This thesis reports a study that aimed to create a better understanding of nursing models. It set out to explore nursing models from the qualified nurse's perspective. Such perspective is of interest to the debate about nursing models which has often been conducted at the rhetorical rather than evidence based level. The methodological approach is that of grounded theory (Glaser and Strauss, 1967) with a three stage interview process as the data collection method. The sample comprised qualified nurses in Scotland who were undertaking educational programmes which included input on nursing models. The central themes from the interview stages were: first interview: operationalising the model; second interview: contextualising the model; and the third interview: nursing models and the reality of practice. These central themes were the foundation for the development of a three model typology distinguishing between: the theoretical model which is the conceptual model of the theorist, is abstract, general and developed through inductive and deductive approaches and presented as a potential picture of nursing; the mental model which is the personal pattern or schema of the individual nurse and represents the way nursing is described by the individual; and the Surrogate model which is a functional representation used by nurses to collect data, communicate and through which the organisation can standardise and audit practice. It is concluded that nursing models should not be seen as pertaining to a single entity but be described in the typologies described above. In this way some of the confusion about the way nursing models have been introduced and taught can be addressed. This is especially viewed in the context of models as forms of truth, external objects, adaptable, tools for use or tools for thought, as having individual or collective value and requiring evaluation from the individual's perspective.

Palm oil has been categorised as a saturated fat and to have a deleterious effect on the risk of CHD. In the present study, the habitual Scottish diet was replaced with palm oil (RBDPO) diet (26% en) and its effects on the indices of CHD risk was compared with the hydrogenated rapeseed (HRSO) and soya oil (HSO) diets. The result showed that RBDPO diets increased plasma total- and LDL- cholesterol concentrations but similarly increase the plasma HDL-cholesterol concentrations. In contrast, the above parameters were decreased in the hydrogenated oil diet groups. Changes in the indicators of lipid peroxidation were not different between groups although plasma conjugated dienes concentrations were shown to increase significantly in the HSO diet group at the end of the study period. Plasma glutathione peroxidase activity was also shown to increase in both hydrogenated oil diet groups. Plasma total Lp(a) concentrations were decreased in the RBDPO diet group whereas they were increased in the hydrogenated oil diet groups. The present study suggested that the effects of RBDPO in decreasing the plasma total Lp(a) concentrations might be due to its effects in increasing the clearance of plasma postprandial TRP-apo(a) by the B/E receptor pathway. It is concluded in the present study that despite the high content of RBDPO incorporated into the Scottish diet (65% of total fat intake), the ingestion of this diet did not confer deleterious effects on the risk of CHD when compared with the HRSO and HSO diets.

This study describes self management behaviour and attitudes among asthmatics, in usual self care, in acute episodes and in behaviour in the month before admission. It relates these behaviours to morbidity, admission history (single admittees versus multiple admittees) and outpatient status (current, discharged or never outpatient). Two hundred and thirty four patients between 16 and 65 years old were interviewed for the study. One hundred and thirty were in hospital at interview, the remainder were not in hospital but had all had a hospital admission between January and December 1987. Details of admissions in the following twelve months were collected for the hospitalised interviewees. In both hospitalised and non hospitalised groups self management was related to being in current specialist care, rather than to admission history. Patients in current specialist care were more compliant and acted at earlier stages of deterioration. When care type was controlled for, patients with multiple admissions were more non compliant with regular medication, and non compliant patients had significantly more frequent episodes. Forty (30%) of the hospitalised group were readmitted within 12 months of interview. Readmission was not related to self management before the 1991 admission or asthma attitudes. It is argued that this is because patients are likely to be referred to specialist care after an admission (almost 50% of first admissions and almost 100% of second admissions) and that this referral will change both their medical management and their self management. Hence, pre admission behaviour and attitudes cannot predict post admission risk. The study concludes that patient behaviour is most strongly influenced by being in specialist care, and that differences in self management, particularly compliance with prophylaxis and early action in deterioration, affect the risk of severe episodes and hospital admission.

The aim of the study was to estimate the effect of the GRampian ASthma Study of Integrated Care [GRASSIC] (for adult asthma patients currently attending hospital clinics) on the care of those patients not attending outpatient clinics. In order to do so, a method was devised for identifying random samples of adult asthma patients treated by general practitioners, using GP10 prescription forms. A two-phase postal and interview survey was carried out in Grampian, where the changes in clinic care were introduced, and Highland, where no changes were planned. Responses to the first postal questionnaire (in 1989), at the start of GRASSIC, were received from 1054 patients (728 from Grampian and 326 from Highland), and 1138 replies to the second (in 1991) (792 from Grampian and 346 from Highland). Interviews were carried out with a subset of 50 patients in Aberdeen and 25 in Inverness, after each postal survey. Detailed analysis of the responses demonstrated that GRASSIC did not have an effect on those patients not attending an outpatient clinic. However, changes in the care of patients treated in the community occurred over the two year period of the study.

The results of the literature review and survey show that tremendous changes have taken place in the United Arab Emirates both in its economic as well as in the provision of health care, since its independence in 1971.  The country has extensive primary health care services that are easily accessible.  The range of services provided includes health promotion, preventive, curative and maternity and child health services. However, the philosophy of primary health care is not generally accepted and the emphasis remains on providing  a curative service and the use of high technology medicine.  There are many other difficulties with the current system including a shortage of manpower; poor co-ordination between primary care and hospital based services; rising cost of health care provision; inadequate provision of health education programmes; inadequately or inappropriately resourced primary health centres; and the lack of reliable and good quality data on primary health care. Several recommendations are made: 1.  Creating a task force dedicated to primary health care and involving all stakeholders in order to identify gaps and deficiencies, make recommendations for improvement and ensure that the recommendations are being implemented. 2.  Emphasising the importance of primary health care in the overall provision of health care. 3.  Establishing a correct balance and a better co-ordination between primary, secondary and tertiary levels of care.  This should include an improvement in the referral and feedback system between primary care and hospitals. 4.  Ensuring the establishment of an effective health education programme aimed at emphasising the  value of primary health care, simple low-cost technology, health promotion and prevention services so minimising the dependence on the use of hospitals and high technology medicine.  This should take into account the different cultural, religious and social backgrounds of both the expatriate community as well as local inhabitants. 5.  Improving the provision of maternal child health care, screening, health promotion, prevention services and the availability of equipment, facilities and resources to enable primary care health professionals to carry out the assessment and management of most common and treatable conditions. 6.  Producing doctors, nurses and other health professionals who will promote health for all people and meet the needs of the society they serve.  This will require a greater collaboration and partnership between medical schools and the Ministry of Health.  7.  Developing a system of continuing professional development with staff training programmes for health professionals, to ensure the maintenance of their competence. 8.  Forming a professional organisation, such as a College or Institute of general practice, in order to identify the professional needs of general practitioners, to represent the specialty on professional matters and on all relevant medical decision making bodies, and to promote professional development at both national and international levels.

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