Describing Independent Nursing Actions That Promote Partnering With Lay Caregivers in Cooperative Care

Margaret E. Wilson, PhD, CPNP¹, June Eilers, PhD, RN², Judith Heermann, PhD, RN¹, and Susan E. Knutson, MSN, RN². (1) College of Nursing, University of Nebraska Medical Center, Omaha, NE, USA, (2) University Hospital, Nebraska Medical Center, Omaha, NE, USA

Population, Sample, Setting, Years: The entire population of Cooperative Care nurses (n=12) participated in the study. The setting was the Lied Transplant Cooperative Care Center, The Nebraska Medical Center, Omaha, Nebraska where lay carepartners assume responsibility for acute care of the transplant recipient in partnership with nurses. Data were collected in 2003.

Methods: Data were collected via two focus groups, 59 narrative logs from 12 shifts dictated by participants immediately following episodes of care and 3 follow-up interviews. Data were audiotaped, transcribed, and analyzed using content analysis.

Findings: Independent nursing actions included Fostering partnership, Teaching/coaching, Monitoring, Managing signs and symptoms, Coordinating, Providing psychosocial support, and Rescuing. A continuum of cognitive processing provided a backdrop for the categories of independent nursing actions. In the model, movement along the continuum from supporting decisions to problem solving was based on needs of the dyad.

Conclusions: Nurses integrated specialized knowledge and expertise while dynamically using a continuum of cognitive processing to provide care. An active partnership between nurses and the recipient/carepartner dyad was essential for optimum outcomes. Cooperative Care is an example of apprenticeship or guided participation in which a community of experts (nurses) guide, support, and challenge novices (lay individuals) to participate in skilled activities until the responsibility for the activity can be transferred to the novice.

Implications: Cooperative Care independent nursing actions identified in this study are the first step in formulating an instrument to measure doses of nursing actions in Cooperative Care. Such an instrument is needed to evaluate interventions designed to prepare and support lay carepartners.

Learning Objective #1: Describe the Cooperative Care acute care delivery model
Learning Objective #2: List and describe seven categories of independent nursing actions in Cooperative Care