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642 UNIT V Middle Range Nursing Theories

2005). Evaluation work is ongoing at St. Tydfil Hospital care have expressed appreciation of the model and the
in Wales. desire to bring it into their practice settings. Other
In New Zealand, a qualitative, hermeneutic, phe- professions support the values, philosophy, and utility
nomenological study followed the implementation of of the Tidal Model. Mental health user/consumer/
the Tidal Model in a secure treatment unit (Cook, survivor communities around the world are involved
Phillips, & Sadler, 2005). Five themes that reflected in the continuing development of this mental health
meanings attached to providing and receiving care recovery theory (Barker & Buchanan-Barker, 2005).
emerged: relationships, hope, human face, leveling, Since its inception, the Tidal Model has gained
and working together, suggesting positive experiences national and international attention. It continues to
and outcomes with implementation of the Tidal be implemented, taught, and studied internationally,
Model. The Tidal Model is set in a research base that with new sites joining from around the world. In No-
provides the possibility of research utilization or vember 2003, the Tidal Model was launched in North
the more contemporary knowledge transfer. Nurses America. As new sites implement and study the Tidal
practicing within the Tidal Model are actively using Model, the practical, theoretical, and research base
research in practice as well as contributing to the is enriched. In 2003, Barker reaffirmed the values
development of nursing practice. The Tidal Model has underlying the Tidal Model in the Ten Tidal Commit-
potential for participatory action research, uncover- ments (see Box 32–1). They provide the necessary
ing knowledge embedded in practice, and developing guidance to pursue and develop the philosophy of the
new knowledge and understandings. Tidal Model. Although Barker expects fidelity to the
Barker and Buchanan-Barker emphasize that any principles and values of the Tidal Model (Ten Tidal
realistic study of the Tidal Model in practice must Commitments) in its implementation, he cautions
focus on the “workings” of the team, both individu- against slavish importation. Rather, implementation
ally and collectively. It must take into account the needs to be tailored to fit the local context, with the
organizational context, the support available to the result that each implementation will be unique and
team, the quality of the environment, and the range contribute to the theory’s development. This reflects
of other physical, social, and interpersonal factors. Barker’s appreciation of the concept of “practice-based
As practitioners begin to work in a Tidal way, key evidence”—what he called the “art of the possible,”
research questions must focus on “what happens?” in that is, developing philosophically and theoretically
Tidal practice. sound forms of practice that are based on consider-
ations of what is appropriate, meaningful, and poten-
tially effective in any given practice context.
Further Development The Tidal Model is developing across cultures
The Tidal Model is clear, concepts are defined, and noted above, with different clinical populations, in a
relationships are identified. This enables the identifi- variety of settings. The body of knowledge framed
cation of areas for further theory development. For within the Tidal Model continues to develop, ac-
example, Barker is reframing his original notion of knowledging the wide range of complex factors that
the “logic of experience” as “practice-based evidence.” define people and their human experiences—personal
Practice-based evidence represents the knowledge of history, personal preferences, values and beliefs, social
what is possible in this particular situation and what status, cultural background, family affiliations, and
might contribute further to our shared understanding community membership (Barker, 2003a).
of human helping (Barker & Buchanan-Barker, 2005).
Several other developments characterize the Tidal Critique
Model. It has evolved from the initial acute, inpatient
use across the continuum of care, with critical, transi- Clarity
tional, and developmental components. The theory The concepts, subconcepts, and relationships are logi-
has evolved to the Tidal Model of Mental Health Re- cally developed and clear, and the assumptions are
covery and Reclamation, broadening both its scope consistent with the theory’s goals. Words have multiple
and utility. Colleagues in other fields such as palliative meanings; however, the major concepts, subconcepts,