In the innovative cooperative care model, nurses partner with lay caregivers who assume responsibility for 24 hour care of the hematopoetic stem cell transplant recipient.  Preparation and support of lay carepartners to assume acute care responsibilities are key nursing interventions.  Identification of the nature and dose of independent nursing actions is critical to evaluate interventions designed to educate/prepare carepartners for their role. No measure exists to quantify the “dose” of nursing actions to accomplish this responsibility.  The purpose of this study was to test the validity and reliability of the Independent Nursing Actions Scale (INAS).

Our conceptual model, Independent Nursing Actions to Manage Signs and Symptoms in Cooperative Care, was developed from a qualitative study of nurses’ independent nursing actions with the lay carepartner. Seven categories of independent nursing actions lead to management of signs and symptoms.  Surveillance leads to problem identification that in turn triggers other actions (teaching, coaching, fostering partnership, providing psychosocial support, and rescuing).  Coordinating manages all aspects of care. 

This methodologic study tested the reliability and validity of the INAS developed from the qualitative data and validated with nurse participants. The 27-item Likert-type instrument was completed by 14 cooperative care nurses during 743 carepartner/recipient shifts to rate the intensity of independent nursing actions.  Patient acuity was rated on a 1 to 3 scale by an independent nurse rater.  Statistically significant differences in INAS scores across the acuity ratings support the validity of the INAS. The coefficient alpha for the total scale was .88.