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Growth and Development

 The key purpose of Tidal is to help the person to reclaim the story of her or his life, as a first step to recovering that life in its most complete, lived sense.  Although nurses are not the only people involved in enabling this process of reclamation and recovery, at least within mainstream mental health services, they often are the key agencies. Consequently, Tidal enjoys a mutual relationship with nursing, especially in relation to its core purpose.

 20 years ago the core purpose of nursing was redefined as trephotaxis – from the Greek, meaning ‘the provision of the necessary conditions for the promotion of growth and development’ [1]. 

·         When nurses help people explore their distress, in an attempt to discover ways of remedying or ameliorating it, they are practicing psychiatric nursing.

·         When nurses help the same people explore ways of growing and developing, as persons, exploring how they presently live with and might move beyond, their problems of living, they are practicing mental health nursing. 

These two forms of caring practice are closely related, with a highly fluid border separating them. The former might be seen as problem-focused or situation-specific, whereas the latter is more holistic: concerned with the person’s life - how it is lived, along with its many inherent meanings.

By emphasising the purpose of nursing, rather than its many different processes, more emphasis is given to the developmental and educative aspects of nursing, where the person learns something meaningful through direct experience. However, nurses do not ‘make’ people develop, far less ‘change’ them; neither do they ‘teach’ them anything directly. Instead, they provide the conditions necessary for the person to experience growth, development and change, and to learn something of significance from their own experience.

Emotional Rescue and the Tidal Model

 When people are acutely distressed, under threat – whether physical, psychological or spiritual - or presenting a risk to themselves or others, the high drama of the situation requires an equally dramatic nursing response. Here, the nurse might need to make the person and the environment as physically safe and emotionally secure as possible. This requires great skill and composure on the nurse’s part. Such dramatic help is akin to the work of the lifesaver rescuing someone from drowning. When people are suicidal or tormented by ‘voices’ they require just this kind of ‘emotional rescue’. In such a situation:

·   The nurse provides the kind of supportive conditions that will reduce the experience of distress and prepare the way for a more detailed examination of what needs to be done next.

When nurses respond to people’s distress by helping to contain it, delimit it, or otherwise fix it, they are practising psychiatric nursing. Both the nurse and the person are locked in the present. The emphasis is on stemming the flow of distress, or keeping a watchful eye out for any signs of exacerbation of the original problem of living.

Growth and the Tidal Model

As soon as the ‘crisis’ has passed, and the person – or their circumstances – appears to have calmed down, the focus turns to something more constructive and developmental. Once the ‘drowning’ person has been dragged ashore and is judged to be ‘safe’ the emphasis switches to ‘rehabilitation’: what needs to happen now to help the person return to normal living. If the person appears to have played a part in their own crisis – whether by accidentally falling or intentionally jumping into the river – the focus turns to an examination of the person’s motives, or understanding of the risks involved. Of necessity, this will involve a more detailed, longer-term inquiry, which aims to ensure the person’s safety and well-being in the future. In such a situation:

·   The nurse tries to foster active collaboration – ‘caring with’ the person [2] developing an active alliance, so that together they might develop an understanding of the problem, its personal meanings and relationship to the overall life of the person.

Such a careful, paced, developmental approach to clarifying the person’s understanding of the function and meaning of her or his problems of living, and their possible solutions, lies at the heart of the Tidal Model and illustrates, in our view, the essence of mental health care.


 

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[1].Barker P Reflections on the philosophy of caring in mental health. International Journal of Nursing Studies 1989, 26(2) 131-41

[2] Barker P and Whitehill I The craft of care: Towards collaborative caring in psychiatric nursing. In S Tilley (Ed) The mental health nurse: views of practice and education. Oxford, Blackwell Science, 1997

 

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