Using operational models for your healthcare practice

Healthcare practices are guided by operational models. Within nursing, they were developed to define what nursing is and could be. They describe the beliefs, values and goals of nursing and the knowledge and skills needed for nurses to practice.

What is a nursing/operational model?

We define a nursing model as ‘a picture or representation of what nursing actually is’, and we incorporate and emphasise that, ‘models offer a framework to guide practice and education.

Seminal models within nursing include the BRENDA Model, the FRAMES model, the Tidal model, the Peplau model, the SAOR model, Roy’s adaptation model, the Roper, Logan, Tierney model on activities of daily living, and finally, Orem’s self-care model.

Each has its advantages and disadvantages. Addiction nursing practitioners have found aspects of the Brenda, the FRAMEs and the Tidal model to be more relevant for their work.

Therefore, in this article, we will address these three operational models.

The BRENDA model

• B – Biopsychosocial assessment
• R – Report assessment findings to patient
• E – Use an empathic approach
• N – Patient needs are identified during the assessment
• D – Direct advice (based on the patient’s needs)
• A – Assessment of the direct advice

The BRENDA model is described as a biopsychosocial approach that combines the medical management of alcohol dependency with a sequence of short structured discussions between the client and practitioner.

BRENDA is described as a collaborative, case-management approach to treatment, incorporating the use of newly-developed medications that target the biological underpinnings of addiction.

The first step is to assess the patient bio-psychosocially, including a history, physical examination, and appropriate laboratory studies.

The FRAMES model

The FRAMES model is an acronym for:

• F – Feedback
• R – Responsibility
• A – Advice
• M – Menu of options
• E – Empathy
• S – Self-efficacy

This model falls under the brief interventions approach, please refer to Week 1 for a recap on BI. The key to a successful brief intervention is to extract a single, measurable behavioural change from the broad process of recovery that will allow the client to experience a small, incremental success.

Clients who succeed at making small changes generally return to achieve more successes.

The Tidal Model

The Tidal Model is a recovery model for the promotion of mental health. The model focuses on the continuous process of change inherent in all people.

It aims to empower people to lead their own recovery rather than being directed by professionals.

In order for the practitioner to begin the process of engagement using the Tidal model, the following needs to be accepted:

• That recovery is possible;
• That change is inevitable;
• Ultimately, people know what is best for them;
• That the person possesses all the resources they need to begin the recovery journey;
• That the person is the teacher and the helper are the pupils and;
• That the helper needs to be creatively curious, to learn what needs to be done to help the person.

The process of engaging with a person in distress takes place in three discrete domains: the domain of self, the world domain and the others domain.

The HAT recovery model

The Healthy Addiction Treatment (HAT) recovery nursing model was developed in order to best address the needs of the client.

To do this, a model must be adaptable with time, be nurse-led, be measurable and implementable, be cognisant of the person and the environment (clinic and community), have a biopsychosocial approach and possibly use a FRAMES brief intervention approach to target a single measurable behavioural change outcome.

Given the summary of key features above, a nurse-led, whole clinic approach is recommended. While a nurse works with individuals possibly using a FRAMES approach for the targeted outcome, the model addresses the health need at the population level.

The model draws on the advantages of the three models of nursing reviewed above, at the individual client level, and on the proven health promotion principles at the population level.

It is underpinned by a logic model based on the theory of change. A logic model is used for illustration and the nurse-led, Healthy Addiction Treatment Model is presented below in figure 1.

_{(Click to expand)
Figure 1: The HAT Addiction Nursing Logic Model. The individual client is at the centre, change is measured at the population level. The greatest need is the target outcome, the whole clinic works on the outcome, the nurse uses a FRAMES approach.}

The guiding principles

This model is guided by the overarching principles of health promotion as observed in other defined settings. These principles include democracy; equity; care; empowerment and action competence; environment; partnership working; transparency; holistic approach; and sustainability.

The guiding principles should define the targeted health-promoting work of the clinic, and in this case, be led by the addiction nurse.

A key to the successful implementation of the HAT model into day to day operational practice is appropriate leadership distributed across and within a service.

Valuable for improving nursing practice

To conclude, operational models are used in healthcare and these models are valuable for improving practice. In relation to the addiction model in nursing, addiction nursing practitioners have found that aspects of the operational models BRENDA, the FRAMES and the Tidal model to be more relevant for their work.

The HAT model seeks to improve one targeted need for the client, the nurse works with the client addressing that need using a brief intervention approach, supported by good leadership which includes training, resource planning and shared responsibilities.

References

^{Comiskey C, Galligan K, Flanagan J, Deegan J, Farnann J, Hall A. Clients’ views on the importance of a nurse-led approach and nurse prescribing in the development of the healthy addiction treatment recovery model. Journal of addictions nursing. 2019;30(3):169-76.
Comiskey C, Galligan K, Flanagan J, Deegan J, Farnann J, Hall A. The Healthy Addiction Treatment Recovery Model: Developing a Client-Driven, Nurse-Led Addiction Nursing Model. Journal of Addictions Nursing. 2021;32(1):E11-E20.}