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Critique of a Middle-Range Nursing Theory - Tidal Model

Abstract Over several decades theories for behavioral care for psychiatry mental health patients were been developed, but not too many of such work has been carried out on the continue-of-care from the acute care setting to the community nursing care (Baker, 1998).Phil Barker a renowned psychiatry nursing professor saw the need lapse and developed the theory of tidal model, to show the importance of nursing care for the psychiatry patients in the community "from the Newcastle University 5-year study" (Barker, 2001). This theory is drawn from the passion he has for psychiatrist patients to be able to continue to receive care beyond the acute care settings (Baker, 2001 He developed his theory on the basis of three domains; the self, the world, and the others. He explained that each part played a major role in facilitating the continuum of care and recovery for psychiatry patients in the community on "multidisciplinary teamwork and models such as bio-psychosocial model" (Barker, 2001). Using the criteria for evaluation of theory by Fawcett ( 2005),  this paper will describe the Barker's theory of Tidal Model, the concepts, "specific needs for psychiatric intervention … and mental health nursing interventions" (Baker, 2001). It will also explain Barker's three domains of the model (the self, the world, and others) as they intertwined in achieving the continuity of care for the patients; it has been tested and applied by the four research studies explored in this paper.

Introduction The Tidal Model (TM) came into existence by the work of Barker a psychiatric nurse. He put together his framework and concepts after seeing the failure of acute care for psychiatry patients. He conceptualized his ideas into three dimensions: the self, the other and the world in TM (Barker, 1998). He attributed the failure to acute care for psychiatry patients to the following: (a) unsatisfactory treatments of the nurses working in acute care hospital; (b) reduces funding for the acute care; and (c) use of temporary staff affecting the continuity of care (Barker, 1998). TM also "explores six guiding principles" (Kilmer &Lane Tillerson, 2012), and "Ten Commitments"(Barker, 2010). The TM is going to be analyzed using research papers to explain the strength/success, weakness; recommendations and results of the application in the nursing profession. For the purpose of this critique paper, CINAHL, Pub Med, PsycINFO, Google Scholar, and Ovid were searched and articles selected using keywords such as nursing theory, psychiatry nursing, and middle range nursing and Tidal Model. The available literature for TM and its application were limited and most of the research studies and their applications were carried out in abroad - Canada, United Kingdom, and Asia. The search for quantitative and qualitative application of TM was extraneous with minimal literature available for review.

The TM addressed the four concepts of metaparadigm of nursing which are the person, health, nursing, and environment in a pragmatic way (McEwen & Wills, 2014, p.41). Barker made several assumptions based on the experiences of the person role in health and nursing care. In the TM, Barker's made several assumptions including the following; Barker (1998) assumes that the person is the only one who can tell his/her story better, amidst of the ‘sea' of person's experience. Barker further explains that the solution to the person's need and the key to recovery to the community is in their story. During the evaluation of one research study, participants gave a verbal account of their experiences. (Gordon, Morton, & Brooks, 2005). "Person's mental distress is wholly a function of their life experience in the natural community" (Barker, 1998,). Barker connect human's problems and experiences to something that flows continuously, he likened it to tides of the sea/water; "fluid, ever changing nature of human experience" (Barker, 1998). He assumes that engaging psychiatry patients in their own care are rewarding, testable and effective, and nurses should learn such practice than the borrowed model of " direct observation" (Barker, 1998). The model "assumes that the person's mental distress is wholly a function of their life experience in the natural community" (Barker, 1998).

According to Barker (2001), the word "water" formed "the core metaphor" of the Tidal Model.He likened the journey of life to a voyage with; (a) the crisis experience which is the storm we face in life- sickness, unpleasant/unplanned events/situations, (b) the breakdown experience- situation that wants to drown us and we do want to continue the journey of life, (c) rehabilitation experience –the help we get along the way back, and lastly, (d)  the recovery – is getting back on track, therefore "life is a journey" (Barker, p.81) for a  psychiatry mental health patient. The use of the mentioned assumptions and the metaphoric indication of TM as a sea of experiences gave this theory is uniqueness among "many normative psychiatric models…" (Barker, 2001, p.81). The philosophy of the TM that the psychiatric mental health patients get a good care when the providers/nurses listen to their stories because the way to their recovery and regaining health is hidden in their experiences. Concepts The TM uses three domains to provide care for a psychiatry patient. Barker's aim is to put the patient at the center of the care and "to understand the present situation of the person, which includes the relationship with the illness and health" (Barker, 2001). TM focuses on the "personhood' of the patients as it relates to the three concepts of the theory; self, world, and others. World: The world domain brings the patient's need and voice to the center stage and it assists in helping the patient respond positively to the care given. Barker uses the Holistic Nursing Assessment format to further extract or generate information from the patient as it's copied in Table 1 (Barker). Self-dimension: This is to pay keen attention to the "emotional and physical security" of the patient as it shown in Table 2 – Security Plan. Others: This dimension is where the other needs of the patient are met such as the medical, psychological, and social needs.(Barker, 2001) among the rest. The nurse's responsibility is to balance the care and the needs of the patient across all the dimensions that will foster the pathway to recovery (Barker, 2001)

JCchild (talk) 07:14, 5 July 2017 (UTC)

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