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638 UNIT V Middle Range Nursing Theories

Our personhood, connections, and fragility “make settings, from day rooms of hospital wards to the
the experience of pain, of sickness, and of death an living room or kitchen of the person’s own home
integral part of life” (Illich, 1976, p. 274). Illich’s (Barker, 1996b). With critical interventions, nurses
(1976) description illustrates both the chaotic and make the person and the environment safe and
Zen sense of “reality.” “Health is not ‘out-there,’ it is secure. Engagement is critical, and the social environ-
not something to be pursued, gained or delivered ment is critical for engagement. When people are
(health-care). It is a part of the whole task of being deemed to be at risk, they need to be detained in a
and living” (Barker, 1999b, p. 240). safe and supportive environment, a safe harbor until
“Health means whole . . . and is likely linked to they return to their ocean of experience in the com-
the way we live our lives, in the broadest sense. This munity (Barker, 2003a). “Nurses organize the kind of
‘living’ includes the social, economic, cultural and conditions that help to alleviate distress and begin the
spiritual context of our lives” (Barker, 1999b, p. 48). longer term process of recuperation, resolution or
The experience of health and illness is fluid. Within a learning. They help persons to feel the ‘whole’ of their
holistic view, people have their own individual mean- experience . . . and engender the potential for heal-
ings of health and illness that we value and accept. ing” (Barker, 2003a, p. 9).
Nurses engage with people to learn their stories and
their understanding of their current situation, includ-
ing relationships with health and illness within their Theoretical Assertions
worldview (Barker, 2001c). Ill health or illness almost The Tidal Model is based upon four premises concern-
always involves a spiritual crisis or a loss of self ing practice, which Barker developed in the mid-1990s
(Barker, 1996a). A state of disease is a human problem with the “expert nurse” focus group (Barker, 1997).
with social, psychological, and medical relations, a These premises were validated by a group of former
whole life crisis. Nursing with the Tidal Model is prag- psychiatric patients led by Barker’s colleague of many
matic and focused upon persons’ strengths, resources, years, the mental health service user and activist,
and possibilities, maintaining a health orientation; the Dr. Irene Whitehill.
Tidal Model is a healthy theory. • Psychiatric nursing is an interactive, developmen-
tal human activity, more concerned with the future
Environment development of the person than the origins or
The environment is largely social in nature, the con- cause of their present mental distress.
text in which persons travel within their ocean of • The experience of mental distress associated with
experience, and nurses create “space” for growth and psychiatric disorder is represented through pub-
development. “Therapeutic relationships are used in lic disturbance or reports of private events that
ways that enhance persons’ relationships with their are known only to the person concerned. Nurses
environment” (Montgomery & Webster, 1993, p. 7). help people access, review, and re-author these
Human problems may derive from complex person- experiences.
environment interactions in the chaos of the every- • Nurses and the people-in-care are engaged in a
day world (Barker, 1998b). “Persons live in a social relationship based upon mutual influence. Change
and material world where their interaction with the is constant, and within relationships there are
environment includes other people, groups, and or- changes in the relationship and within the partici-
ganizations” (Barker, 2003a, p. 67). Family, culture, pants in the relationship.
and relationships are integral to this environment. • The experience of mental illness is translated into
Vital areas of everyday living, including housing, a variety of disturbances of everyday living and
financing, occupation, leisure, and a sense of place and human responses to problems in living (Barker &
belonging are areas of environment (Barker, 2001c). Whitehill, 1997).
The divide between community and institution is These premises are framed within the wider philo-
artificial and rejected as needs flow with the person sophical and theoretical perspective, especially the
across these boundaries. Much psychiatric and men- phenomenological assertion that people own their
tal health nursing takes place in the most mundane of experience; only persons can know their experience