This thesis examines the development of nursing at University College Hospital, London, between 1862, the year in which the All Saints Sisters assumed responsibility for the provision of nursing services at the hospital, and the introduction of the National Health Service in July 1948. Although the care provided by the sisters marked a considerable improvement on what had gone before, in 1899 they were replaced by nurses whose motivation was professional rather than vocational. The profession of nursing was confirmed by the Registration Act of 1919. Following an introduction, the initial chapters of the thesis are concerned with defining and developing the themes of Christian vocation and secular profession. Chapter four is devoted to nursing management across the period, and the following chapter to patterns of care. Prior to 1919 a system of primary care was in operation; this was superseded by task allocation. Chapters six and seven outline the introduction of nurse training in some of the London teaching hospitals in comparison to the training of nurses at U.C.H. An analysis of the probationer records from 1890 - 1948 demonstrates recruitment and retention through these years. With the departure of the All Saints Sisters from U.C.H. in 1899 the school of nursing was established. A preliminary training school was introduced in 1926; ten years later University College Hospital school of nursing pioneered the block system of training which became the norm for all schools of nursing after the Second World War. The next two chapters concentrate upon nursing developments in wartime. The All Saints Sisters were part of the British Red Cross team that served in the Franco-Prussian War of 1870 and the hospital and its nurses were fully involved in the two World Wars. Although this period saw the transformation of nursing at U.C.H. from a Christian vocation to a secular profession, this thesis is as much concerned with continuity as with change - for example in noting the similarities between rules for the probationers and for the novitiates, which had continuing influence throughout the years of this study.

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The purpose of this study was to determine the factors that influence university students use of health services for mental or emotional reasons. Currently accepted models of health service use may not apply to university students due to their unique socio-demographic characteristics and health challenges. The Andersen and Newman model of health service utilization was used as a conceptual framework. The first hypothesis was that many factors that influence use of services in the general population would also apply to the university student population. The second hypothesis was that some student-specific factors would also influence health service utilization for mental or emotional reasons. <p>Data for this study was collected in a survey designed for a larger health needs assessment of University of Saskatchewan undergraduate students. The dependant variable was the use of services for mental or emotional reasons within the past year. Information was also collected for 26 independent variables. A logistic regression was used to determine which of these were related to the dependant variable. <p>The final model of health service utilization for mental/emotional reasons among university students included six independent variables: 1) perceived need for professional help (for emotional problems), 2) previous depression diagnosis, 3) past/present suicide ideation, 4) sexual assault victimization, 5) presence of a family doctor, and 6) gender.<p>The results of this study indicate that many of the factors that influence service use for mental/emotional reasons in the student population are the same as those that exist in the general population. The results also suggest that student-specific factors, such as college, years in university, or academic performance do not influence health service use for mental/emotional reasons. Implications of these findings are discussed.

The purpose of this study was to determine the factors that influence university students use of health services for mental or emotional reasons. Currently accepted models of health service use may not apply to university students due to their unique socio-demographic characteristics and health challenges. The Andersen and Newman model of health service utilization was used as a conceptual framework. The first hypothesis was that many factors that influence use of services in the general population would also apply to the university student population. The second hypothesis was that some student-specific factors would also influence health service utilization for mental or emotional reasons. <p>Data for this study was collected in a survey designed for a larger health needs assessment of University of Saskatchewan undergraduate students. The dependant variable was the use of services for mental or emotional reasons within the past year. Information was also collected for 26 independent variables. A logistic regression was used to determine which of these were related to the dependant variable. <p>The final model of health service utilization for mental/emotional reasons among university students included six independent variables: 1) perceived need for professional help (for emotional problems), 2) previous depression diagnosis, 3) past/present suicide ideation, 4) sexual assault victimization, 5) presence of a family doctor, and 6) gender.<p>The results of this study indicate that many of the factors that influence service use for mental/emotional reasons in the student population are the same as those that exist in the general population. The results also suggest that student-specific factors, such as college, years in university, or academic performance do not influence health service use for mental/emotional reasons. Implications of these findings are discussed.

This study was undertaken with the aim to develop improved measures of health service utilisation (HSU) and direct medical costs following an index injury, utilising large scale datasets linked via anonymous patient identifiers. A cohort of anonymous injury patients resident in Swansea and attending an emergency department (ED) or admitted to hospital between 01/04/2005 and 31/03/2007 were identified and tracked as they progressed through various treatment stages following their index injury, incorporating ED attendances, inpatient stay and outpatient contacts. To determine the extent of the subsequent HSU and direct medical costs associated with the index injury a unique model was developed whereby the numbers, lengths and treatment costs of health service contacts observed amongst the cohort of injured individuals during the follow-up period were compared with the equivalent figures expected in the absence of an injury. On average each index injury was found to lead to an excess of 0.12 (95% Cl 0.11, 0.13) ED attendances, 0.07 (95% Cl 0.06, 0.08) inpatient admissions, 1.00 (95% Cl 0.78, 1.23) inpatient bed days and 0.55 (95% Cl 0.52, 0.58) outpatient contacts being estimated over the follow-up period. Moreover, every index injury resulted in mean excess ED, inpatient and outpatient treatment costs of £12.05 (95% Cl £11.05, £13.05), £492.43 (95% Cl £415.66, £569.21) and £73.30 (95% Cl £68.44, £78.17), respectively, equating to a combined figure of £577.79 (95% Cl £500.32, £655.26). Across the entire injured cohort this amounts to an overall excess direct medical cost total of £17.6 million being incurred, with the equivalent figure for the whole of Wales potentially being as high as £306.4 million. Together with signifying the magnitude of the HSU and direct medical costs resulting from injury, this study has introduced and implemented improved methods for estimating these outcome measures based on the use of anonymous patient record linkage.

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Counselling psychology springs from humanistic and existential/phenomenological values arguing for the need to see human beings in a holistic manner. This value system is a move towards well-being rather than pathology and sickness. The philosophical underpinning of counselling psychology gives a unique identity to the profession, raising different questions for counselling psychologists’ working within NHS settings, which is governed by the medical model. At a time that our profession faces enormous challenges and questions about its future, this study explored the experience of seven chartered counselling psychologists working within different NHS settings using the Interpretative Phenomenological Analysis (IPA) method.︣The analysis of the study revealed six major themes: (1)The process of creating a therapeutic identity; (2) Valuing the counselling psychology founding principles in practice; (3) Working within the medical model;(4) Experiencing tensions: the power of the context; (5) Dealing with the tensions; (6) Current changes and the future of counselling psychology in the NHS.︣The results showed in greater detail that the participants held a strong therapeutic identity; practiced in accordance with the counselling psychology values; experienced different tensions while working within the NHS, but have found different ways to deal with these tensions, including holding a pluralistic stance, assimilating the medical model with their own value base system and prioritizing the clients’ needs over the NHS guidelines. Lastly, the analysis indicated that the recent changes have contributed additional feelings of anxiety and uncertainty to the participants regarding the future of the profession.