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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