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An esthetic and sociopoetic perspective on caring for people with mental disorder: appropriating the Tidal Model


Iraci dos SantosI; Leandro da Silva AndradeII; Araci Carmen ClosIII; Alexandre Vicente NascimentoIV

INurse, PhD in Nursing, Visiting Professor, Department of Nursing Fundamentals and Graduate Program in Nursing at the Nursing School of the State University of Rio de Janeiro. Brazil. Email:iraci.s@terra.com.br
IINurse, PhD student in the Graduate Program in Nursing at the School ofNursing at the Rio de Janeiro State University, Professor at the Castelo Branco University. Rio de Janeiro. Brazil. Email: proflandrade@gmail.com
IIINurse, Master's in Philosophy. Assistant Professor in the Department of Fundamentals of Nursing, School of Nursing at the Rio de Janeiro State University, Brazil. Email: araciclos@yahoo.com.br
IVNurse, Assistant Professor in the Department of Medical Cirurgical, of  Nursing  School at the Rio de Janeiro State University, Brazil. Email:alexvicentesilva@uol.com.br

DOI: http://dx.doi.org/10.12957/reuerj.2014.15663


ABSTRACT: It is asked how an aesthetic and sociopoetic perspective on caring for people with mental suffering can be constructed on the basis of the Tidal Model. The aim was to outline a perspective on nursing care grounded in the core values proposed by Phil Barker in the Tidal Model in nursing. A search in databases for full-length nursing studies this theory, published and available online in Portuguese, was unsuccessful. The book Modelos y teorías en enfermería, published in 2011, in English and Spanish. The concepts and ideas of the author of this theory made it possible to link the principles of Sociopoetics to an understanding of the essential values of this model, which relates to actions proper to a skilled care team. Thus the initial question was answered, and the goal achieved, by the proposal of an aesthetic and sociopoetic perspective on caring, based on the 10 commitments of the theory. It is up to professional nurses to foster sensitive, careful interaction with people in a place where caring is sacred.

Keywords: Nursing; nursing theory; mental health; aesthetic perspective.



The scientific production in nursing requires appropriate innovations and technologies to develop necessary actions for the welfare of the people in the various survival situations in the world, with themselves and others. Its professionals living with challenges arising from the complexity, vulnerability, fragility and / or capability of living of the individual facing difficulties, anxieties and stresses inherent in the contemporary world.

These challenges lead to questions about the application of this production, like the theories that propose conceptual models and paradigms,resignifytaking care of past centuries, but in effect this millennium, such as the psychiatry and mental health(MH) areas1.

The qualified care dates back to self-knowledge and professional recognition of clients, respecting their dignity and human needs in the whole of their body physical, mental and spiritual dimensions2. Therefore, the disease itself is not only restricted to the physical and social body. In the existential complexity, live situations that allow us to weep with joy, be crazy with happiness, lying to being happy, mistreat the one you love, hide angst, loneliness, sadness, unhappiness and work tirelessly, using the cover of the recognized insanity.

Researchers are concerned about these situations, like Phil Barker3-5, who in their curiosity, wondered about aspects related to the work developed with people with mental disorders (MD): what does it mean to be a person? What is the objective of nursing work with people in psychological suffering (PS)? What are nursing actions for? Based on these questions, he invested his intellectuality in building a MHmodel in nursing care.

Considering in this model, it reflects on a contributor object of the study for the qualification of nurses working in psychiatric nursing and MH, aiming at specific care actions with clients admitted to this institution's area. It justified the object of the study's aesthetic/sociopoetic perspective6 when caring for people with mental disorders: appropriation of the Tidal Model3,4, which recommends interpersonal relationship with focus on expression of the history of life and disease by the client them self. For this theoretical, a goal of nursing care is self-knowledge of professional and know the person/client to perform together care in MH2-5.

In the first stage of the thesis development on this subject, there was the difficulty of students in psychiatry and MH discipline in drawing an imaginary profile of the individual with PS. Without knowing your future client, how can the student and/or professional care for him?

It justifies the insertion of sociopoetics in an aesthetic perspective6, seeing the resemblance of philosophical principles, concepts and definitions and power sharing/knowing5-7, of both theories, who value the person from their speech and their rights to live and get along, considering their human dignity.

Thus, the question is: how to build an aesthetic/poetic perspective taking care of people with mental disorders from the Tidal Model Theory?

It was intended to propose a perspective of caring in nursing based on essential values proposed by Phil Barker in the Tidal Model Theory.

It is assumed that the appropriation of this theory is necessary for the construction of the perspective that, on our optics, approaches the sociopoetic practice of caring/educating2,5-7, because presents principles of nursing care, serves as a guide for the professional performance, universally used, and is based on the needs of the person with PS2,5.



The creator of this modeit reflected on the need for the powers to delegate nursing professionals to clients under their care,appreciating their life stories and the experience of madness, seeking recovery of MH, considering personal and spiritual aspects.

Eastern philosophy dominates their studies, as their belief in the ability to live and grow through crises experienced throughout life. Reflecting on the waters of the sea, he claimed to be necessary to help creatively people to cross the turbulent waters, comparable to PS, emphasizing the importance of nurses relating directly with them3,4.

This model draws its central philosophical metaphor of chaos theory, in which the unpredictability of nature resembles human life, comparing it to the power flow of water as the tides perform a coming and going movement3,4. In this, the forces of water mingle without repetitive standards, however, with outlined standards3,4.

Enabling collaborative work through the therapeutic relationship between the person and the healthcare professional; develops methods of active delegation of power, in which the nurses act as an educator, in the Center of interdisciplinary intervention, seeking the resolution of problems and the promotion of MH, by valuing the client's narrative3,4.

It is a philosophy for the recovery of MH, different from the current model of care or treatment of the MD. A specific world view, which helps nurses understand what is MH in the customer's perspective and how to help him in his recovery, including human life in physical, emotional, intellectual, social and spiritual dimensions2-5.

Such phenomenological aspects permeate the Tidal Model, focusing on the experience of the individual, as well as its unique life stories, full of metaphors and narrative interventions3-5.

Its creator uses the concept of therapeutic use of self, proposed by Travelbee contributions (model of relations between human beings)8, which helps achieve the goal of nursing, and three theories that support the Tidal Model Theory -Peplau interpersonal lessons from9; Psychiatric and mental health nursing; Delegation of power in interpersonal relationships3,4.



By situating itself in the 21 century, sought in databases publications on theTidal Model Theory, considering: period of 2001 to October 2014, Portuguese language, full of nursing work available online. The choice of this language aimed to find out if this model was known in the area of Brazilian nursing.Publications were not found in the light of the selected criteria. Therefore, the model books Modelos y teoríasenenfermería3, seventh edition and the Nursing theorist and their work4, eighth edition were used. Realizing that this theory was not published it in the 2011 edition, in English and Spanish.

To understand the appropriation of this model in the theoretical construction of aesthetic/sociopoetic perspective of nursing care in mental health, describes the reflections, ideas andconceptions of Phil Barker.

Concept pillars for the construction of the theory

Nursing- Profession that performs constant exchanges with other professions and areas of knowledge. Social construct and not just a profession. What defines nursing worldwide is the social construction and the role of the nurse3,4. They develop an educational work, constituting themselves as interpersonal activity, lasting and human, focusing on personal growth through exchanges.

Barker extends the conceptions of Peplau9, setting the goal of nursing with the Greek derivation Word thephotaxis,which means to promote personal growth and development. Proposed a psychiatric nurse distinction (PN) for nursing in MH: PN, professional work in this area aims to cure and reduce the symptoms presented by the client; in MH, the nurse's work helps one develop ways to grow and develop, going beyond what currently lives, achieving understanding and overcoming their current mental health problems3,4.

Person-Characterizes the phenomenological vision of experience from the narratives of their life story. They are philosophers in their lives, because life produces significant meanings and values about the world and their relationship with it. Nursing professionals should be able to appreciate the world from their own perspective as well as others perspectives. People are their history, the sense of self, and their relationship to the world of experiences. They are inextricably interwoven in the stories of their lives3,4.

Health-Ability to adapt to the environment and the exchanges.It would encompass the future, including the internal resources to live with it. Resulting in self-knowledge, self-discipline and internal resources as each person controls their paces, from food to sexual aspects. The human personality and its weaknesses resulting from experiences of pain, illnesses and deaths, as an integral part of life3,4.

Health is a whole and resulting from the experience of the individual, including cultural, social, economic, social and spiritual contexts throughout life. From a holistic conception, people ascribe individual meanings of health and illness. It is up to the nurses to know their clients from these different aspects, in order to use them as a resource for treatment3,4.

Surroundings-Social environment where people travel by their ocean of experience and the nurse creates opportunities for growth and personal development. The therapeutic relationships seek the subject's relationship with their surroundings. As human problems can be derived from complex interactions of the individual with those where chaos can be installed in everyday life. In the surroundings are vital areas of everyday life, such as occupation, idleness, the sense of place and belonging3,4.

Key concepts and definitions

. The therapeutic goal of care is in the community. The everyday life of the person is an ocean of experiences and psychiatric crises are among things that can sink it. The goal of care in MH is giving back to people that ocean of experience enabling them to continue their recovery3,4.

The exchanges are an on-going process and people constantly exchange. This can occur in addition to their conscience. One of the main goals is to help them develop an awareness of small exchanges, which have a big effect on their lives3,4.

. The return is in the care process, however individuals have their own power. It should help them use it to constructively gain control of their lives3,4.

. The professional and client are united like the cast of a Ballet. This means that in the genuine meetings they should take care together and not caring for the person3,4.

The three Tidal Model domains – the model directed towards to the person

The model is represented as: self, others and the world. The domain is a sphere in which the person experiences aspects of private and public life. Where he lives, his home3,4.

.Self-domain-Private place, this saves the thoughts, beliefs, values, ideas, and only the living being knows. In it suffers the he first malaise, called mental illness. Many people keep secret much of their private world revealing just what they want. This is the reason that they are a mystery to others3,4.

In this domain, the nurse helps the person to feel safer, face their fears and what makes them suffer. Its main objective is to provide, by the subject, creating what was termed a personal safety plan3,4. A working basis for developing a self-help program.

. World domain - Where the person shares the experiences self-domainwith others in their social environment. When you share thoughts, longings, world views. It characterizes the professional efforts of the center to understand the client and their problems. It becomes possible through a holistic design. It tries to help them identify specific problems that plague their daily lives and in these cases it uses individual sessions3,4.

. Others Domains-In this are found the professional care and other ways to support. It focus primarily on care groups; in them it is possible to share information and find solutions. Participating groups the person develops a value of awareness of the social support they can give and receive from others. This is the basis of the person's understanding of the value of mutual support that will be accessible in daily life3,4.



Describes the proposal for the development of an aesthetic perspective/sociopoetic of caring in nursing from the appropriation of the Tidal ModelTheory.

The attentive reading and reflective of this enabled the bond of the philosophical principles of the sociopoetic the understanding of the 10 commitments of the essence of the developers of the aforementioned value model, which refers to the actions liable to execution by qualified healthcare team. Thus responds to the initial question, and proves to be the scope of the formulated objective, with a proposal from the aesthetic / sociopoetic perspective based on 10 commitments of this theory, as described below.

. The help actions to the person with psychological distress begin with the recovery of their speech, in describing their life history, including the story of suffering, expectations and hopes that mark the beginning and the end of all this care process. Thus, in the practice of sociopoetic care / education, subjects feel free, empowered to pronounce their life in the world7-10.

It raises awareness on the third-person accounts, professional reports, which cannot express exactly the history of the subject, but rather the perception of professionals.. Therefore, the client reports about their history and the perception of health professionals are analyzed together, seeking the loyalty of these reports, which happens in the sociopoetic method11.

. Respecting the language. People describe their life stories in a unique way, report facts that only they know. The understanding of this peculiar form of expression is the medium that illuminates the path to recovery. They are encouraged to speak, using their own words, peculiar to their way to express themselves before the world. A principle of the Sociopoetic, respect the language of the subject is to consider their values, beliefs and knowledge, because they are equal in law, whether oral, sign and/or through artistic practices10,11.

Commonly the professionals record the lines of customers through technical terms, used by the psychiatrist. The Tidal Model proposes that respects the natural language of the person, and this is a way to respect them. Similarly, in educating/handle, the Sociopoetic values the forms of expression of people considering their culture, traditions and ancestry2,6,10,11.

. Develop an original curiosity. The client writes his story, such as a closed book. It is impossible to know the experience of another person. It is up to the nurses and other MH professionals to demonstrate real interest in stories from clients. Thus, it is possible to understand them better12.

Generally professionals interested in just what makes the individual suffer, conducting evaluations that seek signs and symptoms. When they reveal a genuine curiosity, demonstrate an interest in the person and their unique experience. One must understand characteristics that may be common to other subjects in PS. However, it is important to understand and comprehend what is singular. In the sociopoetic care, priority is the recognition of human dignity client considering their completeness and uniqueness2,6,10.

. Become an apprentice. The individual is the world expert of their life history. Professionals can take ownership of these stories in a respectful manner, aiming to make possible a unique learning with each person and their stories. It is the client who shall indicate the path of what must be done12. Just as the revelation of hidden knowledge, repressed feelings that are revealed when one gives time and voice to the subject in sociopoetic workshops13-14.

Nobody is able to know the real experience of an individual. The professionals often think they know a lot more about a person than they do. Barker makes a remark to the question how one can learn more about a person that little is known, than the actual individual who knows himself. It takes time to realize that people will never be able to know the other in in their entirety12.

. Using available tools. The story of the person reveals strategies that worked in the past and that might work in the future. It is the primary tool to unlock or create the recovery story. The tools used by professionals are usually expressed through ideas such as practice based on scientific data. Describe what works on other people potentially could be useful, as long as the toolset is available12.

. Working a step further. The professional caregiver and the cared for person work together to promote the recovery of MH. They decide on the next step to be given. Doing so is crucial and reveals the power exchange, pointing the ultimate goal of recovery. It is said that every journey of a thousand miles begins with a first step. Any trip starts with the imagination. It depends on whether that to predict what will be accomplished. Working one step ahead together with the person; planning together the step rightnow and wondering what will be the next3,4,12.

. Giving it some time. Nothing is more valuable than the time that the person and the caregiver are together. Often the professional complains of not having time to constructively work with people. He needs to note that the time is his and another person, being intended for a constructive interpersonal relationship, valuable to both sides3,4,12.

. Revealing personal wisdom. Only the person knows them self. Writing their story they reveal greater repertoire wisdom. Commonly do not find words to fully express their multiplicity, ineffability and complexity. Evoking personal metaphors to convey their experiences is important. Fundamental activity of the professional is to help them to reveal, acquire, enhance their own wisdom; something possible to support them during their recovery3,4.

. Understanding that the exchanges are constant and inevitable. They comprise the common history of all; their growth is optional. They need to make decisions and elect what will lead the person to growth. The professional task is to recognize that this possibility of exchange and support, decision-making, care for the person overcome the malaise toward recovery3,4.

. Being transparent. If the professional and the person suffering from a team, should lower their defenses and open to possible changes. When writing the story, the professional's pen can become a weapon; threatens to inhibit, restrict and delimit the vital choices of the individual. The professionals have a privileged position; they must win the trust and be transparent, allowing the person to understand what is happening and why they are there. Valuing the language and constructing care plans together with the subject3,4,12.



It is seen that this model guides the professional in search of answers, trying to meet the individual and contextual needs of the person who is under their guidance. In them, the psychological distress is described in metaphorical terms. The creator employs universal or culturally significant metaphors associated with the power of the sea, for representing known aspects of human suffering. Water is the central metaphor as experienced by people, and the nursing care model.

Barker shows a great interest in the human experience of psychological distress. It is incumbent upon the nursing staff, a careful and sensitive interaction with people in a space where caring is something sacred. For him, one of the characteristics of nursing practice is the use of possibilities of collaborative relationships with users of mental health services.



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