Tidal Model of Mental Health Recovery - Research Paper Example

Introduction People with mental health problems and disorders have a dire need for care and treatment. Though the concept of nursing has been normally attributed to the care of patients, psychiatric nurses have not been given the opportunity to exercise new approaches for patient care and treatment as they continue to follow traditional ways of caring (Fletcher & Stevenson, 2001). The recovery of mental health has become an emerging topic for many researchers and has been tackled by numerous theories. However, over recent years, human values and beliefs have had greater influence on the concept of recovery in mental health compared to scientific researches. This paper focuses on the Tidal Model of Mental Health Recovery (Barker, 2001) which is considered as the first model for recovery developed by nurses and practitioners (Brookes, 2006). Tidal Model of Mental Health Recovery Over the past decades, psychiatry was mainly focused on the things that were done to the patients, and not with them. Mental illness was contained in order to significantly reduce the disturbances; however, by the end of the 20th century, the belief that professionals can sort out psychiatric problems was dramatically declining (Davidson & Strauss, 1992). With this, the concept of recovery as well as it focus on values had been highlighted, which has driven Barker (2001) to come up with the Tidal Model of Mental Health Recovery.  The philosophy behind this approach was initially driven by research about what individuals need for mental health care. The theorist was encouraged to establish a theory focusing on values as a component of recovery-focused practice, due to the fact that traditional scientific approaches have not been able to address all mental health issues, especially recovery. Generally, the Tidal approach places emphasis on how professionals and practitioners can modify care to work with each individual’s needs as well as his story and experiences so the person can be capable of paving the way for recovery (Buchanan-Barker & Barker, 2008). The person plays the main role in the recovery process, though a practitioner can help release the potential for recovery of the individual. The Tidal model is the first model of mental health recovery based on research that has also been developed by nurses as well as the support of individuals who have used or have been using psychiatric services (Brookes, 2006). Numerous approaches on recovery often put emphasis on self-management with which people are helped so they can manage their symptoms and develop plans in order to achieve wellness. These methods are only useful when the individual has already recovered from the problem which, in the first place, requires effective mental health care. The Tidal Model strongly suggests that recovery should begin when the individual is at his or her lowest point. When someone is in need of psychiatric care, the recovery process must begin immediately when the individual uses the service. The processes that are integrated in the Tidal Model are more focused on providing help to individuals especially when they are most distressed. There should be instant action because these people are in need of immediate help that will allow them to learn what they should be able to do to manage and cope with the problem. This approach believes that the experience of an individual can be relayed through a personal story or narrative that is developed when the patient collaborates with the professional. The story comes from a series of conversations with which there is an equal power and status between the two sides and from here, the professional gently guides and directs the patient towards a perceived goal. The Tidal Model integrates certain assumptions about people and their experiences and problems of daily living as well as their ability to change (Buchanan-Barker & Barker, 2005). The recovery attitude that is expressed by this concept is reflected in these assumptions including: 1) a strong belief in curiosity with which the professional can be able to actually learn something from the person’s story; 2) the recognition of resources that are available to the individual, whether personal or interpersonal, that is likely to be of help during the recovery process rather than focusing on problems and weak points; 3) regard for the individual’s desires instead of providing strong suggestions that the professional may think are the best things to do; 4) acceptance of the possibility that a crisis may become an opportunity and that difficulties may be a sign that there is a need for change towards the right direction; 5) awareness that each objective belongs to the individual which will symbolize the stages for the process of recovery, and 6) the practice of simplicity which can be the most appropriate means for stirring up changes necessary for recovery compared to complex and overwhelming psychiatric care and treatment. Using these assumptions, a set of values has been created in order to provide professionals and practitioners guidance in taking a philosophical approach when treating and caring for people. This is in stark contrast with just merely controlling the symptoms of patients. Moreover, the Tidal Model is a reminder of the principle that even though rules are come from the head (masculine component), commitment is stirred up from the heart (feminine component) (Lafferty & Davidson, 2006). These Ten Commitments encourages the professional to: 1) value the patient’s story; 2) respect the language used; 3) develop genuine interest and curiosity; 4) become the learner; 5) help reveal potential for recovery; 6) become clear and understandable; 7) utilize available resources; 8) help carry out the necessary steps and changes; 9) spend more time with the patient, and 10) understand that constant change is unavoidable (Lafferty & Davidson, p. 32). Generally, using these values and commitments, the Tidal Model recognizes the nature of work that exists between health care professionals and their patients when cooperating to address the problems or attend to all needs of the patient in his or her human living. Use of Concepts: Relation to the Tidal Model Through this information, the Tidal Model may have been formulated through inductive reason because the theorist and other colleagues began with specific observations and detailed measures. Through the process, they detected regularities and patterns, then they were able to create a conclusion on recovery and mental health care services that they can further explore, and through this, they have developed the conclusion that recovery should start from the moment the individual asks for psychiatric help and that he or she should be at the center of the process. The Tidal Model approach incorporates the concepts of personhood, holistic assessment, focused assessment empowerment, and narrative as medium of self. The concept of personhood revolves around the appreciation of one’s self, of others, and of the surrounding world. These are domains with which the person spends some time with his self while at other times he spends it with others and the world (Carruthers, Collins, & Stevens, 1995). When the person is able to value his personalities, knowledge, experiences, relationships with others, and preferences, it will allow him to preserve his personhood and will have a significant effect on his sense of wellbeing. The Tidal Model encourages the preservation of personhood as its values and commitments aim to reveal and represent not just the patients’ conditions but their life stories in general. When their stories, preferences, and goals are realized, it becomes easier for them to achieve recovery from mental health problems especially when health care professionals are able to help these patients in realizing what needs to be done to work towards a positive change. Second, in relation to the concept of personhood, the concept of holistic assessment also looks at all significant aspects of the patient’s with which the professional carries out a holistic and complete assessment of the patient’s needs and status. This process requires not just a physical assessment but also an examination of the social and psychological status of the patient (Katz & Stroud, 1963); this way, as the Tidal Model puts it, each and every need of the person is identified to help create the steps for recovery.  The concept of focused assessment empowerment can also be identified. Using the Tidal Model, when health care professionals are able to carry out a holistic assessment and the personhood of their patients is valued, it will increase their knowledge, awareness and skills especially when they interact with their patients’ participation to move towards achieving recovery. This way, such professionals are empowered, given a greater sense of self-esteem, and become more assertive and effective in their performance. In turn, their patients, who have been disempowered, gain a greater sense of moral as there is power between their relationships with their health care professionals. Finally, the concept of narrative as a medium of self is completely present when using the Tidal Model due to the fact that a narrative requires the recounting of events with which meanings are established (Polkinghorne, 1988). When experienced by both the teller and listener, narratives do incorporate special characteristics that enhance and deepen the experience particularly in learning and assessment. Because the Tidal Model encourages the patient to tell his story, it serves as a powerful means in discovering the meaning behind these thoughts and experiences that can help create the steps for recovery. The four concepts of personhood, holistic assessment, focused assessment empowerment, and narratives all involve the active participation of both the health care professionals and their patients to establish a strong solution for the problem. However, in the Tidal Model that focuses in ordinary conversation, the patient plays a main role of telling his everyday stories which has a power that is dramatically different from therapeutic conversations. Working with the patient’s story, the combined work of the professional and the patient involves the negotiation of the things to be done, which are likely to respond to the patient’s current problems. Through these concepts, the four metaparadigm concepts of person, environment, health and nursing have been integrated into the Tidal Model because it requires that the entire personhood is evaluated and used which is primarily focused on one’s self as well as his or her surrounding peers and environment, or generally the support systems with which the professional may study the impact of the recovery process on the individual’s emotional state. Furthermore, the person’s health is put into the heart of the process by using nursing practices that are focused on completely caring for the patient especially with a series of daily conversations that will allow these professionals to assess and improve the wellbeing of the individual. Nursing is seen as both a professional and social construct that should express attitudes that will lead to nurturing experiences Application of the Tidal Model I have chosen the Tidal Model of Recovery because I believe that we can never know the actual experience of those who have mental problems and illnesses. However, though we are not capable of looking through their minds and going through each of their experiences, we can encourage these patients to open up their stories, their thoughts and feelings to help us, mental health professionals, to create the necessary steps that they can take for their recovery. I can try to fit myself as much as I can inside the patients’ experiences and develop a sense of interest in their story while understanding their feelings and difficulties. When this is done on a regular basis, more value and meaning is revealed through this connection that will enable me to identify the real needs of my patients. Real recovery is not just a simple matter of being diagnosed and learning numerous facts about one’s health problems and treatment. Rather, it requires a deep and thorough searching and questioning with which a person that is need of care can go through feelings that are not familiar to him, embrace new ideas and concepts, and establish a greater view of him or herself. In my experience of dealing with patients who have mental illnesses, I have always viewed the hospital as a place of containment in which these persons who are in need of care are expected to care for themselves at most times, talk among themselves, watch television and just generally entertain themselves to keep their minds off things. This has been the routine that mental health nurses have observed over the years which have restricted us from creating useful conversations with our patients and I strongly believe that this is not an effective solution. I will discuss with them what they feel may be the reason for their admission as well as what they feel that they have to do in order to address such problems. For example, with a patient that has tried to commit suicide once survives and is encouraged to undergo psychiatric services, the Tidal Model shall be applied by first listening to his or her story and identify the traits that set the person apart from others. I had one patient who was in the verge of committing suicide and was then rushed to the hospital for him to get help. At first, it was extremely difficult to create conversations with him because he was unsure of everything, from the staff members to the hospital to the consequences of his actions. Eventually, as he was probably recovering from shock, he was relatively open to us about his previous experiences that drove him to do such things. Through this occurrence, I believe that mental health care professionals can take this as an opportunity to get to know the person even more especially his experiences, background, preferences as well as intentions in life. This way, he will feel safe and secure, and will know that people actually care for him and his recovery. Daily conversations should be encouraged so we can both continue learning from this experience and find the ways that he will be comfortable with when making changes in his life. Eventually, he will realize the importance of believing in himself, trusting in his family and peers and, most of all, in valuing his life. Through this, trust exists between the mental health professional and the patient with which the partnership formed supports the patient in the entire recovery process. References Barker, P. (2001). The Tidal Model: Developing an empowering, person-centred approach to recovery within psychiatric and mental health nursing. Journal of Psychiatric and Mental Health Nursing, 8(3) 233-40. Brookes N. (2006) Phil Barker: the Tidal Model of mental health recovery, Chapter 32. In: Nursing Theorists and Their Work, 6th ed. (eds Tomey, A.M. & Alligood, M.R.), pp. 696–725. Buchanan-Barker, P. & Barker, P. (2005), Observation: The original sin of mental health nursing. Journal of Psychiatric and Mental Health Nursing 12(5), 541-549. Buchanan-Barker, P. & Barker P. (2008). The Tidal Commitments: extending the value base of mental health recovery. Journal of Psychiatric and Mental Health Nursing, 15, 93–100. Carruthers, M., Collins, S. & Stevens, L. (1985). The category of the person. Anthropology, philosophy, history. Cambridge: Cambridge University Press. Davidson, L. & Strauss, J. (1992) Sense of self in recovery from severe mental illness. British Journal of Medical Psychology, 65, 131–145. Fletcher, E. & Stevenson, C. (2001). Launching the Tidal model in an adult mental health programme. Nursing Standard, 15(49) 33-36. Katz, S. & Stroud, M. (1963). Functional assessment in geriatrics: a review of progress and direction. Journal of the American Geriatrics Society, 37, 267–271. Lafferty, S. & Davidson, R. (2006). Person-Centred Care in Practice: An account of the implementation of the Tidal Model in an adult acute admission ward in Glasgow. Mental Health Today, pp. 31-34. Polkinghorne, D. (1988). Narrative knowing and the human sciences. Albany: State University of New York Press. Read More