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The Tidal Model: analysis based on Meleis's perspective

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

ABSTRACT

Objective:

To critically reflect on the conceptual components of the Tidal Model in the application of the mental healthcare process.

Method:

Critical analysis based on the Models of Theory Analysis, focused on the clarity and consistency of the theoretical components of the Tidal Model.

Results:

The clarity of the theory was verified through the demonstration of the following components: functional, presuppositions, concepts and propositions. The consistency is due to the possibility of proven application in several countries with different populations.

Conclusion:

There is a vast field of research and possibilities of application in the Brazilian nursing consultation, in search of usefulness and support in nursing care.

Descriptors:
Nursing; Nursing Theory; Mental health; Models of Nursing; Evaluation

RESUMEN

Objetivo:

reflexionar críticamente acerca de los componentes conceptuales de la Teoría de la Marea en aplicación del proceso de cuidados en salud mental.

Método:

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

RESUMO

Objetivo:

refletir criticamente acerca dos componentes conceituais da Teoria da Maré na aplicação do processo de cuidar em saúde mental.

Método:

análise crítica fundamentada no Modelo de Avaliação de Teorias, focada na clareza e consistência dos componentes teóricos da Teoria da Maré.

Resultados:

constatou-se a clareza da teoria por meio da demonstração dos componentes funcionais, pressupostos, conceitos e proposições. A consistência ocorre pela possibilidade de aplicação comprovada em diversos países com diferentes populações.

Conclusão:

há um vasto campo de possibilidades de pesquisa e aplicação na consulta de enfermagem brasileira, em busca de utilidade e respaldo no cuidado de enfermagem.

Descritores:
Enfermagem; Teoria de Enfermagem; Saúde Mental; Modelos de Enfermagem; Avaliação

INTRODUCTION

The nursing process is conducted through systematic actions, in view of obtaining positive results, and it takes place through the implementation of a therapeutic plan, supported scientifically with actions based on nursing theories.

Nursing theories articulate the work of nurses and their functions in care, offering insight into the philosophical foundations of nursing. In addition, they present descriptions of how to help patients become comfortable, such as completing treatment with as little damage as possible and achieving the highest level of health. In general, individuals have needs, and nursing care must perceive them and intervene(11 Meleis AI. Theoretical nursing: development and progress. 5th ed. Philadelphia: Lippincott Williams & Wilkins; 2012.).

As observed, the evaluation of a theory constitutes an essential component both for nursing practice and for the development of knowledge, since it chooses the most appropriate theory to be used as a tool for research, teaching, administration and consultation. In addition, the evaluation identifies effective theories for exploring specific aspects of practice, or to guide the research; compares and contrasts different explanations of the same phenomenon; improves the potential of building change, and further develops theory. It also identifies, epistemologically, approaches of a subject by means of focusing on the sociocultural context of the theory and theorist(11 Meleis AI. Theoretical nursing: development and progress. 5th ed. Philadelphia: Lippincott Williams & Wilkins; 2012.).

Thus, the relevance of a nursing theory in care practice or lack thereof should be analyzed. There are several models of analysis of theories and, in this essay, Meleis' Models of Theory Analysis.

OBJECTIVE

To critically reflect on the theoretical components of Phil Barker's Tidal Model in the context of the mental health care process.

METHOD

This is a critical analysis of the Tidal Model, based on Meleis's Theory Evaluation Model, which can be used in whole or in part, consisting of five segments: description, analysis, criticism, testing and theory support(11 Meleis AI. Theoretical nursing: development and progress. 5th ed. Philadelphia: Lippincott Williams & Wilkins; 2012.).

As this study proposed to perform a critical analysis of the Tidal Model, the researchers focused on the third stage of the evaluation method, in the criteria of relation between structure and function, and the units of analysis clarity and consistency were debated on. These components should be clear and objective so that the proposal is considered a nursing theory.

This study appointed the criteria of relation between structure and function. This relation is committed to the development of a critical evaluation, judging the relation between different components of a theory, such as functional components, presuppositions, concepts and propositions. The criteria for critical analysis of the clarity, consistency and usefulness of the theory were addressed(11 Meleis AI. Theoretical nursing: development and progress. 5th ed. Philadelphia: Lippincott Williams & Wilkins; 2012.).

The Tidal Model was chosen to be analyzed due to its conceptual basis in mental health, a research area with which the researchers are familiar with. This is a theory that has been effectively worked with internationally, with several successful projects, but not yet translated into Portuguese(11 Meleis AI. Theoretical nursing: development and progress. 5th ed. Philadelphia: Lippincott Williams & Wilkins; 2012.). Thus, the critical analysis of the Tidal Model enables researches, teaching and practices based on this theory in Brazil.

The study was conducted from August to December 2015 and it was designed in the Postgraduate Program in Clinical Care in Nursing and Health, PhD level, during the subject of Critical Analysis of Clinical Care in Nursing and Health as a method of assessing the knowledge acquired in the course.

Critical analysis of the Tidal Model

For the critical analysis of a theory, one must consider the relation between structure and function, the diagram of the theory, the contagion circle, usefulness and external components(11 Meleis AI. Theoretical nursing: development and progress. 5th ed. Philadelphia: Lippincott Williams & Wilkins; 2012.).

As mentioned, the relation between structure and function is connected to the development of a critical evaluation: it is the one responsible for analyzing the relation between different components of a theory, such as functional components, presuppositions, concepts and propositions. Severe criteria should be taken into account, such as clarity, consistency, simplicity/complexity, and tautology/theology(11 Meleis AI. Theoretical nursing: development and progress. 5th ed. Philadelphia: Lippincott Williams & Wilkins; 2012.).

Clarity is the demonstration of presuppositions, concepts and propositions, in addition to the functional components. In order to have clarity on the concepts, theoretical and operational definitions are necessary, giving consistency to the whole theory, as they are present in a parsimonious and coherent way with the assumptions and propositions of the theory(11 Meleis AI. Theoretical nursing: development and progress. 5th ed. Philadelphia: Lippincott Williams & Wilkins; 2012.).

In view of a better understanding of clarity, the functional components, presuppositions, concepts and propositions of the Tidal Model, which support the functional analysis of the Meleis Models of Theory Analysis, have been described in charts.

The focus is on the functional components, which are defined as follows: client, nursing, health, nurse-patient interaction, environment, nursing problems and nursing care.

Chart 1
Functional components of the Tidal Model
Chart 2
Presuppositions

Another component of a theory are the presuppositions, which are not subject to testing by the theory itself. Instead, they motivate a set of propositions that are tested and form the basis that determines the view of the theorist. In nursing theories, presuppositions are constituted from nursing, human behavior, life, death, health and disease(11 Meleis AI. Theoretical nursing: development and progress. 5th ed. Philadelphia: Lippincott Williams & Wilkins; 2012.).

One more component of a theory are the concepts, which are evaluated along the abstract-concrete dimension. The degree of generalization of the concept determines its abstract-concrete level. The greater the generalization of the concept, the more time and geography are transcended, and the greater the level of abstraction. Concepts can also be classified along the variable/non-variable dimension. Non-variable concepts in nursing are: sex, ethnic origin, religion and marital status. Examples of variable concepts (general variables) are: sexual orientation, level of well-being, degree of cultural identification, level of state of the disease(11 Meleis AI. Theoretical nursing: development and progress. 5th ed. Philadelphia: Lippincott Williams & Wilkins; 2012.).

There are numerous advantages to having general variables. General variables provide more precise classification and allow variations to be more congruent with what actually occurs. Classifying a patient into a man or woman brings some data significance and a certain degree of predictability in the structure and function of biological systems. However, sexual orientation - a general variable - can help us be more accurate in describing clients and predict their patterns of rehabilitation(11 Meleis AI. Theoretical nursing: development and progress. 5th ed. Philadelphia: Lippincott Williams & Wilkins; 2012.). As concepts of the Tide Model, the following are listed.

Chart 3
Concepts of the Tidal Model

Another component of a theory are propositions, that is, descriptive statements of the properties and dimensions of the concept or the description of the union of two or more concepts together. Propositions promote theory with the power of description, explanation or prediction. If the theory has more presuppositions than propositions it is a theory with limited power. This indicates the existence of some degree of conditions for some descriptions or predictions. In considering the relationship between presuppositions and propositions in the form of relation, rather than relationship (with the number of propositions being greater than the number of presuppositions), this will allow a greater power of explanation(11 Meleis AI. Theoretical nursing: development and progress. 5th ed. Philadelphia: Lippincott Williams & Wilkins; 2012.). The propositions of the Tidal Model are detailed below.

Chart 4
Propositions of the Tidal Model

Some questions should be observed to help determine the concept of clarity, such as: are the concepts defined operationally? Do they appear to have content and construct validity? The propositional clarity is manifested in a coherent and logical presence of propositions and systematic connections between the concepts of the theory. In addition, the clarity criteria vary, ranging from high to low clarities(11 Meleis AI. Theoretical nursing: development and progress. 5th ed. Philadelphia: Lippincott Williams & Wilkins; 2012.).

The predominant psychiatric perspective over a long period is based on the power to solve, repair or otherwise correct the problems of life, called "mental illness". In general, belief in psychiatric medicines - often used only to alleviate instead of curing - remains. Likewise, the expectation that some magic exists in the various "spoken" cures seems stronger than ever. However, while there may be "magic", it cannot be denied that traditionally people have been encouraged to believe in this cure(33 Barker P, Buchanan-Barker P. The Tidal Model: a guide for mental health professionals. New York: Routledge; 2009.).

As aforementioned, the Tidal Model incorporated concepts about the therapeutic use of "self" in the development of several roles and functions required in the nursing practice of Peplau (1952), Travelbee (1969) and Forchuk et al. (1998). It also incorporated the potential value of interpreting mental health problems, such as living problems of Sullivan (1953) and Szasz (1961)(55 Barker PJ. The Tidal Model: the lived-experience in person-centered in mental health nursing care. Nurs Philos. 2001;2(3):213-23.).

The theory began to articulate human values in the process of care, recognizing the rational nature and complexity of human experience. This recognition goes beyond quantification, which is observable and knowable, and such values are later considered by the nurse through the inexpressible elements in the nurse-patient relationship.

The structural complexity of nursing is in the social and human natures, in the dialogue, in the mutual interaction between the nurse and the patient, that takes place in a change in the processes of life and human development, as a way of understanding and particular definition of life, health, illness and death.

As a reciprocal process, the nurse-patient relationship happens in verbal and non-verbal communication, in affection, in empathy with the other, in the interaction involving the participants' contexts. This process is perceived and interpreted in a meeting, being "with" the patient to develop care and not "for" nursing practice(66 Brookes N. The Tidal Model in the mental health recuperation. 8th ed. In: Tomey AM, Alligood MR. Nursing theorists and their works. New York: Elsevier; 2014.).

The Tidal Model is based on the inherent value of each individual and their potential to change, as well as the capacity for autonomy in health production, with the understanding that people are able to supply their own basic physical needs(66 Brookes N. The Tidal Model in the mental health recuperation. 8th ed. In: Tomey AM, Alligood MR. Nursing theorists and their works. New York: Elsevier; 2014.).

Often the nurse uses her or his theoretical support and her life-time experiences to increase the capacity for intervention in solving the person's problems, with the sensitivity in the understanding that people differ in their ability to deal with the situations they have experienced. The nurse must allow the development of interpersonal skills to provide holistic and integral attention, facing the problems through intimacy as a way to provide immediate relief, guaranteeing active listening and the authentic presence of the professional(33 Barker P, Buchanan-Barker P. The Tidal Model: a guide for mental health professionals. New York: Routledge; 2009.).

The Tidal Model is structured with well-established and logically appropriate concepts, with broad ideas of the situations lived by the person and with a process of practical application based on scientific data and theories of mental health and psychiatry(66 Brookes N. The Tidal Model in the mental health recuperation. 8th ed. In: Tomey AM, Alligood MR. Nursing theorists and their works. New York: Elsevier; 2014.).

This theory prioritizes the clarity of the concepts through the practical operationalization of the person's language; therefore, this language is not modified to a professional language, which is incomprehensible. In this sense, it can contribute to the orientation of nurses' goals, to meeting human needs, knowing them and knowing that they are the person's, not the professional's.

The tide metaphor intertwines with and facilitates the understanding of ideas, premises, concepts, and relationships as a way of helping everyone through everyday language in the metaphoric ocean of experiences. It can be applied and adapted to different cultures and populations, as it does not require definition of age or gender, and can be installed in various types of patient care services, from primary care services to specialized centers and hospital units.

In addition, the nursing practice occurs through the ten commitments that represent the existence or not of the philosophical foundation of the Tidal Model. These commitments have fostered consistency in care and allow for systematic connections of the concepts and presuppositions of the theory.

It is not easy to determine the boundaries between clarity and consistency. Both the degree of congruence and the fit between the different components of the theory are described in the consistency. Thus, the fit between conceptual presuppositions and definitions, between defined concepts and the use of propositions, and through clinical concepts and examples, it can be determinant of consistency(11 Meleis AI. Theoretical nursing: development and progress. 5th ed. Philadelphia: Lippincott Williams & Wilkins; 2012.).

The vital problems of the person and nursing are based on a systematic investigation that generated the theory. In this context, the Tidal Model goes from a philosophical perspective to a worldview and personal beliefs in the production of care. Therefore, theory is not only centered on seeing, but also on knowing, through clinical observation, practice, research, and philosophy.

As observed, the life histories elaborated based on the meetings between nurse and patient are obtained by the patient's description, as the nurse is oriented to maintain the spirit of stimulation of the person in search of resources of strengthening and healing. These resources are obtained through change strategies built alongside the care plan, highlighting the resources of each person and emphasizing that the change is the only constant(77 Tomey AM, Alligood MR. Modelos y teorías de enfermería. 7ª ed. Madrid: Elsevier; 2011.).

Introduced in nursing care in acute care, the Tidal Model possibilitated the implementation of a concept of continuous care, with emphasis on the needs of the person in three different forms of care: critical, transitional and development. The concept of continuous care ranges from the hospital to the community; the main focus of care is the person's needs, rather than how this need arises(55 Barker PJ. The Tidal Model: the lived-experience in person-centered in mental health nursing care. Nurs Philos. 2001;2(3):213-23.).

Recognized as an important intermediate nursing theory, this theory is practiced by a range of courses across the spectrum of mental health care, being adopted by more than 100 projects in countries such as Australia, Canada, England, Ireland, Japan, New Zealand, Scotland and Wales. It includes young people with acute psychiatric problems, rehabilitation, autistic, with learning disabilities, as well as services of care for the elderly, through the division of hospital care in the community(55 Barker PJ. The Tidal Model: the lived-experience in person-centered in mental health nursing care. Nurs Philos. 2001;2(3):213-23.).

A successful example of the diversity of scenarios to use theory is that of the New Zealand mental health program, which applied it to the Maori Indians. In this way, it avoids the impression that the presuppositions are characteristic of Western psychiatric culture(55 Barker PJ. The Tidal Model: the lived-experience in person-centered in mental health nursing care. Nurs Philos. 2001;2(3):213-23.).

FINAL CONSIDERATION

The clarity of the theory was verified through the demonstration of the functional components, presuppositions, concepts and propositions. The practical operationalization of the language of the individual, through the recognition of their language, emerges as a contribution in the orientation of the nurses' objectives and it favors the attendance of human needs by identifying them, knowing that they are the person's, not the professional's.

Consistency is due to the possibility of application in several contexts, especially by scientific attestation in several countries with different populations, highlighting the theory as a theoretical base in the whole field of mental health.

As the theory has not yet been translated into Portuguese, only two articles in this language address its concepts. Both demonstrate a vast field of possibilities for research and application in the clinical practice of Brazilian nursing in order to support care.

REFERENCES

  • 1
    Meleis AI. Theoretical nursing: development and progress. 5th ed. Philadelphia: Lippincott Williams & Wilkins; 2012.
  • 2
    Barker P. The Tidal Model: developing a person-centered approach to psychiatric and mental health nursing. Perspect Psychiatr Care. 2001;37(3):79-87.
  • 3
    Barker P, Buchanan-Barker P. The Tidal Model: a guide for mental health professionals. New York: Routledge; 2009.
  • 4
    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/10.3109/01612840.2010.487969?journalCode=imhn20
  • 5
    Barker PJ. The Tidal Model: the lived-experience in person-centered in mental health nursing care. Nurs Philos. 2001;2(3):213-23.
  • 6
    Brookes N. The Tidal Model in the mental health recuperation. 8th ed. In: Tomey AM, Alligood MR. Nursing theorists and their works. New York: Elsevier; 2014.
  • 7
    Tomey AM, Alligood MR. Modelos y teorías de enfermería. 7ª ed. Madrid: Elsevier; 2011.

Publication Dates

  • Publication in this collection
    Mar-Apr 2018

History

  • Received
    20 June 2016
  • Accepted
    10 Apr 2017
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