Ottawa

Tidal Model of Mental Health Recovery and Reclamation: 2002-2008

The Tidal Model originated with the nursing faculty at the University of Newcastle, UK, in 1995. It was the result of a 5 year research study into patients’ need for nursing care in mental health settings.

In 2001, Royal Ottawa nurses were expected to demonstrate evidence informed practice as the organization was moving to become a centre of excellence. Nursing practice at that time was uneven and too often nurses came to work here with little or no specialty preparation. We read of the Tidal Model that had been established in several locations in the UK and even visited a site where it was being used. In order to determine its usefulness in our setting, we launched an education series and research project on three units and were able to demonstrate, among other things, shorter lengths of stay and decreased episodes of aggression. We have rolled out the model across all programs in Ottawa and the FTU in Brockville and continue to evaluate its effects.

The Tidal Model is not prescriptive, rather a set of principles – the 10 commitments- serve as a metaphorical compass for the practitioner. They guide the nurse to first learn the patient’s story, completely from his/her perspective and to develop a genuine collaborative relationship, “caring with” people rather than “caring for”. Within this relationship, the nurse and patient search for strengths and solutions to life’s challenges.

The Tidal Model uses the metaphor of water and describes how people in distress can become emotionally, physically and spiritually shipwrecked. It sees the experience of health and illness as a fluid rather than a stable phenomenon and life as a journey on an ocean of experience. It aims to empower people to reclaim control of their lives.

The Royal Ottawa was the first North American site to launch this model in 2002. Since that time colleagues from across Canada and two from the UK have come to learn about it and to establish the model in their home settings. We have presented our work at various academic and service venues as well as a world wide congress in New Zealand in 2005, published and established it a part of the core curriculum at the University of Ottawa and several other Canadian universities.

ROHCG Tidal Implementation

September, 2002: 3 pioneer programs: Forensic, Mood and Substance Use

& Concurrent Disorders

February, 2004: 6 remaining in-patient units – General Psychiatry in Transition, Geriatrics, Intensive Assessment and Evaluation,

Psycho-social Rehabilitation, Schizophrenia, Youth

November, 2005: Forensic Service, Brockville

Research, CQI, Audits

ROH: 3 pioneer programs at 4 time periods including pre-implementation

(replicated Newcastle study)

What we found:

	decreased length of stay with the Mood program;
	increased LOS in SUCD (indicating persons were connected to the program instead of dropping out early – a god thing); and
	no change in LOS for Forensic service (court ordered stays mostly).
	There were insufficient incidents of “risk” (constant observation, restraints etc) for statistical analysis, but a decreasing trend was evident.
	Persons were more participative in their care, decision-making and goal-setting.

February 07: Tidal audit – all ROMHC in-patient clinical records on

February 22 & 23. Assessed the presence of Tidal practice

through the completion of holistic assessments and daily

care planning.

There was a range – one unit had no evidence of Tidal

practice and at the other end several units showed robust

Tidal practice.

Nov/Dec 07 : Data collection and analysis of Tidal study in Forensic

Service at BMHC (replicated Newcastle study)

Education:

Theories and concepts course – 3 hour class for each of University of Ottawa, Algonquin and Post-basic degree students, annually since 2003

Mount Royal – Calgary, Alberta

McMaster University Mental Health Nursing course (one day workshops)

Humber/University of New Brunswick

Mental Health Nurses certificate program – developing in collaboration with Algonquin College – May 06 to present

Community Mental Health Nursing course Sept 03-April 04, Sept 05 – April 06.

All basic nursing students placed at Royal Ottawa Mental Health Centre practice Tidal.

All consolidation, master’s etc students learn Tidal as part of placement @ ROMHC – clinical, research, innovation courses

University of Ottawa, PhD nursing seminar

Site visits (see attached), consultations (see attached)

Scholarship:

North American Launch of the Tidal Model – Nov 2003 at ROH.

Brookes, N.L. (2006) The Tidal Model of Mental Health Recovery. In Alligood & Tomey Nurse theorists and their work

Brookes, N., Tansey, M. & Murata, L. (2006) Guiding practice with the 10 commitments. Journal of Psychiatric and Mental Health Nursing, 13,

Brookes, Tansey & Murata (in progress). The Canadian context. In P. Barker. Psychiatric and Mental Health Nursing – The craft of care

Mentored 2 Advanced Clinical Nursing Practice Fellows (450 hours) -

Canadian Forces –Tidal fellowship - Andrew Sharpe, RN; MN;CPMHN( C)

Suzanne Barnett, RN; CPMHN( C) – Tidal fellowship with Royal Ottawa Place

1^st & 2^nd Annual Ivy Dunn Clinical Nursing Research Day – featuring Phil Barker & Poppy Buchanan-Barker

Dissemination through numerous presentations (see attached)

Tidal Site Visits to ROMHC:

2007, January 19 Niagara Region

2007, February 7 New Brunswick – Regie de la Sante du Restegouche

2007, February 27 & 28 Humber/UNB Collaborative Program

2007, May 31 Truro, Nova Scotia

2007, June 18 & 19 Baycrest, Toronto

2007, November 5 & 6 London – London Health Sciences Centre, St Josephs

2006, October 26 Halton Region

2006-2007, Sept-April RN Canadian Forces – precepted experience

2005, May 20-24 Nottingham, UK

2005, June 17 Tidal workshop day – post graduate Mental Health Course, McMaster University, Hamilton

2005, July 18 & 19 Manchester, UK

2005, September 28 Calgary Health Region and Mt Royal College

2005-2006, September-April Visiting scholar from Iran

2004, March 3 & 4 Capital Health Region, Calgary Alberta

2004, September 17 Halton Health Care & McMaster University, Hamilton

2004, October 21 Nova Scotia Hospital, Dartmoth, NS

2004, October 23 Thunder Bay, On

Invited Tidal Site Visits From ROMHC:

2007:

	Niagara Region May 3 & 4 Nancy Brookes & Lisa Murata
	Niagara Region May 4, 2007 Margaret Tansey

2006:

	Humber/UNB – Sept 15 & 17 Nancy Brookes – visiting scholar
	Hamilton, ON, Feb 15 Margaret Tansey & Nancy Brookes
	Halifax, NS June 15 &16 Nancy Brookes, Celia Li, Lisa Murata
	Kamloops, BC June 5 & 6 Margaret Tansey

Tidal Consultations electronic, telephone, videoconference

2007

Dec 14 Maria Van Vonderen, Child Youth Family program Dept of Mental

Health Services, Antigonish, Nova Scotia

July Deborah Gibson - London Region

June 1 BC – (Dean Avender – psychiatric nursing student)

May 27 Niagara Health (Toni, Child & Adolescent Psychologist)

April Queen’s master in nursing student (Amanda D)

March Ottawa, ON – 3 Algonquin Students, 3 UofO students

Feb 7 Teleconference Lakeridge Health Durham inpatient mental health team (Paul McGary, manager)

Jan 30 General Hospital, Ireland, Kerry – (Cathy O’Sullivan)

Jan 25 Teleconsult with Nova Scotia Hospital

Others:

Post RN student in advanced nursing practice course – Baycrest & York University (Maxine M)

Abbey Lane Halifax (Barbara Lewis)

Thunder Bay (Jennifer)

Toronto East General Hospital (Kristine Legget, Manager)

McMaster University – Pamela Feltham

Calgary - Mount Royal College student - (Patricia Collins)

Nova Scotia Hospital, Dartmouth (Jeslyn Hensbee)

Ponoka, Alberta (Diane MacGregor, Manager)

Baycrest - Toronto, ON(Ursula Dengedza)

Vernon, BC (Russ Ballentyne, Manager)

Vernon, BC (Lee Crever)

London Health Sciences Centre (D. Gibson, Manager)

2006

Dec 5 Edmonton (Elizabeth Hood) – (3-hour videoconference)

Nov 1 Glasgow, Scotland (Stephen Rhodes – Tidal in addictions)

Oct 16 Calgary, Mount Royal student (Patricia Collins)

2005

Nurse from Wales, especially with older adults; Manager from Wales for the entire trust

Manager from Veron, BC

Nurses from Kitchener, ON

Senior Nurse Manager, Adult inpatient services, Dales, Calderdale Royal Hospital, Halifax, UK

PRESENTATIONS: Peer Reviewed

November 2, 2007 – Murata, L Solution focused group for healthy living. Workshop presented at the 2007 Solution Focus conference, Toronto, ON

November 7, 2006 Murata, L., Brookes, N., & Tansey, M. Transforming nursing practice through collaborative, person-centred care. Workshop presented at the Making Gains 2006 Conference, Toronto

September 14, 2006 Brookes, N., Murata, L., & Tansey, M. Back to basics with the Tidal Model of Mental Health Recovery and Reclamation. Paper presented at the PSR Canada 2006 conference, PSR and recovery – Building on the basics. Kingston, Ontario

May 26 & 27, 2005 International Mental Health Nurses conference: Ideas as Endless as the Prairie Sky. Winnipeg, Manitoba

Barnett, S. Enhancing nursing practice in a non-t4raditional setting using the Tidal Model.

Li, C. The Tidal Model: Facilitating implementation.

May, 2005 3^rd Annual University of Ottawa/Tau Gamma Clinical Nursing Research Conference: Research Into Practice, Practice Into Research. Knowledge Transfer: Strategies for Success. Ottawa, Canada.

Nancy Brookes, Margaret Tansey & Lisa Murata Strategies for Success: The Tidal Model of Mental Health Recovery.

Li, C. Tidal implementation story: Strategy for success.

May, 2004 2^nd Annual University of Ottawa/Tau Gamma Clinical Nursing Research Conference: Research Into Practice, Practice Into Research. Ottawa, Canada.

Nancy Brookes & Margaret Tansey The © Tidal Model of Mental Health Recovery: Research into practice - Implementation strategies

October 31 - November 1, 2003 International Mental Health Nursing Conference: The Art, the Science, and the Ethics of Psychiatric and Mental Health Nursing. Toronto, Canada

Nancy Brookes, Margaret Tansey, Lisa Murata Sharing Stories of the © Tidal Model of Psychiatric and Mental Health Nursing Practice

June 2003 Championing Nursing Knowledge: Making a Difference in Patient Outcomes 2^nd Biennial International Conference on Nursing Best Practice Guidelines. Toronto, Canada

June 5 & 6, 2003 Nancy Brookes, Margaret Tansey, Lisa Murata The ©Tidal Model of Psychiatric and Mental Health Nursing Practice: Celebrating Narrative Nursing Knowledge

May, 2003 First Clinical Nursing Research Day, University of Ottawa: Practice Into Research: Research Into Practice Ottawa, Canada

PRESENTATIONS: Invited

September 28, 2005 Li, C., Brookes, N., Tansey, M. The Tidal Model of Mental Health Recovery and Reclamation: Community Advisory Committee, ROH

September, 2005 Tansey, M The Tidal Model of Mental Health Recovery and Reclamation: Mental Health Nurses Interest group, AGM, Ottawa

September 19, 2005 Brookes, N. The Tidal Model of Mental Health Recovery and Reclamation:

Humber Institute of Technology and Learning, Toronto, Ontario

July 1 2005 Tansey, M., Murata, L., & Brookes, N. A conversation Making Waves: Celebrating Diversity and Connection. Totara Springs, Matamata, New Zealand

June 30 2005 Brookes, N., Tansey, M., & Murata, L. Keynote: Sharing Canadian Tidal Stories Making Waves: Celebrating Diversity and Connection. Totara Springs, Matamata, New Zealand

May 18, 2005 Tansey, M., & Brookes, N. The Tidal Model of Mental Health Recovery and Reclamation: Brockville Psychiatric Hospital Nursing Week Keynote

May 26, 2005 Brookes, N., Tansey, M., & Murata, L. Half-day Invited workshop - The Tidal Model: Ideas as endless as the ocean. International Mental Health Nurses conference: Ideas as Endless as the Prairie Sky. Winnipeg, Manitoba

PRESENTATIONS:

December 2, 2005 24 Annual Department of Psychiatry, University of Ottawa Research Day, hosted by the Institute of Mental Health Research.

Murata, L., Brookes, N.L.., Tansey, M. The Tidal Model of Mental Health Recovery: An evaluation

Barnett, S., Brookes, N., & Murata, L. Practising research-based, person-centred nursing in long-term care with the Tidal Model

SCHOLARLY AND PROFESSIONAL ACTIVITIES:

Brookes, N., Murata, L., & Tansey, M. (2006). Guiding practice development using the Tidal commitments. Journal of Psychiatric and Mental Health Nursing, 13, 460-463.

Tansey, M., Brookes, N., & Murata, L. (2006, Winter). Making waves in New Zealand. MHNIG Newsletter, p.8

Brookes, N. (2006). The Tidal Model of Mental Health Recovery. In A.M. Tomey & M.R. Alligood (Eds). Nurse theorists and their work, 6^th Edition. (Chapter 32, pp. 696-725). St Louis: Mosby

2005, September 19-20 Brookes, N Visiting Scholar Humber Institute of Technology and Learning, Toronto, Ontario

2005, Fall Brookes, N Ideas as endless.as the ocean.. RNAO Region 10 Newsletter p.

2005, February 17 Tansey, M., & Brookes, N. Visionary Leadership in Psychiatric and Mental Health Nursing. University of Ottawa, School of Nursing, PhD student seminar

2005, Winter. Brookes, N. Transforming Nursing Practice: The Royal Ottawa Hospital Goes Tidal. Mental Health Nurses Interest Group Newsletter, pp. 3-4.

2005, Winter. Brookes, N. & Tansey, M. Canada - A Passion for Nursing. In P. J. Barker & P. Buchanan-Barker (Eds). The Tidal Model: A guide for mental health professionals. (p. 402-403) London: Brunner-Routledge

2004, September. Brookes, N. Transforming nursing practice: The Royal Ottawa Hospital Goes Tidal. RNAO ~ Region 10 Ottawa Update Newsletter, 16(1), 9.

December 2004 Certificate of Recognition: Mentor - RNAO Advanced Clinical Practice Fellowship (Royal Ottawa Place, Long Term Care, Tidal focus)

2003, 2004, 2005, 2006, 2007 Tidal Model of Mental Health Recovery and Reclamation. Theories and Concepts course, University of Ottawa, School of Nursing - University of Ottawa Campus, Algonquin Campus and Post-basic baccalaureate

August, 2003 Certificate of Recognition: Mentor - RNAO Advanced Clinical/Practice Fellowship (Canadian Forces, Tidal focus)

Continuous Quality Improvement

February 2007 – Royal Ottawa Mental Health Centre (ROMHC)Tidal audit

Spring 2006 – From constant observation to constant care at RONHC