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Tidal Model

Dr Phil Barker's Tidal Model of Mental Health Recovery is a revolutionary nursing theory that focuses on the constancy of change in all people. Its goal is to give patients the power to heal themselves rather than being treated and directed. Since 2000, the model has been used in many international settings, and Dr. Barker is recognized as one of the preeminent contemporary nursing theorists.

The model uses the metaphor of water to describe people's distress and looks upon their problems as fluid and ever changing rather than static. It sees life as a journey on the ocean of experience.


  • There is a belief in the value of curiosity.
  • Resourcefulness is more powerful than focusing on problems and weaknesses.
  • There is a respect for the patients' wishes rather than a paternalistic attitude.
  • o Crisis is an opportunity for growth.
  • Patients must set their own goals.
  • The simplest way to achieve goals should be pursued.
The engagement process incorporates self, world and others. Self is where patients feel their experiences. Developing a security plan makes patients and those around them feel more secure. The world is where patients embrace their stories. Health workers learn these stories with their hidden meanings and using the patients' resources, find out what needs to be done to enhance recovery processes. The others' domain addresses the relationships of patients including those with the health care team.

Engagement Process Beliefs

  • It is possible to recover.
  • Change is constant and unavoidable.
  • Patients know what is best for them.
  • Patients have all of the resources they need to begin their journeys toward health.
  • The patients are the teachers and the health workers learn from them.
  • Health workers need to be curious and learn what needs to be done for the patients.

Ten Commitments of the Tidal Model

  • Patients' stories are the most important aspects of recovery.
  • Let patients use their own way of speaking.
  • Listen to patients' stories with interest and curiosity.
  • Health workers learn from patients.
  • Patients are the experts with their own stories and have personal wisdom.
  • Health workers need to always communicate with patients and let them know what is being done.
  • Use the patients' stories as a guide to find what will be an effective way to return to health.
  • Work with patients moment by moment to make a plan of action.
  • Spend time with patients.
  • Know that change is constantly evolving.

Requirements for Subsystems

  • The system must be protected from harmful influences.
  • The system must be nurtured with suitable input from the environment.
  • Growth does not occur without stimulation.
The Tidal Model of Health Recovery expands Hildegard Peplau's focus on the nurse-patient relationship to include the concept of continuous change. It shows ways that nurses can recognize small changes in people and help them use these changes to work toward recovery. It is a philosophical way of thinking and one that recognizes the individual nurse as a valuable tool in a patient's recovery. The nurse, the patient and his or her family become a team working toward the patient's recovery. The nurse is more interested in helping the patient make his or her own changes rather than controlling symptoms.

Patients who have been helped by this model report that they don't feel as if they are being treated but as if someone is listening to them. Ordinary conversation is used to discover where patients are and what needs to be done. Once this has been discovered, the patient and the nurse can negotiate on how to move forward. The patient is in charge and knows when he or she is ready to change.

The model has been criticized for being anti-psychiatry, but it is actually pro-person. It uses metaphors rather than medical jargon and prefers to speak of the problems of living or mental distress instead of mental illness. It is a move toward empowering people and providing patient-centered mental health care.

Since its inception, the model has been used very effectively in a variety of mental health settings. Nurses in Ireland have used it in community health care settings with excellent results. New Zealand nurses have been the first to use it in forensic care. Because they value the power of storytelling, the people of the Pacific Islands have embraced the use of the model. Nurses in Canada are using it for people with substance abuse problems and the Royal Ottawa Hospital is teaching the model as part of its curriculum. In Australia, it is being used as a tool in palliative care with the goal of providing the conditions necessary for a good life until death occurs.

Using the Tidal Model of Mental Health Recovery, many nurses are returning to the roots of their profession. They are discovering the caring principle that was described by Florence Nightingale as "putting the person in the right condition to be healed by nature or by God." They believe that patients have the unique wisdom to know how to heal themselves, and that nurses play a supportive role in helping patients "set sail" again.

Publications related to the Tidal Model

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