There are no absolutes in health care. A patient's health is fluid, and nurses often have to adapt to an individual patient's situation in order to help him or her get healthy. What works for one patient in his or her illness may not work for another patient in his or her illness. Barker's Tidal Model helps nurses care for patients in the mental health field by recognizing and working with the inevitability of change in a patient's life and environment.

Biography and Career of Phil Barker

With more than 40 years experience in the field of psychiatric nursing, Phil Barker was the United Kingdom's first professor of psychiatric nursing at Newcastle University. He is currently a psychotherapist and honorary professor at the University of Dundee in Scotland. He has authored more than a dozen books, including the Tidal Model of Mental Health Recovery and Reclamation.

Barker was awarded an honorary doctorate at the Oxford Brookes University in 2001.

Phil Barker's Contribution to Nursing Theory: Tidal Model

The Tidal Model of nursing, created by Phil Barker, Poppy Buchanan-Barker and their colleagues, is widely used in mental health nursing. It views health and illness as fluid, and life as a journey undertaken on an ocean of experience. However, it states that patients can become physically, emotionally, or spiritually shipwrecked. This metaphor of water throughout the theory should be appreciated by nurses to help them gain a better understanding of the patient's current situation, as well as the inevitability of change.

Barker's model includes six philosophical assumptions: a belief in the virtue of curiosity; recognition of the power of resourcefulness; respect for the patient's wishes; acceptance of the paradox of crisis as opportunity; acknowledging that all goals must belong to the patient; and the virtue of pursuing elegance, which means the simplest possible means should be sought.

In order for the nurse to start the engagement process with the patient, six things must be accepted: recovery is possible; change is inevitable; ultimately, people know what's best for them; the patient has all the resources he or she needs to start the recovery journey; the patient is the teacher and the helpers are the students; and the helper needs to be creatively curious, to learn what needs to be done to help the patient recover.

The engagement process takes place in three domains: self, world, and others. The self domain is where people feel their experiences, and it includes an emphasis on making patients more secure through the development of a Security Plan to reduce threats to the patient and others around him or her. The world domain is where people hold their stories. The Tidal Model nurse uses a specific way of questioning to explore the patient's story, reveal its hidden meanings, the patient's resources, and find out what needs to be done to help with his or her recovery. The others domain represents the relationships of the patient, past, present, and future. This includes the patient's care team.

The values of the Tidal Model are revealed in the Ten Commitments:

1. Value the voice. That is, the patient's story is paramount.
2. Respect the language, which means to let the patient use his or her own language.
3. Develop genuine curiosity, or show interest in the patient's story.
4. Become the apprentice to learn from the person being helped.
5. Reveal personal wisdom. Patients are experts in their own stories.
6. Be transparent. Nurses should model confidence by being transparent and helping make sure the patient always knows exactly what's being done.
7. Use the available toolkit; the patient's story contains valuable information as to what works and what doesn't.
8. Craft the step beyond. That is, the patient and nurse work together to construct an appreciation of what needs to be done in that moment.
9. Give the gift of time to foster change.
10. Know that change is constant.

Each of the Ten Commitments has two Competencies associated with it. These were introduced to help with generating practice-based evidence for the Tidal Model.

For more detailed information: Barker's Tidal Model of Mental Health Recovery