The tidal model as experienced by patients and nurses in a regional forensic unit

Abstract

The Tidal Model has been implemented in Rangipapa, a regional secure mental health forensic unit in New Zealand. A phenomenological study was undertaken to obtain reflective description of the nursing care experience from the perspective's of four Registered Nurses and four Special Patients. Five major themes were identified that appeared to capture the experiences of the participants. The themes show changes to the unit's unique culture and values following implementation of the model. These changes engendered a sense of hope, where nurses felt they were making a difference and patients were able to communicate in their own words their feelings of hope and optimism. Levelling was experienced as an effect emerging from individual and group processes whereby a shift in power enhanced a sense of self and connectedness in their relationships. These interpersonal transactions were noted by the special patients as being positive for their recovery. This enabled effective nurse-patient collaboration expressed simply as working together. The participants reported a feeling of humanity, so that there was a human face to a potentially objectifying forensic setting. Implications arising from this study are that the use of the model enables a synergistic interpersonal process wherein nurses are professionally satisfied and patients are validated in their experience supporting their recovery.

Getting to know the person behind the illness – the significance of interacting with patients hospitalised in forensic psychiatric settings

“…Another approach to forensic nursing is described by Cook et al . (); rather than focusing on re‐enacting, they highlight how patients need to reclaim their stories as a part of recovery. This is not possible without close interactions with other people.…”

Cultural boundary surfing in mental health nursing: A creative narration

“…Buchanan- Barker (2004) originally framed these as the moral, ethical and philosophical commitments, which practitioners would need to make if they were to reshape their practice along Tidal lines. As Cook et al (2005) noted, when practitioners commit themselves to the adoption of a new orientation to care and caring, the effects extend far beyond the personal domain, affecting both the team culture and the social milieu of practice. In this sense, the expressed values of the Tidal Model have implications, not only for those who receive nursing care (i.e.…”

“…To date, four major studies have explored the value of implementing the Tidal Model, within the discrete settings of acute care (Gordon, Morton, & Brooks, 2005;Lafferty & Davidson, 2006;Stevenson, Jackson, & Barker, 2003) and forensic care (Cook, Phillips, & Sadler, 2005). Whilst acknowledging the diffi culties in demonstrating empirical 'proof ' of the relationship between the Model and the various outcomes, far less any overt causal relationship, these studies illustrated positive changes (perceived as gains) in the areas of nursing morale and patient satisfaction, alongside manifest reductions (losses) in self-harming behaviour, suicide attempts, absconding, and aggression, whether directed towards staff or other patients.…”

Using the Tidal Model of Mental Health Recovery to Plan Primary Health Care for Women in Residential Substance Abuse Recovery

“…Inpatient psychiatric settings have tested implementation of the model and have had reductions in patient physical assault, violence, and harassment and, understandably, increased nurse satisfaction (Gordon, Morton, & Brooks, 2005). In New Zealand, a phenomenological study of implementation of the Tidal Model in a secure psychiatric facility resulted in five themes related to giving and receiving care: relationships, hope, human face, leveling, and working together (Cook, Phillips, & Sadler, 2005). Continued research into the usefulness of the Tidal Model is encouraged.…”