Academic journal article Perspectives in Psychiatric Care

The Tidal Model: Developing a Person-Centered Approach to Psychiatric and Mental Health Nursing

Academic journal article Perspectives in Psychiatric Care

The Tidal Model: Developing a Person-Centered Approach to Psychiatric and Mental Health Nursing

Article excerpt

TOPIC. Overview of the theoretical and practical basis of a new model of psychiatric and mental health nursing practice.

PURPOSE. To illustrate the history of the development of the model and some of the processes that aim to re-empower the patient and develop genuinely collaborative approaches to care.

SOURCES. Literature review, author's research, and related clinical experience.

CONCLUSIONS. The Tidal Model provides a practice framework for the exploration of the patient's need for nursing and the provision of individually tailored care.

Search terms: Empowerment, holism, interdisciplinary teamwork, narrative, nursing theories and models, psychiatric nursing

Despite the popular acceptance of the hypothesized, biological, and/or genetic basis of serious mental disorders (such as schizophrenia), a considerable body of research challenges these assumptions (Dawson, 1997; Johnstone, 1999). More important, there is evidence that viable alternatives to such biological constructions of mental distress exist, suggesting the possibilities for more holistic forms of psychosocial intervention (Alanen, Lehtinen, & Aaltonen, 1991; Pylkkanen, 1997). The Tidal Model springs from a similar set of assumptions to those expressed in the work of Alanen et al. when they suggested that people, their families, and those close to them need to be helped to:

   Conceive of the situation (e.g., admission) as a consequence of the
   difficulties the patients and those close to them have encountered in their
   lives, than as a mysterious illness the patient has developed as an
   individual. (p. 97)

Such a pragmatic and respectful approach to addressing the lived-experience of the person and her/his significant others is diametrically opposed to the so-called psychoeducational approach, which assumes an organic basis for schizophrenia (Brooker & Butterworth, 1994). Despite more than 40 years of sustained criticism, the medical model continues to dominate the interpretation of mental health problems and intervention within mental health services (Newnes, Holmes, & Dunn, 2000; Szasz, 2000).

Although originally associated with a particular discipline or school of thought, the medical and, more recently, the biopsychosocial model stimulated by Engel (1977) and other `psychosocial' models (e.g., Foa, 2000) are all used by various disciplines in their efforts to establish what needs to be done in the name of care and treatment. It is not surprising that a specific model of nursing for psychiatric and mental health care has failed to emerge, at least within the United Kingdom, or that nursing theories have been so badly received by nurses themselves (Gournay, 1995; McKenna, 1997). Unlike medicine and disciplines drawn from the social sciences (e.g., clinical psychology, social work), nursing has long been viewed as an intellectual lightweight, with limited research and no home in either the health or social sciences (Barker, 1997).

Traditionally, nurses have been cast as a supporting act in the therapeutic drama. As Nightingale first acknowledged, nurses are akin to foot soldiers: carrying the generals' plans into the battle against illness (Nightingale, 1860/1969). Despite 200 years of effort to establish an independent voice and a distinct understanding of the need for nursing (Barker, Jackson, & Stevenson, 1999), nursing still appears to be haunted by the ghosts of the Crimea (Group & Roberts, 1974). Given that the overall plan of mental health care continues to involve the attribution of a medical diagnosis and the expression of specific medical interventions, albeit through the medium of nursing, the need for any distinct model of nursing has been seriously challenged (Gournay, 1995).

The marginalized status of nursing also might explain why so many mental health nurses have tried to validate their therapeutic standing as nurses by training in a parallel discipline, or field of therapy, that is more established and possesses a higher social status (Michael, 1994). …

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