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Transition Theory: Afaf Ibrahim Meleis

Jamie Kruger

Ferris State University

Abstract

Transition Theory is a nursing theory developed by Afaf Ibrahim Meleis and colleagues during three decades of research in the late twentieth century. Transition Theory is based on the concept that all people go through life changes and during these changes, nurses, have the opportunity to facilitate the transformation in terms of health and wellness. This theory will be explained in terms of person, environment, health, and nursing with further explanation on how the model can be used in practice.

Keywords: Transition, Theory, Nursing, Health, Model

Transition Theory

Transition Theory, developed primarily by Afaf Ibrahim Meleis, is a nursing theory that seeks to identify individuals experiencing life changes and then assisting these individuals in terms of health promotion. Transitions, or changes, can impact a patient’s health in a variety of ways. By recognizing these times of transition, nurses can develop appropriate interventions for their patients which assist them in achieving positive outcomes.

Afaf Ibrahim Meleis is a prominent nurse sociologist, educator, theorist, and researcher that began her nursing career in her native Egypt in the 1960’s (Alligood & Tomey, 2010). Ms. Meleis first developed Transition Theory while working on her doctorate in the mid 1960’s and further refined it over the next three decades while working as a nurse researcher and educator. While working on her idea of ‘role supplementation’, Ms. Meleis conceptualized the idea of Transition Theory as it applies to nursing practice. The theory is described as having “five essential properties- awareness, engagement, change and difference, time span, and critical points and events” (Meleis, Sawyer, Im, Hilfinger-Messias, & Schumacher, 2000, p. 17).

Transition Theory is significant because Ms. Meleis developed it at a time when nursing was experiencing a rapid change from being vocational based to professional based, in a time when nursing science was emerging (Alligood & Tomey, 2010). Ms. Meleis, in creating the theory, capitalize on the critical thinking skills needed by nurses to recognize those times when patients were transitioning, thus choosing those optimal moments that interventions could then take place (Chick & Meleis, 1986).

Analysis of Model

Person

Transition Theory operates under the assumption that all people experience transitions, or change, in their life. This theory can be applied to all people at all times across the continuum, the only variable needed is for the person to be under going some kind of transformation. In terms of person, this theory takes into consideration that all people are unique and will interpret their transition in different ways. The nurse must assess how the individual perceives their change and thus develop therapeutics geared toward that perception, assessing for feedback along the way (Chick & Meleis, 1986). In a more global setting, Transition Theory has application value in terms of whole populations or groups of people.

Environment

Environments are not static as they are constantly changing. Chick and Meleis link transition in relation to environment in two ways. Firstly, change, whether fast or slow, may prompt the transition, but rapid changes usually require a greater adjustment (1986). A paraplegic that is displaced from his home because of a flood may feel uncomfortable adhering to his self-catheterization schedule while he is at a shelter and he may develop chronic urinary tract infections. Secondly, change, also impacts the transition in terms of what the environment offers in terms of support. That same individual may not be able to stay at the shelter if it has no handicapped facilities.

Health

In terms of health, there are many variables which shape individual experiences and outcomes. Change has a potential impact on the health of the individual, but not all individuals experience the same change in the same way as human beings have different perceptions of the same phenomena. Socioeconomic status, cultural beliefs, and education level can all affect potential health related outcomes (Meleis, et al., 2000).

Nursing

This theory, when applied in terms of transition, creates a model from which nursing can develop appropriate interventions for their patients. How an elderly, Japanese woman experiences pain is very different from how an adolescent, Caucasian male experiences it, and nursing interventions need to be tailored to each individual. Transition Theory has also been applied in many different nursing research projects that apply to discrete populations undergoing a change.

Further Concepts

Transition Theory can be further explained outside of person, environment, health, and nursing. While these all focus on nursing therapeutics, there are further concepts that help explain the theory.

Types and Patterns of Transitions

Alligood and Tomey have pointed out that there are “developmental, health and illness, situational, and organizational types of transitions” (2010, p. 420). Developmental transitions refer to those patients that are undergoing changes in terms of aging milestones such as facing death. Health and illness changes can refer to changes brought on by an acute illness, while an example of a situational crisis can be one that a person can move in and out of, experiencing circumstantially. Organizational transitions are those brought on by environmental factors. It is also pointed out that people often are experiencing multiple transitions at one time and these may not be interrelated.

Properties of Transition Experience

As mentioned previously, there are five properties of this theory and they include awareness, engagement, change and difference, time span, and critical points and events. Alligood and Tomey (2010) state that awareness and engagement refer to the person’s being conscious of the change and their willingness to participate in the components that result of this change. Change and difference is the perception the transition means to the individual. From this perception, one can then alter their pattern of behavior. Alligood and Tomey go on to say that time span refers to the constant flow of change across time; there must always be a forward motion in order for change to occur. Finally, critical points and events are described by Alligood and Tomey as specific occurrences that cause an increase in awareness of the transition, which can produce and increase in engagement (2010).

Transition Conditions

Transition Conditions are those that are described as having influence on how a person moves through a change, such as personal conditions, community, or societal factors (Alligood & Tomey, 2010). These conditions are unique to individuals and will alter how nursing approaches the plan of care for the patient.

Patterns of Response

A Pattern of Response is an assessment tool that shows how a person is reacting and coping with the transition. Nursing can evaluate how a person is managing their change and alter the plan of care if there are negative responses to the transition.

Clinical Applications

There are many clinical applications to Transition Theory. An example of a person going through a significant transition would be a patient that is scheduled to have a limb amputated. The patient most likely will be aware of his transition, but perhaps not the scope of the change. The nurse can arrange for the patient to meet with someone that has gone through the same change and has effectively adapted to his new way of accomplishing goals. The patient can become engaged with his transition by examining the different types of prosthetics available to him. The patient’s changes and differences are examined when the nurse encourages the patient to speak about his feelings related to the surgery. The patient may perceive himself to be different and not “whole”. Different nursing staff will most likely measure time span. There will be a period of pre-surgery, inpatient status, and rehabilitation that will be managed by different personal. The patient will need different therapeutics at each level specific to his care at that time. Critical points and events are when the patient has become accustomed and adapted to his new way of life. The period of transition was marked by the loss of his limb and in the process of healing and rehabilitation he has learned new ways of accomplishing goals.

Framework for Patient Assessment

In reviewing the components of the Transition Theory, patient assessment can be tailored to a specific patient. The nurse must assess the patient for level of knowledge, their readiness to learn, cultural considerations and beliefs; even socioeconomic status can impact how a nurse will assess their patient. The physical assessment might even change if the patient is a married female with beliefs that only her husband may see her nude.

Nursing Education

Ms. Meleis states that Transition Theory is “experiencing a growing international interest” (Alligood & Tomey, 2010, p. 425). There are a number of nursing schools that have modeled their nursing programs to that of Transition Theory. The theory and its components are clear cut and easily applied. Afaf Meleis is currently positioned as the Dean of Nursing at the University of Pennsylvania. The university has established the NewCourtland Center for Transitions and Health with research being targeted toward patients with chronic illnesses. The center states by “using multiple research methods, the research members are creating a body of knowledge using Transition Theory that will directly benefit patients” (University of Pennsylvania School of Nursing, 2008).

Strengths and Limitations

Transition Theory is popular because of its simplicity. The theory finds its strengths in that it can be applied to any patient population, as all patients are experiencing change. The properties are clear and easy to understand. One of the weaknesses of this theory is that it has not been exhaustively tested in the arena of research. Alligood and Tomey state “Transition Theory has been formulated and theorized through induction by the use of existing research” (2010, p. 424). A greater respect for this theory would ensue if original research were completed to prove its usefulness as a nursing application.

Conclusion

Transition Theory is a solid Nursing Theory as it has ease of use and is widely applicable to a variety of patient populations. The methodologies within the theory are clear, not difficult to learn and not painfully abstract. Change is inevitable. With change, opportunities to impact health in a negative way are to be expected and likely. Unhealthy outcomes can be avoided if the nurse can assist the patient in adapting to their transition. With further research, the theory has the potential to be a model for change in the coming years.

References

Alligood, M. R., & Tomey, A. M. (2010). Nursing theorists and their work. Maryland

Heights, MO: Mosby.

Chick, N., & Meleis, A. I. (1986). Transitions: A nursing concern. In P.L. Chinn (Ed.).

(1986). Nursing research methodology, (pp. 237-257). Boulder, CO: Aspen

Publication.

Meleis, A.I., Sawyer, L.M., Im, E., Hilfinger-Messias, D.K., Schumacher, K. (2000).

Experiencing transitions: An emerging middle-range theory. Advances In

Nursing Science, 23(1), p. 12-28.

University of Pennsylvania. School of Nursing. (2008). NewCourtland Center for

Transitions and Health. Philadelphia, Pennsylvania.

|Grading Rubric for Theory Paper |Possible points |Points Earned |

|1. Introduction of theory/model | | |

| a. Introduction clear and well focused |5 |5 |

| b. History and significance of model |5 |5 |

| | | |

|2. Analysis of Model | | |

| a. Explain the model in terms of: Person, Environment, Health, and Nursing. |10 |10 |

| b. Explain other concepts that are unique to the model. |10 |10 |

| c. Demonstrate how the model can be used in clinical practice. |10 |10 |

| d. Explain how the model can be used as a Framework for patient assessment. |10 |10 |

| e. Explain the model within the context of nursing education. |10 |10 |

| f. Identify strengths and limitations of the model. |10 |10 |

| g. Analyze the model overall, demonstrating new insights about the model. |10 |10 |

|3. Evidence of Academic Writing | | |

| a. Development of a clear, logical, well-supported paper; demonstrating original thought and|5 |5 |

|content. | | |

| b. Evidence of research with a minimum of 2 research articles in addition to the course |5 |4 |

|required texts. Correct acknowledgement of sources using APA style referencing. Attaches APA | | |

|checklist | | |

| c. Overall presentation; grammar, spelling, punctuation, clean and legible. |5 |5 |

| d. Stays within page limit which includes: one cover page, one reference page, body of paper|5 |5 |

|is to have a maximum of 5 pages and a minimum of 3 full pages. | | |

|Total Possible Points |100 |99 |

|Total Points EarnedGood job. Well done | | |

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