Reflecting on Some Nursing Theories Based on Meleis’ Evaluation Model

Analysis of Nursing Theory
Analysis of Nursing Theory
Nursing as a profession has been advanced through the efforts of nursing theorists. Nursing theories have been developed through a formulation of ideas; implanted through patient trials and group studies that have steered nursing practice. This process has been ongoing over the years through education, research, and training; today, there is a myriad of nursing theories to guide the activities of the profession (Colley, 2003). The theories differ in their scope and efficacies based on the circumstances under which they are applied. No single nursing theory is a panacea to all nursing problems. Thus, the ability to choose an appropriate nursing theory to use in a given situation is critical to the success of a nurse’s praxis (Colley, 2003). This paper demonstrates the process of evaluating a nursing theory using one of many frameworks for assessing nursing theories. The analysis focuses on the Tidal Model developed by Professor Phil Barker.
Overview of the Tidal Model
In simple terms, the purpose of the Tidal Model is a recovery model to aid mentally ill patients to get back to normalcy. The most recognized name among its developers is that of Professor Phil Barker, who officially acknowledged as the developer of the model, but he did not come up with single-handedly. The model was a culmination of the efforts of several individuals, including professor, Poppy Buchanan-Barker as well as other colleagues (Barker & Buchanan-Barker, 2005). This model was established from empirical studies of the essential need for nursing and the process of empowerment in clinical nursing practice (Barker, 2002).
Its underpinning idea is continuous change inherent in every human being (Barker, 2002). Through this change, mentally ill patients are supposed to be permitted to take charge of their recovery, as opposed to being directed by the nurse or physician. The model anchors on six fundamental philosophical assumptions, including belief in curiosity, the power of resourcefulness, patient autonomy, construing paradoxes as opportunities, patient originated goals, and the pursuit of elegance (Barker & Buchanan-Barker, 2005). To operationalize these assumptions the following guiding principles must be applied; it is possible to recover, no condition is permanent, everyone knows what is in their best interests. Also, the resources needed for recovery lie within the patient, the patient is the teacher and caregivers are the pupils, creative curiosity on the part of the caregiver is paramount (Barker & Buchanan-Barker, 2005). The caregiver must understand the domain in which the patient is in before they apply any of these principles. The patient could be in the self-domain, world domain, or others domain and how they are to be engaged in each of these domains differs (Barker & Buchanan-Barker, 2005).
A further aspect of the Tidal Model is the ten commitments, which essentially capture the values surrounding it. These include valuing the patient’s voice, respecting their language, being genuinely curious about their situation, and learning from the patient. Bringing out personal wisdom where necessary, being transparent, picking and using valuable information from the patient’s story, knowing what needs to be done at any one time, being persistent with the patient, and knowing that the only permanent thing is change (Barker, 2002). Finally, attached to each of these commitments are two competencies for the practice environment (Barker, 2002), mostly aimed at gathering data for evidence-based practice.
Applying the Nursing Theory Evaluation Framework to the Tidal Model
The framework that has been chosen for use in analyzing the Tidal Model is the theory evaluation model proposed by Meleis, which focuses on “description, analysis, criticism, test and support” as the evaluation points for a nursing theory (Neto et al. 2016, p. 164). It is critical to note that each of the five points of evaluation (phases) is significantly detailed, making the evaluation framework so elaborate that no nursing theory can satisfy all of its criteria (Neto et al. 2016). Consequently, it will be used as applicable in this analysis.
The description phase of the analysis process focuses on elements such as “assumptions, concepts, and propositions” (Neto et al. 2016, p. 164). The Tidal model meets the criteria in this phase, as it features the six philosophical assumptions highlighted in the overview section. The three domains have propositions in the form of commitments. Which are supposed to guide the interaction between a patient and a caregiver. The other aspect of this phase focuses on the functional components of a theory such as “focus, client, nursing, health, environment, nurse-client interaction, nursing problems and nursing therapy” (Neto et al. 2016, p. 164). Again, the Tidal model satisfies most, if not all, of these criteria because the theory’s primary aim is to bring healing to mental health patients. Thus, it focuses on this group of patients specifically and advises the nurse or caregiver on how to handle in every possible circumstance so that the recovery process becomes successful. The functional criteria are each satisfied with the method of using the Tidal model to care for mental illness patients.
The second phase of Meleis’ theory assessment framework is the theory analysis phase. It entails a look into how the theory’s structure relates to its functional components, including origins, the logic behind it as well as the semantics of the theory (Piccoli et al., 2015). The Tidal model, for instance, comprises of six philosophical assumptions, three domains, ten commitments and twenty competencies. A look at the manner in which these elements interact when the model is in use constitutes the analysis phase. It should be remembered that the theory also uses a metaphor to explain the condition of a mentally ill patient (Barker, 2002). To make the Tidal model work, one must understand how the components and underpinning principles, as well as logic, tie together to deliver utility.
A caregiver looking after a mentally ill patient must be curious, resourceful, and respectful of the patient’s wishes, while at the same time believing that the patient will recover, as no condition is permanent. This understanding ties to the metaphor of water to grant the caregiver a full recognition of the seriousness of the patient’s problem without taking away their optimism that the patient will recover (Barker & Buchanan-Barker, 2005). Underlying the model is insightful logic that a caregiver can base upon their understanding. The different components of the model connect with each other while, making it possible for the model to achieve utility. This application is attested by the evidence that this model has been in use for nearly 20 years, spreading outside the U.K. The implication of its amplified use demonstration its success in the U.K. and is considered by other practitioners elsewhere as being viable for dealing with mentally ill patients (Piccoli et al., 2015).
The third phase of the theory assessment process focuses on the clarity, consistency, simplicity, and complexity of this theory (Neto et al. 2016). The Tidal model is presented using precise functional language for the medical professional. This theory demonstrates the value of the nurse-patient relationship, identifying the human needs and emerging them into components that can be used for a successful transition from a psychology crisis to normalcy. The assumptions integrate well with commitments or values, and the competencies derive from these commitments. Within itself, the model is unlikely to experience conflict. Another angle from which the concept of consistency can be looked at, regarding simplicity; the Tidal Model is among one the simple nursing theories used today. It is easy to understand and apply in current practices, thus giving it an element of soundness when consistency applied in the mental health population.
The fourth phase of the analysis process is the testing phase. As a model that is currently in use, this phase does not need theoretical justifications to show that it could work. Beginning in the year 2000, the model has been in use in the practice setting. It was first used in Newcastle, U.K. Upon successfully achieving the desired outcomes, its use has expanded over the years to the rest of the developed world (Barker & Buchanan-Barker, 2005). The model is yet to become the standard in caring for mentally ill patients. Considering that the developed world reports very high rates of mental problems, it can be argued that the Tidal model is being used by significant numbers of people across the world.
Finally, the support phase kicks in to measure the extent of acceptability of a theory. As noted in the preceding paragraph, the Tidal model is currently in use in most of the developed world. Specifically, the country’s in which the model is in use include the U.K., New Zealand, Japan, Australia and Canada (Barker & Buchanan-Barker, 2005). Although not used as the standard for delivering mental health care, this model has been accepted reasonably well; often giving a good score on the acceptability criteria. Essentially, the Tidal model is a well-rounded nursing theory that meets most of the requirements set out in Meleis’ theory assessment model.
Summarily, the Tidal model, as a framework, achieves the objective for which it was developed. Those who have chosen and used it in dealing with mentally ill patients have produced positive outcomes as attested to by its spread from the U.K. to most of the developed world, where mental illness is a significant healthcare problem. A personal take on this model is that it delivers utility and is thus useful from the perspective that the working model achieves therapeutic outcomes. Implementing this theory as a standard of practice within the mental illness population can bring forth an optimal healing environment. This nursing theory is useful to both healthcare professionals and society at large.
Barker, P. (2002). The Tidal Model: The healing potential of metaphor within a patient’s
narrative. Journal of Psychosocial Nursing & Mental Health Services, 40(7), 42-55.
Barker, P., & Buchanan-Barker P. (2005). The Tidal Model: A guide for mental health
professionals. Brunner- Routledge, London.
Colley, S. (2003). Nursing theory: Its importance to practice. Nursing Standard, 17(46), 33-37.
Piccoli, T., Nunes, S. F. L., Tramontina, P. C., de Oliveira Juliane, R. T., dos Santos, E. K. A., &
Amante, L. N. (2015). Reflecting on Some Nursing Theories Based on Meleis’ Evaluation Model. Cogitare Enfermagem, 20(2), 433-438.
Ramalho Neto, J. M., Marques, D. K. A., Fernandes, M. D. G. M., & Nóbrega, M. M. L. D. (2016). Meleis’ Nursing Theories Evaluation: Integrative review. Revista Brasileira De Enfermagem, 69(1), 162-168. doi:10.1590/0034-7167.2016690123i

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