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CHAPTER 32 Phil Barker 639

and what it means. Mental distress is a symbolic force, The theory classifies a body of nursing knowledge
which is known only, in phenomenological terms, to that is largely story-based. The components are clearly
the person involved. The lived experience is the me- presented and logically derived from clinical observa-
dium through which we receive important messages tion, practice, theory, research, and philosophy.
about our life and its meaning (Barker, 2001c). Barker The emergent evidence from users of the theory in
views mental distress as part of the whole of the the UK, Ireland, Canada, and New Zealand confirms
person, not something split off from their “normal” the importance of the simple affirmation of the per-
being. sonal story, with its emphasis on understanding what
The Tidal Model assumes and asserts that people is happening for and to the person, and what this
know what their needs are, or can be helped to recog- means for persons in their own language. Stories gen-
nize or acknowledge them over time. From that erated within the caring context are written in the
minimally empowered position, people may be person’s own voice, helping the person to “take back”
helped to meet these needs in the “short” term. What the personal story, which has been lost from view
nurses and everyone else in the person’s social world by becoming a “patient” or “client.” Even when the
relate to is the expressed behavior. Mental illness is person is severely disabled by problems of living, the
disempowering, and “people who experience any of nurse keeps the focus on helping the person deter-
the myriad threats to their personal or social identi- mine “what needs to be done” and on finding the
ties, commonly called mental illnessor mental health personal and interpersonal resources necessary to be
problems, experience a human threat that renders empowered.
them vulnerable.” However, “most people are suffi- The attempt to understand persons’ constructions
ciently healthy to be able to act for themselves and to of their world is expressed through the holistic as-
influence constructively the direction of their lives” sessment that helps persons to relate their story and
(Barker, 2003a, pp. 6–7). Recovery is possible, and explore what needs to be done. Care planning is a
people have the personal and interpersonal resources collaborative exercise with emphasis on developing
that enable this recovery process (Barker, 2001c). an awareness of change and revealing solutions. The
celebration of personhood and the holistic narrative
approach creates a style of practice of working
Logical Form collaboratively with people. It emphasizes persons’
The Tidal Model is logically adequate, the structure of inherent resources and acknowledges change as an
relationships is clear, and the concepts are precise, enduring characteristic.
developed, and developing. It contains broad ideas,
addresses many situations of persons with problems
in living, follows the “logic of experience” (Barker, Acceptance by the Nursing Community
1996b), and develops “practice-based evidence” The Tidal Model appeals to those interested in per-
(Barker & Buchanan-Barker, 2005). son-centered care and theory-based practice. The
Barker and colleagues constructed a metatheory of literature illustrates the wide acceptance and use of
psychiatric and mental health nursing. Questions the theory in practice and in research. Acceptance
about the nature of persons, problems in living, and of the theory is facilitated by the philosophical, theo-
nursing were followed with systematic inquiry. The retical, research, and practical base, along with clearly
theory informs and is shaped by research. The Tidal stated values and principles.
Model flows from a particular philosophical perspec-
tive and worldview that provides the context for beliefs Practice
about persons and nursing. The Tidal Model was developed in practice between
The theory identifies the core of nursing practice 1995 and 1997 and was introduced formally on two
as “knowing you, knowing me.” It specifies a nursing acute psychiatric wards in Newcastle, England, in
focus of inquiry, identifies phenomena of particular 1998. It was subsequently adopted by the Mental
interest to nurses, and provides a broad perspective Health Program, and in 2000 rolled out across nine
for nursing research, practice, education, and policy. acute psychiatric wards, their associated community