Applications

SAMPLE CASE 1

Ms. ML, 25-year old, female, came in at the OPD, accompanied by her aunt, due to severe depression. Her Aunt noticed that she had sudden loss of weight and is constantly staring out the window. She was also laid off from work a week ago because of constant tardiness. Upon history taking, her aunt claimed that her parents met an accident three months ago. Ms. ML is an only child and lives alone after her parents died. Her aunt just visits her once in a while. 

NURSING INTERVENTION 

As a nurse practitioner, applying Tidal theory is very helpful to Ms. ML's way to recovery. Using the competencies and values instilled in the model, this will aid Ms. ML to explore her needs and assist nurses to plan for individualized care. Staying with the patient and encouraging her to verbalize concerns by actively listening is a way of developing genuine curiosity and valuing the voice of the patient as indicated in the 10 commitments of the Tidal model. Nurses should be equipped by the 20 competencies, such as letting the patient express her feelings on the death of her parents, allowing us to see the factors affecting the patient. The nurse can now identify the causes which contribute to the mental distresses of the patient. As health care providers, we must educate her on different coping mechanisms to overcome the situation. Finding ways to alleviate these stresses in life can assist Ms. ML to further develop self-worth, therefore identifying strengths and weaknesses as well. Given that Ms. ML lives alone, there is really a tendency of severe depression. We must encourage relatives and significant others to be involved in the care plan for the patient in the treatment of emotional distress. Moreover, guiding her to identify future needs is also to assist her towards a positive direction of her desired goals. 

SAMPLE CASE 2

Ms. MJ was driving along a deserted country road when a moderate earthquake caused the bridge she was passing to collapse. She was trapped in her car for several hours, in swirling water up to her neck. Years later, she still has nightmares about the event and re-experiences the feelings of fear and isolation associated with being trapped in the car. She avoids driving over bridges. She indicates that her relationships have not been normal since the event happend because she is so tense. It has been a hard time for her since the accident. 

CARE PLAN

Assessment for Ms. MJ should start as soon as she feels relaxed and ready to open up. This assessment is vital and must not be forgotten. It gives the patient the chance to state the complete story in her own words, have it listened to, valued and incorporated into the care plan.

Questions should be focused on the patient and must be answered by her alone. Its goal is self-awareness and reflection. Sample questions: 

• Why have I come here? What is the problem? When did I first notice it? 
• How do I feel about it? How has it changed over time?
• How has it affected your life? relationship with family and friends?

Self assessment will help Ms. MJ express herself, in doing so- it's letting her know her own problems and be aware of what is going on. Intervention includes letting Ms. MJ verbalize her own feelings and worries. It's letting her decide on her own what needs to be done. 

SESSIONS: one-on-one sessions are useful tools for Ms. MJ. Meeting her regularly will help both the nurse and Ms. MJ be aware of their needs and help address problems as they arise.

PEER/DISCUSSIONS: usually done together with patients having the same case. 

Therapeutic relationships must be established in order for the therapy to be successful. Establishing rapport will help the nurse and the patient from the beginning up to the last part of the care plan. Bridging Ms. MJ to the experience she had means exposing her gradually to situations that may bring again memories but will help her overcome the fear she has. Bridging is also helping Ms. MJ restore her daily living. Returning to her usual daily routine is one. Helping her gain confidence again will bring forth the self-esteem she needs to maintain good relationships with families and friends. It is in the plan of care (Tidal Model approach), the application of its principles and the combination of all therapeutic care that will conclude the result of the care. Nurses can help patients in different ways. The approach for the patient should consider physiologic, social, mental and spiritual needs. It is meeting the patient's need in holistic care. In Ms. MJ's case, having a mental health problem unlike physical ones, attacks the oracle of life, the deepest and innermost sense of it. This often leads to poor self-esteem, inner conflicts and even loss of personal identity. Applying the Tidal Model seeks to promote value-based practices to generate practice-based evidences of what constitute good care. It is an approach that centers on people's lived experiences, thus on the story of her life.

Reference:

Fletcher E, Stevenson C (2001) Launching the Tidal Model in an adult mental health programme. Nursing Standard. 15, 49, 33-36. Retrieved from http://nursingstandard.rcnpublishing.co.uk/archive/article-launching-the-tidal-model-in-an-adult-mental-health-programme/