
three (moderate), or six (high).
For instance, an individual examined for resilience or his or her capacity to recover to
initial degree of operating after a condition is given a degree one if the individual had recorded

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low resiliency degree, a three for moderate resiliency, as well as a six for a high degree of
resiliency. It should be noted that each feature is examined similarly.
The eight characteristics of the nurses in the AACN synergy model for patient care entail clinical
moral agency and advocacy, judgment, collaboration, learning facilitation, systems thinking,
caring practices, clinical inquiry, and response to diversity (Moffat, 2014). In the same
evaluation given to the patients, healthcare provider can be examined by applying the features of
a provider on a similar measure of one to five anchored on the capacity in a field from capable
(one) to professional (five). The collaboration happens when the features as well as needs of a
medical unit, patient are harmonized with the capabilities of the nurse. It is key to note that the
model for the individual car has been widely used in numerous setting from the military to
inpatient care. The ultimate element of the AACN synergy model for patient care is results.
There are three degrees of results (Miner, 2015). The initial results is gotten from the individual
as well as entails satisfaction, function as well as other loci of the patient-centered care. The
results derived from the nurse entail absence or presence of complications and challenges, the
level to which treatment or care aims were achieved, and physiological changes. The results
derived from the system are resource or cost utilization and recidivism (Jenkins, Wootton, Howe
& Cooper, 2015).
Adaptation of the model to acute or critical care transport
The person with responsibility to make triage decision in the transfer process between
facilities of critical care carries responsibilities of making sure that the most effective mode of
transport, the degree of care and time are offered (Manente, 2017). An ineffective choice in any
of those mentioned facets may have adverse consequences for the healthcare system as well as

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the patient, which might entail an ineffective destination area for the patient, the condition of the
patient getting worse, caregiver or patient mismatch, or in worse scenario death of the patient
(Jain, Richardson, Meyer-Hermann & Byrne, 2014). The predominant systems put the entire or
whole obligation for the decision made on the referring official. The referring provider has no
generally agreed tool to help on this decision. It is key to note that a provider from the referring
healthcare institution starts the transfer between the two facilities by sending out a request for
transfer to the receiving clerk at likely host healthcare institution. It should be noted that a clerk
then adheres to the healthcare institution-specific processes for seeking for an accepted provider
(Moffat, 2018). This is followed by a mutual conversation between the receiving and the
referring provider. If the transfer is acknowledged and the patient is given a bed, the referring
healthcare institution staff is given a notice of the assignment of the bed as well as offered cell
phone to call nursing report (Campbell et al. 2014).
In numerous cases, officials from the referring healthcare facility make arrangements on
transport with a local agency dealing with transport logistics. Characteristically, a person taking
the call at the transport agency completes a form which is specific on transport details and data
and the team near the facility is sent out to finalize the logistics on transfer. Triage in acute care
transfer is commonly anchored on numerous interventions like invasive medications as well as
catheters. The involvement of the provider in the process of transfer differs broadly depending
on the context, even though the sending provider mostly does a clinical order for the transfer.
The objective of designing this tool is to give various solutions to the current triage process and
emphasize on the patient's needs as well as the medical competencies of the transport nurses
chosen (Fauver & Ramanarayanan, 2016).

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The synergy model for patient care offers a conceptual foundation to design a novel
transport triage tool, triage tool, and the relationship between the transport triage tool and the
synergy model for patient care (DeForest et al. 2018). Utilities for the tool is approximated to
influence the effective level of transport staff, thus, enhancing the outcome of the patients via
obligation of effective official while raising the effectiveness of the limited resources of transfer.
It should be noted that trained healthcare staff are often integrated in the decision to transfer
triage. However, higher referral institutions that utilize their recovery teams can utilize these
expert and trained teams in making the decision. Every request for transfer may be evaluated at
these facilities by applying a tool developed uniquely for the aim of examining the characteristics
of the individual as well as the aligning level of transport care, needs, and transport mode to best
meet such needs (Leider, DeBruin, Reynolds, Koch & Seaberg, 2017). Operationalizing the link
between the characteristics of the patient and the degree of care us till conceptual at this point;
this will be considered as a subject for my future empirical research.
Implications to nursing practice
The AACN synergy model for patient care highlights the need for healthcare knowledge
and skills in health and care of as well as making decision concerning acutely ill individuals
(Venditti, 2015). Via the resiliency of the synergy model for patient care to the transfer triage
decision taking place between two facilities, the healthcare continuity of health and care is
prolonged to receiving acute care field from the sending acute care field. Professional providers
have a role to play in the process of collective care as part of the professionals leading to holistic,
harmless care for acute care individuals in the unstructured transfer settings (Iversen, Broström
& Ulander, 2017). Particularly, most nations need that at least one crew person of an acute care

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transport unit has to be a registered professional nurse. I have given out one example of how the
synergy model is applied in the acute or critical care transport triage (Paricharak et al. 2018).
Case study or example of synergy model for patient care
A man of 50 years went to the emergency department at a local healthcare institution
having a three-day medical history of progressive shortness of breath and weakness. The patient
also had a medical history of vital mild chronic obstructive pulmonary disease, hypertension as
well as coronary heart disease with two coronary stents put on him seven months ago. The levels
of cardiac enzymes were recorded as normal; there were elevations of the level of brain
natriuretic protein which indicated an overload of fluid as well as cardiac failure.
Electrocardiography revealed an old inferior wall myocardial infarction (Wang, Watanabe &
Asaka, 2017). His uncompensated cardiac failure was tested and treated using diuretics and was
hospitalized to the ICU The client facility course was made worse by the establishment of the
recurrent sporadic ventricular hypotension and tachycardia which needed intravenous
amiodarone as well as a vasopressor. When an echocardiogram was read (O’Donnell et al.
2019)., it revealed an almost akinetic left side of the ventricle having an ejection fraction of 12%.
There were no recorded cases of kidney compromise, that is, the levels of serum creatinine were
normal, yet the patient had reduced production of urine.
The clinical officer decided to transfer from the facility to a tertiary hospital for further
examination as well as management and likely examination of the cardiac transplant. The clinical
a made a call to the transfer line in the receiving facility, 100 kilometers. A dialogue followed
between the clinical staff, the transfer coordinator at the hospital, the cardiology fellow and the
nurse professional from the transfer team of the receiving healthcare institution. There was an

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acceptance of the patient in the receiving healthcare institution and was assigned a cardiac
intensive care unit bed. Moreover, the healthcare provider on the team of transport finalized the
evaluation of the transfer triage (Follmann et al. 2019). The examination was anchored on the
adaption of the synergy model for individual care into transfer tool as well as examined the needs
of the patient on eight distinct features. The present patient support entailed two peripheral sites
for an intravenous catheter, a vasopressor which was frequently titrated, oxygen at 5 L/min
through a nasal cannula, and an anti-arrhythmic infusion. The patient was not given access to
central venous, no invasive check-up, and no heart assist devices like a ventricular assist device.
His present significant signs were hypertension, cardiac rate 105 beats/min, rates of respiratory
of 27/min as well as saturation of oxygen of 94% on 4 L/min. The patient was anxious which
meant he required benzodiazepines. Based on this information and data, the levels of care during
the process of the patient should be at the level of the provider, anchored on the characteristics of
the nurse of clinical judgment, collaboration, and systems thinking.
It should be noted that an advanced nursing practice will match the needs of the patient in
these fields with the clinical judgment and prescriptive agency at this level of nursing practice.
Moreover, the safety needs of the patient can be monitored as well as acted upon by the
advanced nursing practice during the process of transportation. The initial safety requirement of
the patient is the need for specific monitoring of pressure in the arteries through an arterial
catheter which is put by the more experienced nurse (Balconi, Gatti & Vanutelli, 2018).
Furthermore, monitoring of the non-invasive blood pressure during the process of transportation
is mostly problematic due to the motion and vibration during transport (Cesari, Camponogara,
Papetti, Rocchesso & Fontana, 2014). Another safety requirement is considered as the
requirement for prescriptive agency due to the incidence of an infusion of the vasopressor health

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medication which can need titration with the need to control fluid balance as well as likely
association of the benzodiazepines. The complexity level cannot be managed effectively and
appropriately under a system based on the protocol as well as needs the prescriptive provider
presence.
Conclusion
Patient transport between two different facilities has occurred for numerous times, and
even though, the application remains to increase, an idea for the defining effective transfer
staffing has been poorly comprehended and unused. Therefore, a novel triage tool anchored on
the synergy model for patient care offers a conceptual outline as well as direction in the
provision of nursing care between two facilities. The tool is designed with the likelihood to
differentiate nursing care level needed during this era of change and instability for the patient
(Xie, Cao, Huang & Ong, 2016).

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