My Perceptions of the Tidal Model of Psychiatric and Mental Health Nursing 

James M Lynch

Dublin City University

Mental Health Nursing is a demanding and rewarding profession. The role of the mental health nurse has evolved and now includes recognizing that each person has individual needs and taking such action as is necessary to meet those needs. This requires specialist use of the professional nurse-patient relationship, incorporating skills of an interpersonal nature and dealing with the issues that may arise within such relations. Skilful assessments and interventions assist this process. The use of a recognized model of nursing e.g. The Tidal Model of Mental Health Nursing facilitates this process.

Mental health nursing has had an uneasy relationship with nursing theories and models. This may well reflect nurses’ lack of confidence in the value of nursing itself, or the enduring supremacy of medical, psychological and social theories of mental distress and the models of practice that have developed from such theories.

 

Mc Kenna considers that if theory was based upon know how knowledge (clinical practice) it might be easier for practitioners to accept it as being appropriate for their practice. One way of achieving this is to use a phenomenological approach to knowledge development. Phenomenology encourages the generation of theoretical knowledge through exploring the meaning and experience of among other things, know how practice. This can lead to the generation of new theories having their foundations in the know how knowledge of practitioners. The Need for Nursing study (out of which the Tidal Model was borne) increases the Tidal Model’s credibility for the author because the data generated is very ‘pure’ as it is coming from clinicians in practice i.e. know how knowledge. The author agrees with McKenna and considers that it make the model more acceptable to mental health nurses in the ‘swampy lowlands’ of everyday practice.

The experience of mental ill health is disempowering, limiting the persons ability to function in everyday living. When mental health problems endure or reoccur frequently, the family or community may view the person as disabled. The processes of psychiatric care and treatment often add to this disempowerment of the person. Barker states that the commonest form of disempowerment involves the failure to afford a proper hearing to the person’s story of the experience of problems of living. In his opinion the three dimensions of the Tidal Model aim to avoid reducing the person to a patient phenomena, whilst recognizing the impossibility of developing anything more than a provisional account of the persons lived experience and the persons immediate need for nursing. The experience of distress associated with a mental health problem is represented through public behavioural disturbance or reports of private events known only to the individual concerned. These experiences represent the phenomena, which are the proper focus of nursing. Mental health nursing involves the provision of the necessary conditions under which people may access and review such experiences. Such collaborative re-authoring of the person’s life might result in the healing of past distress, the alleviation of present distress and the opening of ways to further development.

If nurses are ever to develop true working alliances, they must begin with the person’s past experiences, rather than with the their experience of them as a ‘patient’. This premise incorporates ‘the person’ component of the the Tidal Model’s metaparadigm. The collaborative element of this premise appeals to the author. The people in our care gain a much greater understanding of what is going on for them if their care is planned in collaboration with them. This can be achieved by involving them in defining what the problem is, planning their care and getting them to sign their care plan. This defines for the author the concept of person-centred care, one which he aspires too.

Peplau commented that nursing has its deepest roots in nature. Historically, mental health nursing practices were primarily nurturing ones while the psychiatrists went about their business of figuring out what were the diseases of mental illness. Attempts to derive viable nursing practices from the theories of prescriptive psychiatry were largely unsuccessful. Throughout its history, mental health nursing has been modified in response to changing circumstances. Innovations in practice arise from the findings of nursing research, from changes in within healthcare systems or from demands in society. The Tidal Model is part of this innovation and represents a shift in emphasis for mental health nursing practice. Barker considers that many nurses are casting around, looking for methods and models of practice in other fields that somehow might fill the perceived vacuum in their nursing lives. Many nurses are encouraged to believe the need to develop ‘new’ skills or learn ‘new’ therapeutic models in order to become effective in mental health care.

The Tidal Model challenges this assumption. It offers a philosophy that strikes a chord in the hearts of these practitioners. It strengthens the relationship between practice, theory and research and it facilitates the role that nurses play in the future of our discipline. Now that daybreak has finally dawned on this new millennium mental health nurses will face many challenges. The author considers that The Tidal Model will assist them in facing these challenges. We await with optimism the realisation of its legacy.

 
Hugh McKenna,  Nursing Theories and Models (London:  Routledge, 1997),  36.
Hildegard E. Peplau,  “Psychiatric Mental Health Nursing: Challenge and Change.” 
 Journal of Psychiatric and Mental Health Nursing 1 (1994): 3-7.