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628 UNIT V Middle Range Nursing Theories

unequivocally human, rather than psychological, so- A feature of Barker’s nursing practice has been his
cial, or physical (Barker, 2002b). The Tidal Model exploration of the possibilities of genuine collabora-
“emphasizes the central importance of developing tive relationships with users of mental health services.
understanding of the person’s needs through collab- In the 1980s, he developed the concept of “caring
orative working, developing a therapeutic relationship with” people, learning that the professional-person
through discrete methods of active empowerment, relationship could be more “mutual” than the original
establishing nursing as an educative element at the nurse-patient relationship defined by Peplau (1969).
heart of interdisciplinary intervention” (Barker, 2000e, Barker further developed this concept during the
p. 4) and seeks to resolve problems and promote men- 1990s in a working relationship with Dr. Irene White-
tal health through narrative approaches (Stevenson, hill and others who used mental health services
Barker, & Fletcher, 2002). (Barker & Whitehill, 1997). This led to the “need
The Tidal Model is a philosophical approach to for nursing” and “empowerment” studies as well as a
recovery of mental health. It is not a model of care commitment to publish the stories of people’s experi-
or treatment of mental illness, although people ence of madness, and their voyage of recovery, com-
described as mentally ill do need and receive care. plete with personal and spiritual meanings (Barker,
The Tidal Model represents a worldview, helping the Campbell and Davidson, 1999; Barker, Jackson, &
nurse begin to understand what mental health might Stevenson, 1999a; Barker & Buchanan-Barker, 2004b).
mean for the person in care, and how that person Barker enlisted the support of Dr. Whitehill and
might be helped to begin the complex voyage of other “user/consumer consultants,” to evaluate “user
recovery. Therefore, the Tidal Model is not prescrip- friendly” qualities of the original processes of the
tive. Rather, a set of principles, the Ten Tidal Com- Tidal Model. This involvement of “user/consumer
mitments, serve as a metaphorical compass for consultants” is seen in several ongoing projects and
the practitioner (Buchanan-Barker & Barker, 2005, represents a distinctive feature of continued develop-
2008). They guide the nurse in developing responses ment of the Tidal Model.
to meet the individual and contextual needs of Barker’s long-standing appreciation of Eastern phi-
the person who has become the patient. The experi- losophies pervades his work. The work of Shoma
ence of mental distress is invariably described in Morita is a specific example of how the philosophical
metaphorical terms. The Tidal Model employs the assumptions of Zen Buddhism were integrated with
universal and culturally significant metaphors asso- psychotherapy (Morita, Kondo, Levine, & Morita,
ciated with the power of water and the sea, to repre- 1998). Morita’s dictum—”Do what needs to be done”—
sent the known aspects of human distress. Water is resonates in many of the practical activities of the
“the core metaphor for both the lived experience of Tidal Model. In contrast to the zealous “problem-
the person . . . and the care system that attempts to solving” attitude embraced by much of Western psy-
mold itself around a person’s need for nursing” chiatry and psychology, Morita believed that it was
(Barker, 2000e, p. 10). futile to try to “change” oneself or one’s “problems,”
Barker describes an “early interest in the human which come and go like the weather. Instead, the focus
content of mental distress . . . and an interest in the should be on answering the questions:
human (phenomenological) experience of distress,” • What is my purpose in living?
which is viewed in contexts and wholes rather than • What needs to be done now?
isolated parts (Barker, 1999b, p. 13). The “whole” nature People have the capacity to live and grow through
of being human is “re-presented on physical, emotional, distress, by doing what needs to be done. For people
intellectual, social and spiritual planes” (Barker, 2002b, who are in acute distress, especially when they are at
p. 233). This phenomenological interest pervades the risk to self or others, it is vital that nurses relate
Tidal Model with an emphasis on the lived experience directly to the person’s ongoing experience. Origi-
of persons, their stories (replete with metaphors), and nally Barker called this process engagement, but he
narrative interventions. Nurses carefully and sensitively has since redefined the specific interpersonal process
meet and interact with people in a “sacred space” as bridging, a supportive human process necessary to
(Barker, 2003a, p. 613). reach out to people in distress. This emphasizes the