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Introduction
Theories are widely used in nursing to guide practice. They not only shape practitioners skills but also their views and beliefs about their clients and work (Barker, 2009). Various theories have been formulated by different scholars in the nursing profession to guide the nursing practice.
One such theory is the Transition Theory propounded by Afaf Ibrahim Meleis. Meleis began developing the Transition Theory in the mid-1960s while doing her Doctor of Philosophy degree (Meleis, 2007). The Transition Theory is fundamentally about the characteristic of transitions and the experience of human beings as they transition from one state of being to another. This theory has proved useful in research studies that examine different forms of transition such as immigration, menopause, family care-giving of critically ill patients, and patients with psychological or mental illnesses, to mention but a few.
This essay will critically examine the Transition Theory of Meleis including the purpose of the theory, theory concepts and sub-concepts, theory concept relationship and assumptions surrounding the theory.
The essay will also assess the applicability of Meleis Transition Theory, its clarity, complexity, generality, strengths and weaknesses of the theory. Specifically, some research studies that have made use of the theory will be critically reviewed. Lastly, the essay will make recommendations on whether any part of the theory should be accepted or rejected for practice as well as whether any changes can be made to the theory to improve on it.
Theory Component Assessment
This section will assess the components of Meleis Transition Theory. Specifically, it will look at the purpose of the theory, the concepts of the theory, concept relationships and assumptions surrounding the theory.
Theory purpose
Meleis main purpose of developing the Transition Theory was to give a clear definition to the transition process and the goal as well as prerequisites of successful transition. She achieved this by developing concepts that are associated with the transitioning process. The theory was also formulated to enable nursing professionals provide effective assistance to individuals who are undergoing a transition phase (Meleis, 2007).
Theory concepts
Meleis Transition Theory is made up of five major concepts. These include: types and patterns of transition, properties of transition experience, transition conditions, patterns of response or process and outcome indicators and nursing therapeutics. Under types of transition, Meleis (2007) gave several sub-concepts which included developmental, health and illness, situational, and organizational (p. 217).
Developmental transition entails how people transition from one phase to another throughout the lifecycle, that is, from birth to death. Health and illness transition entails the process of staying healthy, getting sick and recovering from an illness. Situational and organizational transitions refer to environmental conditions.
Patterns of transition refer to whether an individual is experiencing single or multiple transitions, and if multiple transitions experienced are taking place concurrently or in succession. They also refer to the degree to which multiple transitions are overlapping with each other, as well as the relationship between the events that are causing the transitions.
Regarding the properties of transition experience, there are sub-concepts such as: awareness, which refers to perceiving, knowing and recognizing a transition experience; engagement, which refers to the extent to which an individual is involved in the transition process; changes and identities, which refer to the dynamics of transition; time span, which refers to the duration over which transition takes place; and critical points and events, which refer to incidents that happen in an individuals life and which mark the transition from one phase of life to another (Meleis, 2007b).
The concept of transition conditions refers to the situations that affect the manner in which an individual moves from one phase of life to another, and which can either enhance or hamper a successful transitioning process.
This concept includes other sub-concepts such as: personal conditions, which refer to the personal attributes of an individual such as knowledge, culture, social and economic status, which affect individuals reaction to transition; community conditions such as community resources; and societal conditions such as prejudice towards immigrants. All these conditions affect the way individuals view their transitions as well as whether or not they will transition successfully (Schumacher & Meleis, 1994).
The concept of process indicators and outcome indicators were described as affecting successful transition. Process indicators that help individuals undergoing a transition to move in the right direction were described as facilitating effective transitioning process and vice versa. Process indicators are crucial for nurses for they enable nurses to intervene early so as to help individuals to transition successfully. Examples of process indicators include the necessity of being connected and feeling safety.
Meleis gave an example of immigrants and argued that if the immigrants make new acquaintances and friends in the new country but still maintain contact with their family and friends at their home country, their transition will be successful. On the other hand, outcome indicators are used to gauge whether or not a transition is successful. However, Meleis argued that outcome indicators should not be assessed too early in the transition stage because they may also reflect other incidents taking place concurrently with the transition and which affect the individuals life (Meleis, 2007).
Lastly, the concept of nursing therapeutics was used to describe the role of nursing in the transition process. Meleis argued that nurses need to evaluate individuals undergoing transition for readiness. Nurses also have a role to play in preparing individuals for transition, for instance, through education. Of utmost significance to this concept is the relationship between the nurse and the client. A healthy relationship translates into a successful transitioning process (Meleis, 2007b).
Theory concept relationship
The relationships between different concepts and sub-concepts were explicitly stated by Meleis (2007). The first relationship was that the different types and patterns of transitions developmental, health and illness, and organizational are critical to nursing practice. Second, the different properties of transition awareness, engagement, changes and identities, time span, and critical points and events are correlated and together made up a composite process.
Third, there was a direct relationship between the degree of awareness and the degree of engagement in that the degree of awareness affected the degree of engagement and an individual could not become engaged in a transition if he or she was not aware of it. Fourth, the opinions of and meanings attached by individuals towards health and illness were affected by and in turn significantly affected the conditions of the occurrence of a transition. Fifth, process and outcome indicators were interrelated and together determined the successful (or otherwise) transitioning of individuals. Lastly, nursing therapeutic the relationship between nurses and their patients was a great determinant of successful transitioning. Such a relationship was described as a mutually occurring process that affected both parties involved.
Theory assumptions
Meleis (2007) gave several assumptions surrounding the Transition Theory and which make the theory hold. The first assumption is the complexity and multidimensional nature of transitions. This assumption implied that transition is not an easy process and is influenced by many factors of different nature. The second assumption is that the patterns of transitions are also complex and multiple. Third, transition flow and move over time and hence the time aspect of transitions. This implies that transitions do not just happen at a point in time, but rather they take place over an extended period of time.
Fourth, transitions change the identity, responsibilities, capabilities, relations and behavioral patterns of the affected individuals. Once an individual transitions from one phase/stage of life to another, he or she cannot remain the same; rather, various aspects of his/her life are altered. Fifth, transition is not one and the same thing with change and differences. Similarly, change and differences cannot be interchanged because they are not tantamount. Lastly, transition is both a consequence and a cause of change (Meleis, 2007b).
Theory Applicability
This section will critically review a number of published journal articles that used Meleis Transition Theory. The applicability of the theory to the study, the theorys clarity, complexity, generality, strengths and weaknesses will also be assessed.
Article 1: A situation-specific theory of Korean immigrant womens menopausal transition (Im & Meleis, 1999)
Im and Meleis (1999) made use of Meleis Transition Theory so as to expand on the theory by incorporating the transition experiences of Korean immigrant women with low incomes living in the United States during their menopause period. This study was cross-sectional in nature. The researchers made use of a sample of one hundred and nineteen Korean immigrant women of the first generation who were characterized as low-income earners based on their occupations.
Various types of data analyses were conducted including descriptive, inferential statistics, thematic analysis, and integrative conceptual analysis. The researchers found that menopausal transition among the Korean immigrant women did not receive as much attention from the women as did their immigrant status and occupation. Second, the Korean immigrant women were not open about their menopausal experience due to cultural factors. Third, the symptoms of menopause were either normalized or endured by the women.
Meleis Transition Theory is applicable in this study to a great extent. To begin with, Im and Meleis (1999) identified several concepts inherent in the Transition Theory. These concepts include: type of transition and transition conditions. The type of transition identified in the study is multiple transitions because the Korean immigrant women were undergoing transitions in occupation, settling in the United States, and menopause.
Because of these multiple transitions, the participants did not place much importance on menopausal transition, arguing that other transitions were more serious to them. Various transition conditions were also identified and include: socio-economic status, gender, context and attitude towards health and illness. All these affected the menopausal transition process of the participants. Other concepts properties of transition experience, process indicators and outcome indicators, and nursing therapeutics were not included in the study.
The relationship between the concepts was also not included, saving for the relationship between the sub-sections of the transition conditions. The clarity of the theory was sufficient. Although few concepts were used, Im and Meleis (1999) explained the theory and its application clearly. The generality of the theory in this study was limited. This is because the researchers were mainly interested in examining the menopausal transition process of Korean immigrant women. Therefore, the results would differ if a sample of different age group or a different ethnic group and social status was used instead.
Article 2: Meleis theory of nursing transitions and relatives experiences of nursing home entry (Davies, 2005)
Davies conducted this study to assess the degree to which Meleis Transition Theory is supported by the experiences of relatives when their loved one is taken to a nursing home. The study was carried out based on a previous study that had been done on relatives experiences of entry into a nursing home. Davies (2005) re-analyzed the data of the previous study with a main objective of finding out the extent to which such experiences replicated the theoretical underpinnings of the Transition Theory. Davies (2005) collected data using 37 qualitative interviews of 48 family members of older persons who had recently been taken to a nursing home, (p. 665). The study supported all the concepts of Meleis Transition Theory.
The main concepts and sub-concepts that were found to support Meleis Transition Theory include transition type, in which all types of transition were seen to affect the experiences of relatives of older persons admitted to a nursing home. The pattern of transition was found to be multiple because majority of the relatives were dealing with more transitions than entry of their loved one into a nursing home.
Other concepts were awareness and engagement whose degree differed from relatives to relatives, thereby having different effects on the transition process. Change and difference, time span, transition conditions, and process and outcome indicators were also found to be consistent with Meleis Transition Theory. In short, the study fully supported Meleis Transition Theory.
The clarity of the theory in Davies (2005) study was excellent. Davies explained in detail all the domains of Meleis Transition Theory alongside with an explanation of how each domain was support by his study. The clarity of the theory was further enhanced by the use of all concepts in Meleis Transition Theory for the study.
However, the relationship between the concepts and sub-concepts was not highlighted. The studys generality is also limited to relatives of older persons admitted in nursing homes. This is because the experiences of relatives admitting their older family members differ from the experiences of relatives of other types of patients such as critically ill patients and the like.
Conclusion
Recommendation for theory application
Todays world is characterized by numerous transitions from one situation to another. Rapid globalization, industrial competition, outbreak of new illnesses and a long life span imply that all individuals have to experience a transition from one phase of life to another. Meleis Transition Theory is about making successful transitions in life. It is about the factors that cause and influence transition. Meleis Transition Theory should be accepted for application in the nursing profession.
This is because the theory provides valuable information which can help nurses and other healthcare practitioners to develop intervention programs for individuals undergoing different types of transition so as to reduce the stress associated with transition, thereby making transition a positive and effective experience.
Recommendation for theory change
Meleis Transition Theory is comprehensive enough hence there is no need for any changes to be made to it.
Reference List
Barker, A. M. (2009). Advanced practice nursing: essential knowledge for the profession. Sudbury, MA: Jones and Bartlett Publishers.
Davies, S. (2005). Meleiss theory of nursing transitions and relatives experiences of nursing home entry. Journal of Advanced Nursing, 52(6), 658-671.
Im, E., & Meleis, A. I. (1999). A situation-specific theory of Korean immigrant womens menopausal transition. The Journal of Nursing Scholarship, 31(4), 333-338.
Meleis, A. I. (2007). Theoretical nursing: development and progress (4th ed.). Philadelphia, PA: Lippincott Williams & Wilkins.
Meleis, A. I. (2007b). Transitions theory: middle-range and situation-specific theories in nursing, research and practice. New York, NY: Springer Publishing Company.
Schumacher, K. L., & Meleis, A. I. (1994). Transitions: A central concept in nursing. Journal of Nursing Scholarship, 26, 119-127.
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