By understanding the tensive issues that could potentially influence the quality of collaboration, MDs and APNs can consider communication measures geared toward strengthening their partnerships.

Although both parties reference identical terms, when the language is unpacked, different behaviors are sought by APNs and MDs to achieve collaboration. This suggests that discussions concerning collaboration between APNs and MDs should not remain at the level of generalizations wherein apparent agreement might be assumed; instead, focused exchanges must concern specific behaviors in discrete instances.

In this qualitative study we used Dialectical Theory to analyze contradictions occurring between medical doctors (MDs) and nurse practitioners (NPs) working collaboratively on a health care team. The analysis of interview data revealed contradictions in two areas: (1) NPs espouse a need for heightened autonomy in their working associations with medical doctors, whereas conversely, MDs emphasize a need for ongoing connection, and (2) MDs argue that NPs should be more proactive problem solvers and frame their working relationships as educational. However, NPs argue that MDs enact patterns of behavior that limit proactive problem solving and curtail the educational potential of those relationships, thus reinforcing predictable work routines. Both areas of contradiction constitute what dialectical theorist Leslie Baxter refers to as "oppositions." Examples of these oppositions are provided in the analysis. The study concludes with an assessment of how such contradictions might constitute developmental opportunities for NPs and MDs working in collaboration.

Transformational leadership is important because it provides not only direction but it also creates opportunities for professional development. This qualitative investigation explored how medical doctors, in order to be transformative, should negotiate with advanced practice nurses while working in collaboration with them. The results first suggest that medical doctors and advanced practice nurses should negotiate appropriate levels of supervision in their working relationship commensurate with the education and experience that the advanced practice nurses bring to the practice. Second, mentoring should be a reciprocal communication process between medical doctors and advanced practice nurses, where thoughtful feedback facilitates appropriate adjustments in respective communication and time management styles. Third, educating necessitates mutual learning, with each party acknowledging the possibility of learning from the other and being sensitive to the value of what the other contributes to the working relationship. The authors conclude that effective leadership involves negotiating along these dimensions, which will contribute to effective team-building.

Manyfamilies ofterminally ill dementiapatients may wish to carefor their relatives at home until death occurs either because theyfeel strongly that home is the most appropriate setting or in response to a past promise. Until recently, this had been difficult to accomplish because caring for patients with dementia is a demanding, time-consuming andfrustrating task that can pose a tremendous threat to the welfare andhappiness ofthe caregivers so that they eventually become secondary victims ofthe illness, and eventually seek institutional carefor their relatives.A hospice home care program provides thepractical help and emotional support that caregivers need in order to cope more effectively with the care and eventual death oftheir loved ones at home. This article describes the development and activities of the Alzheimer's Family Care Hospice, a pilotprogram sponsored by the Rush Alzheimer's Disease Center, and the Chicago area chapter oftheAlzheimer's Association. This program has provided services to a total of nine terminally ill dementia patients and theirfamilies during the past ten months. Severe dementiaAccording to the Office of Technology Assessment, an estimated 1.5 million Americans suffer from severe dementia. This number is expected to reach 2.4 million by the year 2000 unless cues or means of prevention are found for the common causes of dementia.' The highest rate of dementia is in the population over age 75, which is the age group that is increasing at the fastest rate. Even if the percentage of those affected by severe dementia remains constant, the size of the affected cohort will be immense by the turn of the century.Generalized seizures are seen in perhaps as many as 10 percent of late stage AD patients.The best estimate of the prevalence of dementia in a specific population was reported in a Finnish study which showed an incidence of 6.7 percent for the group aged 65 and over and 17.3 percent at 85 and over.2 A survey conducted in a California retirement community found a prevalence of dementia of 15.3 percent for the over 65 population and 35.8 percent for the over 80 population.3