Overview of the Theoretical Review Process
Critical Care Nurse, Vol.
20, No. 1, February 2000
Karen R. Sechrist, RN, PhD, Linda E. Berlin, RNC, DrPH,
Melissa Biel RN, MSN
Since the development of the Synergy Model by the AACN Certification
Corporation, the major tenets of the model have been described, tested in a validation
study (Greenberg S, Muenzen PM, Smith IL, unpublished manuscript, 1999) and applied
in clinical settings. The next logical step, as identified by the Board of Directors
of AACN Certification Corporation, was to obtain critical evaluation of the Synergy
Model by an independent panel of reviewers with expertise in nursing theory analysis
from varying clinical perspectives. The goal of the review process was to identify
the strengths and weaknesses of the Synergy Model and obtain recommendations regarding
refinement of the model. The Board of Directors contracted with Berlin Sechrist
Associates to develop the review instrument, oversee the entire review process,
and summarize the results. The Board of Directors appointed an advisory group to
provide input into all aspects of the process. Members of the Synergy Model Advisory
Group: Kimmith Jones, RN, MS, CCRN; Aimee Lyons, RN, MSN, PNP, CCRN; Patricia McGaffigan,
RN, MS; and Daphne Stannard, RN, PhD. Martha Curley, RN, PhD, CCNS, CCRN joined
the group following selection of the reviewers.
As a call for reviewers, all members of the American Academy
of Nurses were sent a letter, in which the objective of the review process and the
selection criteria were described, accompanied by a reprint of Curley's article,
Patient-Nurse Synergy: Optimizing Patients' Outcomes. Respondents were invited to
apply or to encourage nonmember colleagues to submit applications. The 84 respondents
provided copies of their curricula vitae, along with signed forms indicating willingness
to participate and meet the time line obligations. Berlin Sechrist Associates reviewed
all credentials and recommended 10 individuals based on the following selection
criteria: expertise in analysis of theoretical and conceptual frameworks or models,
clinical specialty, and geographic region.
Berlin Sechrist Associates developed a review form that was
designed to obtain qualitative and quantitative information. Development of the
form was challenging because there is considerable variation with respect both to
the terminology and essential components for the evaluation of conceptual frameworks
or theory in the literature. Rather than selecting one critique schema, an attempt
was made to meld existing terminology and components into criterion categories that
would prompt thoughtful responses regardless of the framework preferences of the
The review instrument was organized in six major criterion
sections: clarity, consistency, adequacy, utility, significance, and summary. Reviewers
were asked to respond separately to specific components of each criterion to ensure
comprehensiveness of responses (Table). In addition to narrative response, six-point
scales were developed to measure quantitative ratings for each of the criterion
components. Each rating scale was anchored by the total absence to total presence
of the criterion component, such as "unclear" and "very clear" for clarity.
Model review instrument criteria and criterion components
Explanation of the philosophical bases of the Synergy Model
Description of the central principle, definitions, and assumptions
Inclusion of the meaningful diagrams and explanations
Logic of presentation
Lack of ambiguity
Congruence of the Model with its philosophical bases
Constancy in use of terms, interpretations, and components
of the Model
Coherence in concepts of the Model
Comprehensive of scope within area of concern and level of
Inclusive of concepts related to person, environment, health,
Reflective of current nursing realities
Feasibility of using concepts of the Model to guide nursing
practice, education, administration, and research
Applicability of the Model beyond the critical care setting
to other clinical, cultural, and geographic settings
Attainability of projected outcomes
Testability of concepts of the Model
Ability of the Model to generate quantitative and qualitative
Delineation of essential issues in nursing
Derivation of nursing interventions influencing patient outcomes
Development of nursing knowledge
Discrimination of nursing from other health professions
Congruence of the Model with patient, community, and healthcare
Potential contribution of the Model to nursing as a discipline
Potential of the Model to positively affect patient outcomes
Strengths of the Model
Weaknesses of the Model
Recommendations for refinement of the Model
On September 1, 1999, review materials, including all publications
about the Synergy Model, were mailed to reviewers. Nine of the 10 reviewers completed
the in-depth review process by November 1; they are Barbara Stevens Barnum, RN,
PhD; Marion E. Broome, RN, PhD; Rose E. Constantino, PhD, JD, RN; Jacqueline Fawcett,
PhD; Edna M. Menke, PhD, RN; Carolyn Murdaugh, RN, PhD, Patricia Moritz, PhD, RN;
Bonnie Rogers, DrPH, COHN-S; and Marilyn Frank-Stromborg, EdD, JD, ANP.
Reviewers' responses and comments were summarized using quantitative
and qualitative analytic procedures. The results were discussed with the Synergy
Model Advisory Group and presented to the AACN Certification Corporation Board of
Directors. Further, results will also be presented at the AACN National Teaching
Institute and will be summarized for publication. The results will be used to further
guide the refinement of the Synergy Model.
1. Biel M. Reconceptualizing Certified
Nursing Practice: Envisioning Critical Care Practice of the Future. Aliso
Viejo, Calif.: AACN Certification Corporation; 1997.
2. AACN Certification Corporation.
Resource Booklet. Aliso Viejo, Calif.: AACN Certification Corporation;
3. Curley MAQ. Patient-nurse synergy: optimizing patients'
outcomes. Am J Crit Care. 1988;7(1):64-72
4. Edwards DF. The Synergy Model: linking patient needs to
nurse competencies. Crit Care Nurse . 1999;19(1):88-90.
5. Moloney-Harmon PA. The Synergy Model: contemporary practice
of the clinical nurse specialist. Crit Care Nurse.
6. Small B, Moynihan P. The day the lights went out: one charge
nurse's nightmare. Crit Care Nurse. 1999;13(3):79-82.
7. Czerwinski S, Blastic L, Rice B. The Synergy Model: building
a clinical advancement program. Crit Care Nurse.
8. Barnum, BS. Nursing Theory: Analysis,
Application, Evaluation, 5th ed. Philadelphia, Pa: Lippincott; 1998.
9. Chin PL, Kraemer MK. Theory and
Nursing: A Systemmatic Approach. St. Louis, Mo: Mosby-Year Book; 1991.
10. Fawcett J. Analysis and Evaluation
of Conceptual Models of Nursing, 3rd ed. Philadelphia, Pa: FA Davis; 1995.
11. Meleis AI. Theoretical Nursing:
Development and Progress. 3rd ed. Philadelphia, Pa: Lippincott; 1997.
12 . Silva MC, Sorrell JM. Testing of nursing theory: critique
and philosophical expansion. Adv Nurs Sci. 1992;