Running head: THE TIDAL MODEL: A THEORETICAL APPROACH TO NURSING
The Tidal Model: A theoretical approach to psychiatric nursing
Trina Skinner
Stenberg College
June 02, 2012
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Running head: THE TIDAL MODEL: A THEORETICAL APPROACH TO NURSING
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The development of the Tidal Model revolves around the concept of clients involved in
the mental health system finding empowerment, acting as the catalyst to precipitate and
implement the necessary change to free themselves from the effects of mental/emotional distress
they may experience as a result of mental illness. In order to describe this theoretical approach to
psychiatric nursing while exploring its validity and use, three topics to consider are, the
circumstances/history in which this model was derived, exploration of the central metaphor on
which the model operates, and the application and assumed role of the psychiatric nurse in
providing care within the constructs of the Tidal Model in psychiatric nursing.
The Tidal Model theory is a relatively modern approach to psychiatric nursing in which
central concepts and “key elements” that form the basis of the model are influenced by
theoretical, philosophical, and practical ideology. The Tidal Model was created as a result of the
findings of a five year study conducted at the University of Newcastle focused on the ‘need for
psychiatric nursing’. This theoretical approach to nursing was “originally developed across two
pilot sites in Newcastle, UK between 1997 and 1999” by Dr. Philip Barker alongside his wife
and colleague Poppy Buchanan Barker, and others involved in the study that preceded the birth
of the Tidal Model. A “revised model” was subsequently introduced across the “Adult Mental
Health Programme…and their associated community support teams in its entirety [2000. May],
where an interdisciplinary evaluation of the model in practice is being conducted, using action
research methodology” (Barker 2001).
(Barker, 2001) explains that “The Tidal Model extends…some of the traditional
assumptions concerning the centrality of interpersonal relations within nursing practice”.
Running head: THE TIDAL MODEL: A THEORETICAL APPROACH TO NURSING
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These “traditional assumptions…” (Barker) mentions refer to the influential work of Peplau and
her ‘Interpersonal theory’ that revolutionized the discipline of psychiatric nursing. Peplau’s work
plays a significant role in the underpinning of the theoretical framework that Barker’s Tidal
Model was developed on. Barker’s Tidal Model has been described as having a “Peplau-vian
flavor” (Titleborn, 2012).
The philosophical aspect of the Tidal Model is based on the fundamental principles of the
chaos theory, which refers to an area of study in mathematics that involves applications in
various disciplines, including philosophy. The chaos theory “studies the behavior of dynamical
systems that are highly sensitive to initial conditions” (Wikipedia, 2012). Minor changes in
initial conditions may result in massive variations for these ‘dynamical systems’ making future
prediction virtually impossible (i.e. weather).
Such changes may occur regardless of the fact that these systems are deemed
“deterministic, meaning that their future behavior is fully determined by their initial conditions,
with no random elements involved” (Wikipedia, 2012). Contrary to what the deterministic
quality of these systems would suggest, the fact they are deemed deterministic does not make
them predictable, thus this unpredictable nature that occurs in these (deterministic) systems as a
result of disruption of ‘initial conditions’ is a behavior termed “deterministic chaos” or simply
“chaos”. The philosophical underpinning of the chaos theory as an influential principle in
development of the model is evident in (Barker’s) self expressed acknowledgement of “the fluid
nature of human experience, characterized by incessant change and unpredictability.”
The influential element of the model in terms of practicality is Dr. Barker and his
colleague’s belief that the client, and not the nurse, is ultimately responsible for redirecting their
lives and attaining liberation from the pain/suffering experienced as a result of mental illness.
Running head: THE TIDAL MODEL: A THEORETICAL APPROACH TO NURSING
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The creators of the Tidal Model draw attention to the use of metaphors and their presence
in all aspects of life, noting the necessity of metaphor as a tool that attempts to explain the
inexplicable, to describe a concept less than tangible. Dr. Barker developed his central metaphor,
borrowed from the chaos theory, in the interest of describing the theoretical principles that serve
as the foundation for this Model in such a way that is more comprehensive for the average
person to grasp. “We use metaphors when we find it difficult to describe a 'thing' or an
'experience'… we borrow a word or a phrase, which appears similar to the 'thing' or 'experience',
which we are trying to describe” (Tidal Model website).
The central metaphor on which the Tidal Model revolves is essentially based on the everchanging patterns of water. The tides of the ocean serve as an example of ‘deterministic chaos’
in that if initial conditions remain unaffected by outside influence the pattern of movement of
water is considered predictable. However, influence from external factors may cause an
unpredictable change in tidal patterns (i.e. excessive winds), it is by this ideology that Dr. Barker
has developed his theory, relating the deterministic behavior of the tidal patterns of the ocean to
the human experience as an individual moves fluidly through his/her life. (Barker’s)
understanding of the nature of human experience as being fluid and in a constant state of
evolution, provides an opportunity to explore the theory on which the Tidal Model is formed.
“Life is a journey undertaken on an ocean of experience.
All human development, including the experience of
illness and health, involves discoveries made on the
journey across that ocean of experience.”
(Barker, 2001)
Dr. Barker further implements the use of this metaphoric “oceanic journey” of human experience
by applying nautical terms (italicized for the purpose of connecting key concepts) to various
aspects of lived human experience.
Running head: THE TIDAL MODEL: A THEORETICAL APPROACH TO NURSING
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The Tidal model compares life itself to the constant ebb and flow of the tides on the
ocean. Dr. Barker explains that individuals may experience life crises, suffering from potentially
debilitating effects of mental illness and therefore find themselves in (metaphorically) “deep
water and risk drowning”. In the case of individuals who have experienced significant traumas in
their lives, such as abuse or serious injury, according to (Barker, 2001) it is not uncommon for
these individuals to express a ‘loss of self’, the Tidal Model compares this loss of one’s “sense of
self” as a result of trauma to “piracy” suggesting that the experience has ‘robbed’ the individual
of their true sense of self. In this case (Barker, 2001) explains that the individuals discussed
above are in need of a “form of life saving (psychiatric rescue) followed…by the kind of
development work necessary to engender true recovery”.
This ‘psychiatric rescue’ may occur in one’s community, in the “safe haven of a crisis
stabilization unit” or on an inpatient basis as per a client’s individual needs. Following the initial
‘psychiatric rescue’, emphasis is placed on the nature of help necessary to navigate the individual
in psychological distress “back on course” providing an opportunity for the client to return or
experience perhaps for the first time a ‘meaningful life’ in his/her community. “Once the ship of
life is made intact again, and the person has regained their sea legs, the ship may set sail again,
aiming to chart the return to the life course.”(Tidal Model website). As stated above, the primary
aim of the Models’ heavy emphasis on metaphor is to function as a vehicle offering a description
of the theoretical principles and concepts underpinned by the Tidal Model, as an approach to
psychiatric nursing.“Unlike normative psychiatric models, the Tidal Model holds few
assumptions about the proper course of a person’s life...”(Tidal Model website)
Running head: THE TIDAL MODEL: A THEORETICAL APPROACH TO NURSING
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Application of the Tidal Model and the role of a psychiatric nurse in the ‘recovery
process’ of a client effected by mental illness, differs significantly in comparison to more
traditional methods of therapeutic treatment in comparable theoretical approaches of nursing.
(Barker, 2001) explains that the majority of “therapeutic constructs aim to effect some change”
in the projection of a client, the Tidal Model “has more modest ambitions, which may –
ultimately – be more ambitious”. As opposed to the biomedical model of nursing that involves
the nurse’s preoccupation with the pathological aspects of a client’s psychological disorder, Dr.
Barker’s model “focuses on contacting the person. The aim… is to understand the present
situation of the person, which includes the relationship with illness and health”.
The Tidal Model has strong philosophical ties that facilitate the belief that the client
retains the ability to become their own ‘healer’. Barker’s model also relies heavily on the concept
of holistic health in which the client is viewed as a whole person, rather than a sum of their parts.
In this respect psychiatric nurses are not responsible for ‘curing’ the client but rather function as
a passenger on the individual client’s journey to overall health in daily function. The nurse may
offer knowledge and practical skills to assist the client in embarking on and throughout their
journey back to wellness from the disruption of mental illness hindering the client’s ability to
live and maintain a meaningful life.
“Although the nurse expresses a curiosity about the person, this is in pursuit of
knowledge of what is happening within the person’s experience of world, self and
colleagues; and what this might mean in terms of essential care of the person”
(Barker, 2001).
Within the constructs of the Tidal Model, an individual is theoretically represented by
three personal domains: Self, World, and Others. Stated in simple terms a domain may be
referred to as a place where someone lives.
Running head: THE TIDAL MODEL: A THEORETICAL APPROACH TO NURSING
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In regards to the Tidal Model the term domain relates to areas of a person’s life experience that
they may act out either publicly or privately (Barker, 2001). An individual spends time
throughout his/her life continuously alternating between each of the three personal domains.
The domain of Self refers to aspects of an individual’s private life. Thoughts, feelings,
and personal beliefs are examples of elements contained within the domain of Self. The Tidal
Model suggests that this is the place in which “mental illness is first experienced” (Tidal Model
website). The main focus from a psychiatric nursing perspective in regards to the Self domain is
to assist the client in developing feelings of safety and security. The main objective in this
domain is to assist the client in creating a “personal security plan”.
The World domain relates to the client’s social life and involves aspects of the
individual’s private life that he/she chooses to share with other people. This domain “becomes
the focus of our efforts to understand the person and the person’s problems of living. This is
done through use of the Holistic Assessment” (Tidal Model website). In this domain psychiatric
nurses attempt to help the client to “identify and address specific problems of living” on a daily
basis, this process is most effectively executed through “one-to one sessions”.
The Others domain refers to a client’s interactions with other individuals, their ‘public
life’ so to speak. “Organization and delivery of professional care and other forms of support” are
located in this domain (Tidal Model website).
Running head: THE TIDAL MODEL: A THEORETICAL APPROACH TO NURSING
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In conclusion, with health care continuing to becoming increasingly “technical and emotionally
distant, The Tidal Model assumes that nurses need to get close to [clients], so that they might
explore (together) the experience of health and illness” (Barker, 2001).
Through exploring the history and circumstances contributing to the birth of the Tidal
Model, attaining comprehension of the central metaphor on which the mid-range theory is
hinged, and developing conscious understanding of the application of key concepts outlined in
the model and the role in which a psychiatric nurse adopts throughout the process, one is able to
understand the nature of the Tidal Model as an opportunity to allow a client utilizing mental
health services to empower themselves and act as the main facilitator in their own recovery and
restoration of holistic health and wellness. This theoretical approach to nursing maintains its
focus on “helping individual people, make their own voyage of discovery. In that sense, the only
real 'evidence' of usefulness, is what happens - or is 'discovered' - for the individual person”
(Tidal Model website).
Running head: THE TIDAL MODEL: A THEORETICAL APPROACH TO NURSING
References
Barker, P. (2001, June). The Tidal Model: developing an empowering, person-centred approach
to recovery within psychiatric and mental health nursing. Journal of psychiatric and
mental health nursing, 8(3): 233-240. doi:10.1046/j.1365-2850.2001.00391.x
Chaos theory. (2012). Retrieved from http://en.wikipedia.org/wiki/Chaos_theory
Tidal Model of mental health nursing. (2012, January). Nursing Theories. Retrieved from:
http://currentnursing.com/nursing_theory/Tidal_Model.html
Titleborn, J. (2012, April). Instructions for Essay no. 1. Basic Concepts and Contexts of
Psychiatric Nursing. Retrieved from :
http://stenbergcollege.mrooms3.net/mod/assignment/view.php?id=13559
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