Case studies
Timbury House Tidal Model
The Tidal Model is a theory-based approach to Mental Health Nursing. It requires nurses to listen to, and work closely with their patients and carers at all stages of the individual's care whilst encouraging the patient to take ownership in developing and participating in their unique care package.The guiding principles of the Tidal Model are that of curiosity, resourcefulness, respect, seeing crisis as an opportunity and thinking small and simplistically. It focuses on the person's experiences and what they need in order to feel safe. It promotes a holistic assessment where the person is seen as an individual and highlights how they see their situation and finally it focuses on the type of support the individual can provide for him / herself and what they will need from others. The model itself is recovery focused and has three phases to it, namely Immediate Care, Transitional Care and Developmental Care.
During 2004 the Mental Health Services (Greater Glasgow part) of Greater Glasgow and Clyde undertook a commitment to test the Tidal Model in an identified adult admission wards across the Glasgow Inpatient areas. Rutherford House, in Gartnavel Royal Hospital, agreed to undertake the pilot for the west area. At the time of the pilot the feeling within older people's inpatient areas was that this approach could be utilised by individuals over 65 and should not have an age imposed limit.Staff agreed that if the evaluation of the pilot was a success, then they would consider adapting and piloting this recovery focused model in Timbury House.
The initial pilot was successful and discussions took place between the ward team, patients, carers and the staff from the adult pilot ward. Nursing staff were invited to attend day or two training sessions.There was a lengthy staged approach to implementing the full model. This was firstly because it has not, as we were aware being used in this environment and we wanted to take things at a slower pace to ensure individuals had time to adapt. To date the programme in the ward is as follows:-
The ward holds recovery and solution groups for patients three times per week. .These groups are aimed at helping the individual take positive steps towards their own recovery. Other groups include self esteem and relaxation. Staff are utilising "living life to the full" package including rating scales for depression. The physiotherapy department provide exercise groups twice per week The occupational therapy programme is geared towards a recovery approach and covers various group work including information sessions.
Patients also have dedicated one to one sessions with their named nurse, focusing on the individual's immediate needs; with emphasis on the part the individual can play to support their recovery
Whilst some of the above did happen in the past it is now more co-ordinated and structured. The group sessions are continuously evolving and changing based on patient and carer feedback. A formal evaluation has taken place with evidence suggesting that The Tidal Model has a very positive impact on patient's perceptions of their care journey.
Putting the Principles into Practice
Staff in Timbury House were keen to provide a more proactive approach to care and one which encompassed a recovery aspect to it. They recognised the uniqueness of every patient and felt that their day to day practice could be enhanced to better reflect this and to provide more collaborative working. Working with this model provides greater involvement for patients and carers. Staff were keen to embrace the principle of the Mental Health (Care and Treatment) (Scotland) Act 2003 and radically reviewed and changed how the ward operated in order to do this.
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The person's past experiences and strengths are utilised.
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There is respect for the person's wishes and aspirations.
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Carers are encouraged to participate with the individual's consent in all stages of the care pathway.
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Staff are encouraged to look at their behaviours and how they treat people through the guiding principles of curiosity, resourcefulness and respect.
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The recovery based approach to care encourages individuals to be fully involved, as much as they are able to do so, in their own care.
Evaluation
Feedback from patients and carers was very positive. Individuals felt their contact and communication with staff was about right.Results from nursing staff varied. 67% of nursing staff felt that the Tidal approach prompts nurses to listen and talk to patients and carers more, it improved the standard of nursing care and provided a clear and more defined way of working. The Multi-Disciplinary questionnaire had a lot of "I do not know" responses.
Incidents of self-harm dropped by 100% and incidents of aggression towards staff decreased by 50%. There were fewer individuals on raised levels of observation and if they were, this tended to be for a shorter period of time. There was a decrease in the usage of as required medication by 54%.
