The word ‘cherish’ is defined in this way:
To hold dear; Tenderly care for; To foster; To cheer; To entertain kindly; To keep warm; To give ease to; To entertain in the mind; Harbour fondly.
Ethos
The Tidal Model and its ten commitments apparently make for a radical reframing of the psychiatric nursing profession. I believe instead that this model offers an ethos that directly addresses some of the struggles I witness amongst the postgraduate students I teach, and the clinical staff I have worked with as they come to terms with consumer/user/survivor/ex patient perspectives and the realities of working in clinical settings. It is both an ethos and a way of doing things differently, affecting practice and service culture.
Nurses will be faced with ‘ugly’ tasks in which they must take part in the violation of the will of another. It remains unclear how the consequences of such obligations can be mitigated. But an approach that sets store on a person’s own calculation of their ‘emergence’ (emergency) can only begin by coming to know the experience of another and learning the language they use to describe themselves and their world. It is always sacred – nowhere more so than in the realm of psychiatry. The tidal model offers an answer to the question: How then, is mental health nursing to take place? It is an ethos that emanates from a desire to cherish the lifefulness of another.
Teaching
In a first session with a new group, I will often ask what it was that drew people into psychiatric nursing. For most, though not in so many words - this profession is felt to be a calling. Yet I see that students are perplexed - confronted with an extremely medicalised view of what a person is, and feeling as though the 'doing' of the work often means that they do not spend the 'real' and important time with the people in their care that they wish for. Not surprisingly, many people in receipt of care say the same – that they are regarded as a collection of pathological symptoms and that nobody seems to be around to just ‘spend some time’ with them.
In their first written assignment, I ask students to explore the concepts of narrative approaches and placing the person at the centre of their care. In addition, they are asked to write up situations where they have ‘advocated’ for someone in their care, inviting that person to ‘evaluate’ their practice. The tidal model literature is the primary source for this assignment.
I have conducted many workshops in Melbourne over the last three years with clinical staff, and often found that they too are aware of something missing. A growing sensitization to user perspectives seems to be converging with a renewed sense of there being something ‘more than’ what is offered by medical approaches alone – there is a growing desire to articulate what it is that nurses do, and want to be doing. Importantly the Tidal Model unlocks the imagining of different ways to practice and to organize services, redefining the kind of relationships that clinicians can have with those in their care and addressing user perspective critique.
Practice
Clinical practice can be redefined when the one who ‘seeks ease’ is truly heard – made to matter. The Tidal Model has attracted attention here in Melbourne and the Centre for Psychiatric Nursing Research and Practice is keen to begin a pilot program that would incorporate staff supervision provided by service users. A feature of the ten commitments that appeals to us is the articulation of the centrality of the language and experience of the one who comes to the attention of the psychiatric service system. This opens up new possibilities for the ways in which conversation and writing take place in psychiatry and what their purposes are.
It is very easy to be a champion of the Tidal Model from a user perspective.
© Cath Roper
