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.
[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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