Teoría de la Marea: análisis pautado en la perspectiva de Meleis

análisis crítico fundamentado en el Modelo de Evaluación de Teorías, enfocado en la claridad y consistencia de los componentes teóricos de la Teoría de la Marea.

Resultados:

se constató la claridad de la teoría por medio de la demostración de componentes funcionales, presupuestos, conceptos y proposiciones. La consistencia ocurre por la posibilidad de aplicación comprobada en diversos países con diferentes poblaciones.

Conclusión:

hay un amplio campo de posibilidades de investigación y aplicación en la consulta de enfermería brasileña, en búsqueda de utilidad y respaldo en el cuidado de enfermería.

Descriptores:
Enfermería; Teoría de Enfermería; Salud Mental; Modelos de Enfermería; Evaluación

Autoría

Liane Araújo Teixeira CORRESPONDING AUTHOR: Liane Araújo Teixeira. E-mail: lianeteixeiras@hotmail.com

Universidade Estadual do Ceará, Postgraduate Program in Nursing. Fortaleza, Ceará, Brazil.Universidade Estadual do CearáBrazilFortaleza, Ceará, BrazilUniversidade Estadual do Ceará, Postgraduate Program in Nursing. Fortaleza, Ceará, Brazil.

Ana Ruth Macedo Monteiro

Maria Vilani Cavalcante Guedes

Universidade Estadual do Ceará, Health Sciences Center. Fortaleza, Ceará, Brazil.Universidade Estadual do CearáBrazilFortaleza, Ceará, BrazilUniversidade Estadual do Ceará, Health Sciences Center. Fortaleza, Ceará, Brazil.

Lúcia de Fátima da Silva

Maria Célia de Freitas

CORRESPONDING AUTHOR: Liane Araújo Teixeira. E-mail: lianeteixeiras@hotmail.com

SCIMAGO INSTITUTIONS RANKINGS

Tablas

Tablas (4)

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Chart 1
Functional components of the Tidal Model

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Chart 2
Presuppositions

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Chart 3
Concepts of the Tidal Model

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Chart 4
Propositions of the Tidal Model

Chart 1 Functional components of the Tidal Model

Focus	To identify what needs to be done to help the person address, solve, overcome or adapt to the problems of life associated with what might be called their "mental illness" or "psychiatric disorder"⁽²2 Barker P. The Tidal Model: developing a person-centered approach to psychiatric and mental health nursing. Perspect Psychiatr Care. 2001;37(3):79-87.⁾.
Client	The human being is represented by the physical, emotional, intellectual, social and spiritual dimensions. Recovery is possible, and change is inevitable because nothing is lasting in the perspective that the individual will always be changing. The individuals always know what is best for them. They have the necessary resources for their recovery, as they are the ones who guide the care. They are represented in three dimensions: the world, the self, and the others. The desires of the human being remain at the center of the care process⁽²2 Barker P. The Tidal Model: developing a person-centered approach to psychiatric and mental health nursing. Perspect Psychiatr Care. 2001;37(3):79-87.⁾.
Nursing	Nursing aims to help people access and evaluate their particular experiences in an effort to make them once more writers of the history of their lives, and to begin healing the distress of the past and present as a way to promote human development⁽²2 Barker P. The Tidal Model: developing a person-centered approach to psychiatric and mental health nursing. Perspect Psychiatr Care. 2001;37(3):79-87.⁾.
Health	It is the result of the person's autonomy, which occurs through their ability to adapt to every change promoted by the healing environment, even when there is damage. It is also when people maintain their regular daily activities, being aware of themselves and how they deal with it, understanding that pain, illness and death are fundamental parts of life. Thus, nurses must know the personal and social aspects of the individual, as well as how they define health and illness⁽²2 Barker P. The Tidal Model: developing a person-centered approach to psychiatric and mental health nursing. Perspect Psychiatr Care. 2001;37(3):79-87.⁾.
Nurse-patient interaction	The Tidal Model assumes that the care process is best characterized as "to care for", which incorporates both the need for "to care about" and "to care for" the person. The collaborative nature of "to care for" produces changes both for the professional and for the person⁽²2 Barker P. The Tidal Model: developing a person-centered approach to psychiatric and mental health nursing. Perspect Psychiatr Care. 2001;37(3):79-87.⁾.
Environment	It is the context in which people live their vast experiences and nurses create a space for growth and development. One should consider the person-environment relation, which should be understood as a whole and not just as each of its parts. It is the place where the nurse motivates the patient to see that the environment is safe, through a dynamic relationship⁽²2 Barker P. The Tidal Model: developing a person-centered approach to psychiatric and mental health nursing. Perspect Psychiatr Care. 2001;37(3):79-87.⁾.
Nursing problems	The events of life that motivate the person to contact the services, which are seen as opportunities. These events are the natural signs that "something needs to be done". If you respond appropriately, this can be seen as an opportunity for change, a chance to take a new turn in life. These critical events are similar to checking the map or redefining the compass: necessary answers to the ups and downs of the journey of life⁽²2 Barker P. The Tidal Model: developing a person-centered approach to psychiatric and mental health nursing. Perspect Psychiatr Care. 2001;37(3):79-87.⁾.
Nursing care	The initial goal is to identify "what needs to be done" and all care is focused on ways to involve the person (and eventually others) in meeting that need. By focusing on what is absolutely necessary, the care plan becomes simpler and more elegant⁽²2 Barker P. The Tidal Model: developing a person-centered approach to psychiatric and mental health nursing. Perspect Psychiatr Care. 2001;37(3):79-87.⁾.

Chart 2 Presuppositions

Nursing	It is interactive, developed, a human activity more concerned with the future development of the person than with the origins or causes of his present suffering⁽³3 Barker P, Buchanan-Barker P. The Tidal Model: a guide for mental health professionals. New York: Routledge; 2009.⁾.
Human behavior	The experience of mental suffering, associated with mental illness or psychiatric disorder, is represented by disturbances of public behavior, or reports of private events known only to the individual in question⁽³3 Barker P, Buchanan-Barker P. The Tidal Model: a guide for mental health professionals. New York: Routledge; 2009.⁾.
Life	As the tide metaphor suggests, the journey transversed by people endures throughout their lives. This is similar to a trip to the sea. When individuals talk about their personal development stages, or the stages through which they have to go through life, this is similar to sailing from one port to another, or from one continent to another. The nature of the journey of life - large or small - determines the changes in human experience⁽³3 Barker P, Buchanan-Barker P. The Tidal Model: a guide for mental health professionals. New York: Routledge; 2009.⁾.
Death	Careful exploration of the suicide story is within the "care development" aspect of the Tidal Model. The responsibility is to enable a dialogue with the suicide; one who can begin to address the deep emotional insecurities that make him or her likely to commit suicide. This dialogue is the means for the emotional rescue that forms the interpersonal basis for the implementation of the security plan. In the case of a death wish, the professional's responsibility is to help the person feel emotionally safer by offering to talk about what is important in their life⁽³3 Barker P, Buchanan-Barker P. The Tidal Model: a guide for mental health professionals. New York: Routledge; 2009.⁾.
Health	The main focus is on engaging with the real world of experience. This approach is characteristic of the nursing focus in the experience and relationship with health and disease, rather than health and disease per se⁽³3 Barker P, Buchanan-Barker P. The Tidal Model: a guide for mental health professionals. New York: Routledge; 2009.⁾.
Disease	The experience of psychiatric disorder is translated into a variety of disorders experienced each day; the practice of therapeutic nursing is located exclusively within the context of everyday life⁽³3 Barker P, Buchanan-Barker P. The Tidal Model: a guide for mental health professionals. New York: Routledge; 2009.⁾.

Chart 3 Concepts of the Tidal Model

Nurse	The professional often acts more like a lifeguard, who, realizing that the person is drowning, organizes a rescue. However, the lifeguard does not restrict or dominate the person. Invariably, the lifeguard, "along with" the writhing movements of the drowning person, gradually diminishes them to help him or her swim or float alongside the savior on the trip to the beach. It is the life-guard who helps you build a personal security plan. It is necessary to evaluate and, if needed, frequently revise this plan⁽³3 Barker P, Buchanan-Barker P. The Tidal Model: a guide for mental health professionals. New York: Routledge; 2009.⁾.
Patient/person	People are defined, above all, by their experience. Consequently, the main focus involves developing the necessary conditions to identify and analyze in depth the patient's experience. Through this process, one obtains the appreciation of the human needs of the individual and what needs to be done to identify them⁽³3 Barker P, Buchanan-Barker P. The Tidal Model: a guide for mental health professionals. New York: Routledge; 2009.⁾.
Nurse-patient relationship	The caregiver and the patient in care are involved in creating a highly specific version of the life narrative. This will include the identification that the person believes to be necessary at that time in terms of support; and it holds the promise of what "needs to happen" to meet that need. As it is believed that, as a result, the simple act of speaking about the experience can change "who" and "what" we are⁽³3 Barker P, Buchanan-Barker P. The Tidal Model: a guide for mental health professionals. New York: Routledge; 2009.⁾.
Life	It is a journey in an ocean of experience. All human development, including the experience of sickness and health, involves discoveries made in a journey through this ocean of experience⁽³3 Barker P, Buchanan-Barker P. The Tidal Model: a guide for mental health professionals. New York: Routledge; 2009.⁾.
Mental disorder	At critical points in the person's life journey, one can experience storms or even piracy (crisis). At other times, the ship may begin to submerge and it may face the prospect of drowning or sinking (disintegration). People who suffer from life crises are (metaphorically) in water and risk of deep drowning, or they may feel as if they have been thrown to the rocks⁽³3 Barker P, Buchanan-Barker P. The Tidal Model: a guide for mental health professionals. New York: Routledge; 2009.⁾.
Nursing problems	The patient affected by a severe and disabling form of mental illness experiences what the layman calls "mental collapse." In the metaphor, such people experience a psychic wreck, and if the proper kind of rescue and recovery does not come soon enough, the person will begin to feel like a psychiatric castaway⁽³3 Barker P, Buchanan-Barker P. The Tidal Model: a guide for mental health professionals. New York: Routledge; 2009.⁾.
History of life	On a personal level, history is the theater of experience within which reflection and discussion evolve into a permanent form of text editing. The caring process begins and ends here, as all people express the need to develop a coherent account of what has happened and is happening to them in the light of their individual experience. This story is more significant when framed in the patient's vernacular, illustrated by the metaphorical language extracted from its history and the social and cultural environment of the patient's daily life⁽³3 Barker P, Buchanan-Barker P. The Tidal Model: a guide for mental health professionals. New York: Routledge; 2009.⁾.
Nursing care	They use the person's journey experience and its associated meanings to chart the "next step" to be taken on the journey of life. The core evaluation material is entirely written in their own voice. The caregiver's goal is to help people make choices that will guide them based on their current life problems so they can begin to chart a "home" course in their ocean of experience. They emphasize the virtues of giving "the conditions that will be necessary for the promotion of growth and development, rather than instituting care"⁽³3 Barker P, Buchanan-Barker P. The Tidal Model: a guide for mental health professionals. New York: Routledge; 2009.⁾.
Social inclusion	It highlights the effect of family and friends' permission in empowering the individual to take charge of their lives by grasping (metaphorically) the helm of their experience and starting to chart the course home. In this sense, these emerging findings suggest that reverence for the storyteller is the oldest and most enduring form of empowerment⁽³3 Barker P, Buchanan-Barker P. The Tidal Model: a guide for mental health professionals. New York: Routledge; 2009.⁾.
Rehabilitation/recovery	The person may need to be guided to a safe haven to perform repairs, or to recover from trauma (rehabilitation). The ship is new only once, but if the person has recovered the necessary parts from their ship, they may set sail again, in order to put it back into the course of life (recovery)⁽³3 Barker P, Buchanan-Barker P. The Tidal Model: a guide for mental health professionals. New York: Routledge; 2009.⁾.

Chart 4 Propositions of the Tidal Model

Valuing the voice	The subject's history is the beginning and the end of any care meeting. This history covers not only the share of suffering, but also the hope for its resolution. This is the voice of experience. You should guard it well; it is the voice that begins to help the person rebuild⁽⁴4 Young BB. Using the Tidal Model of mental health recovery to plan primary health care for women in residential substance abuse recovery. Issues Ment Health Nurs [Internet]. 2010 [cited 2016 Apr 4];31(9):569-75. Available from: http://www.tandfonline.com/doi/abs/10.3109/01612840.2010.487969?journalCode=imhn20 http://www.tandfonline.com/doi/abs/10.31... ⁾.
Respect the language	The person develops a unique way of expressing their life history, of representing to others what only they know. The language of history, with its unusual grammar and personal metaphors, is the ideal way to illuminate the way⁽⁴4 Young BB. Using the Tidal Model of mental health recovery to plan primary health care for women in residential substance abuse recovery. Issues Ment Health Nurs [Internet]. 2010 [cited 2016 Apr 4];31(9):569-75. Available from: http://www.tandfonline.com/doi/abs/10.3109/01612840.2010.487969?journalCode=imhn20 http://www.tandfonline.com/doi/abs/10.31... ⁾.
Develop genuine curiosity	The person is the writer of his life history, but that does not mean that this history is an "open book." It is necessary to develop ways of expressing genuine interest in the person's history as it is written, because it continues to be written. In this way, it will be possible to better understand the storyteller⁽⁴4 Young BB. Using the Tidal Model of mental health recovery to plan primary health care for women in residential substance abuse recovery. Issues Ment Health Nurs [Internet]. 2010 [cited 2016 Apr 4];31(9):569-75. Available from: http://www.tandfonline.com/doi/abs/10.3109/01612840.2010.487969?journalCode=imhn20 http://www.tandfonline.com/doi/abs/10.31... ⁾.
Become the apprentice	Each individual is the primary expert in his or her life history. One may begin to learn something from the force of this history, but this will only happen by applying oneself diligently and respectfully to the task by becoming the apprentice⁽⁴4 Young BB. Using the Tidal Model of mental health recovery to plan primary health care for women in residential substance abuse recovery. Issues Ment Health Nurs [Internet]. 2010 [cited 2016 Apr 4];31(9):569-75. Available from: http://www.tandfonline.com/doi/abs/10.3109/01612840.2010.487969?journalCode=imhn20 http://www.tandfonline.com/doi/abs/10.31... ⁾.
Reveal personal wisdom	One has developed a powerful storehouse of wisdom in writing life history. One of the key tasks for the professional is to help reveal this wisdom, which will be used to support the individual and guide the journey of appreciation and recovery⁽⁴4 Young BB. Using the Tidal Model of mental health recovery to plan primary health care for women in residential substance abuse recovery. Issues Ment Health Nurs [Internet]. 2010 [cited 2016 Apr 4];31(9):569-75. Available from: http://www.tandfonline.com/doi/abs/10.3109/01612840.2010.487969?journalCode=imhn20 http://www.tandfonline.com/doi/abs/10.31... ⁾.
Be transparent	Both the patient and the professional view the opportunity to become a team. If this relationship thrives, both must be willing to trust each other. The professional is in a privileged position and should model this reinforcement of confidence. It is up to the professional to be transparent at all times, helping the person to understand what is being done and why⁽⁴4 Young BB. Using the Tidal Model of mental health recovery to plan primary health care for women in residential substance abuse recovery. Issues Ment Health Nurs [Internet]. 2010 [cited 2016 Apr 4];31(9):569-75. Available from: http://www.tandfonline.com/doi/abs/10.3109/01612840.2010.487969?journalCode=imhn20 http://www.tandfonline.com/doi/abs/10.31... ⁾.
Use the available toolkit	The personal history contains countless examples of "what worked" or "what might work" for that person. These represent the main tools to be used to unlock or construct the recovery history⁽⁴4 Young BB. Using the Tidal Model of mental health recovery to plan primary health care for women in residential substance abuse recovery. Issues Ment Health Nurs [Internet]. 2010 [cited 2016 Apr 4];31(9):569-75. Available from: http://www.tandfonline.com/doi/abs/10.3109/01612840.2010.487969?journalCode=imhn20 http://www.tandfonline.com/doi/abs/10.31... ⁾.
Ability to take a step further	The professional and the person work together to build an appreciation of what needs to be done "now." The first step is crucial and reveals the power of change that points to the ultimate goal of recovery⁽⁴4 Young BB. Using the Tidal Model of mental health recovery to plan primary health care for women in residential substance abuse recovery. Issues Ment Health Nurs [Internet]. 2010 [cited 2016 Apr 4];31(9):569-75. Available from: http://www.tandfonline.com/doi/abs/10.3109/01612840.2010.487969?journalCode=imhn20 http://www.tandfonline.com/doi/abs/10.31... ⁾.
Give the gift of time	There is nothing more valuable than the time the practitioner and the patient spend together. Time is the midwife of change. There is no merit in asking "How long do we have?". We have all the time we need. The question is certainly "how can we use this time?"⁽⁴4 Young BB. Using the Tidal Model of mental health recovery to plan primary health care for women in residential substance abuse recovery. Issues Ment Health Nurs [Internet]. 2010 [cited 2016 Apr 4];31(9):569-75. Available from: http://www.tandfonline.com/doi/abs/10.3109/01612840.2010.487969?journalCode=imhn20 http://www.tandfonline.com/doi/abs/10.31... ⁾.
Experience constant change	Change is inevitable because it is constant. This is the story common to all. The professional task is to develop awareness of how this change is happening and how this knowledge can be used to guide the person to stay out of danger or distress, returning to the course of appreciation and recovery⁽⁴4 Young BB. Using the Tidal Model of mental health recovery to plan primary health care for women in residential substance abuse recovery. Issues Ment Health Nurs [Internet]. 2010 [cited 2016 Apr 4];31(9):569-75. Available from: http://www.tandfonline.com/doi/abs/10.3109/01612840.2010.487969?journalCode=imhn20 http://www.tandfonline.com/doi/abs/10.31... ⁾.

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Teoría de la Marea: análisis pautado en la perspectiva de Meleis

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[1] CORRESPONDING AUTHOR: Liane Araújo Teixeira. E-mail: lianeteixeiras@hotmail.com