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The Healing Potential of Metaphor Within a Patient's Narrative
Psychiatric nurses traditionally have used different methods of approaching patients in their care. These methods reflected, at least in part, nurses construction of the phenomena of m developed during the past half-century into various theories and models of nursing practice. Increasin"1 nurses have acknowledged the need to focus on de oping active methods of helping patients participate in their own care, fostering the active collaboration of patients and significant others (Peternelj-Taylor Hartley, 1993). Peplau s original representation of the therapeutic potential of the nurse-patient relationship currently would appear to have been supplemented by a variety of concerns for the political dynamics of the relationship itself (Barker & Stevenson, 2000).
Latvala, Janhonen, and Wahlberg (1999) described three distinct methods of helping used by nurses that suggest the dynamics between nurses and patients. Catalytic methods emphasize the use of participatory dialogue and assume the agency responsible for the patient will permit the development of mutual collaboration. Educational methods provide precedence to nurses professional monologues, assuming patients are no more than responsible recipients and the cooperative relationship will be driven primarily by the professionalism of nurses. Finally, confirmatory methods begin with an assumption that mental illness arises from physical causes. This assumption limits the nursepatient relationship to general discussion, within which the patient is a passive recipient of information. Any cooperation that occurs is within a hierarchical context.
A RESEARCH-BASED MODEL OF MENTAL HEALTH NURSING
The Tidal Model was developed in England between 1995 and 1998 from a series of studies that explored the need for psychiatric nursing (Barker, Jackson, & Stevenson, 1999, p. 273) and, more specifically, the discrete nature of the power relationship between nurses and patients (Barker, Leamy, & Stevenson, 2000). The model acknowledges mental illness can be iewed from differing theoretical perspectives. However, it also appreciates the value of construing mental health problems primarily as problems of living that exist within a human system. These hypothetical problems delimit the effective functioning of patients at various levels (e.g., intrapersonal, interpersonal, transpersonal, spiritual).
The Tidal Model uses a pragmatic and respectful approach to the identification of problems of living. It echoes the view expressed by Alanen, Lehtinen, and Aaltonen (1991) that patients with serious mental health...