Psychometric properties of an attitude scale measuring physician-nurse collaboration.

This study examined the psychometric properties of an assessment tool for measuring attitudes toward physician-nurse collaboration. A survey addressing areas of responsibility, expectations, shared learning, decision making, authority, and autonomy was administered to first-year medical and nursing students. Factor analysis of the survey indicated that the survey measured four underlying constructs of shared education and collaborative relationships, caring as opposed to curing, nurse's autonomy, and physician's authority. A scale was developed in which 15 items of the survey with large factor loadings were included. The alpha reliability estimates of the scale for medical and nursing students were .84 and .85, respectively. The mean of the scale was significantly higher for nursing than medical students. Results supported the construct validity and reliability of the scale. This scale can be used to evaluate the effectiveness of programs developed to foster physician-nurse collaboration, and to study group differences on attitudes toward interpersonal collaboration.

Homelessness: care, prevention, and public policy.

Homeless men, women, and children make up a growing population that is vulnerable to preventable disease, progressive morbidity, and premature death. Homelessness and poverty are inextricably linked, and subgroups of persons who live in poverty have a particularly high risk for becoming homeless. Providing effective primary care for homeless persons is a formidable task because of many internal and external barriers to care. Targeted care strategies and new approaches to primary care are required to lower these barriers. Effective disease prevention in the homeless requires effective programs and policies to prevent homelessness. It is imperative that health professionals, the societies to which they belong, and academic health systems reaffirm their social responsibility, commit to changing public policies that perpetuate homelessness, and assist in the development and provision of primary health care services for persons who are homeless or on the brink of homelessness.

The role of the primary care physician in the care of the terminally ill.

The primary care physician is often the provider best situated and suited to deal with all aspects of the care and management of the elderly patient with a terminal illness. Despite the many barriers physicians face (the most significant of which are inadequate training and poor reimbursement), providing quality care for the terminally ill is a critically important task. As Angell editorialized in 1982 about pain management, "the quality of mercy is essential to the practice of medicine. Here, of all places, it must not be strained."

A collaborative community approach to homeless care.

Homelessness is a social, economic, and public health problem of increasing magnitude in the United States. The past methods and approaches to delivering health care to those without homes have been inadequate because of the many complex problems faced by homeless persons today. To facilitate a discussion of a collaborative community approach to homeless care, it is helpful to include a definition of homelessness, describe the homeless population and the health status of homeless individuals, and explain what is meant by health care for the homeless.

Collaborative care between nurse practitioners and primary care physicians.

Primary care practices are looking at methods of providing quality care for an increasing number of patients, and one method of achieving this goal is the development of a collaborative agreement with a physician(s) and nurse practitioner(s). There is a need for information about the role of the nurse practitioner and the advantages of collaboration. This article reviews the history of the nurse practitioner movement, practice standards, and the scope of practice for nurse practitioners. Models of collaborative practice and the advantages of these models are discussed. Considerations for entering into collaborative practice are addressed also.

Pain management in advanced cancer.

This article presents a primary care approach to pain management in patients with advanced cancer. Assessment of "total" pain is reviewed along with interdisciplinary care. Pharmacologic and nonpharmacologic therapies are outlined, with emphasis on the correct use of narcotics and adjuvant analgesics.

Hospice care.

Hospice care is a philosophy and system of care for the terminally ill patient that accepts death in an affirmative way and provides palliative care and emotional support to dying patients and their families. The primary care physician needs to better understand the hospice concepts, the reasons for and growth of hospice care, and the depth of resources that can assist in equality management of the terminally ill.