University of the Philippines Manila
The Health Sciences Center
COLLEGE OF NURSING
WHO Collaborating Centre for Leadership in Nursing Development
Sotejo Hall, Pedro Gil St., Ermita, Manila
Tel.: (632)523-1472 / Telefax: (632)523-1485
N-109.1: Nursing Interventions 3-A
Nursing Care of Clients with Life-Threatening Conditions
1st Semester AY 2016-2017
SYNERGY MODEL: Critical Care Nursing Practice
Patient Characteristics /
Level 1 Level 3 Level 5
Needs
Stability Minimally stable Moderately stable Highly stable
The ability to maintain a Labile; unstable; unresponsive Able to maintain steady Constant; responsive to
steady-state equilibrium. to therapies; high risk of death state for limited period of therapies; low risk of death
time; some responsiveness
to therapies
Complexity Highly complex Moderately complex Minimally complex
The intricate entanglement of Intricate; complex Moderately involved Straightforward; routine
two or more systems (e.g., patient/family dynamics; patient/family dynamics patient/family dynamics;
body, family, therapies) ambiguous/vague; atypical simple/clear cut; typical
presentation presentation
Predictability Not predictable Moderately predictable Highly predictable
A characteristic that allows one Uncertain; uncommon patient Wavering; occasionally Certain; common patient
to expect a certain course of population/illness; unusual or noted patient population/illness; usual and
events or course of illness unexpected course; does not population/illness expected course; follows
follow critical pathway, or no critical pathway
critical pathway developed
Resiliency Minimally resilient Moderately resilient Highly resilient
The capacity to return to a Unable to mount a response; Able to mount a moderate Able to mount and maintain a
restorative level of functioning failure of response; able to initiate response; intact
using compensatory/coping compensatory/coping some degree of compensatory/coping
mechanisms; the ability to mechanisms; minimal compensation; moderate mechanisms; strong reserves;
bounce back quickly after an reserves; brittle reserves endurance
insult
Vulnerability Highly vulnerable Moderately vulnerable Minimally vulnerable
Susceptibility to actual or Susceptible; unprotected, Somewhat susceptible; Safe; out of the woods;
potential stressors that may fragile somewhat protected protected, not fragile
adversely affect patient
outcomes
Participation in decision- No participation Moderate level of Full participation
making Patient and family have no participation Patient and family have
Extent to which patient/family capacity for decision-making; Patient and family have capacity, and makes decision
engages in decision-making requires surrogacy limited capacity; seeks for self
input/advice from others in
decision-making
Participation in care No participation Moderate level of Full participation
Extent to which patient/family Patient and family unable or participation Patient and family fully able
engages in aspects of care unwilling to participate in care Patient and family need to participate in care
assistance in care
Resource availability Few resources Moderate resources Many resources
Extent of resources (e.g., Necessary knowledge and Limited knowledge and skills Extensive knowledge and
technical, fiscal, personal, skills not available; necessary available; limited financial skills available and accessible;
psychological and social) the financial support not available; support available; limited financial resources readily
patient/family/community minimal personal/psychological available; strong
bring to the situation personal/psychological supportive resources; personal/psychological
supportive resources; few limited social systems supportive resources; strong
social systems resources resources social systems resources
Source: American Association of Critical Care Nurses, 2016. Page 1 of 3
University of the Philippines Manila
The Health Sciences Center
COLLEGE OF NURSING
WHO Collaborating Centre for Leadership in Nursing Development
Sotejo Hall, Pedro Gil St., Ermita, Manila
Tel.: (632)523-1472 / Telefax: (632)523-1485
N-109.1: Nursing Interventions 3-A
Nursing Care of Clients with Life-Threatening Conditions
1st Semester AY 2016-2017
SYNERGY MODEL: Critical Care Nursing Practice
Nurse Competencies Level 1 Level 3 Level 5
Clinical judgment Collects basic-level data; Collects and interprets Synthesizes and interprets multiple,
Clinical reasoning, which follows algorithms, complex patient data; makes sometimes conflicting, sources of data;
includes clinical decision- decision trees and clinical judgments based on an makes judgment based on an immediate
making, critical thinking and a protocols with all immediate grasp of the whole grasp of the whole picture, unless working
global grasp of the situation, populations and is picture for common or routine with new patient populations; uses past
coupled with nursing skills uncomfortable deviating patient populations; recognizes experiences to anticipate problems; helps
acquired through a process of from them; matches formal patterns and trends that may patient and family see the "big picture";
integrating formal and knowledge with clinical predict the direction of illness; recognizes the limits of clinical judgment
informal experiential events to make decisions; recognizes limits and seeks and seeks multidisciplinary collaboration
knowledge and evidence- questions the limits of appropriate help; focuses on and consultation with comfort; recognizes
based guidelines one's ability to make key elements of case, while and responds to the dynamic situation
clinical decisions and sorting out extraneous details
delegates the decision-
making to other clinicians;
includes extraneous detail
Caring practice Focuses on the usual and Responds to subtle patient and Has astute awareness and anticipates
Nursing activities that create a customary needs of the family changes; engages with patient and family changes and needs; fully
compassionate, supportive and patient; no anticipation of the patient as a unique patient engaged with and sensing how to stand
therapeutic environment for future needs; bases care on in a compassionate manner; alongside the patient, family and
patients and staff, with the aim standards and protocols; recognizes and tailors caring community; caring practices follow the
of promoting comfort and maintains a safe physical practices to the individuality of patient and family lead; anticipates hazards
healing and preventing environment; patient and family; and avoids them, and promotes safety
unnecessary suffering. acknowledges death as a domesticates the patient's and throughout patient's and family's transitions
Includes, but is not limited to, potential outcome family's environment; along the healthcare continuum;
vigilance, engagement and recognizes that death may be orchestrates the process that ensures
responsiveness of caregivers, an acceptable outcome patient's/family's comfort and concerns
including family and healthcare surrounding issues of death and dying are
personnel met
Advocacy / moral agent Works on behalf of patient; Works on behalf of patient and Works on behalf of patient, family and
Working on another's behalf self assesses personal family; considers patient community; advocates from patient/family
and representing the concerns values; aware of ethical values and incorporates in perspective, whether similar to or different
of the patient/family and conflicts/issues that may care, even when differing from from personal values; advocates ethical
nursing staff; serving as a surface in clinical setting; personal values; supports conflict and issues from patient/family
moral agent in identifying and makes ethical/moral colleagues in ethical and perspective; suspends rules - patient and
helping to resolve ethical and decisions based on rules; clinical issues; moral decision- family drive moral decision-making;
clinical concerns within and represents patient when making can deviate from rules; empowers the patient and family to speak
outside the clinical setting patient cannot represent demonstrates give and take for/represent themselves; achieves
self; aware of patients' with patient's family, allowing mutuality within patient/professional
rights them to speak/represent relationships
themselves when possible;
aware of patient and family
rights
Response to diversity Assesses cultural diversity; Inquires about cultural Responds to, anticipates and integrates
The sensitivity to recognize, provides care based on differences and considers their cultural differences into patient/family care;
appreciate and incorporate own belief system; learns impact on care; accommodates appreciates and incorporates differences,
differences into the provision the culture of the personal and professional including alternative therapies, into care;
of care; differences may healthcare environment differences in the plan of care; tailors healthcare culture, to the extent
include, but are not limited to, helps patient/family possible, to meet the diverse needs and
cultural differences, spiritual understand the culture of the strengths of the patient/family
beliefs, gender, race, ethnicity, healthcare system
lifestyle, socioeconomic status,
age and values
Source: American Association of Critical Care Nurses, 2016. Page 2 of 3
Nurse Competencies Level 1 Level 3 Level 5
Clinical inquiry Follows standards and Questions appropriateness of Improves, deviates from or individualizes
The ongoing process of guidelines; implements policies and guidelines; standards and guidelines for particular
questioning and evaluating clinical changes and questions current practice; patient situations or populations; questions
practice and providing research-based practices seeks advice, resources or and/or evaluates current practice based on
informed practice; creating developed by others; information to improve patient patients' responses, review of the literature,
practice changes through recognizes the need for care; begins to compare and research and education/learning; acquires
research utilization and further learning to improve contrast possible alternatives knowledge and skills needed to address
experiential learning patient care; recognizes questions arising in practice and improve
obvious changing patient patient care; (The domains of clinical
situation (e.g., judgment and clinical inquiry converge at
deterioration, crisis); needs the expert level; they cannot be separated)
and seeks help to identify
patient problem
Facilitation of learning Follows planned Adapts planned educational Creatively modifies or develops
The ability to facilitate learning educational programs; sees programs; begins to recognize patient/family education programs;
for patients/families, nursing patient/family education as and integrate different ways of integrates patient/family education
staff, other members of the a separate task from teaching into delivery of care; throughout delivery of care; evaluates
healthcare team and delivery of care; provides incorporates patient's patient's understanding by observing
community; includes both data without seeking to understanding into practice; behavior changes related to learning; is able
formal and informal facilitation assess patient's readiness sees the overlapping of to collaborate and incorporate all healthcare
of learning or understanding; has educational plans from providers' and educational plans into the
limited knowledge of the different healthcare providers' patient/family educational program; sets
totality of the educational perspectives; begins to see the patient-driven goals for education; sees
needs; focuses on a nurse's patient as having input into patient/family as having choices and
perspective; sees the goals; begins to see consequences that are negotiated in relation
patient as a passive individualism to education
recipient
Collaboration Willing to be taught, Seeks opportunities to be Seeks opportunities to teach, coach and
Working with others (e.g., coached and/or mentored; taught, coached and/or mentor and to be taught, coached and
patients, families, healthcare participates in team mentored; elicits others' advice mentored; facilitates active involvement and
providers) in a way that meetings and discussions and perspectives; initiates and complementary contributions of others in
promotes/encourages each regarding patient care participates in team meetings team meetings and discussions regarding
person's contributions toward and/or practice issues; and discussions regarding patient care and/or practice issues;
achieving optimal/realistic open to various team patient care and/or practice involves/recruits diverse resources when
patient/family goals; involves members' contributions issues; recognizes and suggests appropriate to optimize patient outcomes
intra- and inter-disciplinary various team members'
work with colleagues and participation
community
Systems thinking Uses a limited array of Develops strategies based on Develops, integrates and applies a variety of
Body of knowledge and tools strategies; limited outlook - needs and strengths of strategies that are driven by the needs and
that allow the nurse to manage sees the pieces or patient/family; able to make strengths of the patient/family; global or
whatever environmental and components; does not connections within holistic outlook - sees the whole rather than
system resources exist for the recognize negotiation as an components; sees opportunity the pieces; knows when and how to
patient/family and staff, within alternative; sees patient to negotiate, but may not have negotiate and navigate through the system
or across healthcare and non- and family within the strategies; developing a view on behalf of patients and families;
healthcare systems isolated environment of of the patient/family transition anticipates needs of patients and families as
the unit; sees self as key process; recognizes how to they move through the healthcare system;
resource obtain resources beyond self utilizes untapped and alternative resources
as necessary
Source: American Association of Critical Care Nurses, 2016. Page 3 of 3
