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646 UNIT V Middle Range Nursing Theories
Accessibility
This substantive theory is grounded in data that Summary
emerged inductively from studies of the need for The Tidal Model developed from a discrete focus on
nursing. Studies guided by the Tidal Model suggest its psychiatric nursing in acute settings to a more flexible
utility and precision and provide confidence that the mental health recovery and reclamation model for any
theory is useful, practical, and accessible. Studies of setting, relevant to any discipline. It emphasizes em-
the impact of implementation of the theory in prac- powering forms of engagement or bridging, the impor-
tice also support its utility and precision. The “need tance of the lived experience, and an appreciation of the
for nursing,” the proper focus of nursing, and the potential for healing that lies within the re-authoring of
empowering interactions framework provide a strong the story (Barker & Buchanan-Barker, 2004a).
empirical base for the Tidal Model. The Tidal Model provides an orientation to practice
Nurses working with different clinical popula- that is research-based, holistic, and person-centered.
tions and in a variety of settings are testing the Keen (in Barker & Buchanan-Barker, 2005, pp. 231–241)
Tidal Model in practice. The focus of inquiry is describes a “deeply collaborative, person-centered, so-
person-centered outcomes and the lived experience lution-focused (McAllister, 2003), narrative-based,
of persons collaborating in care. Studies addressing pragmatic, and systemic theory.” The theory describes
the outcome orientation empower interactions that various assumptions about people, their inherent value,
contribute to empirical adequacy and confidence in and the value of relating to people in particular ways. It
this solution-oriented perspective. describes how people might come to appreciate differ-
ently, perhaps better, their own value and the unique
Importance value of their experience. The Tidal Model opens pos-
The Tidal Model has clearly illustrated that it pro- sibilities of new ways of being with people in relation.
vides direction and focus for nursing. The theory is Perhaps some of its appeal is that it harkens back to
accessible conceptually and linguistically and lends “our roots” and values, which brought us into nursing
itself to research. This research, relevant to nurses’ in the first place. While the theory provides direction
work, contributes knowledge to guide and inform for practice, education, research, and policy, it is not
practice. Studies guided by the Tidal Model also ex- easy. Nurses are aware of the challenge in making the
plore its impact and a variety of outcomes. Narrative shift to commit to change and to grow and develop in
knowledge derived from the theory advances the enacting the essence of the Tidal Model, the Ten Tidal
practice of nursing, nursing education, nursing Commitments.
research, and policy. The Tidal Model is represented
by a range of “holistic (exploratory) and focused
(risk) assessments which generate person-centered CASE STUDY
interventions that emphasize the person’s extant Scott was a young man described as having a first
resources and capacity for solution-finding” (Barker, episode psychosis. He had beaten his father, who
2001b, p. 82). subsequently died. Scott was transferred to a secure
Working with the Tidal Model has enabled nurses to unit, where his primary nurse began to explore his
articulate their practice and “invisible skills” (Michael, story with him through a Holistic Assessment,
1994). For example, empowerment strategies such as which represents Scott’s world of experience at this
respecting the person and inspiring hope also give voice moment in time.
to nurses themselves. Nurses gain confidence working How this began: “It all started when my father
as interprofessional team members where their contri- punched my mother again, he was totally drunk
bution and focus is clearly articulated. that night. It was so noisy in that room, the T.V., the
Challenges exist at a practical, personal, and sys- banging, and those voices in my head, they kept
tem level with any change, and these are anticipated yelling at me to do something fast to save my
and addressed. However, the Tidal Model is an im- mother. I don’t remember exactly what had hap-
portant and essential theory to develop and guide pened after. I was so confused.”
practice in psychiatry and mental health care.