Tidal Model Patients outside of the psychiatric unit rarely have their mental health evaluated beyond the standard question of history of suicidal attempt or present feelings of suicidal ideation. Unfortunately, the mental health of those patients is often unchecked. The purpose of this paper is to discuss the lack of mental health care for patients outside of the psychiatric setting by introducing Phil Barker and his Tidal Model of Mental Health Recovery, the six key assumptions and the main concept of the model. The paper will also examine the impact of not addressing mental health in non-psychiatric settings and a possible solution to adequately accommodate this underserved population. Challenge within Nursing PracticeIndividuals who are in the hospital for an illness not associated with mental health, have a higher probability to develop mental distress related to a new or existing diagnosis and when combined mental health conditions, there is a direct linked to an extended hospital stay and increased hospital costs (Orthwein, 2017). The challenge for nurses outside of the psychiatric unit is to adequately care for a patient’s mental health while caring for their physical well-being. Incorporating an assessment tool and encouraging the patient to talk about their feelings and experiences will help patients find their voice and process mental distress while simultaneously enhancing the nurses’ a feeling of humanity (Barker & Buchanan-Barker, 2010). It is crucial to allow an exploration of feelings without being interrupted or judged. There is no monetary fee attached to implementing this model. Only time is spent to encourage dialogue from a person experiencing mental distress. By implementing this model, hospital stays might be lowered along with hospital costs and the overall mental health of the patient will improve (Orthwein, 2017). Introduction of Dr. Phil BarkerPhil Barker was born in 1946 in Scotland who during the 1960’s studied sculpting and painting (Brookes, 2017 p 504) which introduced him to the chaos theory from Eastern philosophies which emulates his theory of nursing. Barker’s interest in nursing began in 1970 when he obtained a job as an attendant at an asylum and became more interested in people, their life experiences and individual mental distress (Brookes, 2017 p. 504). In 1974, Barker expanded his nursing studies to include behavioral, cognitive and family therapies. In 1980, Barker began to explore the lives of women who were living with depression and he was faced with the dilemma of therapies that were not individualized to the person. Barker was more concerned with the meaning and the experience of mental distress and he wanted to analyze what recovery from mental stress meant to those suffering from it (Brookes, 2017, p 505). In 1993, Dr. Barker became the first Professor of Psychiatric Nursing Practice that sustained his practice of nursing while developing his tidal model of mental health recovery (Brookes, 2017, p 505). The tidal model is the first mental health model created by experienced mental health care workers and also the first mid-range recovery-focused mental health care model recognized internationally (tidal-model.com, 2019) Summary of the Tidal Model of Mental Health Recovery Dr. Barker’s Tidal Model is described as a philosophical pathway to mental health recovery (tidal-model.com, 2019. The Tidal Model is based on chaos theory and uses water as a metaphor which means human nature is erratic and unpredictable and forever changing (tidal-model.com, 2019). The Tidal Model states that growth and change happen through small changes that sometimes follow patterns which are constant in their unpredictability (tidal-model.com, 2019) and patients require help to establish awareness of their past, awareness of their present, and how to use this information to guide them to a more positive future (Barker & Buchanan-Barker, 2009). Dr. Barker describes patients during different periods of emotional trauma by relating it to a journey in a ship across an ocean. He states a patient who experiences health issues unearth discoveries made on a journey across that ocean and during the journey, that patient may experience a storm or crisis (Barker & Buchanan-Barker, 2009). Sometimes patients may feel as if their ship is taking on water or becoming emotionally overwhelmed which Barker associates with a mental breakdown (Barker & Buchanan-Barker, 2009). After a mental breakdown, a patient needs to recover their ship or rehabilitate themselves in order from the emotional trauma and from there, the patient is able to set sail again or begin recovery and nurses are required for this journey because nurses provide care and support to patients and are present to listen to the patients while they relieve themselves of pain and distress (Barker & Buchanan-Barker, 2009). Dr. Barker discussed ideas concerning his model with his mentor, Hilda Peplau who shared his thoughts about “people make themselves up as they talk” which means individuals try to explain their thoughts and experiences through stories and dialogue (Brookes, 2017, p. 506). Hilda Peplau affected Dr. Barker’s development of the model by mirroring the use of the interpersonal paradigm which was deemed to be an interpersonal process (Brookes, 2017, p. 506). The Tidal Model was also influenced by Annie Altschul, the Grande Dame of British psychiatric nursing, because she believed mental distress required much more than regular psychiatric theories offered (Brookes, 2017, p. 507). Ten Tidal Commitments and Main ConceptsFor the Tidal Model to be implemented and to work effectively, the Ten Tidal Commitments along with the twenty competencies and the main concepts must be followed (Barker & Buchanan-Barker, 2010). The Ten Tidal Commitments focuses on the values relating to patients and they frame nurses’ efforts to help patients during their moments of mental anguish (Barker & Buchanan-Barker, 2009). Each of the Ten Tidal Commitments has two competencies attached to them to assess if the nurse is using the Commitments properly (Barker & Buchanan-Barker, 2010). The first Commitment states to value the voice of the patient and its importance in telling the story of the patient (Barker & Buchanan-Barker, 2010). The competencies attached to this Commitment stresses how the practitioners of this model must allow for the patient to listen actively and help the patient express themselves using their words (Barker & Buchanan-Barker, 2010). Commitment two states how a patient’s language is unique to them and how it is very important to their recovery Barker & Buchanan-Barker, 2010). The competency associated with this Commitment stresses that the practitioner of the model allows for the patient to use their own vernacular to express themselves (Barker & Buchanan-Barker, 2010). Commitment three asks the nurse to become the apprentice in the relationship and learn from the patient (Barker & Buchanan-Barker, 2010). The patient is the best author of their story and only they can give a full assessment of their history (Barker & Buchanan-Barker, 2010). The competencies associated with this Commitment dictates the nurse to create a care plan with the needs and concerns of the patient in mind as well as including any specific problems related to areas of living (Barker & Buchanan-Barker, 2010). Commitment four states the nurse uses a “toolkit” given to the nurse by the patient which are the factors that worked for the patient and the use of these tools help with the recovery process (Barker & Buchanan-Barker, 2010). The competencies associated with this Commitment states that the nurse should encourage the patient to use what works for them and also identify those who can help advance the journey to health recovery (Barker & Buchanan-Barker, 2010). The fifth Commitment expresses that there should be a craft beyond the step which addresses what the patient needs to be doing now to initiate the first step and the steps beyond to help the healing begin (Barker & Buchanan-Barker, 2010). The competencies associated with this Commitment express that the practitioner of the model helps the patient identify the types of changes that would represent this step and what would need to happen to make the first step possible (Barker & Buchanan-Barker, 2010). The sixth Commitment states that the gift of time should be authentic and be given wisely (Barker & Buchanan-Barker, 2010). The competencies associated with this Commitment tells the nurse to help the patient realize that time needs to be given to the process and to value the time dedicated to the process of health recovery (Barker & Buchanan-Barker, 2010). The seventh Commitment explains how nurses need to develop a sincere curiosity concerning the stories of patients and ask more in-depth questions regarding their situation (Barker & Buchanan-Barker, 2010). The competencies associated with this Commitment stresses the importance of being genuinely interested in the story of the patient and simultaneously letting them unfold the story at their own pace (Barker & Buchanan-Barker, 2010). The eighth Commitment states that change is constant, and the course of recovery is determined by the focus and decisions the patient (Barker & Buchanan-Barker, 2010). The competencies associated with this Commitment tells how the nurse should help the person appreciate changes caused by thoughts and actions of the patient and how the changes have been influenced by others and their situations (Barker & Buchanan-Barker, 2010). The ninth Commitment proclaims that the only patient knows what works for them and what does not (Barker & Buchanan-Barker, 2010). The patient has the strength within them to begin their recovery and the competencies associated with this reiterates this thought by stating that the nurse helps reveal the patient’s strengths and weaknesses while encouraging their autonomy and self-reliance (Barker & Buchanan-Barker, 2010). The tenth and final Commitment asks the nurse and patient to be transparent with one another because, for a relationship to work, the patient needs to be aware of all actions and words spoken by the nurse (Barker & Buchanan-Barker, 2010). The corresponding competencies reinforce this by stating the nurse needs to provide any documentation and care plans regarding care to the patient (Barker & Buchanan-Barker, 2010). Barker’s Tidal Model has four major concepts in addition to six key assumptions that must be honored to implement the model appropriately (Barker, 2001). The first of the four principles states that the core of mental health is the natural community and it can be disturbed by a crisis that can be overcome by redirecting the patient back to their natural community and life experience to continue with healing life journey (Barker, 2001). The second principle is the constant state of change, regardless of how minute, change is constantly happening (Barker, 2001). Empowerment is the center of the caring process is the third principle (Barker, 2001). Those who are suffering from a mental health crisis need to be shown how they have the power and knowledge to redirect their situation (Barker, 2001). The fourth principle is the therapeutic relationship between the patient and the nurse (Barker, 2001). The six assumptions within the Tidal model are paramount for a therapeutic nurse-patient relationship to function (Barker, 2001). The first of the assumptions is the belief in the virtue of curiosity of the life and story of the patient by the nurse (Barker, 2001). The second assumption is nurses must recognize the resourcefulness of the patient meaning the nurse helps the patient realize all avenues of aid within their interpersonal and social networks (Barker, 2001). The third assumption is to value the patient’s wishes by doing what they want when they want and not diminishing what they think is important (Barker, 2001). The fourth assumption is the acceptance that a crisis is an opportunity, not a problem that needs to be controlled or managed because according to the Tidal Model, a crisis and a normal phenomenon that is an opportunity for change to occur and improve a situation (Barker, 2001). The fifth assumption is small steps are just as important as large steps and all are equally important and any step toward the road to recovery is celebrated (Barker, 2001). The final assumption is the virtue of pursuing elegance is the emphasis given to recognize the simplest action that might bring the changes necessary to experience a change in the present circumstances (Barker, 2001).Application of TheoryThe Tidal Model is a personalized model that relies on accounts from the patient and measures the personal gratification with deliverance of service but for patients outside of the psychiatric setting, staff can face a challenge measuring the outcome of the theory of mental distress was not the admitting diagnosis or if a patient is unwilling to participate (Barker & Buchanan-Barker, 2010). To implement the theory, the nurse can evaluate the patient for any signs of mental distress such as withdrawing from staff and/or family or the opposite such as lashing out in a violent or harassing manner. The nurse is with the patient the majority of their stay at a facility and the nurse is more capable of recognizing mental health changes with the patient. The Tidal Model values can be documented on existing forms found in most platforms of electronic medical records (Parker, Dunn, & Kong, 2017) and should not require any additional monetary cost to facilities. To implement this model into future research or practice, nurses and providers need to become aware that disease processes often contribute to mental distress and both need to be treated accordingly (Barker, 2001). Nurses and providers should treat the entire patient, not only the disease process. In conclusion, Barker’s Tidal Model is a useful tool used to evaluate patients outside of a psychiatric setting for mental distress because it helps assess those who are suffering or at risk from mental distress associated with a new or existing health crisis. The information detailed in the model provides a blueprint to adequately implement the theory and care for a patient in an acute care setting. Caring for the entire patient is paramount. Mental health is often not a priority outside of a psychiatric unit and that needs to change.