Tidal Model Of Mental Health Care Recovery Essay

CENTRIA UNIVERSITY OF APPLIED SCIENCES

According to Barker 2002, the tidal model of mental health recovery originated from England between1995-1998 from a meta-analysis of series of studies. These studies focused on the initial period a person requires psychiatry nursing care (Barker et al. 1999) and the discrete characteristic of the power-relationship between mental health nurses and the patients in their plan of care (Barker et al. 2000.). This model supports the idea that crisis associated with mental illness can be viewed through a different theoretical dimension, but asserts the virtue of analyzing such critical situation, basically, as a problem of living that can reduce the quality of life of an individual on various interpersonal, intrapersonal, and spiritual levels (Barker et al. 1999.).

Initially, the tidal model was introduced in to acute psychiatry setting (Barker, 1998) and since then has developed into a theory of a treatment or care continuum in different hospital, forensic, community and rehabilitation settings. The tidal model lays detailed emphasis on the client’s need for three main forms of care. These include critical, transitional and developmental hypothetical phase of care. Tidal Model Of Mental Health Care Recovery Essay. The tidal model however may also be employed in addition to other care and treatment administered by other disciplines as its main objective is to analyze and develop the lived-experience of the client in care (Barker et al. 1999.).Detailed attention and focus is attached to ways of unraveling and clarifying values and reasoning, that client’s attaches to his or her problems of daily living (Barker 2000.).In conducive and appropriate situations, this investigation or exploration can shift from intrapersonal dimension through interpersonal conceptions of self and others (Barker 2000.).

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The Tidal Model utilizes an efficient, respectful and humane in addressing the care by recognizing the patient’s situation (Alanen et al. 1991.).It is vital to assist as well as supporting patient and their families to accept the situation, and also view it as a result of the difficulties the patient or clients and people around have faced in their lives(problem of living the client has encountered) rather than as a mysterious illness within the person (Alanen et al. 1991.). The model also includes emphasizing the core value of lived experiences of the client and his or her relatives. The need for mutual understanding between the mental health nurse and client in care is also taken into consideration as well as a holistic, individualistic and contextually binding form of care and treatment is secured (Barker 2008.).

In this model, to properly construct the client’s experience of selfhood, there is a mutual understanding and discussion and all evaluations and treatments are as a result of cooperation(co-creation) between client in care and those supporting the patient(nurse or family) and this process was initially connoted as ‘caring with’(Barker and Whitehill 1997.).The tidal model adopts a philosophical approach in defining and discovery of mental health. It focuses on assisting people to regain the personal story of their mental distress by recuperating their voice. In utilizing the client’s own voice, personal stories and metaphors they usually start to express and reveal things and issues important in their lives (re-living their experiences). This is the initial and major step in the recovery of control over their lives. The responsibility of nursing professional is to assist clients realize and achieve in their lives (Barker 2000.). Tidal Model Of Mental Health Care Recovery Essay.

THE COMMITMENTS GUIDE TO TIDAL MODEL APPROACH TO MENTAL HEALTH CLINICAL PRACTICE.

According to Barker 2008 stipulated 10 commitments guide the Tidal Model approach to mental health clinical practice. Nurses should value the voice of the clients as their voice of experience is the core concept to which can assist in recovery but not the professional medical terminologies (Barker 2002.). This brings hope to the patient and their process of recovery and this may begin at a turning point, or appear gradually as a minute and fragile feeling, and may change with desperation. The nurse or professional should respect the language of the client because the words people use to describe their lived experiences and what they have gone through is very important to their recovery process (Barker 2008.). The best way of the nurse to assist the patient or client in this regard is to be a learner or an apprentice and the patient is the center or reservoir of information as the person is the expert of their own situation (Barker et al. 1999.). Thus the caregiver must assist the client to reveal their possessed or inner wisdom as they truly know themselves better. It is very useful for the mental nurse to generate genuine interest and curiosity about the client’s situation by listening, gathering client’s resources, and patience and to take everything they into great consideration (well noted for continuous care planning). Tidal Model Of Mental Health Care Recovery Essay. Giving time and been patient with the clients helps to generate great bonds and establish great trust in nurse-patient relationship (Altschul 1972.). Transparency and honesty is one major factor which is very useful in the tidal model especially with the use of the person’s language in the care and evaluation procedure during the process of recovery (Barker 2008.).

ASSUMPTIONS- CONCEPT OF CHANGE AND NARRATION (CLIENTS OWN STORY)

There are two main assumptions underlying the Tidal Model (Barker & Buchanan-Barker 2004.).The assumption that change is the only constant that is nothing lasts or remains

the same forever. Every human experiences involves flux and people are constantly changing and developing (growth).This implies the value of helping people become more aware of how change is happening within and around them in the ‘now’(Barker & Buchanan-Barker 2004.).It focuses however on the type of care and support that client requires ‘now’ in order to take the next step in their journey to recovery. Deegan (1996) and Barker et al. (1999) revealed that the process of entering, enduring and recuperating from critical traumatic life crises is perpetually exhibited in terms of metaphors (Barker & Buchanan-Barker 2004.).

Clients encountering life crises are seen as been in deep water and risk drowning or sometimes may have the sense of feeling of like been casted or thrown to the rocks (Barker 2002.).In this kind of situations, clients require a well- coordinated form of psychiatry rescue which is monitored at an appropriate time interval, also by the type recuperating work needed to ensure better recovery. This most often take the form of crisis intervention by the community mostly in ‘safe haven’ or crisis homes. Focus is switched to the kind of care and support to get the client back on course thus returning to a meaningful and productive life in the community once the rescue is complete mostly done by mental health nurses (Barker & Buchanan-Barker 2004.).Nurses act translators for the clients to treatment team and others and also the binding agent that holds the entire treatment system together (Stevenson& Fletcher 2002.).

Secondly, the concept of narration implies that clients or people are their own narratives (MacIntyre, 1981), that is the mirror for their own reflections and personal or self-theories which reveals the happenings and perceptions about what is goes on within and in their relation to the outer world of experience. Tidal Model Of Mental Health Care Recovery Essay. The person’s perception of self, the world of experience which includes the experience of close relations is totally connected to the life story and the different importance they attach to it (Casey and Long 2002.). Utilizing the person’s own language, without translating into in to professional terms or jargons, has contributed to the fruition of the theory. Most essentially, the narrative focus of the Tidal Model is not necessarily to reveal the causative course of the person’s current problems of living, but the goal is to apply the experience of the person’s journey and its associated meanings. This helps to formulate the next step that is what needs to be implemented to assist the person progress on his/her life journey (Barker & Buchanan-Barker 2004.).

REFLECTION

During the assignment, I learnt a great deal of the tidal model of mental recovery. The recovery doesn’t necessarily mean to return to normalcy but rather for the client to live a fulfilled life despite the mental distress. In this model, mental disorder is viewed as a problem not a mysterious sickness. Despite it wide use in some major countries, it faces stiff opposition in the world of Evidence based practices. The 10guidelines helps nurses and professionals to give care to mental distressed client by using their own language as a tool of recovery.

Ever since the dawn of nursing, nurses have long been regarded as intellectually inferior to the other members of the healthcare team (Barker, 1997). Tidal Model Of Mental Health Care Recovery Essay.

As highlighted by Risjord (2009, p.2), it was only during the mid twentieth centuries that nurses began to realize the importance of having sound theory-based knowledge in order to practice nursing efficaciously. It was indeed a significantly huge step forward in the history of nursing.

Elder, Evans, and Nizette, (2009, p.15), defined theory as a set of constructs, hypotheses, principles and propositions, which provide the rationale for the actions that guide our practice. (Psychiatric and Mental Health Nursing by Ruth Elder, Katie Evans, Debra Nizette; 2009; chatswood, Australia: Elsevier; 2nd ed.; p.15)

Following the emergence of nursing theorists and their various theories which caters to the many different schools of thoughts, the professionality of nurses was further established.

The author would like to discuss about ‘the Tidal Model of psychiatric nursing care’, as it is a nursing model, which is of particular relevance to one’s work.

A psychiatric institution is hardly similar to a general hospital; therefore besides having a specialized body of knowledge, there is also inevitably a need for a different approach in the way the psychiatric nurses work.

Hayes and Collins supported this, by suggesting that, registered nurses with general training do not appear a reliable source of recruits to the field and that a ‘nursing’ approach to the issue may not well serve the interests of mental health (E. W. Hayes; John Collins. 2007) Tidal Model Of Mental Health Care Recovery Essay.

The Tidal Model (Barker, 1998, 2000) emphasizes a utilitarian approach in identifying the problems of living, which is at the same time respectful towards the patients. The model aims to construct a narrative-based form of practice (Barker and Kerr, 2001), treating each patient as a singular and unique person. This differs from most other contemporaneous nursing models which employ evidence-based approaches, where features were established on the assumption that each patient is an equivalent subject to that of the research population (Barker and Kerr, 2001).

The main objective is to explore the patient’s life experiences and various needs through using a set of dimensions, namely the World dimension, the Self dimension, and the Others dimension.

Under the World dimension of the Tidal, the nurse explores the patient’s experiences of distress, trauma, or illness, which led to the current state which she or he is in. This may also include factors such as how does the patient feel that her or his condition had affected their relationship with their loved ones in anyway, and what they feel needs to be done to help in their recovery (Barker, 2001, p.83).

The Self dimension of the Tidal Model looks into issues that revolve around the patient’s emotional and physical security, exploring the emotional stability and the likelihood of her or him harming themselves physically. The nurse also explores ways and means which could help the patients maintain their sense of security, through validating with them what were the things that made them felt secured before and what could the nurse do to help in their current situation (Barker, 2001, p.83).

Lastly, the Others dimension, the emphasis is shifted onto the patient’s means of leading a normal life after recovery. The nurse explores which are the resources the patient has, and possibly, equipping them with the resources they lack (Barker, 2001, p.83).

As introduced in Jacqueline Fawcett’s “Analysis and Evaluation of Conceptual Models of Nursing” (1980), the metaparadigms are extremely general concepts that serves as a conceptual basis. Tidal Model Of Mental Health Care Recovery Essay. Their purpose is to direct the activity of the nursing profession, in aspects such as knowledge, philosophy, theory, educational experience, practice orientation, research methodology and literature identified with the profession (Meleis, 1997 and Marriner-Tomey and Alligood, 1998).

The author shall now attempt to co-relate the Tidal Model of psychiatric nursing care with the four nursing metaparadigms, Health, Person, Environment, and Nursing.

The author’s feels that the ‘Environment’ metaparadigm, with regards to the Tidal Model refers much more to the ’emotional environment’, rather than the physical environment.

(Barker et al. 2000), mentioned that the concept and values of care should be valued as indispensable environmental prerequisites right from the commencement of the recovery journey. Through providing the necessary support to ensure the patient’s emotional and physical safety while assisting her or him in exploring and identifying what needs to be changed, to facilitate recovery and exploring the possible roles of professionals, family and friends, and enlisting their help, in the entire recovery process. All these provide the patient with a metaphorical hopeline, to the supportive environment where it is easier for her or him to begin to feel secure and comfortable enough to begin the recovery process.

Hence, the author feels that the emotional environment is of paramount importance in helping the patient with her or his recovery. As suggested in the Tidal Model, most patients experience ‘shipwrecks’ prior to the onset of their mental illness.Tidal Model Of Mental Health Care Recovery Essay.  These ‘shipwrecks’ may encompass events of extreme stress, or environments which were extremely oppressive and adverse beyond the patient’s point of threshold. Hence, the significance of ‘Environment’ in this model; while the nurse may process the skills to provide a comfortable and stable emotional environment for the patient, physical environment should also be soothing and relaxing. This is of particular relevance in the mental health context; the ‘milieu’ or the venue which surrounds the patient plays an important part in regulating the patient’s emotional stability, and thus should not be neglected.

The ‘Nursing’ metaparadigm looks at what the nurses does to alleviate the patient’s suffering. These include the care, the treatment, and the compassion rendered to the patients. These may be demonstrated in the form of nursing interventions to assist the patients in their recovery; and in the psychiatric setting, first and foremost an effective and efficacious therapeutic nurse-patient relationship needs to be in place. Most psychiatric nurses would agree that the nurse-patient relationship has to be a collaborative one, before the patient would readily participant in any therapeutic activity which the nurse has to offer.

Therapeutic nurse-patient relationship has always be regarded as the crux of mental health nursing, considering its potential in instilling support and bringing about insight and behaviour change in the patient (Stuart 2001; Thelander 1997). Hummelvoll (1996) had also described the nurse-client-relationship as the cornerstone of psychiatric nursing.

Barker (1997) highlighted that, the Tidal Model places emphasis on making contact with and understanding the patient, rather than focusing on the disorder or illness. This makes the Tidal Model a relevant and appropriate caring model for use by the nurses, as nurses spend more time with the patients and are blessed with having the opportunity of establishing a higher level of rapport with them, as compared to other members in the multi-disciplinary team.

Clay (2203) also highlighted that, promoting connectedness with the patient is one of the main objectives of the Tidal Model. This is beneficial because it enables patients to feel as though they are working with friends and colleagues, rather than with some care providers whom are “higher-up” in status.

Peter Wilkin (2002) mentioned that psychiatric care is often delivered through surveillance. The author feels that this is true in the context of Singapore as well. The healthcare team, nurses and physicians in particular, would at times confront the patients via the means of threats, implementation of curfews and limiting of relatives’ visiting when patients do not behave in the way they were expected to. Tidal Model Of Mental Health Care Recovery Essay. Clearly, this is against the nursing’s philosophy of caring. Building an effective and efficacious therapeutic nurse-patient relationship with our patients requires an appreciable amount of effort, and intimidating our patients in anyway would be counter-effective.

Often in the mental health setting, healthcare professionals behave and work in a way as though they do not believe, or are skeptical of a possible recovery in the patients. The author believes this to be the least desirable trait in psychiatric nursing.

(Merton, 1968) mentioned that, “‘self-fulfilling prophecy’ is of critical importance to the therapeutic outlook”. Therefore, to be an effective helper, the nurse also needs to realize that her or his beliefs about the patient, and the possibility of their recovery, can create a marked difference.

The ‘Patient’ metaparadigm refers to the various recipients of care, which includes the patient, their family, and the community (Perry A.G, 2001). Each patient is a unique individual who processes a different set of life stories and problems waiting to be explored. In order to help the patient, there is a need for the nurse to know the patient better. The nurse needs to generate a genuine sense of curiosity in what the patient has to share, rather than merely seeking noticeable signs and symptoms. Healthcare professionals often have the habit of assuming that they are the ones whom know the patients best, this attitude tends to hinder them from getting to know their patients better. Barker (2006) suggested that no matter how much they share, the nurses will never have the same amount of knowledge about their lives than the patients themselves.

The nurse should also employ verbatim techniques, at every opportunity, whilst communicating with the patient. By doing so, the nurse gains an upper hand at gaining a deeper insight into the patient’s inner world of thoughts. Tidal Model Of Mental Health Care Recovery Essay.

Saunders (1997) emphasized the importance of exploring each of the person’s construction of experience through narrative. The nurse can achieve this by utilizing verbatim whilst interacting with the patient, and recording the person’s accounts of needs and problems in her or his own words, without employing any form of translation, thus minimizing the amount of distortion to the patient’s original message.

After achieving a sound understanding of the patient’s experiences and problems, the nurse should then aim to address the patient’s problems by drawing up an individualized nursing care plan; nursing goals should look into the multidimensional needs of the specific patient in need.

From the mental health perspective, the ‘Health’ metaparadigm looks at the patient’s perception of her or his own health, and addresses what needs to be done to restore emotional health and well-being. The nurse could well borrow concepts from the Tidal Model’s narrative, in accomplishing this task.

The Tidal Model (Barker, 2002) suggests that the narrative, as the metaphoric steering wheel for the nurse. It is an avenue for the nurse to better her or his understanding of how the patient became emotionally, physically or spiritually ‘devastated’. Rapport with the patient can be enhanced through demonstrating a keen interest in learning the patient’s life experiences. There is then, good opportunity to comfort the patient by showing concern, and also to know the patient in a more in-depth matter. This way, the nurse may form a collaborative alliance with the patient, to undo the damages mentioned.

Till the early 19th centuries, ‘keeper’ used to be the term given to those whom were entrusted with the care of the mentally ill.Tidal Model Of Mental Health Care Recovery Essay.  The keepers, who cared for the mentally ill, had controlled the movements of their patients in similarly primitive ways as with how zoo-keepers and game-keepers managed animals and game. (Nolan, 1998, p.6)

It is no surprise that in Singapore itself, psychiatric nursing is also often regarded as being more backward than the other areas of nursing. Psychiatric nursing has always been enveloped by tons of controversies, and these can be at times, overpowering. Locally, psychiatric nurses are often referred to as being nurses of mediocre quality, or nurses with ‘rusty’ nursing knowledge, having being not practicing and honing their nursing skills as often as nurses in the other disciplines.

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Nursing is a profession based on caring, compassion, and it is often said that nurses are our patient’s advocates. As a psychiatric nurse, the author dearly affirms by this statement. In the psychiatric health setting, advocating for the mentally ill is ever more so important, for this special group of patients often lack the ability to advocate for themselves. Hence, an important and crucial role of the psychiatric nurse, besides caring for our patients, would be, to be our patient’s advocators, constantly advocating in their best interest. However, in order to render nursing care that is appropriate and beneficial to the patients, one of the most indispensable prerequisite would be a body of wisdom which is used to support nursing practice.

The author firmly believes that, apart from having additional education, to equipping us with specialized knowledge, as registered mental health nurses; the presence and adherence of nursing models, as such of the Tidal Model, are cardinal in maintaining credible standards in the quality of the nursing care we deliver as mental health nurses. Tidal Model Of Mental Health Care Recovery Essay.