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staff handout final version2
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BASIC INFORMATION FOR NURSING STAFF AND OTHER PROFESSIONALS
The Background
Theory based The Tidal Model is a continuum. longer term.
approach theory-based approach to
Mental Health Nursing. It Immediate care – when Within the Tidal Model
Focused on emphasizes the need for simple solutions are nursing care focuses on
developing a nurses to collaborate required to ‘rescue’ the what needs to be done to
user closely with the people by person from crisis. help the person
empowering developing a therapeutic overcome, or adapt to, the
therapeutic user-empowering Transitional Care – problems of living which
relationship
relationship. where effective are associated with their
collaborative working is psychiatric condition.
3 phases of
At present the model is required when a person is
care
being tested in a number moving from one care The model also stresses
- immediate of international pilot sites situation to another. the need for nurses to
including the Republic of tread a path which
- developmental Ireland, England, Wales, Developmental care – balances their need for
Australia and New which is the active the ‘professional role’, with
- transitional Zealand. care/support designed to the service user’s need to
place the emphasis on be engaged and involved
The model focuses on learning to deal with life in an ‘ordinary’ way using
three phases of the care problems in the medium to everyday language.
6 Guiding
The Guiding Principles.
principles: There are 6 guiding them into the healthcare resources within the
principles concerning the setting. person’s personal and
1. Curiosity nature and functioning of social network which
2.Resourcefulness
the nurse’s therapeutic 2. Resourcefulness: might aid problem
relationship with the Traditionally patients are resolution.
3. Respect person, which are defined in terms of their
fundamental to the model. problems, deficits, 3. Respect: Nursing care
4. Crisis as an
diagnoses or other is often wholly based on
opportunity
1. Curiosity: The person symptoms of their illness ‘objective’ assessment of
is a mystery which or disorder. Although the the person and on doing
5. Think small requires to be explored if model recognizes the what the careteam think is
6. Think simple their needs are to be reality of these problems, ‘best’ for that person. The
identified and met. The it is primarily concerned Tidal Model emphasizes
nurse must seek to find with focusing on, and the importance of
out what exactly the working with, the person’s collaborating actively with
person thinks, feels and obvious (and perhaps not the person to identify what
knows about him/herself so obvious) strengths and s/he sees as their current
and what is the person’s how s/he manages to live needs – it is essential to
understanding of the and cope with these continue to do this.
nature and severity of the various problems. It also However, it is also
problems which brought seeks to identify other important to respect the
The Tidal Model Page 2
The Guiding Principles - cont’d.
person’s wishes by trying needs to be done. It can therefore be small and
to meet the needs that be helpful if the person in highly specific.
they feel are important. crisis and the nurse view
The wishes of the person the situation as an 6. Think simple: Nursing
should be at the heart of opportunity for change. careplans are often
the caring process. extremely complex. The
5. Think small: Nurses Tidal Model stresses the
4. Crisis as an often set care goals which need for the simplest form
opportunity: represent the end-point of of intervention which
Traditionally crises have the care process. Within might bring about the
‘The wishes of been viewed as problems the Tidal Model small changes necessary for the
the person
which need to be steps are emphasized – person to experience a
should be at the
heart of the managed and controlled. the steps that the person positive difference,
caring process’. The Tidal Model needs to take to move however small.
emphasizes the need to away from the
view crises as signs that circumstances which
something needs to brought them into hospital
change – as natural in the first place. The
signals that something initial goals should
The Therapeutic Philosophy.
The Tidal Philosophy immediate future , given 4. How to limit
involves asking 4 basic the history, personality restrictions? Nurses
The questions. and general life should aim to use the
Therapeutic circumstances? least restrictive means to
Philosophy. 1. Why this, why now? help people to address
- Why this Why
The nurse needs to 3. What is the personal their problems. Much
now? consider why the person theory? – This is where emphasis in the model is
is experiencing this the nurse considers how place on identifying how
particular life difficulty the person understands little the nurse might do to
- What works? now. The focus is very their problem(s) and what help the person and also
much on what the person explanations they bring to how much the person
is experiencing at this these understandings. In might do to bring about
- What is the moment in time and what effect, the nurse wants to therapeutic change.
personal
needs to be done now to know what ‘sense’ the Together these represent
theory?
rectify the situation. person makes of their the least restrictive
problems. intervention.
- What is the 2. What works? The This is a vital part of the
least restrictive nurse should ask what will overall model. Rather than By adopting a highly
intervention? work for the person under giving the person a person-centred approach,
the present ‘professionalised’ the therapeutic philosophy
circumstances? This explanation of their is highly individualistic and
represents the ‘person- difficulties – in the form of aims to develop the most
centred’ focus of the care. theory or diagnosis – the realistic form of
Rather than using ‘broad- nurse tries to understand therapeutic intervention:
brush’ techniques the how the person i.e. one that fits the needs,
model aims to identify understands their perspective and general
either what has worked in experience. Hence – what motivation of the person
the past for this person or is the ‘personal theory’. concerned
what might work in
The Tidal Model Page 3
The Domains of the Tidal Model
A ‘domain’ is defined as a address the person’s person or in their own
sphere of control or problems of living. words and signed of by
influence them. The assessment
The Tidal Model The Self Domain – explores: -
comprises three inter- focuses on the person’s § When and how this all
related domains of experience of crisis and began
assessment and emphasizes the need for § How it has affected me
intervention: – them to feel safe. It § How I felt at the
§ the ‘Self’ domain prompts the development beginning
§ the ‘World’ domain of a ‘security plan’. The § How things have
§ the ‘Others’ domain. security plan sets out what changed
These 3 domains has to be done to help the § How have my Three
represent the separate yet person feel safe. both relationships been Domains:-
inter-connected physically and emotionally. affected
dimensions of the person’s § How I feel now § Self
life which control or The World Domain – § What needs to happen § World
influence the person’s emphasizes the person’s now § Others
presentation. need to be understood . It § What do I expect from
Lead to: -
prompts the ‘holistic the nurses
The aim of both the assessment’ which § Security
nursing and the multi- includes the person’s The Others Domain – plan
disciplinary assessment is evaluation of their situation focuses on the type and § Holistic
to understand better the and the degree to which nature of support the Assessment
influences that are being they think they can control person might need from § Wider care
exerted on the person, it. It gives the person an other people, and support
from within each of these opportunity to describe, professionals and plan
domains and how discuss and examine their agencies in order to live an
interventions from within experience of illness and ordinary life.
each domain might help to health. It is written by the
Clinical Risk Screening – observation and engagement
Use Glasgow
The ‘Glasgow Risk It is essential at this point nature of engagement Risk Screen
Screen’ should be used to that the findings of the risk appropriate, given the to identify
determine the potential for screening and the NGASR person’s needs and potential
risk of harm to self, harm are discussed with the mental state. This should risks.
to others and risk of self- wider multi-disciplinary be carried out in
neglect. team and in particular with collaboration with the Use NGASR
scale to
the consultant psychiatrist person and their carer assess
Where the screening has
(or recognized deputy). whenever possible and be suicide risk.
identified a potential
Wherever possible it reflected in the careplan.
suicide risk the nurse will
should involve the person Good practice dictates Agree level of
conduct a structured observation.
and their carer(s). These that the wider careteam
suicide risk interview and
discussions should should have input into
rate the potential risk Agree the
determine the level of determining the required nature and
using the Nurses Global
clinical observation level of engagement. level of
Assessment of Suicide
appropriate for the person engagement
Risk (NGASR) instrument
at that moment in time. required.
which is an integral
component of the Tidal Nursing staff must then
Model. determine the level and
The Tidal Model Page 4
The Levels of Engagement
The levels of engagement interactions recorded. observation.
are intended to harmonise
with the Divisional The aim of these brief People offered level 1
Observation Policy they contacts is to assess the engagement will have a
are not intended to over- person’s situation, monitor nurse in continuous
ride it. well being, discuss how attendance throughout the
Three levels of they are managing their day. However, this does
engagement. There are 4 levels of security plan and offer not mean that the nurse
The levels of engagement within the emotional support. will be actively engaged
engagement are Tidal Model. with the person at all
intended to These interactions will be times and in all
harmonise with Level 4 engagement :– It over and above the formal circumstances.
the Observation is anticipated that all engagement offered under
Policy not
patients on General level 4. It does mean that the
replace it.
Observation will be person will have
engaged at this level. In Level 2 engagement:- Will uninterrupted access to a
effect it means that the be appropriate for people nurse for support
person will be formally deemed to be significantly throughput the day.
All, patients engaged by staff at least vulnerable. They will
should be once per day in such as a often, but not always, be People on level 1
offered level 4 one-to-one session, group on Constant observation. engagement should also
engagement discussion or family be offered the level of
plus one of the
meeting. The person will require input defined at level 4.
other three
depending upon frequent contact and
their needs and This level of engagement regular support from
degree of is intended to provide the nursing staff throughout
vulnerability. active care required to the day. A designated
address specific needs. nurse must make regular
and recurrent enquiries
It should also be offered over the course of the day
to people on Constant and in relation to how the
Special observation, person feels and respond
It is
acknowledged though it is acknowledged appropriately to maintain
that people who that there ability to interact physical and emotional
are on constant at this level maybe security.
and special impaired by their
observation prevailing mental state. People on level 2
may not be able engagement will also be
to interact at Level 3 engagement:- offered the degree of input
level 4 but all Once again it is defined under level 4
should be
anticipated that this will be engagement.
offered the
opportunity to closely aligned with
do so. General Observation. The Level 1 engagement:-
person will usually be People offered this level of
deemed to be at low risk engagement will usually
but the nature of there be deemed to be very
needs dictates that they vulnerable requiring the
be briefly formally fullest support possible.
engaged by staff at least 3
times – morning, This level of engagement
afternoon and evening aligns closely but not
and the outcome of these exclusively, with Special
Page 5 The Tidal Model
The Security Plan
The security plan is to identify exactly what it beliefs – that could
devised in the knowledge is that the person might be precipitate a harmful
that if the person does not able to do for themselves event. The aim in this
feel physically safe and to reduce the likelihood of respect, is to identify how
emotionally secure then an untoward event the person might be able
all other interventions, happening. It will also to manage their own
however sophisticated, identify the type of support thoughts, feelings and
are likely to have little the person will require if impulses to minimize the
effect. they are to successfully risk of harm. The Security plan is
enact their responsibilities designed to make
the person feel
The composition of the In developing the plan it physically and
plan is informed by the The security plan is the can be helpful to explore emotionally secure.
assessment undertaken in bedrock of the person’s things that the person
the Self Domain. contribution to their own might have done in the The emphasis is on
careplan and requires to past to offset risks and a joint Person /
The assessment will be reviewed and update how might these Nurse collaborative
identify significant risks regularly and as frequently strategies be utilised or approach to
related to self-harm, as the person’s needs developed to address the minimizing risk.
suicide, harm to others dictate. current situation.
The plan is the
and self neglect and the bedrock of the
plan will focus on The plan is likely to The security plan person’s contribution
addressing these risks include common-sense assumes a willingness on to their careplan
and making the person measures like removal of the part of the person to
feel as secure as possible. harmful objects, materials collaborate in the
that might prove harmful careplan. This is designed
The emphasis is on and people that might to empower the individual
developing a Person / prove harmful. Such by helping them to realize
Nurse collaborative measures are usually the that they have the
approach to risk responsibility of the capacity to manage their
minimization and the plan careteam. own risks if they are
should include provided with appropriate
responsibilities on their A major consideration will, support. This positive
both parts. however, be the risks that attitude of the nurse helps
lie within the person – instill a sense of hope
The aims of the plan are their thoughts, feelings,
Individual Work
One-to-one work should Initial sessions may be person’s awareness of
focus on addressing the very informal but it is change however small or
immediate needs of the anticipated that things will gradual and use this to Individual work
person and the move fairly quickly to a instill hope for the future focuses on the
continuation of the more focused approach. and to build on. developing
awareness of
assessment process. change and
In all care settings the instilling hope
The emphasis should be nurse should regularly
on encouraging the person spend time with the person
to become aware of the in focused one-to-one
part they can play in sessions. Although such
identifying needs and sessions should appear
working out potential like ordinary conversation
solutions. the aim is to develop the
Page 6 The Tidal Model
Groupwork
The aims of groupwork § The Recovery Group information, illness
undertaken within the § The Information Group education, self-help
Tidal Model are:- § The Solutions Group groups, housing issues
etc.
§ To share experiences of The Recovery Group:- Is
difficulty, distress and focused on a set of The Solutions Group:-
disability. questions that aim to Supports and builds upon
§ To obtain support from generate simple reflection the one-to-one work and
other group members. and informal conversation is focused upon bringing
§ View problems from a and helps people to about and recognizing
Within the different perspective and identify their strengths – change. Ideally it should
model there are
learn from the ideally it should be held in be held in the afternoon
3 types of
Groups. experiences of others. the morning when people and allow people time to
§ Experience helping often need a boost. reflect and unwind
§ The Recovery others. afterwards. A separate
Group § Sharing of information. The Information Group:- information sheet provides
§ The § Exploring options for Aims to demystify the further details about this
Information resolving problems. language of psychiatry group session.
Group § Developing and develop the person’s
§ The Solutions assertiveness, social understanding of their
Group
skills and problem- illness, situation and
solving skills. treatment. Such sessions
might include discussions
Within the model there are on medication
3 types of Groups. management, benefit
Builds upon
nursing’s core
Summary
concepts of The Tidal Model builds It contains little that could The model should be
caring about
people.
upon nursing’s core be described as ‘new’ – considered as the basic
concepts of caring about but it successfully everyday tools of the
people. redevelops and reframes mental health nursing
‘old’ solutions in a more trade – upon which more
The model is based upon
creative package. specialized interventions
working collaboratively
and treatment approaches
with people, promoting The model is not intended
can be overlaid.
recognition of their to be slavishly followed or
personal strengths and worshipped and there is
attributes and their ability scope to develop it at a
to bring about change in local level by adding
their own lives with components to it e.g.
appropriate support from rating scales, assessment
formal and informal instruments, outcome
carers. measures and so forth.
Primary
Care Trust
Mental
Health
Division
