Independent Nursing Actions in Cooperative Care

June Eilers

Judith A. Heermann

Margaret E. Wilson

Sue Knutson

ONF 2007, 32(4), 849-855. DOI: 10.1188/05.ONF.849-855

Purpose/Objectives: To identify and describe independent nursing actions in cooperative care.

Design: Qualitative, descriptive, inductive study.

Setting: The Nebraska Medical Center's Lied Transplant Center in Omaha, where lay care partners assume responsibility for acute care of transplant recipients in partnership with nurses.

Sample: 12 cooperative care nurses.

Methods: Two focus groups, 59 narrative logs, and three follow-up interviews were tape recorded, transcribed, and content analyzed.

Main Research Variable: Independent nursing actions in cooperative care.

Findings: Independent nursing actions included surveillance, teaching, coaching, fostering partnerships, providing psychosocial support, rescuing, and coordinating. Surveillance leads to problem identification that, in turn, triggers other actions. Because all nursing actions occur in the context of nurse, dyad, and healthcare team relationships, coordinating is the category of nursing action used to manage all aspects of care.

Conclusions: The nurses integrated specialized knowledge and expertise while dynamically using surveillance to identify problems that trigger nursing actions to manage signs and symptoms. Cooperative care is an example of apprenticeship or guided participation in which a community of experts (nurses) guides, supports, and challenges novices (lay individuals) to participate in skilled activities until the responsibility for the activities can be transferred to the novice.

Implications for Nursing: Independent nursing actions identified in this study are the first step in formulating an instrument to measure "doses" (frequency and intensity) of nursing actions in cooperative care. Such an instrument is needed to evaluate interventions designed to prepare and support lay care partners.

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    Aiken, L.H., Clarke, S.P., Sloane, D.M., Sochalski, J., & Silber, J.H. (2002). Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction. JAMA, 288, 1987-1993.
    Benner, P. (1984). From novice to expert: Excellence and power in clinical nursing practice. Menlo Park, CA: Addison-Wesley.
    Benner, P., & Tanner, C. (1987). Clinical judgment: How expert nurses use intuition. American Journal of Nursing, 87, 23-31.
    Benner, P.E., Hooper-Kyriakidis, P.L., & Stannard, D. (1999). Clinical wisdom and interventions in critical care: A thinking-in-action approach. Philadelphia: Saunders.
    Blakeney, B. (2003). Nursing's message to the world. Creative Nursing, 9(3), 4-8.
    Bransford, J.D., Sherwood, R., Vye, N., & Rieser, J. (1986). Teaching thinking and problem solving. American Psychologist, 41, 1078-1089.
    Bull, M.J., Maruyama, G., & Luo, D. (1995). Testing a model for posthospital transition of family caregivers for elderly persons. Nursing Research, 44, 132-138.
    Callery, P., & Smith, L. (1991). A study of role negotiation between nurses and the parents of hospitalized children. Journal of Advanced Nursing, 16, 772-781.
    Compton, K., McDonald, J.C., & Stetz, K.M. (1996). Understanding the caring relationship during marrow transplantation: Family caregivers and healthcare professionals. Oncology Nursing Forum, 23, 1428-1432.
    Devine, B.C., & Westlake, S.K. (1995). The effects of psychoeducational care provided to adults with cancer: Meta-analysis of 116 studies. Oncology Nursing Forum, 22, 1369-1381.
    Fairman, J. (1992). Watchful vigilance: Nursing care, technology, and the development of intensive care units. Nursing Research, 41, 56-60.
    Fossey, D. (1970). Making friends with mountain gorillas. National Geographic Society Magazine, 137(1), 48-67.
    Franco, T., Warren, J.J., Menke, K.L., Craft, B.J., Cushing, K.A., Gould, D.A., et al. (1996). Developing patient and family education programs for a transplant center. Patient Education and Counseling, 27, 113-120.
    Gallant, M.H., Beaulieu, M.C., & Carnevale, F.A. (2002). Partnership: An analysis of the concept within the nurse-client relationship. Journal of Advanced Nursing, 40, 149-157.
    Grieco, A.J., McClure, M.L., Komiske, B.K., & Menard, R.F. (Eds.). (1994). Family partnership in hospital care: The cooperative care concept. New York: Springer.
    Grimm, P.M., Zawacki, K.L., Mock, V., Krumm, S., & Frink, B.B. (2000). Caregiver responses and needs. Cancer Practice, 8, 120-128.
    Harris, P.B. (1993). The misunderstood caregiver? A qualitative study of the male care giver of Alzheimer's disease victims. Gerontologist, 33, 551-556.
    Harvath, T.A., Archbold, P.G., Stewart, B.J., Gadow, S., Kirschling, J.M., Miller, L., et al. (1994). Establishing partnerships with family caregivers: Local and cosmopolitan knowledge. Journal of Gerontological Nursing, 20(2), 29-35.
    Heermann, J.A., Eilers, J.G., & Carney, P.A. (2001). Use of modified OSCEs to verify technical skill performance and competency of lay caregivers. Journal of Cancer Education, 16(2), 93-98.
    Heermann, J.A., & Wilson, M.E. (2000). Nurses' experiences working with families in an NICU during implementation of family-focused developmental care. Neonatal Network, 19(4), 23-29.
    Henneman, E.A., Lee, J.L., & Cohen, J.I. (1995). Collaboration: A concept analysis. Journal of Advanced Nursing, 21, 103-109.
    Martin, K.S., & Scheet, N.J. (1992). The Omaha system: Applications for community health nursing. Philadelphia: W.B. Saunders.
    McCloskey, J.C., & Bulechek, G.M. (Eds.). (2000). Nursing interventions classification (NIC) (3rd ed.). St. Louis, MO: Mosby.
    Page, A. (Ed.). (2004). Keeping patients safe: Transforming the work environment of nurses. Washington, DC: National Academies Press.
    Payne, J. (2000). The nursing interventions classification: A language to define nursing. Oncology Nursing Forum, 27, 99-103.
    Pyles, S.H., & Stern, P.N. (1983). Discovery of nursing gestalt in critical care nursing: The importance of the gray gorilla syndrome. Image: The Journal of Nursing Scholarship, 15(2), 51-57.
    Rogoff, B. (1990). Apprenticeship in thinking: Cognitive development in social context. New York: Oxford University Press.
    Saba, V.K., O'Hare, P.A., Zuckerman, A.E., Boondas, J., Levine, E., & Oatway, D.M. (1991). A nursing intervention taxonomy for home health care. Nursing and Health Care, 12, 296-299.
    Schmit-Pokorny, K., Franco, T., Frappier, B., & Vyhlidal, R.C. (2003). The cooperative care model: An innovative approach to deliver blood and marrow stem cell transplant care. Clinical Journal of Oncology Nursing, 7(5), 509-514, 556.
    Silber, J.H., Williams, S.V., Krakauer, H., & Schwartz, J.S. (1992). Hospital and patient characteristics associated with death after surgery: A study of adverse occurrence and failure to rescue. Medical Care, 30, 615-629.
    Turner, H.A., & Catania, J.A. (1997). Informal caregiving to persons with AIDS in the United States: Caregiver burden among central cities' residents eighteen to forty-nine years old. American Journal of Community Psychology, 25, 35-59.
    Wagman, M. (2002). Problem-solving processes in humans and computers: Theory and research in psychology and artificial intelligence. Westport, CT: Praeger.
    Werley, H.H., & Lang, N.M. (Eds.). (1988). Identification of the nursing minimum data set. New York: Springer.