Tidal Model: uncommon sense, The

Mental Health Nursing,  May 2004  by Buchanan-Barker, Poppy

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How does the Tidal Model' look five years after its first report 'launched' the idea on a wider ocean? Tyneside, famous for its ship building, was the 'yard' for this striking vessel of the mind which has now sailed to ports all over the globe. Poppy Buchanan-Barker describes the voyages it has made since then, the cargoes it has carried to practitioners internationally and the messages for mental health nurses everywhere

It is just over five years since the publication of the first report on the Tidal Model (Barker, 1998). Since then, nurses from all four corners of the globe have begun to express interest in this alternative model for mental health recovery. What began as a local attempt in Tyneside to re-focus acute mental health nursing care, has developed into recovery paradigm for the whole mental health continuum, proving attractive to staff in both hospital and community settings, working with older and younger people alike (Barker, 2002). By far the commonest comment received through the Tidal Model website is - 'this reminds me why I came into nursing in the first place'.

The Tidal Model develops Peplau's original emphasis on the nurse-patient relationship (Peplau, 1952) to include an appreciation of the chaotic nature of change, which is the only true constant (Barker, 1996). The Model emphasises ways that nurses might help people in their care to become aware of the small changes which are occurring to them, and through them, as part of their everyday reality. Most importantly, the Model emphasises pragmatic ways that people might learn 'what works' for them and why. Such 'personal wisdom' represents the basis of the person's recovery - the knowledge they will use to navigate the metaphorical storms of the recovery voyage.

International projects

By the beginning of 2004 almost 100 formal Tidal Model projects had been established worldwide. Most of these projects are in England, Wales and Scotland, but exciting developments are also happening abroad.

Nurses in the Irish Republic were the first to introduce the Model into community care -first within a day hospital project and then in a primary care setting at Tosnu - Gaelic for 'a fresh start' - attached to a health centre in Cork city. In New Zealand, nurses at the Rang/papa forensic service in Porirua have been developing their care around the Tidal Model for almost three years and were the first forensic service in the world to adopt the model. The Tidal Model's emphasis on narrative has proven particularly attractive to the indigenous Maori and Pacific Islands people, who greatly value the power of story telling.

In Canada, nurses at the Royal Ottawa Hospital have implemented the model across most of their services, including their substance abuse programme - both residential and community. This represents the first use of the model with people with drug and alcohol related problems. The Royal Ottawa Hospital has developed a specific curriculum for teaching the model and one of the graduate students has developed the model for use in family work. Finally, in Australia, there is considerable interest in using the model within palliative care. The model's focus on the 'here and now' of everyday experience aims to identify the conditions necessary for promoting what the person would call a 'good life'. Naturally, the same process is possible for promoting the idea of a 'good death', which is the culmination of the 'good life'.

A value-based philosophy of constructive living

Although the Tidal Model has led to the development and adaptation of specific 'tools' of assessment and care delivery, it is essentially a philosophical approach to mental health care. The Model emphasises the fact that the individual nurse is the key 'tool' that might begin to unlock the person's potential for recovery. The principles upon which the Model is based, and the various principles for its practice are, like all theories, merely 'ideas on paper'. The Model assumes that knowing 'how' to aid recovery is more important than simply knowing 'that' recovery is possible. Consequently, the focus is always on the recovery attitude and the infinite range of possible practices that might flow from such an attitude.

Regrettably, in much contemporary nursing practice the emphasis is on 'documentation' and other forms of paperwork, which can dominate the nurse's field of vision. Most of these paper templates derive from legislation or come via some other 'top down' route. Not surprisingly, the point of these paper exercises is often either lost or unclear to the practitioner, far less the person in care. In the Tidal Model the paperwork is seen as similar to the ship's log: merely a record of the journey that has been taken and the various events that have occurred en route. The record is merely an attempt to capture some of the attempts that have been made, to help the person begin or undertake the voyage of recovery.

The Tidal Model developed from practice research into what people needed nurses for: what do people and their families value in nurses? - what do nurses do that appears to make a difference? (Barker et a/, 1999). Related research on the dynamics of empowerment (Barker et a/, 2000) helped develop further our understanding of how the nurse and the person (and/or family) could become a team - working together to identify and enact the necessary steps on the road to recovery.