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The Tidal Model approach to mental illness

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Branksome Ward is a 21-bed acute inpatient facility, within St Ann?s Psychiatric Hospital, Poole, Dorset. The ward is currently piloting 'The Tidal Model? with the expectation that the philosophy of care that this model provides will spread throughout the hospital, improving patient care through therapeutic interventions providing support, empowerment, collaborative care-planning and a highly person-centred care approach.

The pilot takes the form of a 'therapy team? led by deputy charge nurse, Dawn Coveney and currently consists of an occupational therapist, a staff nurse and a mental health support worker. The therapy team are not involved in the day-to-day running of the ward or included in the shift allocations. During one of her presentations to staff in the hospital, Dawn explained that 'initially we had hoped to introduce the philosophy as a ward team. But it became apparent that during the early stages, this would not be possible. Reasons for this include staff reaction to change and also, the need for a gradual introduction of the philosophy to the patients, which in time impacts on the ward environment, creating the therapeutic atmosphere that this philosophy requires for it to be effective.? (Coveney 2006)

The components of the model, currently used on the ward include story gathering, one-to-one work, ward round planning, goals to get me home, group work, discovery work and a solutions group. Continuous evaluation of the benefits to both the patient experience, their outcome, the ward environment and the nursing team, enables the team to review, update and improve both the components and the care delivery.

Having previously worked on this ward as a healthcare assistant, prior to the implementation of this pilot, I was already familiar with many of the patients and the ward environment. Therefore, returning as a second year student, on placement, I have observed many changes that appear to have been influenced by the introduction of this model. These include:

? the amount of therapeutic time that the patients receive from the 'therapy nurses?

? the atmospheric environment - which is one of support and comradeship amongst the patients

? patients appear to be more focused on their expectations of care and more willing to engage and interact with the nursing staff.

I was also very impressed with the way in which it was evident that several of the patients had prepared for their MDT ward rounds and were able to work in collaboration with the team with confidence. Many of the patients displayed evidence of empowerment and had a clear understanding of their goals and the care plans that they were working with. This approach demonstrates, in practice, a clear example of the much talked about provision of holistic care.

Roger?s client-centred care is a model that specifically aims to raise self-esteem and self-worth. This reflects in the patients who have worked with the Tidal Model and is a core element and outcome of its principles.

It appears, at present, that one of the fundamental elements for the success of this pilot is the autonomy and provision of allocated time that the therapy team have in carrying out their role. Providing patients with valuable time, consistency and structure, reflected in a strong theme of collaboration between themselves and the team.

The emphasis of The Tidal Model is placed on the problems, concerns, needs and goals of the patient, with the nurse focusing on the provision of basic fundamental therapeutic nursing skills. This philosophy of mental health nursing, in practice, provides both student nurses and those already qualified, with more opportunity to practice, using skills and knowledge that they have developed during their training. Skills that - due to busy wards, copious amounts of paperwork and all the everyday practicalities of working on an acute in-patient ward - they may not have the opportunity to use as often as they might wish.

I hope Branksome succeeds in introducing the Tidal Model as a philosophy of care. The benefits to the patients seem very clear and there is a lot of scope for the nurse to use and develop the skills and therapeutic qualities that they possess, in providing more effective, user-led, quality care for those suffering from mental illness.

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