Nursing theories are meant to improve patient health and quality of life by implementing certain nursing practices. It is essential to examine, evaluate, and utilize nursing theories as it helps to feel the gap between practice and theory. Smith and Parker (2015) note that the theories are useless if they are not applied in creative nursing practice. Nurses should carefully select a theory for study as it will influence and alter their everyday practice. The purpose of this paper is to describe, analyze, and evaluate transitions theory by Afaf I. Meleis to investigate how it contributes to nursing science.
Theory Description
The description of the selected theory greatly assists in its further analysis and evaluation. It is stated that “it is helpful to read about the theory from primary sources or the most notable scholars and practitioners who have studied the theory” (Smith & Parker, 2014, p. 27). Thus, this phase might be helpful to get a general understanding of the theory, its concepts, and assumptions.
Purpose
The transitional theory is regarded to be one of the main concepts in the nursing phenomenon. It has a descriptive purpose and is developed to understand the nature of the changes and responses to it, support the relevant experience, and sustain health at all the stages of the process of transferring to a different state. Some researchers note that this theory “is arguably the most well developed among the extant literature and has been used to explicate experiences of chemotherapy, menopause, relatives’ experiences of nursing home entry, and recovery from depression” (Ramsay, Huby, Thompson, & Walsh, 2014, p. 607).
Scope
The transition theory has a middle-range scope. It is stated that they are narrower than grand theories (Smith & Parker, 2015). Thus, they offer the linkage of grand theories with explanation and description of specific phenomena related to nursing practice.
Major Concepts and Propositions
The given theory provides a possibility to examine the experience of people who are living with or confronting the event or a situation that requires gaining new skills and behaviors. It is emphasized that in such conditions “self-organization refers to new behaviors or new patterns that emerge from individual agents’ reaction to changes within the complex organization” (Eika, Dale, Espnes, & Hvalvik, 2015, p. 126). The concept of transition is multifaceted and includes various components. The transition experience is characterized by a type of change. The properties of the transition include time span, awareness, process, disconnectedness, and milestones.
Major Assumptions
It is assumed that therapeutic and preventive actions can have an impact on outcomes. The nature of experience determines the outcomes of transition experience. The individuals experience these outcomes and responses to changes now matter of the level of awareness of the situation. Thus, change that takes place during the illness and health events initiate the process of transition. It is stated that the changes in work role or environment can result in the experience of transition (Chargualaf, 2016). For example, bad experience of transitions among nurses is caused by job dissatisfaction, ultimately turnover, and burnout.
Theory Analysis
The analysis of the theory discusses its main terms and definitions. The main term utilized in the scope of the described theory is a transition. Some researchers note that “despite an abundance of studies investigating transitions and numerous recommendations for improving the experience, the process remains challenging and problematic” (Chargualaf, 2016, p. 125). The variables that impact the development of the theory can be changed depending on the age and health condition of individuals involved in the process of transition.
Theoretical and Operation Definitions
The transition can be defined as transferring from one condition, status, or a life phase to another. In the transition case, the environment is defined as social, physical, organizational, and cultural experience, outcomes, and interventions. Some researchers note that experts advocate for including person-environment relations into the aspects that should be taken into consideration during such transition as a developmental one (Joly, 2016).
Linkages
The development of transition theory is closely linked with role theory related to changing the behavior of patients in a new condition and role supplementation related to behavior and goals analyzing by nurses. It is emphasized that “the need to provide psychosocial support throughout the transition to ward-based care has been identified internationally” (Ramsay et al., 2014, p. 606). This theory is also influenced by the lived experience which provides a contrast between the received views and perceived ones.
Logical Organization
The conditions that initiate the transition process are logically related to properties and patterns of response. The properties can be influenced by change triggers. The preventive interventions are utilized depending on the change triggers, while the therapeutic interventions influence the patterns of response. Some researchers argue that concepts of other complex adaptive systems should be integrated to connect the process of transition to a context in which it occurs (Eika et al., 2015).
Summarize the Model/Diagram
It is emphasized that transitions can be situational, developmental, organizational, or related to the state of health. All types of transitions impact an individual. It is stated that emotional component of transition related to health care is underestimated in the scientific literature (Ladores, 2015). Thus, the change event becomes a turning point for a transition state and is a cornerstone of the model of the transition process.
Stated Outcomes or Consequences
The conditions of changes can be global or driven by community norms while the responses follow process and outcome patterns. The interventions to support healthy behavior during the transition consist of providing expertise and resources, modeling the roles, and setting goals. It is noted that possible nursing interventions in the process of transition might include role supplementation, assessment, granting healthy environment, and resource mobilization (Eika et al., 2015).
Theory Evaluation
It is generally recognized that the evaluation of the selected theory usually follows its analysis and study to identify the significance of the theory and its value. Evaluation can be defined as the process determining theory value, significance, and worth (Smith & Parker, 2015). The middle-range theories have certain criteria of evaluation to identify their contribution to nursing knowledge and practice.
Congruency with Nursing Standards and/or Nursing Interventions
Transition theory is applied to research, policy, and evidence-based practice to increase the quality of medical care. The intervention goals for this theory are to develop nursing therapeutics that would facilitate healthy transition process and outcome responses. It is noted that such therapeutics involve nursing standards and strategies, which help nurses to select appropriate interventions according to the health condition of an individual (Eika et al., 2015).
Advanced Practice Nurse
It should be noted that transitions theory is widely utilized in advanced nursing practice as a theoretical base for research to study a wide range of transition experience and develop interventions. For example, advanced nursing practitioners are expected to “learn the fine art of terminating relationships with chronically ill adolescents and their parents, and to play the role of advocates and allies in their transition to AHC” (Ladores, 2015, p. e128). Nursing therapeutics also include identifying readiness for transition and preparation of a patient to a different environment.
Validity, Relevance, and Significance
It is believed that transition theory is significant to understanding the caregiver and patient transitions. It assists in allocating resources and implementing necessary interventions. Some researchers state that “indicator of successful transition is identity reformulation that reflects the changes associated with the transition” (Joly, 2016, p. 1254).
Strengths and Weaknesses
The evaluated theory has multiple strengths in implementation such as the possibility to apply it to nursing education and nursing practice to help communities and families to prepare to transition experience and improve health outcomes. It is noted that “there has been remarkably little critique of Meleis et al.’s (2000) theoretical framework” (Ramsay et al., 2014, p. 607). Still, in future implementation attempts, it is advisable to take into consideration the challenges of contemporary nursing practice related to complexity and acuity of patients and organizational constraints.
Contribution to Science of Nursing
It is a general opinion that transition theory was applied to a number of important scientific studies in the field of nursing. Some researchers emphasize that “nurses are particularly well-positioned to support successful transition to adulthood by virtue of nursing’s ontological underpinnings as a discipline whose mission is to support health, well-being” (Joly, 2016, p. 1251). Thus, this theory is widely used to research the interventions needed both for health care and situational transition of people with chronic conditions and healthy individuals.
Conclusion
The thorough description, analysis, and evaluation of transitions theory by Afaf I. Meleis has helped to investigate its main assumptions and concepts. It is possible to say that this theory serves as a theoretic base for many studies of transitions of people with chronic conditions and adolescents. It is also used to investigate transition cases in the nursing profession.
References
Chargualaf, K. A. (2016). Situational transitions and military nurses: A concept analysis using the evolutionary method. Nursing Forum, 51(2), 125-135.
Eika, M., Dale, B., Espnes, G. A., & Hvalvik, S. (2015). Nursing staff interactions during the older residents’ transition into long-term care facility in a nursing home in rural Norway: An ethnographic study. BMC Health Services Research, 15(1), 125-137.
Joly, E. (2016). Integrating transition theory and bioecological theory: A theoretical perspective for nurses supporting the transition to adulthood for young people with medical complexity. Journal of Advanced Nursing, 72(6), 1251-1262.
Ladores, S. (2015). Concept analysis of health care transition in adolescents with chronic conditions. Journal of Pediatric Nursing: Nursing Care of Children and Families, 30(5), e119-e129.
Ramsay, P., Huby, G., Thompson, A., & Walsh, T. (2014). Intensive care survivors’ experiences of ward‐based care: Meleis’ theory of nursing transitions and role development among critical care outreach services. Journal of Clinical Nursing, 23(5-6), 605-615.
Smith, M. C., & Parker, M. E. (2015). Nursing theories and nursing practice (4th ed.). Philadelphia, PA: F. A. Davis.