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.
