The Tidal Model at Halifax, Nova Scotia
The Nova Scotia Nurses’ Story of Discovery with the Tidal Model
The Nova Scotia Tidal Working Group
Several interconnected conversations and discoveries brought the Tidal Model into view for a group of nurses working in Nova Scotia.
Over the period 2003 – 2004 a number of intriguing articles caught our interest as they resonated with the current discussions and inquiry about how we framed and provided mental health services, and the various multidisciplinary roles. This made us reflect on our practice and how we provide care to individuals and families.
(Pictured - Back: Jeslyn Hendsbee, Clinical Practice Leader Mayflower Unit; Marg Foster Unit Manager 7 Lane; Ken Scott, Program Manager, Acute Mental Health Services.
Front: Mary Campbell, PMH Clinical Nurse Specialist; Charlene Day,
Clinical Nurse Educator; Kristi Kempton, Professional Practice Leader;
Jane Hughes, Clinical Nurse Educator
Following attendance at the Canadian Federation of Mental Health Nursing conference in October 2003, two nurses (from MH Seniors services and the forensic hospital) shared their reflections and learnings about Tidal with their colleagues. They were excited about the model which helped frame their philosophical ideas about nursing practice in a way that was truly client centered.
With its focus on recovery and the caring process, through the therapeutic relationship with the person-in-care, the Tidal Model seemed to be the right fit for our program and our focus on Mental Health nursing practice.
The desire to further understand this model led a group of nurses to seek support from the Director of MH program and apply for a Capital Health ‘Improving Nursing Practice grant’. The grant provided an opportunity to further explore the model and consider the implications for our nursing practice environment.
In October 2004 we connected with, and visited, the Royal Ottawa Hospital, where the Tidal Model had been adopted in 2002. During the site visit, the ROH staff nurses provided their personal stories of successes and challenges experienced in learning and using the Tidal Model. They described the positive impact it has made with the individuals in their care and how it has enhanced their nursing practice. The group provided examples of their experiences and shared about implementation. Nancy Brooks, Margaret Tansey, Celcia Li and Lisa Murata along with staff nurses from the various units totally captivated our attention. They exemplified the Tidal Commitments and underpinnings as they shared their journey. They highlighted the benefits of this practice change to the people they serve, the nurses themselves and how it values the treatment team.
Following our visit, we reached out past our formal brick walls to involve nurses from the other parts of the province. A Nova Scotia group formed to build our knowledge about the Tidal Model and share personal narratives and experiences about nursing practice.
As this process was moving forward, the Mental Health Strategic planning process had begun. As the dialogues about changing mental heath services unfolded, and the core values of our MH program emerged, we could see strong similarities with the key concepts and principles of the Tidal Model.
As part of the MH services re-design there was an agreement to develop nursing care delivery based on The Tidal Model. A Steering committee formed to create and support the implementation process and Tidal Champions were identified. Tidal Champions are nurses who have embraced the Tidal Commitments and provide ongoing support, guidance and information to unit staff throughout the implementation process. This is accomplished in a number of ways: through ongoing dialogue, building their expertise, group and one-on-one clinical support.
To date, implementation has focused on 3 core areas of practice; 2 Acute care units, 2 Community Focused Living units (which are transition Services) and Forensic services. (this includes Assessment services and 2 Rehabilitation units).
To begin creating an environment of discovery to this change in practice, we offered workshops focused on the ‘World Domain’. The focus was on empowerment, learning the holistic assessment and care planning. The workshops incorporated reflection and solution focused strategies to help explore the model and demonstrate the concepts.
‘Sharing stories’ is key to our understanding of practice. To help nurses reclaim their practice and embrace this change, we invited 3 staff from the Royal Ottawa Hospital to spend time on our nursing units sharing their stories. Nancy, Celia and Lisa, provided first hand accounts of their experiences with Tidal Model. Our staff appreciated hearing from their direct experiences.
Conference and Consultancy
In October, Phil and Poppy provided 2 days of consultation with staff on the nursing units. This proved to be an inspiring experience for many nurses. A few nurses remarked that meeting with Poppy and Phil helped clarify their understanding of the holistic assessment, especially around the questions ‘What does all of this mean for you” and "What does this say about me as a person?”
We also had the pleasure to host a one day conference with Phil and Poppy. Over 130 Mental health staff attended from across Nova Scotia and throughout Canada. The majority of participants were nurses but the interest from other groups was overwhelming. Several Occupational Therapists, Social Workers and Spiritual Care providers came to participate, learn about the model and how it may influence their practice.
Evaluations from the conference were overwhelmingly positive. Phil and Poppy don’t just talk about the model but truly exemplify the essential therapeutic commitments. They share stories that demonstrate the Tidal ebb and flow. Their presence and genuine compassion for individuals and their stories is constantly flowing and proves meaningful.
Where are we NOW…..Well, our path has had many turns and rough water to navigate. We are venturing to refocus our attention and support to nursing staff in more concrete ways.
Education
Within the Dalhousie School of Nursing, students have been encouraged to explore and study the Tidal Model. We are seeing pockets of new staff entering our work environment with expectations that they will have opportunities to practice within a tidal model philosophy.
In Nova Scotia, the Registered Nurses-Professional Development Centre provides continuing education programs in specialty areas of nursing practice. The Psychiatric Mental Health Nursing program is coordinated by Loretta Whitethorne. The Tidal Model is the framework for which this competency based nursing program has been developed.
