Provision of emotional support and teaching
 
Acute renal failure is often very sudden and unexpected for both the patient and the family members. Thorough patient teaching about nutritional needs, fluid restrictions, medications, and the role of dialysis is essential in providing emotional support patients and family members.
 
Success story as it relates to the AACN synergy model
 
Nurse competencies
 
The complex care needs identified in John’s case exemplar should be correlated with the assigned nurse’s skill set and competencies according to AACN Synergy Model. The eight nursing competencies of the Synergy Model are as follows: clinical judgment, advocacy and moral agency, caring practice, collaboration, systems thinking, response to diversity, facilitator of learning, and clinical inquiry. Each competency is important in providing care; however, the competencies that take priority for John are clinical judgment, clinical inquiry, collaboration, and response to diversity.
 
The nurse would need strong clinical judgment to interpret and make decisions based on assessment findings that indicate John is in ARF caused by sepsis. John’s complex care requires his nurse to be clinically competent in assessment skills and additional skill sets for mechanical ventilation, pharmacology, and CRRT.
 
The clinical inquiry in John’s case incorporates ongoing questioning and evaluation of practice to direct John’s care through the use of evidence based guidelines. The use of Norepinephrine and CRRT are currently standard of practice for ARF.
 
Collaboration with multiple caregivers was also essential based on John’s complex needs for mechanical ventilation, IV vasopressor, and dialysis. John’s rapid decline and loss of consciousness warrants an advocate acting in his behalf to resolve both ethical and clinical concerns. Both response to diversity and caring practice are important due to the embarrassment of his erectile dysfunction, frequent partners, and use of Viagra.
 
Outcomes
 
The AACN Synergy Model measures nursing outcomes based on the dimensions of nursing practice. According to Kaplow and Hardin (2007), when the nursing competencies are properly assigned based on the patient characteristics, the expected outcomes should include “the extent to which care objectives are met, management of physiological changes, and the presence or absence of preventable complications” (p. 4). The outcomes from John’s case exemplar were very favorable.
 
Forty-eight hours after CRRT was started, John’s potassium level was 3.5, his creatinine level was 6.3, and his BUN was 61. Potassium was added to his intravenous fluids and his electrolytes continued to trend toward normal.
 
After five days of the initiation of antibiotic, John’s sepsis was slowly resolving and he was weaned from both the ventilator and his vasoactive drips. Total parenteral nutrition and IV antibiotics were continued until day 14 of hospitalization. John’s renal function returned and he was discharged from the hospital on day 18.
 
Conclusion
 
The AACN Synergy Model is especially applicable in critical care areas where patient care is very complex. ARF occurs in two-thirds of intensive care patients and those who are treated with CRRT have a mortality rate of 40-60% even with correction of biomarkers.
Utilization of nursing competencies in the AACN Synergy Model for screening, treatment options, and measureable outcomes in ARF will provide optimal patient outcomes as evidenced by decreased length of stay, decrease costs, and decreased mortality.
 
References

 Broden, C. (2009, April 1). Acute renal failure and mechanical ventilation: reality or myth?
Critical Care Nurse, 29(2), 62-75.
 Campbell, D. (2003, January 1). How acute renal failure puts the brakes on kidney function.
 Nursing 2003, 33(1), 59-63.
 Kaplow, R., & Hardin, S. (2007). Critical care nursing: Synergy for optimal outcomes. Sudbury,
 Massachesetts: Jones and Bartlett Publishers.
 Kosinski, M. (2009). What's old is new again: AKI and ARF. Presented at the 2009 NTI and
 Critical Care Exposition. AACN.
 Murray, P., & Hall, J. (2000). Renal replacement therapy for acute renal failure. American
 Journal of Respiratory Care Medicine, 162, 777-781.
 Pannu, N., Klarenbach, S., Wiebe, N., Manns, B., & Tonelli, M. (2008, February 20). Renal
 replacement therapy in patients with acute renal failure a systematic review. JAMA,
 299(7), 93-805.
 Paton, M. (2007, September 1). CRRT: Help for acute renal failure. Nursing Made Incredibly
 Easy! pp. 28-38.
 Thurman, P. (2009) Ins and outs of continuous renal replacement therapies: a case study
 approach. Presented at the 2009 NTI and Critical Care Exposition. AACN.
 Uchino, S., Kellum, J., Bellomo, R., Doig, G., Morimatsu, H., Morgera, S., Schetz, M., Tan, I.,
 Bouman, C., Macedo, E., Gibney, N., Tolwani, A., & Ronco, C. (2005, August 17).
 Acute renal failure in critically ill patients: A multinational, multicenter study. JAMA,
 294(7), 813-818. 

Back to Top

Bookmark this page

Digg Facebook Google Bookmarks Stumbleupon Livejournal Twitter