NU245CL Unit 8 Tidal Model Case Formulation Example

Foil on Every Window Since the New Meters: A Case Formulation for a Composite Fifty-Two-Year-Old Man Built From His Own Account of One Season, Through the Tidal Model's Self, World and Others Domains, to a Plan He Said He Could Live With

[Student Name]

Purdue University Global

NU245CL: Mental Health Nursing Clinical

Unit 8 Case Formulation

[Instructor Name]

[Date]

The patient and family are composite; values and dates are bracketed where illustrative, and diagnosis and treatment decisions belong to the treatment team and the patient.

His Season, Told His Way

[Mr. K.], composite, 52, lives by himself and retired from the postal service [two] years ago. In his words: "They put in the new meters in April. After that the hum started. I could feel it at night. I figured they were reading more than the electricity. So I put up the foil. I stopped using my phone because it's connected. My sister kept calling and I didn't pick up, because I didn't know who else was on the line." He was brought in by police after a neighbor reported him shouting at the meter room at night. He slept two to three hours a night and had lost [6] kg.

Three Supports Thinning Together

Over the same months, three things he relied on became thinner. His mail route friends drifted after his retirement in [January]. His mother, who lived nearby, moved to a care home in [March]. And his sleep, already poor, worsened after the meters. The formulation does not claim any of these caused his beliefs, but persecutory beliefs are more likely to take hold under stress, poor sleep and isolation, when unusual sensations are explained as threats and the explanation is not tested with others (Freeman, 2016).

By summer the only voice he was hearing regularly was his own, explaining the hum.

Self, World and Others

The Tidal Model organizes care around three domains: the self, where the person's sense of safety and security is attended to; the world, where the person's own story and meaning are explored; and others, where relationships and support are rebuilt (Barker & Buchanan-Barker, 2005). Self: he does not feel safe at night. His priority is sleep and a room without "the hum." Plan: a quiet room away from the unit's equipment area, a regular sleep routine and, as ordered, medication to help with sleep and distress. World: his story makes sense to him and is the starting point. Staff do not argue about whether the meters are reading his thoughts. They ask what the hum is like, when it is worse and what helps. Others: his sister is his closest relationship. Plan: rebuilding contact at a pace he chooses.

Two Columns and a Middle

His view: the meters are monitoring him, and the foil keeps him safe. The team's view: he has developed persecutory beliefs in the context of stress, isolation and severe sleep loss, and treatment may help. The middle, written with him: he does not feel safe and has not slept, and both he and the team want him to sleep, eat and feel less frightened. Care begins from the middle.

Consent About His Sister

He agreed that the team could call his sister, but only to tell her he was safe and in hospital, and that he would call her himself when ready. On day [four], he did, with the nurse sitting nearby.

Measures Both Sides Chose

Sleep hours per night, from the staff log, with a goal of five or more by day [7]. His own rating of how unsafe he feels at night, 0 to 10. Whether he speaks with his sister twice a week. Whether he eats two meals a day. He chose the rating scale; the team added sleep hours.

Evaluation at One Week

Sleeping five to six hours, unsafe rating down from [9] to [5], two calls with his sister, eating most meals. He still believes the meters are monitoring him, but says, "It bothers me less when I've slept." Discharge planning includes his sister helping him remove some of the foil and a follow-up with a community team (Halter, 2022).

What the Nurse Did Not Do

No one argued with him about the meters, and no one agreed with him either. When he asked a staff member directly whether she believed him, she said, "I believe the hum is real to you, and I can see how frightening it has been. I don't think the meters can read thoughts, but I'm more interested right now in helping you sleep." That answer was honest, did not mock him and kept the focus on what they could work on together. Arguing tends to entrench persecutory beliefs, while agreeing would have been dishonest.

What the Formulation Adds

Without the formulation, his care might have been organized around one question: does he still believe the meters are monitoring him? The formulation shifts the question to what he needs to feel safe and connected, which is something both he and the team can work on, and it gives every shift the same starting point.

References

Barker, P., & Buchanan-Barker, P. (2005). The Tidal Model: A guide for mental health professionals. Brunner-Routledge.

Freeman, D. (2016). Persecutory delusions: A cognitive perspective on understanding and treatment. The Lancet Psychiatry, 3(7), 685-692. https://doi.org/10.1016/S2215-0366(16)00066-3

Halter, M. J. (2022). Varcarolis' foundations of psychiatric-mental health nursing: A clinical approach (9th ed.). Elsevier.