Mental Health Care for Alcohol Dependence: Tidal Model's Impact

The authors of the study aimed to answer the research question of how do psychiatric nurses tailor care to fit the specific needs of a person and a person’s story and unique lived experience so that the person might begin or advance to a road of recovery. The theoretical basis behind the Tidal Model is that it is a real practice that is in the form of thoughts about what needs to be done to ease the recovery process in individuals.

What individuals need to overcome the problems they are facing is having a close and empowering relationship with the psychiatric nurse working with them. When it comes to psychiatric nursing, it is evident that having one-on-one sessions where the Tidal Model is used, that individualized care is provided to fit that certain individual’s care and needs.

The design was done using the stratified randomization technique in the order that the individuals were admitted into the hospital. The research was conducted on 36 individuals (18 experimental and 18 control).

The experimental design was used to investigate the effect of the psychiatric nursing approach using the Tidal Model on coping and self-esteem in adults with alcohol dependency. The strength of the design of the research is the use of the Tidal Model because it is used for searching for solutions, revealing solutions, and identifying resources. The research population was alcohol-dependent individuals who were admitted for treatment at the Izmir Katip Celebi University Atatürk Education and Research Hospital at the Alcohol and Substance Addiction Treatment clinic.

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The dependent variables of the study were self-esteem using the Coopersmith Self Esteem Inventory (CSEI) tool and coping using the Coping Inventory (COPE) tool. The independent variables were addiction using the Addiction Profile Index (API), anxiety using Beck Anxiety Inventory (BAI), and depression using the Beck Depression Inventory (BDI). The inclusion criteria were individuals with alcohol dependency who were between 30 and 50 years old to narrow and homogenize the sample and scored a 2 or more on the API. The exclusion criteria included individuals who were severely depressed with a BDI of 41 or more and a BAI of 26 or more. Also, individuals who had co-morbid diseases were excluded. After finding the change difference between the experimental group and the control group in a pilot study that had been previously undertaken, the sample size was calculated by a power analysis. In the pilot study that had eight participants, the effect size was found to be .97 which is a large and clinically important effect. With power analysis Type I error 0.05 and Type II error as 0.2 need to be taken into account. When you take 1 − you get the power of the study which is 0.80 and is chosen as the least power value that could be contained in clinical studies. They then got the experimental and control group numbers as 18 each based on an independent t-test.

External Validity

The factors that support the external validity of this research is that the individuals that the population consisted of were admitted to a clinic for alcohol dependency. These individuals also had to meet certain exclusion and inclusion criteria to be considered in the study to begin with. Factors that fail to support the external validity is they excluded individuals who had co-morbidities that could have no effect on alcohol dependency which could have in return decreased the generalizability of the study.

Internal Validity

Factors that support the internal validity was the randomization of the assignment of the individuals in the research to either the experimental or control group. The study had proper power analysis which increases its internal validity and data was collected using two different assessment tools for self-esteem and coping that increased reliability. Factors that failed to support internal validity is 7 people dropped out of the study and failed to be reached for their post-test which if they would have participated it could have increased internal validity. This research only included people between the ages of 30-50 but alcohol dependency affects individuals of all ages so this could decrease internal validity as well. Since this research was done in a short amount of time October 2013- December 2014, the long-term results are not recorded which also decreases internal validity.

Measurement Methods

The dependent variables measured in this study were coping and self-esteem. Coping and self-esteem were measured using Coopersmith Self Esteem Inventory (CSEI) and Coping Inventory (COPE). These dependent variables were applied before the application and three months after the application. With routine treatment and follow-up, the psychiatric nursing approach based on the Tidal Model was then used in one-on-one sessions.

Data Management and Analysis

Appropriate statistical tests were used and the study was appropriately powered. Baseline demographics of the participants in the research and stages of change three months later were calculated using Pearson Chi-Square and Fisher’s Exact tests. Descriptive statistics and inferential statistics were both used. Changes between pre and post-intervention scores were tested with the Wilcoxon Signed Ranks test. Comparison of change scores between the experimental and control group was calculated with the Mann-Whitney U. The statistical significance was accepted at a level of p < .05.

Results

In the control group, there were no significant differences between pre and post-test (COPE) mean scores or the subscale apart from positive reinterpretation and growth, use of emotional social support, and substance abuse. The difference in the experimental group between pre and post-test on the subscale of positive reinterpretation and growth was much greater than the control group and was found to be statistically significant. A statistically significant difference was found between pre and post-test mean self-esteem (CSEI) scores in the experiment group but was not found to be statistically significant to the control group.

Interpretation of Results

The researcher’s findings justified their interpretation because it was seen that the nursing approach based on the Tidal Model had a significant effect on increasing the alcohol-dependent persons’ scores on positive coping and self-esteem growth.

Clinical Implications

Helping individuals that are alcohol dependent can be a difficult task but the findings in this research support the effectiveness of Tidal Modal therapy in positive coping, self-esteem, and growth in alcohol-dependent populations.