course material

1. Organizational Application of Nursing Theory Discussion
Organizational Application of Nursing Theory DiscussionTheories present a system of ideas
and suppositions that explain things based on independent general principle. Nursing
theories are intended for application. Kaplow and Reed (2008) explore the application of
AACN Synergy Model for patient care with a focus on achieving magnet designation. In this
case, the theory acts as a model whose application guides the organization to match its
activities with the 14 magnetism forces. The reason advanced for using the theory is that it
facilitates synergy as a philosophy that gets all the stakeholders to work together in
achieving a common goal. With the application of the model and synergy being achieved in
nursing care delivery, there is an assurance that the needs of all the stakeholders (patients,
nurses and health care system) would be met thereby helping the organization to achieve
magnet designation. Overall, the article identifies the model as providing a framework for
identifying the characteristics and needs of stakeholders in nursing care delivery, and
matching the needs with nursing competencies Organizational Application of Nursing
Theory Discussion.ORDER YOUR PAPER HEREAhtosham & Sommer (2015) present an
analysis of Virginia Henderson’s Need Theory in nursing practice. The authors note that the
application of any theory in practice is primarily dependent on the clinical practice context.
However, irrespective of the context, the primary needs of patients remain the same with a
focus on providing quality care. The application of needs theory offers a framework for
anticipating the dynamic needs of patients while elaborating the role of nurses. It notes that
the needs of patients will typically fall within the fourteen components identified in the
theory, and in applying the theory as a framework, then nurses can identify and meet all the
nursing care needs of patients Organizational Application of Nursing Theory Discussion
.ReferencesAhtisham, Y., & Sommer, J. (2015). Integrating nursing theory and process into
practice: Virginia’s Henderson need theory. International Journal of Caring Sciences, 8(2),
443-450.Kaplow, R., & Reed, K. D. (2008). The AACN synergy model for patient care: A
nursing model as a force of magnetism. Nursing Economics, 26(1), 17-25.The AACN Synergy
Model for Patient Care: A Nursing Model as a Force of MagnetismKaplow, Roberta; Reed,
Kevin D.Nursing Economics; Pitman Vol. 26, Iss. 1, (Jan/Feb 2008): 17-25.Kaplow, R., &
Reed, K. D. (2008). The AACN synergy model for patient care: A nursing model as a force of
magnetism. Nursing Economics, 26(1), 17-25. https://www.proquest.com/scholarly-
journals/aacn-synergy-model-patient-care-nursing-as-force/docview/236965479/se-
2?accountid=35812 Organizational Application of Nursing Theory
DiscussionAbstractTranslateTop of FormBottom of FormThe AACN Synergy Model for

2. Patient Care In the 1990s, the American Association of Critical-Care Nurses (AACN)
assembled a think tank to discuss an envisioned new paradigm for nursing practice and
create a conceptual framework for certified practice.n When all three sides of the synergy
model are in place, it can provide the framework for a professional model of care that
supports excellence in nursing care and satisfies the criteria outlined in the Magnet
designation program.Full TextTranslateTop of FormBottom of
Form0:00 /0:00HeadnoteEXECUTIVE SUMMARY*One of the 14 Forces of Magnetism
requires a health care organization to have a professional model of care.*The eligibility
requirements stipulate that this model must be utilized throughout the health care system
and that the same philosophy must be used throughout the system.*The American
Association of Critical-Care Nurses Synergy Model for Patient Care describes nursing
practice based on eight patient characteristics, and also describes eight nurse
competencies.*The core concept of the 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.*The synergy model is an excellent framework to organize the
work of patient care throughout the health care system.*It can be used and applied in
various ways and provides a comprehensive framework for assuring success in building a
philosophy that supports the Forces of Magnetism.MAGNET® STATUS IS AWARDED by the
American Nurses' Credentialing Center (ANCC) to hospitals that satisfy a set of criteria
designed to measure the strength and quality of their professional nursing practice.
Designation as a Magnet hospital originated in the 1980s. It was awarded to hospitals that
were successful in recruiting and retaining nurses during the nursing shortage of that time
(Gleason, Sochalski, & Aikin, 1999). It is purported that nurses in Magnet-designated
hospitals deliver excellent patient outcomes (The Center for Nursing Advocacy, 2006).
When a health care organization receives Magnet designation, it is recognition of a facility's
attainment of excellence (ANCC, 2006a) Organizational Application of Nursing Theory
Discussion ."The Magnet Recognition Program ® identifies and defines the 'Forces of
Magnetism' as the characteristics displayed by health care organizations that develop and
maintain a professional practice environment that helps recruit and retain nurses" (ANCC,
2004). To date, over 200 hospitals in the United States and one in Australia are recognized
with Magnet designation (ANCC, 2006b). For a health care organization to receive Magnet
designation, the environment must be provided where nursing care promotes attainment of
the highest achievable patient outcomes (ANCC, 2004). Evaluation of patient outcomes is an
important topic because of the concern about the quality of healthcare.ORDER YOUR PAPER
HEREOne of the 14 Forces of Magnetism requires a health care organization to have a
professional model of care. The eligibility requirements stipulate that this model must be
utilized throughout the health care system and that the same philosophy must be used
throughout the system. The model of care is to "give nurses the responsibility and authority
for the provision of direct care." Further, "the models of care provide for the continuity of
care across the continuum." The models take into consideration patients' unique needs and
provide skilled nurses and adequate resources to accomplish desired outcomes" (ANCC,
2005) Organizational Application of Nursing Theory Discussion .Related Practice

3. ModelsWhile use of a nursing model to guide care has the potential to affect patient
outcomes, use has been the subject of criticism. The primary source of this criticism has
been on their value and purpose in nursing practice. Their importance in nursing science
has also been doubted (Tierney, 1998; Wimpenny, 2002).Despite the questionable value of
nursing models, data from other multidisciplinary research has supported a relationship
between use of models and attainment of patient outcomes, including mortality and patient
satisfaction (Gleason et al., 1999). The data, however, are variable in their results.Earley and
colleagues (2006) compared outcomes of patients who underwent an appendectomy using
an acute care surgery model with those using a traditional home-call attending surgeon
model. In this study, patients with acute appendicitis who were cared for by an in-house
acute care surgeon had significantly decreased the time to operation, rupture rate,
complication rate, and hospital length of stay as compared with the traditional home-call
attending surgeon model Organizational Application of Nursing Theory Discussion .Parley
(2001) studied persons with learning disabilities. Data from this study suggest that
outcomes are improved when a person- centered care model was used. When this model
was used, staff were being more respectful to clients and there were improved
opportunities for clients to make everyday choices. The researcher concluded that in order
for this model to be effective, a multidisciplinary approach to care is essential.Siminerio,
Zgibor, and Solano (2004) described use of a chronic care model to improve diabetes care
processes and outcomes in clinical settings. Aspects of the model included decision support,
clinical information systems, selfmanagement education, and delivery system design.
Improved patient outcomes were reported with use of this model.Mark, Salyer, and Wan
(2003) evaluated the impact of professional nursing practice on organizational and patient
outcomes. Their results suggest a positive relationship between professional nursing
practice and nursing satisfaction but only partial effect on other organizational or patient
outcomes. Patient outcomes in this study included patient satisfaction; collaboration among
physicians, nurses, and other staff; and satisfaction with pain relief and level of comfort
sharing concerns with nurses. Organizational outcomes included nurses' work satisfaction,
nursing turnover, and length of patient stay. In this study, professional nursing practice was
defined as "a system that supports registered nurse control over the delivery of nursing
care and the environment in which care is delivered" (p. 224) Organizational Application of
Nursing Theory Discussion .Results from other studies suggest a relationship between
professional nursing practice and improved patient outcomes. A significant inverse
relationship has been reported between professional nursing practice and mortality rates
(Aiken, Smith, & Lake, 1994; Aiken, Sloan, Lake, Sochalski, & Weber, 1999). Other
researchers revealed a significant inverse relationship between professional nursing
practice and needlestick injuries (Aiken, Sloan, & Klocinski, 1997). Units with professional
nursing practice reportedly have safer work environments (Institute of Medicine,
1983).Burnes-Bolton and colleagues (1990) reported an increase in patient satisfaction on a
medical/ surgical unit using the cost containment model of Cedars-Sinai Medical Center.
The authors attributed the increased patient satisfaction scores based on the perception
that nurses were spending more time with patients and families. Similar findings were
reported by Lamb and Huggins (1990), who reported increased patient satisfaction and

4. decreased length of stay in two diagnostic groups. The model used in this latter study was
the St. Mary's Professional Nursing Network.Daly, Rudy, and Thompson (1991) evaluated
outcomes of chronically critically ill patients. They reported increased patient and family
satisfaction in patients in a special care unit for chronically critically ill patients as
compared with patients in a traditional intensive care unit.While some positive
relationships between nursing models and patient outcomes have been reported, these
studies are dated and a number of methodologic issues have been reported on these same
studies. These issues relate to how and why the outcomes were selected for each of the
studies, sampling issues, lack of randomization, lack of a theoretical link between the
nursing model and patient outcomes selected, and timing of the studies (Weisman, 2006)
Organizational Application of Nursing Theory Discussion .The AACN Synergy Model for
Patient CareIn the 1990s, the American Association of Critical-Care Nurses (AACN)
assembled a think tank to discuss an envisioned new paradigm for nursing practice and
create a conceptual framework for certified practice. The think tank members agreed that
certified practice should be based on meeting patient needs and optimizing outcomes rather
than delineating a set of skills performed by nurses caring for acute and critically ill patients
(Hardin, 2005).From the original work of the think tank came a description of
characteristics a patient brings to a health care setting and a set of competencies that a
nurse brings to the bedside. Those original lists were later modified by a group of subject
matter experts to the eight patient characteristics and eight nurse competencies of the
AACN Synergy Model of Patient Care (Hardin, 2005).The AACN Synergy Model for Patient
Care describes nursing practice based on the eight patient characteristics. These
characteristics span the health-illness continuum (AACN, 2006). The patient characteristics
are resiliency, vulnerability, stability, complexity, resource availability, participation in care,
participation in decision making, and predictability.The synergy model also describes eight
nurse competencies. These competencies consist of clinical judgment, advocacy and moral
agency, caring practices, collaboration, systems thinking, response to diversity, facilitation
of learning, and clinical inquiry. According to the synergy model, "nursing care reflects an
integration of knowledge, skills, experience, and attitudes needed to meet the needs of
patients and families. Thus, continuums are derived from patient needs" (AACN, 2006). The
continuum ranges from 1 to 5, where 1 = competent; 5 = expert (AACN, 2006). Each of the
patient characteristics and nurse competencies are described in Tables 1 and 2, respectively
Organizational Application of Nursing Theory Discussion .The core concept of the 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
(AACN, 2006).The underlying tenets of the synergy model are: (a) patients' characteristics
are of concern to nurses; (b) nurses' competencies are important to patients; (c) patients'
characteristics drive nurses' competencies; and (d) when patients' characteristics and
nurses' competencies match and synergize, outcomes for the patient are optimal (Hardin &
Kaplow, 2005).The assumptions guiding the AACN Synergy Model for Patient Care are:?
Patients are biological, psychological, social, and spiritual entities who present at a
particular developmental stage. The whole patient (body, mind, and spirit) must be

5. considered.? The patient, family, and community all contribute to providing a context for
the nursepatient relationship.? Patients can be described by a number of characteristics. All
characteristics are connected and contribute to each other. Characteristics cannot be looked
at in isolation.? Similarly, nurses can be described on a number of dimensions. The
interrelated dimensions paint 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 care is to move a patient toward a peaceful death
(AACN, 2006) Organizational Application of Nursing Theory Discussion .Since its inception
in the 1990s, the synergy model has been used in a variety of clinical and academic settings.
Reed, Cline, and Kerfoot (2007) from Clarian Health Partners, Indianapolis, IN, which has
Magnet designation, describe how the synergy model has been implemented in their
facilities. Other facilities nationwide are in various phases of implementing the model. Pope
(2002) suggests considering implementing the synergy model to optimize patient
outcomes. Several clinical anecdotes and case studies of how the synergy model was
implemented and optimized patient outcomes in the clinical practice setting are available
on the AACN Web site at www.certcorp. org/certcorp/certcorp.nsf/edcfc72
ba47aaa708825666b0064bdcf/53b a8a716a70373d882567f700046eb4
?OpenDocument.The Synergy Model as a Professional Model of CareConceptual models are
important because they illuminate what is essential or relevant to a discipline (Curley,
2004). The evidence that has been presented supports the idea that models for professional
nursing practice lead to improved patient outcomes. When utilized as a professional model
of care, the synergy model provides a framework that defines the nurse's relationship with
the patient, other nurses, and the health care system. The model can also facilitate the
evolution of a common language for nurses in identifying and communicating the needs of
patients. It provides a viable means for delineating the role of professional nurses in directly
impacting the outcomes of patients and ultimately the overall success of health care
organizations (Reed et al., 2007) Organizational Application of Nursing Theory Discussion
.The synergy model is an excellent framework to organize the work of patient care
throughout the health care system (Kerfoot, 2004). It can be used and applied in various
ways and provides a comprehensive framework for assuring success in building a
philosophy that supports the Forces of Magnetism. The three components of the model
(patient characteristics, nurse competencies, and the health care environment) are all
integral parts that interact hyperdynamically to form a professional model of practice.The
patient side of the model provides a means of describing patients and their families in a way
that resonates with nurses and other caregivers. It provides the opportunity to build a
common language for caregivers as they describe patient needs. More importantly, it
emphasizes patient centrality and the need to know the patient. Further, the patient side of
the model facilitates the development of nursing practice that is grounded in the nurse-to-
patient relationship.Utilizing the eight characteristics of patients embedded in the AACN
Synergy Model, patient needs can be identified along a continuum of illness utilizing the
assessment parameters of vulnerability, resiliency, stability, complexity, predictability,
resource availability, participation in decision making, and participation in care (Reed et al.,
2007). As outlined in the eligibility requirements for Magnet designation, the model

6. provides a means for identifying and discussing patients' needs in an organized and
structured way, addressing their uniqueness and providing for care continuity throughout
the episode of illness. The characteristics out lined by the patient side of the model can then
be utilized to develop nurse communication via nurse-to-nurse report, documentation
systems, and the articulation of patient acuity. The information collected by assessing the
patients' needs assists in the development of an individualized plan of care and helps to
identify the nurse competencies required to meet those needs Organizational Application of
Nursing Theory Discussion .The nurse characteristics outlined by the synergy model
provide a comprehensive and contemporary view of the work of nurses (Curley, 1998). The
eight competencies included in the nurse side of the model, including clinical judgment,
caring practices, advocacy/ moral agency, response to diversity, clinical inquiry, facilitator
of learning, collaboration, and systems thinking provide a framework to articulate the work
of nurses and enables the ability to differentiate various levels of expertise. They can serve
as a basis for nurse job descriptions that distinguish various levels of nursing practice for
the purpose of skill enhancement, professional development, and career advancement.The
nurse side of the model delineating the eight characteristics of nurses can be utilized to
differentiate practice and assure that the competencies of the nurse match the needs of the
patient. It can serve as a trajectory for career development, including leadership skills, that
spans the continuum from novice to expert practitioner. The environment side of the model
addresses the context in which patient needs and nurse competencies come together.
Without an environment that supports these two sides of the model, the synergy will be less
than optimal and the realization of the best outcomes will not occur.The development of job
descriptions based on the nurse characteristics of the synergy model serves as a blueprint
for defining nursing practice and competencies that link to the needs of patients and their
families (Hardin & Kaplow, 2005). Each of the eight nurse characteristics of the model
allows for the categorization of essential elements of nursing practice that span the
continuum of novice to expert. Performance standards designed to enhance patient, nurse,
and system outcomes can then be leveled to form the framework for a career advancement
program. Movement along the career advancement continuum includes progressive degrees
of autonomy and authority that evolve through formal and experiential learning. Defined as
the expectation of independent nursing judgment, autonomy has been reported by Magnet
hospital staff nurses as an essential component of Magnetism and is one of the 14 Forces
outlined by ANCC for Magnet hospitals (Kramer & Schmalenberg, 2004) Organizational
Application of Nursing Theory Discussion .ORDER YOUR PAPER HEREDifferentiated
practice and the support of professional development require ongoing competencybased
educational programming characterized by judgment, intellect, leadership, and contribution
(Paccini, 2005). Creating this type of programming to support the use of the synergy model
promotes higher levels of independent nursing judgment where autonomy and
accountability are enhanced. Curricula designed to enhance the competencies outlined by
the nurse characteristics of the model can also support movement toward Magnet status by
demonstrating support and value for personal and professional growth and
development.The context of the health care environment provides the backdrop for the
synergy model and determines the successful interaction between the nurse and patient

7. characteristics. This side of the model includes the gestalt of organizational values that
support, recognize, reward and, value the contribution of nurses. These qualities are
inherent in the core values of the Magnet Recognition Program and include shared decision
making, competitive salaries, adequate resources, professional development opportunities,
and positive interdisciplinary relationships. It includes the organizational elements of
excellence in nursing care that is referred to as the Forces of Magnetism Organizational
Application of Nursing Theory Discussion .When all three sides of the synergy model are in
place, it can provide the framework for a professional model of care that supports
excellence in nursing care and satisfies the criteria outlined in the Magnet designation
program. When fully developed, it optimizes the ability to operationalize all of the Forces of
Magnetism. It provides a common philosophy to clearly set the direction for what is often
referred to as the "Magnet journey" by defining the work of patient care, the professional
development of nurses, and ultimately continuous improvement of patient, nurse, and
system outcomes.The synergy model is congruent with the Nursing Care Report Card for
Acute Care Settings framework for outcome analysis (Curley, 1998). When evaluating the
use of the model as a basis for nursing care delivery, three levels of outcomes can be
delineated; those derived from the patient, the nurse, and the health care system. Outcomes,
including nurse-sensitive indicators that help to distinguish nursing's unique contribution
to patients and their families, can be considered for measurement. These include such
things as patient satisfaction, complication rates, failure to rescue, and cost. Although clear
and distinct linkages between the use of the model and outcomes are difficult to infer,
several anecdotal reports illustrating the results of the use of the synergy model appear in
the literature.The model has been used in an array of clinical settings. Descriptive reports
and case studies exemplify how the model guided clinical care of acute and critically ill
patients (Hardin & Hussey, 2003; Smith, 2006), and helped to attain optimal patient
outcomes (Annis, 2002; Ecklund & Stamps, 2002; Hartigan, 2000; Hayes, 2000; Markey,
2001; Rohde & Moloney- Harmon, 2001). Additionally, the model has served as a
framework for conducting nursing rounds (Mullen, 2002) and in use with interdisciplinary
planning (Annis, 2002; Small & Moynihan, 1999) Organizational Application of Nursing
Theory Discussion .The synergy model has also been implemented by educators both in the
academic setting as the conceptual framework for clinical nurse specialist curricula (Cox &
Galante, 2003; Zungolo, 2004) and in the clinical arena (Kaplow, 2002).Reports further
exemplify how the synergy model has been used by advanced practice nurses to promote
optimal patient outcomes. The model provides a framework to assist APNs to identify levels
of patient characteristics and match the needs of the patient and family with the
competencies of the nurse providing care (Collopy, 1999; Moloney-Harmon, 1999).Nurse
leaders have utilized the synergy model in a number of ways. These include helping
determine adequate staffing ratios (Hartigan, 2000), as a framework for nurse job
descriptions, peer review evaluations, and developing a clinical advancement program. The
developers of this latter program reported using outcomes measurements, including
financial indicators, as components of the program (Czerwinski, Blastic, & Rice, 1999).
Other outcomes reported to be achieved through the development of a clinical advancement
program using the model include improvement in Leapfrog quality and safety measures,

8. patient satisfaction, nursing turnover, and the use of contracted labor (Cox, Reed, & Cline,
2007).$SidebarThe synergy model has also been implemented by educators both in the
academic setting as the conceptual framework for clinical nurse specialist curricula and in
the clinical arena Organizational Application of Nursing Theory Discussion
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from http://www.nursingknowledge. org/Portal/main.aspx?pageid=35
07&ContentID=56394 Organizational Application of Nursing Theory
DiscussionAuthorAffiliationROBERTA KAPLOW, PhD, RN, AOCNS, CCNS, CCRN, is a Clinical
Nurse Educator, Innovex, Inc., Parsippany, NJ. She is an immediate past member of the
AACN Board of Directors and former Director of the AACN Certification Corporation. She is
also co-editor of Synergy for Clinical Excellence. The AACN Synergy Model for Patient Care
and Critical Care Nursing. Synergy for Optimal Outcomes.KEVIN D. REED, MSN, RN, CNA, BC,
is the Director of Adult Critical Care Services/ Neurosciences, Clarian Health Partners,
Indianapolis, IN, which uses the AACN Synergy Model for Patient Care as the model for
nursing practice. He is also the Chair of the AACN Certification Corporation Organizational
Application of Nursing Theory Discussion