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AJ was almost 2 years old and had never been in the hospital. In the weeks before admission, his parents noticed that he was holding his head to one side and resisting efforts to straighten it. AJ was also becoming ataxic. A few days before admission, he experienced emesis and became lethargic. His parents were frightened when they were told that AJ had a malignant brain tumor. He was admitted to the pediatric intensive care unit (PICU) after craniotomy for removal of the tumor, was medically stable, and required routine postoperative care. The morning after surgery, AJ was awake and looked around but avoided eye contact. He refused to smile or to pay attention to books or toys. He held his special blanket close to his face. His eyes were huge under the gigantic turban of gauze and tape. With pain medication, he relaxed somewhat but still refused to interact with his nurse. AJ initially brightened when his mother arrived but showed little interest in her efforts to beguile him. Because AJ was preverbal, it was impossible for him to tell us why he was so unhappy. As his mother talked, she stated that AJ was one of four boys. His oldest brother was almost 5 years old, the next boy was 3 years old, and AJ had a twin brother, NJ. The boys’ father was at home with them until grandparents arrived from another state to help with their care. AJ’s mother was assured that the children were welcome to visit and that the certified child-life specialist would help them understand what to expect before coming into the unit. When the rest of the family arrived, AJ was observed closely. The sight of his father and older brothers elicited a response similar to that of his mother’s arrival, but when AJ saw his twin brother, a metamorphosis occurred. When twin NJ saw AJ, he broke loose from his father’s hand and ran to the bed. It was suggested that his mother pick up NJ and place him on the bed next to AJ, at which time AJ became a “new man.” He sat up straight, looked around the room, and smiled with his nurse and his entire family. AJ’s twin had brought Mylar balloons, and within minutes both AJ and NJ were hitting the balloons and laughing out loud. AJ’s mother later expressed her feelings about the encounter. When she and AJ’s father had seen the change in their son, they were able to remain hopeful about their ability to face the future. Their need, at that time, was for their family to be together. AJ’s special need was to be with his twin brother. Regardless of the anticipated outcome, admission of a child to the PICU is a highly stressful event for families. Effective pediatric critical care nurses see the child and family as an integral unit that is central to the healthcare system and are perceptive to the needs of the entire family as they move through the crisis. Nurses who view patients and families as partners in care acknowledge both the psychosocial and physical needs of the developing child and family. When guided by the American Association of Critical-Care Nurses (AACN) Synergy Model for Patient Care, nursing practice places the patient’s and the family’s needs as its central or driving force. When nursing competencies are based on these needs, optimal patient outcomes result (Curley, 2001). By practicing within the Synergy Model for Patient Care, the pediatric critical care nurse can articulate how he or she contributed to the patient’s outcomes. THE SYNERGY MODEL FOR PATIENT CARE The AACN Synergy Model for Patient Care was initially developed by the AACN Certification Corporation to serve as the foundation for certifying critical care nursing practice (AACN Certification Corporation, 2015; Hardin & Kaplow, 2017). A. Core Concepts The following are core concepts of the Synergy Model for Patient Care: 1. The needs and characteristics of patients and their families influence and drive the competencies of the nurse. 2. Synergy occurs when individuals work together in ways that move them toward a common goal. 3. An active partnership between the patient and the nurse will result in optimal outcomes. CARING FOR CRITICALLY ILL CHILDREN AND THEIR FAMILIES Jodi E. Mullen and Mary Frances D. Pate 1 2 ■ 1. Caring for Critically Ill Children and Their Families B. Patient and Family Characteristics Every patient and his or her family bring a unique set of characteristics to the care situation. Each characteristic exists along a continuum, and the patient can fluctuate along that continuum as his or her needs evolve over time. 1. Stability. The ability to maintain a steady state 2. Complexity. The intricate entanglement of two or more systems (body, family, therapies) 3. Predictability. A collective characteristic that allows the nurse to anticipate the patient moving along a certain illness trajectory 4. Resiliency. The capacity to return to a previous level of functioning 5. Vulnerability. Susceptibility to stressors that may affect outcomes 6. Participation in Decision Making. The extent to which the patient and family participate in decision making 7. Participation in Care. The extent to which the patient and family can participate in care 8. Resource Availability. Resources (e.g., personal, financial, social) the family brings to the care situation C. Nurse Competencies Nurse competencies are driven by the needs of the patient and family. These competencies reflect the integration of nursing knowledge, skills, and experiences that are required to meet the patient’s and family’s needs and to optimize their outcomes. Each competency has different levels of experience ranging along a continuum from novice to competent to expert practitioner. Although the competencies, as a whole, reflect the entirety of nursing practice, each competency becomes more or less important depending on the patient’s needs at the time. 1. Clinical Judgment. Clinical reasoning and critical thinking skills 2. Caring Practices. Creating a therapeutic environment based on the unique needs of the patient and family 3. Advocacy/Moral Agency. Working on another’s behalf; resolving ethical concerns 4. Collaboration. Working with others in a way that encourages each person’s contribution toward the patient’s goals 5. Systems Thinking. Recognizing the interrelationship within and across healthcare systems 6. Response to Diversity. Recognizing and incorporating differences into care 7. Clinical Inquiry. Ongoing questioning and evaluation of practice 8. Facilitator of Learning. Facilitating patient and family learning D. Outcomes Optimal outcomes result when the patient characteristics and nursing competencies are matched. Because the Synergy Model for Patient Care views the patient and family as active participants in the model, the outcomes measured should be patient and family driven. The following are examples of potential outcomes to be measured (Curley, 2001). 1. Outcomes from a patient perspective a. Functional change b. Behavioral change c. Trust d. Satisfaction e. Comfort f. Quality of life 2. Outcomes from a nursing perspective a. Physiologic changes b. Presence or absence of complications c. Extent to which treatmen