In this study Byrum et al. (2020) developed the ADT-SMAT, which was based on elements of The Synergy Model, “to quantify the intensity of patient care monitoring and interventions in order to incorporate the complexity and variability of patients’ responses and to capture nurses’ critical thinking and intuition. The ADT-SMAT combines the intimacy of the relationship with the patient and the patients characteristics with the complexity of the nurses work in maintaining patient stability” (Byrum et al, 2020, p.62). ). The ADT-SMAT is a tool that could be used by nurses during patient care to facilitate the use of The Synergy Model developed by the AACN to “quantify and standardize patient characteristics in determining the appropriate level of care associated with admission, discharge, and transfer decisions” (Byrum et al, 2020, p.69), and would “enable evidence-based staffing decisions to optimize the match of nursing competencies with patients’ needs (Byrum et al., p.66). After analyzing the data the researchers found that the ADT-SMAT, “demonstrates strong internal consistency when the same patients were scored independently by 2 critical care RNs” (Byrum et al., 2020, p.69). The researchers concluded that more testing is needed to test the construct validity of the descriptive elements included in the Synergy Model and to see how accurately the scores can predict the actual care level needs of patients especially when determining if a patient is ready to transfer to another unit for a lower level of care.
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Determining transfer and discharge criteria in the ICU is challenging. I can understand how more testing is needed to test the construct validity of this study.
Sanson et al. (2020) investigated whether nursing complexity upon ICU discharge is an independent predictor for adverse events. The Patient Acuity and Complexity Score (PACS) was developed to measure nursing complexity (Sanson et al., 2020). Its predictive power was tested and was determined to have a very good discrimination power (Sanson et al., 2020). The level of nursing complexity independently predicts risk of adverse effects and should be considered in establishing patient’s eligibility (Sanson et al., 2020).
This was the only study I could find that discussed similar subjects. This study was limited to transfers and discharges and did not discuss admission criteria into the ICU. Additionally, it focused on adverse effects rather than patient characteristics and nurse skill set.
The availability and usefulness of this acuity tool hopefully will allow charge nurses to better “match” patients with the right nurse or as you mentioned at least make it easier to determine if the patient’s acuity is so high that a one-to-one is required. I never would have known that there would even be a study about this.
Sanson, G., Marino, C., Valenti, A. Lucangelo, U., & Berlot, G. (2020, February 14). Is my patient ready for a safe transfer to a lower intensity care setting? nursing complexity as an independent predictor of adverse events risk after ICU discharge. Heart & Lung. https://www.heartandlung.org/article/S0147-9563(20)30015-7/fulltext
Thank you for your thoughtful response. It should always be a priority of the charge nurse to match patient complexity with nursing skill set. The ability to give charge nurses a reliable tool for matching patients to nurses would be invaluable. My most recent experience with witnessing a life-threatening mismatch was when we had a nurse from another department, float to the ICU for the day. She was one of the most advanced aged nurses I have ever worked with, and although she had plenty of nursing knowledge, I learned that day that she lacked the basic skills of attention and was casual in her responses to critical events and changes. During her shift that day, a patient’s cardiac red alarms were sounding off at the nursing station and when I and a few other nurses arrived to investigate, we found the floating nurse putting the patient’s socks on his feet and not paying attention to the alarm. The patient was in a lethal arrhythmia, unbeknownst to the primary nurse, who was more concerned about getting patients socks on. She had an inability to prioritize and should have never been asked to float to the ICU or paired with this patient.
To be honest, it took me a bit to figure out what this article was about based on the summary. This is a field that is very different than what I’m in, so I wasn’t familiar with the terms. Now that I’m caught up this is a great topic. I wasn’t aware there were tools available to help assess patient needs and staff competencies in order to pair them appropriately. This made me wonder what, if any, options were available other than the one presented in the article. The Complexity Assessment and Monitoring to Ensure Optimal Outcomes (CAMEO) is another tool that was used to quantify patient acuity relating to nursing skill set (Connor et al., 2019). This study created an adapted version called the CAMEO II for the pediatric ICU. They did indicate that further research is needed to assess use across multiple sites. I can see how the ADT-SMAT or CAMEO can help to improve patient care. Thank you for the great information.
Connor, J. A., Lagrasta, C., Gauvreau, K., Porter, C., Oʼbrien, K., & Hickey, P. A. (2019). Scaling the Measurement of Pediatric Acuity Using the Complexity Assessment and Monitoring to Ensure Optimal Outcomes (CAMEO II) Tool. Dimensions of Critical Care Nursing, 38(3), 146–152. doi: 10.1097/dcc.0000000000000356
Thank you for looking up that information on the CAMEO II. I wonder how a nurse would go about getting training, accessing and implementing a tool like the CAMEO II or the ADT-SMAT? Warren et al. (2016) examined nurse’s perceptions and ability to implement evidence based practice (EBP) in their workplace. They found that internationally nurses had a positive view of EBP and believed that implementation of EBP within their hospital would be beneficial to their hospital and to patients. But these same nurses also reported many barriers in implementing EBP, such as a basic lack of knowledge on how to implement EBP in the clinical setting. Warren et al. (2016) suggest that implementation of EBP starts with nurse leaders who will “share the vision for implementing EBP” (p.15) and provide nurses with educational resources and tools.
Reference
Warren, J. McLaughlin, M. Bardsley, J., Eich, J. Esche, C., Kropkowski, L. Risch, S. (2016). The strengths and challenges of implementing EBP in healthcare systems. World Views on Evidence Based Nursing, 13(1), 15-24. doi: 10.111/wvn.12149
Although the study shows positive results, it needs more extensive research in different settings. This research must take further action to prove the results to be valid. Berke & Ecklunc (2002) explained that there several ways to measure the level of care for patients. Using acuity systems and patient classification systems can also describe the patients’ traits and requirements. Through a collaborative effort in management and nurse staffing, each type of acuity system can provide objectivity to staffing needs. A comprehensive strategic plan of care involves regulated examining processes and techniques of risk management, proactive approaches or guidelines, and constant supervision of possible patient care cases or quality indicators. The various acuity systems will help to determine patients’ level of care, thus furthering the study’s purpose and need.
Berke, W. J., & Ecklunc, M. M. (2002). Keep pace with step-down care. Nursing Management, 33(2), 26-29. doi:http://dx.doi.org.ezproxy.fhsu.edu:2048/10.1097/00006247-200202000-00012
Thank you for your response. I wonder at what point do researchers consider a tool valid, safe, accurate, practical, and user-friendly for the clinical setting? Warren et al. (2016) suggest that world-wide EBP educational courses called “massive open online courses (MOOC)” and Magnet conferences can serve as resources for nurses to increase their knowledge of and exposure to EBP. These resources help nurses to plan out ways to implement EBP in the clinical setting and I would imagine the tools/education submitted by the MOOC or Magnet conferences would only be recommended for clinical use once they had been thoroughly studied for accuracy and safety.
Reference
Warren, J. McLaughlin, M. Bardsley, J., Eich, J. Esche, C., Kropkowski, L. Risch, S. (2016). The strengths and challenges of implementing EBP in healthcare systems. World Views on Evidence Based Nursing, 13(1), 15-24. doi: 10.111/wvn.12149
This study was very interesting to me and how this method is used. I never heard of it before but it appears to be a very good tool to use and it could only improve the outcome of the patient and their experience during their hospital stay along with staffing assignments as well. From the information I was able to obtain from other research is that When the competencies and characteristics of the nurse match the needs of the patient (physical, psychosocial, and spiritual), synergy occurs and optimal outcomes are achieved.(Am J Crit Care (2020)p.70)This method will also improve the rate of nursing shortage that continue to be a big issue in healthcare today. If nurses are more competent in a certain area they will excel in that area due to it being something there interested in and most importantly allow them to connect more with the patients.
Cain.C.DNP,RN,CNS,CCRN.(2020). Applying the Synergy Model to Achieve Safe Staffing. American Journal Critical Care.29(1):70 doi.org/10.4037/ajcc2020323
Thank you for responding to my post. I think you are right; nurses should become proficient in an area of nursing that is interesting and important to them. Patients and co-workers know when a nurse is passionate about their work and this allows nurses to connect with patients at a deeper level. Developing greater competency in nursing also helps nurses to become more passionate about their work, especially when they can see that they have successfully promoted a positive change within their organization. Nurses should be given the education and tools needed to spearhead changes within their workplace based on implementation of EBP. Fisher et al. (2016) stated, “studies suggest that successful EBP change in an organization requires senior leadership support and a systematic program for long term practice change”. In their study they developed a specific framework for nurses to progress through with the goal of getting nurses competent in analyzing and conducting research on EBP, implementing EBP in the clinical setting, supporting quality improvement, and “commit[ing] resources and easy access to experts in EBP, QI and research” (Fisher et al, 2016). This framework is called INSPIRE (Innovation for nursing-sensitive practice in a research environment). If all health professionals had access to this framework as well as the support needed to work through the framework, nurses would feel more confidence in implementing EBP in the clinical setting, which would increase nursing competency.
Reference
Fisher, C., Cusack, G., Cox, K., Feigenbaum, K., Wallen, G. (2016). Developing competency to sustain evidence-based practice. The Journal of Nursing Administration, 46(11), 581-585. doi:10.1097/NNA.0000000000000408.