Posted: April 3rd, 2022

The Tidal Model: Use in nursing

Tidal model of mental health nursing
Dr. Phil Barker and Poppy Buchanan-Barker created the “tidal model” to improve mental health nursing and benefit both healthcare workers and those being cared for. It is a path to discovering mental health, with the goal of Helping people in gaining control over their own lives by first comprehending what actually occurred, namely, their own story. (2005) (Barker and Buchanan-barker) In this article, we’ll look at how it relates to the four metaparadigms: health, person, environment, and nursing.
• The tidal model is a mental health recovery model that can serve as the foundation for interdisciplinary mental health care.

It was created by phil barker and poppy buchanan-barker of the University of Newcastle in the United Kingdom.

• It is regarded as a nursing theory in the middle.

The model’s primary goal is to Help individuals in embarking on their own voyage of discovery.
• The tidal model is a philosophical approach to discovering mental health. It focuses on Helping people in reclaiming their personal story of mental distress by reclaiming their voice. People begin to express something of the meaning of their lives by using their own language, metaphors, and personal stories. This is the first step in Helping them in regaining control of their lives.” – the barker
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The tidal model provides a practice framework for determining the patient’s nursing needs and providing individually tailored care. (Barker et al., 2001)
• The tidal model takes its core philosophical metaphor from chaos theory, comparing the unpredictable – yet bounded – nature of human behavior and experience to the dynamic flow and power of water and the tides of the sea. (Barker et al., 2001)
Assumption
Six key philosophical assumptions are used to apply the tidal model:
1. Belief in the virtue of curiosity: the individual believes that they are the world authority on their life and its problems. The professional can learn something about the’mystery’ of the person’s story by expressing genuine curiosity.
2. Rather than focusing on problems, deficits, or weaknesses, recognize the power of resourcefulness.
3. Rather than being paternalistic, respect the person’s wishes.
4. Recognizing the paradox of crisis as opportunity
5. Recognizing that all goals must be personal.
6. The virtue of seeking elegance—the simplest means should be sought.
• In the tidal model, the person, the individual, is theoretically represented by three personal domains: self, world, and others.
According to the theory, our mental health is determined by our individual life experiences, such as our sense of self, perceptions, thoughts, and actions.

Application of the theory to the four nursing meta-paradigms
Limon (2007) defines health as “the degree of wellness or well-being that the client experiences.” Tidal Model believes that nothing is permanent, that situations change, that a patient’s mental state changes, and that a problem faced by the patient will either get worse or better, and that a healthcare worker should not expect the patient to be well every day and assume that they are throwing tantrums or attempting to cause trouble by telling you that the voices are taunting them again. The healthcare worker, on the other hand, should make the patient aware that change is constant in order to prepare them to be able to manage their situation and avoid being crippled by the problems. Whitehill (2002)

It is said that the effects of a mental illness are far more devastating than those of a physical illness. It strikes right at the core, the very foundation of a person, the innermost sense of self, resulting in a loss of identity, low self-esteem, and other symptoms, as well as a serious health crisis. Person-Centred & Collaborative Mental Health Care (Person-Centred & Collaborative Mental Health Care, 2008)

Person
Limon (2007) defines a person or client as a recipient of nursing care, which includes patients, their families, and communities. Tidal focuses on person-centered care and empowering patients who have been disempowered by mental distress and mental health services. Barker (2001) The model looks at people as individuals rather than just their symptoms, statistical populations, or diseases. It is a solution-focused approach to care rather than a problem-focused approach. As a result, it contributes a new and refreshing perspective on the person and his or her difficulties. Person-Centred & Collaborative Mental Health Care (Person-Centred & Collaborative Mental Health Care, 2008)

The first domain of the Tidal Model, ‘Self,’ refers to what a person believes, values, and feels. It could be what a person is feeling right now that is causing him or her distress, or it could be the belief or religion on which a person will rely to keep going. Devon Recovery, n.d. According to the Ten Commitments of Tidal, the experience of oneself is unique, and another party can never truly understand this person’s experience, whether it is joy, pain, or mental distress. (Theory of the Tidal Model, 2000) As nurses, we must always consider why our patients behave in this manner or are experiencing this particular crisis at this time, how they perceive their current situation or problems, and what they believe will help them overcome or improve their circumstances. Listen to what the Ten Commitments are saying, and be the apprentice rather than the advisor. What a nurse can do to help is to document the patient’s verbatim as accurately as possible, rather than summarizing it in our own words and thus drowning out the patient’s voice.)

Environment
The term “environment” refers to the client’s internal and external surroundings, which include family, friends, and significant others. (Limon, 2007) In ‘World,’ Tidal’s second domain, the person shares his or her thoughts and feelings, as well as whatever has happened from their point of view. For example, they could be discussing how helpful they believe their families have been in times of need. This domain addresses issues such as current fears and concerns as well as future plans. ‘Others,’ Tidal’s final domain, refers to the organization and society, the support network that the patient has or needs, who can help the patient cope, in times of distress, through the recovery route, and re-step into the in community. (Recover Devon, undated) The environment also has a significant impact on a patient’s recovery and subsequent reintegration into the community. Cultivating a supportive environment on the ward is critical to the patient’s well-being, as is adequate family and community support, which the patients will require in order to muster the courage to take the first step. Tidal emphasizes listening to your patients, engaging them in their own treatment plans and goals, being there to support them, and encouraging group work among patients, all of which contribute to the creation of a therapeutic environment that reduces the likelihood of crisis and violent outbreaks during hospitalization, as well as the length of stay in hospital. 2005 (Cook, Phillips, and Sadler)

Nursing
According to Limon (2007), nursing, one of the four metaparadigms, refers to the attributes, characteristics, and actions of the nurse who provides care. A nurse does not make medical diagnoses; rather, she uses her nursing knowledge and experience to develop a set of nursing diagnoses and an individualized plan of care for each patient. Perry (2001), p.91

According to Tidal, in order to help a patient, a staff member must not impose her ideas, opinions, and advices on the patient, but rather forget your obligations, your occupation, and see your patient or client as a person in distress, be there for him or her, listen to what your patient is truly saying, not with your nursing knowledge but with your heart, to care with, not care for. 2007 (Nursing Times) The power of simple understanding, care, and encouragement cannot be underestimated. Each interaction with another person has the potential to either help or harm the person’s fragile sense of self. As a result, developing a therapeutic relationship between the nurse and the patient is critical. 2005 (Cook, Phillips, and Sadler) To strengthen that bond, patients should be given the opportunity to tell their story and have it heard, understood, and valued. Only then will they receive the personal acceptance and nurturing that they so desperately require in order to recover. (2000, Clan Unity)

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Tidal urged nurses to simply reach out, care for, and hold hope for someone in crisis rather than alienating people by belittling them, saying negative things about them, removing power from them, and ignoring their feelings simply by the way we treat them, even if we do so in an officially ‘professional’ manner. Person-Centred & Collaborative Mental Health Care (Person-Centred & Collaborative Mental Health Care, 2008)

Conclusion
Tidal Model is a person-centered nursing and reclaiming life model that is specifically designed for use in mental health nursing. It emphasizes the importance of providing a supportive environment for patients, nurses being active listeners, patients being included in the planning and discussion of treatment plans and goals, and patients being kept up to date on their progress and behavior without any withholding of information on the part of the staff in order to foster a therapeutic and nurturing relationship and supportive environment.

Discussion
The author currently works on the high dependency psychiatric unit at the Institute of Mental Health, Woodbridge Hospital. The unit cares for patients who have been transferred in from acute psychiatric wards who are extremely disturbed and violent, and who have mostly been physically retrained while in their respective wards. The writer believes that the Tidal model would be extremely useful in the environment in which she works. In fact, some of the staff’s actions are quite similar to the Tidal Model. For example, when the patient first enters the ward, adequate orientation to the surroundings, introduction to the ward staffs, and explanation before each procedure help a great deal in preventing agitation or violence from the patient due to fear and confusion. While the doctors are using chemical means to stabilize patients, the rest of the multidisciplinary staff continues to help and support the patient by spending a lot of time listening to what the patient has to say, supporting them and their families through the difficult times, before handing over care to the original ward staff when they are more stabilized. However, the author believes that implementing the Tidal Model to the rest of the hospital’s wards at this time may be difficult because the current staff-to-patient ratio is about 1:10, making it impossible to provide enough time for staff to be with each patient. The heavy workload may have already emotionally drained and stressed the staff, leaving them unable to support and implement the Tidal Model. However, it may be feasible in the near future if the hospital increases staff quotas and sends staff to Tidal Model training.
References
Bag, B. (2019). Tidal model in mental health and psychiatric nursing practices. Psikiyatride Guncel Yaklasimlar, 11(4), 547-560.
Kusdemir, S., Oudshoorn, A., & Ndayisenga, J. P. (2022). A critical analysis of the Tidal Model of Mental Health Essay Recovery. Archives of Psychiatric Nursing, 36, 34-40.
Kress, K. J. (2022). Implementation of an Evidence-Based Drug Screening Tool for Inpatient Behavioral Health Admissions.

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