Running head: THE TIDAL MODEL: A THEORETICAL APPROACH TO NURSING 9
The Tidal Model: A theoretical approach to psychiatric nursing
Trina Skinner
Stenberg College
June 02, 2012
The development of the Tidal Model revolves around the concept of clients involved in the mental health system finding empowerment, acting as the catalyst to precipitate and implement the necessary change to free themselves from the effects of mental/emotional distress they may experience as a result of mental illness. In order to describe this theoretical approach to psychiatric nursing while exploring its validity and use, three topics to consider are, the circumstances/history in which this model was derived, exploration of the central metaphor on which the model operates, and the application and assumed role of the psychiatric nurse in providing care within the constructs of the Tidal Model in psychiatric nursing.
The Tidal Model theory is a relatively modern approach to psychiatric nursing in which central concepts and “key elements” that form the basis of the model are influenced by theoretical, philosophical, and practical ideology. The Tidal Model was created as a result of the findings of a five year study conducted at the University of Newcastle focused on the ‘need for psychiatric nursing’. This theoretical approach to nursing was “originally developed across two pilot sites in Newcastle, UK between 1997 and 1999” by Dr. Philip Barker alongside his wife and colleague Poppy Buchanan Barker, and others involved in the study that preceded the birth of the Tidal Model. A “revised model” was subsequently introduced across the “Adult Mental Health Programme…and their associated community support teams in its entirety [2000. May], where an interdisciplinary evaluation of the model in practice is being conducted, using action research methodology” (Barker 2001).
(Barker, 2001) explains that “The Tidal Model extends…some of the traditional assumptions concerning the centrality of interpersonal relations within nursing practice”.
These “traditional assumptions…” (Barker) mentions refer to the influential work of Peplau and her ‘Interpersonal theory’ that revolutionized the discipline of psychiatric nursing. Peplau’s work plays a significant role in the underpinning of the theoretical framework that Barker’s Tidal Model was developed on. Barker’s Tidal Model has been described as having a “Peplau-vian flavor” (Titleborn, 2012).
The philosophical aspect of the Tidal Model is based on the fundamental principles of the chaos theory, which refers to an area of study in mathematics that involves applications in various disciplines, including philosophy. The chaos theory “studies the behavior of dynamical systems that are highly sensitive to initial conditions” (Wikipedia, 2012). Minor changes in initial conditions may result in massive variations for these ‘dynamical systems’ making future prediction virtually impossible (i.e. weather).
Such changes may occur regardless of the fact that these systems are deemed “deterministic, meaning that their future behavior is fully determined by their initial conditions, with no random elements involved” (Wikipedia, 2012). Contrary to what the deterministic quality of these systems would suggest, the fact they are deemed deterministic does not make them predictable, thus this unpredictable nature that occurs in these (deterministic) systems as a result of disruption of ‘initial conditions’ is a behavior termed “deterministic chaos” or simply “chaos”. The philosophical underpinning of the chaos theory as an influential principle in development of the model is evident in (Barker’s) self expressed acknowledgement of “the fluid nature of human experience, characterized by incessant change and unpredictability.”
The influential element of the model in terms of practicality is Dr. Barker and his colleague’s belief that the client, and not the nurse, is ultimately responsible for redirecting their lives and attaining liberation from the pain/suffering experienced as a result of mental illness.
The creators of the Tidal Model draw attention to the use of metaphors and their presence in all aspects of life, noting the necessity of metaphor as a tool that attempts to explain the inexplicable, to describe a concept less than tangible. Dr. Barker developed his central metaphor, borrowed from the chaos theory, in the interest of describing the theoretical principles that serve as the foundation for this Model in such a way that is more comprehensive for the average person to grasp. “We use metaphors when we find it difficult to describe a 'thing' or an 'experience'… we borrow a word or a phrase, which appears similar to the 'thing' or 'experience', which we are trying to describe” (Tidal Model website).
The central metaphor on which the Tidal Model revolves is essentially based on the ever-changing patterns of water. The tides of the ocean serve as an example of ‘deterministic chaos’ in that if initial conditions remain unaffected by outside influence the pattern of movement of water is considered predictable. However, influence from external factors may cause an unpredictable change in tidal patterns (i.e. excessive winds), it is by this ideology that Dr. Barker has developed his theory, relating the deterministic behavior of the tidal patterns of the ocean to the human experience as an individual moves fluidly through his/her life. (Barker’s) understanding of the nature of human experience as being fluid and in a constant state of evolution, provides an opportunity to explore the theory on which the Tidal Model is formed.
“Life is a journey undertaken on an ocean of experience.
All human development, including the experience of
illness and health, involves discoveries made on the
journey across that ocean of experience.”
(Barker, 2001)
Dr. Barker further implements the use of this metaphoric “oceanic journey” of human experience by applying nautical terms (italicized for the purpose of connecting key concepts) to various aspects of lived human experience.
The Tidal model compares life itself to the constant ebb and flow of the tides on the ocean. Dr. Barker explains that individuals may experience life crises, suffering from potentially debilitating effects of mental illness and therefore find themselves in (metaphorically) “deep water and risk drowning”. In the case of individuals who have experienced significant traumas in their lives, such as abuse or serious injury, according to (Barker, 2001) it is not uncommon for these individuals to express a ‘loss of self’, the Tidal Model compares this loss of one’s “sense of self” as a result of trauma to “piracy” suggesting that the experience has ‘robbed’ the individual of their true sense of self. In this case (Barker, 2001) explains that the individuals discussed above are in need of a “form of life saving (psychiatric rescue) followed…by the kind of development work necessary to engender true recovery”.
This ‘psychiatric rescue’ may occur in one’s community, in the “safe haven of a crisis stabilization unit” or on an inpatient basis as per a client’s individual needs. Following the initial ‘psychiatric rescue’, emphasis is placed on the nature of help necessary to navigate the individual in psychological distress “back on course” providing an opportunity for the client to return or experience perhaps for the first time a ‘meaningful life’ in his/her community. “Once the ship of life is made intact again, and the person has regained their sea legs, the ship may set sail again, aiming to chart the return to the life course.”(Tidal Model website). As stated above, the primary aim of the Models’ heavy emphasis on metaphor is to function as a vehicle offering a description of the theoretical principles and concepts underpinned by the Tidal Model, as an approach to psychiatric nursing.“Unlike normative psychiatric models, the Tidal Model holds few assumptions about the proper course of a person’s life...”(Tidal Model website)
Application of the Tidal Model and the role of a psychiatric nurse in the ‘recovery process’ of a client effected by mental illness, differs significantly in comparison to more traditional methods of therapeutic treatment in comparable theoretical approaches of nursing. (Barker, 2001) explains that the majority of “therapeutic constructs aim to effect some change” in the projection of a client, the Tidal Model “has more modest ambitions, which may – ultimately – be more ambitious”. As opposed to the biomedical model of nursing that involves the nurse’s preoccupation with the pathological aspects of a client’s psychological disorder, Dr. Barker’s model “focuses on contacting the person. The aim… is to understand the present situation of the person, which includes the relationship with illness and health”.
The Tidal Model has strong philosophical ties that facilitate the belief that the client retains the ability to become their own ‘healer’. Barker’s model also relies heavily on the concept of holistic health in which the client is viewed as a whole person, rather than a sum of their parts. In this respect psychiatric nurses are not responsible for ‘curing’ the client but rather function as a passenger on the individual client’s journey to overall health in daily function. The nurse may offer knowledge and practical skills to assist the client in embarking on and throughout their journey back to wellness from the disruption of mental illness hindering the client’s ability to live and maintain a meaningful life.
“Although the nurse expresses a curiosity about the person, this is in pursuit of knowledge of what is happening within the person’s experience of world, self and colleagues; and what this might mean in terms of essential care of the person”
(Barker, 2001).
Within the constructs of the Tidal Model, an individual is theoretically represented by three personal domains: Self, World, and Others. Stated in simple terms a domain may be referred to as a place where someone lives.
In regards to the Tidal Model the term domain relates to areas of a person’s life experience that they may act out either publicly or privately (Barker, 2001). An individual spends time throughout his/her life continuously alternating between each of the three personal domains.
The domain of Self refers to aspects of an individual’s private life. Thoughts, feelings, and personal beliefs are examples of elements contained within the domain of Self. The Tidal Model suggests that this is the place in which “mental illness is first experienced” (Tidal Model website). The main focus from a psychiatric nursing perspective in regards to the Self domain is to assist the client in developing feelings of safety and security. The main objective in this domain is to assist the client in creating a “personal security plan”.
The World domain relates to the client’s social life and involves aspects of the individual’s private life that he/she chooses to share with other people. This domain “becomes the focus of our efforts to understand the person and the person’s problems of living. This is done through use of the Holistic Assessment” (Tidal Model website). In this domain psychiatric nurses attempt to help the client to “identify and address specific problems of living” on a daily basis, this process is most effectively executed through “one-to one sessions”.
The Others domain refers to a client’s interactions with other individuals, their ‘public life’ so to speak. “Organization and delivery of professional care and other forms of support” are located in this domain (Tidal Model website).
In conclusion, with health care continuing to becoming increasingly “technical and emotionally distant, The Tidal Model assumes that nurses need to get close to [clients], so that they might explore (together) the experience of health and illness” (Barker, 2001).
Through exploring the history and circumstances contributing to the birth of the Tidal Model, attaining comprehension of the central metaphor on which the mid-range theory is hinged, and developing conscious understanding of the application of key concepts outlined in the model and the role in which a psychiatric nurse adopts throughout the process, one is able to understand the nature of the Tidal Model as an opportunity to allow a client utilizing mental health services to empower themselves and act as the main facilitator in their own recovery and restoration of holistic health and wellness. This theoretical approach to nursing maintains its focus on “helping individual people, make their own voyage of discovery. In that sense, the only real 'evidence' of usefulness, is what happens - or is 'discovered' - for the individual person” (Tidal Model website).
References
Barker, P. (2001, June). The Tidal Model: developing an empowering, person-centred approach to recovery within psychiatric and mental health nursing. Journal of psychiatric and mental health nursing, 8(3): 233-240. doi:10.1046/j.1365-2850.2001.00391.x
Chaos theory. (2012). Retrieved from http://en.wikipedia.org/wiki/Chaos_theory
Tidal Model of mental health nursing. (2012, January). Nursing Theories. Retrieved from: http://currentnursing.com/nursing_theory/Tidal_Model.html
Titleborn, J. (2012, April). Instructions for Essay no. 1. Basic Concepts and Contexts of Psychiatric Nursing. Retrieved from : http://stenbergcollege.mrooms3.net/mod/assignment/view.php?id=13559