The evaluation of a nursing model for long-stay psychiatric patient care. Part 1--Literature review and methodology.

A modified action research approach was used to implement a selected nursing model on a long-stay psychiatric ward. Within a broader quasi-experimental design, specific quality of care indicators were appraised before and after the implementation of the model. These dependent variables were also monitored on a control ward and data were collected on both wards at one pre-test and two post-test points. This paper presents a comprehensive overview of the literature and the methodology for the study. Planned change theory was used as a guiding framework for the implementation of the model and this process is described in detail.

The evaluation of a nursing model for long-stay psychiatric patient care. Part 2--Presentation and discussion of findings.

A nursing model selected by a population of ward managers was implemented on a long-stay psychiatric ward in Northern Ireland using an adapted action research approach within a quasi-experimental design. A range of dependent variables were appraised at one pre-test and two post-test evaluation points on an experimental (Ward X) and a control ward (Ward Y). A thorough review of the literature and methods used can be found in Part 1 (McKenna et al., 1995, Int. J. Nurs. Stud., 32, 79-94). The findings and their interpretations are presented here. Results indicate that on the experimental ward there were statistically significant improvements in "Psychiatric Monitor", patients' and staff's perception of ward atmosphere, patient satisfaction, staff's views about nursing models, and patient dependency levels. No significant changes were noted in nurse satisfaction levels nor nurses' perception of patients' behaviour. Particular emphasis is placed on the possible threats to the internal and external reliability of these findings and on the attempts made to control these threats.

Early colonial health developments in Mauritius.

The historical development of Mauritius and in particular the early developments in health care are crucial to an understanding of the contemporary health system. The introduction of major epidemic diseases through the movements of French soldiers to and from India and the immigration of indentured laborers from India account for the high mortality and morbidity rates in the 18th and 19th centuries and later. The colonial economy created and fortified the dependence on a single cash crop and on imported food. It also contributed toward the impoverization of large sections of the Mauritian population. The colonial era is also responsible for initiating a three tier system of health care.

PIP: Knowledge of the historical development of Mauritius and in particular the early developments in health care is crucial to an understanding of the contemporary health system. Research shows that smallpox, rabies, and cholera were introduced to the island by French soldiers coming from India during the French administration in the 1700s. After English occupation of the island in the early 1800s, epidemics became commonplace as indentured laborers transported from India replaced the emancipated slaves. There was such a demand for the laborers that quarantines were loosely enforced. The descendents of the slaves (Creoles) became increasingly pauperized. Poverty contributed to ill health and ill health to poverty through reduced productivity among both Creoles and Indians. Planters were held responsible under the law for the provision of health facilities and care to their laborers, but compliance with the law in this and other obligations was minimal. Where there were hospitals, they were usually inadequately provided for and inhospitable. Even the motivation to provide for health and welfare to keep labor productive was weak because more cheap labor could be imported. Children were uneducated, the male/female ratio was high, and there was rampant recourse to prostitution, alcohol, and drugs. The colonial economy created and fortified the dependence on a single cash crop (sugar) and on imported food, which continue today. Only late in the 19the century did health services become available to Creoles in paupers' hospitals. Then 3 medical systems (European, Asian, and "African") existed, as they do today. Despite some success of vaccination and hygiene programs, the health system has not made significant progress in combating health problems, which are still poverty-related.