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The Tidal Model of psychiatric nursing care

Ever since the dawn of nursing, nurses have long been thought to be intellectually inferior compared to the other customers of the healthcare team (Barker, 1997).

As highlighted by Risjord (2009, p. 2), it was only through the mid twentieth hundreds of years that nurses started to realize the importance of having audio theory-based knowledge in order to practice medical efficaciously. It was indeed a significantly huge step forward in the annals of nursing.

Elder, Evans, and Nizette, (2009, p. 15), defined theory as a set of constructs, hypotheses, ideas and propositions, which supply the rationale for the actions that guide our practice. (Psychiatric and Mental Health Medical by Ruth Elder, Katie Evans, Debra Nizette; 2009; chatswood, Australia: Elsevier; 2nd ed. ; p. 15)

Following the emergence of medical theorists and their various theories which suits the countless different institutions of thoughts, the professionality of nurses was further established.

The author wish to discuss about 'the Tidal Model of psychiatric nursing care', as it is a medical model, which is of particular relevance to one's work.

A psychiatric establishment is hardly similar to a general medical center; therefore besides getting a special body of knowledge, addititionally there is inevitably a dependence on a different methodology in the manner the psychiatric nurses work.

Hayes and Collins recognized this, by suggesting that, documented nurses with basic training do not seem a reliable source of recruits to the field and a 'nursing' approach to the issue might not well serve the interests of mental health (E. W. Hayes; John Collins. 2007)

The Tidal Model (Barker, 1998, 2000) emphasizes a utilitarian methodology in identifying the problems of living, which reaches the same time respectful towards patients. The model aspires to create a narrative-based form of practice (Barker and Kerr, 2001), dealing with each patient as one and unique person. This differs from most other contemporaneous medical models which make use of evidence-based solutions, where features were proven on the assumption that all patient can be an equivalent at the mercy of that of the research people (Barker and Kerr, 2001).

The main purpose is to explore the patient's life experiences and different needs through by using a set of dimensions, namely the planet dimension, the Personal dimension, and the Others dimension.

Under the earth dimensions of the Tidal, the nurse explores the patient's activities of distress, stress, or health problems, which resulted in the current state which she or he is in. This might also include factors such as how exactly does the patient think that her or his condition had damaged their marriage with their loved ones in anyhow, and what they feel must be done to assist in their restoration (Barker, 2001, p. 83).

The Self dimension of the Tidal Model looks into issues that revolve around the patient's mental and physical security, discovering the emotional stability and the probability of them harming themselves in physical form. The nurse also explores methods that could help the patients maintain their sense of security, through validating with them what were things that made them noticed secured before and what could the nurse do to assist in their current situation (Barker, 2001, p. 83).

Lastly, the Others sizing, the emphasis is shifted onto the patient's means of leading a standard life after restoration. The nurse explores which will be the resources the patient has, and possibly, equipping them with the resources they lack (Barker, 2001, p. 83).

As presented in Jacqueline Fawcett's "Analysis and Analysis of Conceptual Types of Medical" (1980), the metaparadigms are really general concepts that assists as a conceptual basis. Their purpose is to steer the experience of the medical vocation, in aspects such as knowledge, viewpoint, theory, educational experience, practice orientation, research strategy and literature recognized with the career (Meleis, 1997 and Marriner-Tomey and Alligood, 1998).

The creator shall now attempt to co-relate the Tidal Style of psychiatric nursing attention with the four medical metaparadigms, Health, Person, Environment, and Nursing.

The author's feels that the 'Environment' metaparadigm, based on the Tidal Model pertains a lot more to the 'mental environment', as opposed to the physical environment.

(Barker et al. 2000), stated that the idea and beliefs of care should be appreciated as indispensable environmental prerequisites right from the commencement of the recovery quest. Through providing the necessary support to ensure the patient's emotional and physical safe practices while assisting them in exploring and figuring out what needs to be transformed, to facilitate recovery and checking out the possible assignments of professionals, family and friends, and enlisting their help, in the whole recovery process. All these supply the patient with a metaphorical hopeline, to the supportive environment where it is easier for her or him to get started to feel secure and comfortable enough to begin the recovery process.

Hence, the writer feels that the emotional environment is of paramount importance in helping the patient with her or his recovery. As advised in the Tidal Model, most patients experience 'shipwrecks' before the onset of their mental health problems. These 'shipwrecks' may encompass situations of extreme stress, or conditions which were extremely oppressive and unfavorable beyond the patient's point of threshold. Hence, the significance of 'Environment' in this model; as the nurse may process the skills to provide a comfortable and secure emotional environment for the patient, physical environment should also be calming and relaxing. This is of particular relevance in the mental health context; the 'milieu' or the location which surrounds the individual plays an important part in regulating the patient's psychological stability, and therefore shouldn't be neglected.

The 'Nursing' metaparadigm looks at what the nurses does to ease the patient's anguish. These include the care, the treatment, and the compassion rendered to the patients. These may be demonstrated by means of nursing interventions to aid the patients in their recovery; and in the psychiatric environment, above all a powerful and efficacious restorative nurse-patient relationship must be in place. Most psychiatric nurses would agree that the nurse-patient romance has to be a collaborative one, before the patient would easily participant in any therapeutic activity that your nurse provides.

Therapeutic nurse-patient romance has continually be regarded as the crux of mental health nursing, considering its potential in instilling support and causing insight and behaviour change in the patient (Stuart 2001; Thelander 1997). Hummelvoll (1996) experienced also described the nurse-client-relationship as the cornerstone of psychiatric medical.

Barker (1997) outlined that, the Tidal Model places emphasis on making contact with and understanding the individual, rather than concentrating on the disorder or condition. This makes the Tidal Model a relevant and appropriate caring model for use by the nurses, as nurses spend additional time with the patients and are blessed with having the chance of establishing a higher degree of rapport with them, when compared with other users in the multi-disciplinary team.

Clay (2203) also highlighted that, promoting connectedness with the individual is one of the key aims of the Tidal Model. That is beneficial since it allows patients to feel as if they will work with friends and acquaintances, rather than with some care providers whom are "higher-up" in position.

Peter Wilkin (2002) described that psychiatric care is often supplied through surveillance. The writer feels that this is true in the framework of Singapore as well. The medical care team, nurses and medical professionals specifically, would at times confront the patients via the method of threats, execution of curfews and limiting of family members' going to when patients do not respond in the way they were likely to. Obviously, this is against the nursing's school of thought of caring. Building an effective and efficacious restorative nurse-patient relationship with this patients requires an appreciable amount of work, and intimidating our patients in anyways would be counter-effective.

Often in the mental health environment, healthcare professionals act and work in a way as though they do not imagine, or are skeptical of any possible recovery in the patients. The writer is convinced this to be the least desirable characteristic in psychiatric medical.

(Merton, 1968) brought up that, "'self-fulfilling prophecy' is of critical importance to the restorative perspective". Therefore, to be a highly effective helper, the nurse also needs to realize that her or his beliefs about the individual, and the opportunity of their recovery, can create a designated difference.

The 'Patient' metaparadigm identifies the many recipients of good care, which includes the patient, their family, and the city (Perry A. G, 2001). Each patient is a unique individual who functions a different group of life tales and problems ready to be explored. In order to help the individual, there's a dependence on the nurse to know the individual better. The nurse needs to generate an authentic sense of curiosity in what the patient has to reveal, rather than just seeking noticeable signs and symptoms. Healthcare professionals frequently have the habit of let's assume that they are the ones whom know the patients best, this frame of mind tends to hinder them from learning their patients better. Barker (2006) recommended that no matter how much they promote, the nurses will never have the same amount of understanding of their lives than the patients themselves.

The nurse also needs to make use of verbatim techniques, at every opportunity, whilst interacting with the patient. By doing so, the nurse profits an upper palm at getting a deeper perception in to the patient's interior world of thoughts.

Saunders (1997) emphasized the value of exploring each of the person's structure of experience through narrative. The nurse can achieve this by utilizing verbatim whilst getting together with the individual, and recording the individuals accounts of needs and problems in her or his own words, without employing any form of translation, thus lessening the quantity of distortion to the patient's original communication.

After achieving a sound understanding of the patient's experiences and problems, the nurse should then aim to dwelling address the patient's problems by sketching up an individualized nursing treatment plan; nursing goals should look into the multidimensional needs of the precise patient in need.

From the mental health point of view, the 'Health' metaparadigm looks at the patient's conception of her or his own health, and addresses what must be done to restore emotional health and well-being. The nurse could well borrow principles from the Tidal Model's narrative, in accomplishing this task.

The Tidal Model (Barker, 2002) suggests that the narrative, as the metaphoric steering wheel for the nurse. It really is an avenue for the nurse to raised his understanding of how the patient became emotionally, bodily or spiritually 'devastated'. Rapport with the individual can be increased through demonstrating a keen affinity for learning the patient's life experience. There exists then, good chance to comfort the patient by showing concern, and also to know the patient in a far more in-depth matter. In this manner, the nurse may form a collaborative alliance with the individual, to undo the damage mentioned.

Till the early 19th decades, 'keeper' used to be the term given to those whom were entrusted with the health care of the psychologically ill. The keepers, who cared for the mentally ill, had handled the movements of these patients in similarly primitive ways as with how zoo-keepers and game-keepers handled family pets and game. (Nolan, 1998, p. 6)

It is no surprise that in Singapore itself, psychiatric medical is also often regarded as being more backward than the other areas of medical. Psychiatric nursing is definitely enveloped by tons of controversies, and these can be at times, overpowering. Locally, psychiatric nurses tend to be referred to as being nurses of mediocre quality, or nurses with 'rusty' medical knowledge, having being not training and honing their medical skills as often as nurses in the other disciplines.

Nursing is a profession predicated on caring, compassion, which is often said that nurses are our patient's advocates. As a psychiatric nurse, the writer dearly affirms by this affirmation. In the psychiatric health environment, advocating for the mentally ill is a lot more so important, because of this special band of patients often lack the ability to advocate for themselves. Hence, an important and critical role of the psychiatric nurse, besides looking after our patients, would be, to be our patient's advocators, constantly advocating in their best interest. However, in order to render medical care that is appropriate and good for the patients, one of the most indispensable prerequisite will be a body of intelligence which is used to support nursing practice.

The author strongly believes that, aside from having additional education, to equipping us with particular knowledge, as authorized mental health nurses; the presence and adherence of nursing models, consequently of the Tidal Model, are cardinal in maintaining credible benchmarks in the quality of the nursing care we deliver as mental health nurses.

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