TRANSITIONS

THEORY

Afaf Ibrahim Meleis FIRST UP

CONSULTANTS
 SHORT HISTORY Afaf Ibrahim

OF THE THEORIST Meleis

SHORT HISTORY OF THE THEORIST
Afaf Ibrahim Meleis
• Daughter of a nurse whom is considered the Florence
Nightingale of the Middle East
• Graduated magna cum laude from the University of Alexandria
in 1961
• She earned an MS in nursing (1964), an MA in sociology (1966)
and a PhD in medical and social psychology (1968) from the
University of California, Los Angeles.
• Dean at the University of Pennsylvania School of Nursing
• Professor of Nursing and Sociology
• Director of the School's WHO Collaborating Center for Nursing
and Midwifery Leadership
• Currently serving as Council General of the International
Council on Women's Health Issues (ICOWHI)
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SHORT HISTORY OF THE THEORIST
Afaf Ibrahim Meleis
• The development of Transition theory began in the mid-1960s,
when Meleis was working on her PhD, and it was traced
through years of research with students and colleagues.
• In Theoretical Nursing: Development and Progress, she
describes her theoretical journey from her practice and
research interests
• Her research focused on people who do not make healthy
transitions and discovery of interventions to facilitate healthy
transitions.
• Her earliest work with transitions defined unhealthy
transitions or ineffective transitions in relation to role
insufficiency.

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BACKGROUND OF Afaf Ibrahim

THE THEORY Meleis

THE DEVELOPMENT OF
TRANSITION THEORY
• Began in the mid-1960s, when Meleis working in her PhD
• Her master’s and doctoral research investigated phenomena of
planning pregnancies and mastering parenting roles.
• She focused on spousal communication and interaction in effective or
ineffective planning of the number of children in families (Meleis,
1975)
• Subsequently, her research focused on people who do not make
healthy transitions and the discovery of interventions to facilitate
healthy transitions.
• This shift in her theoretical thinking led her to role theories, as noted
in her publications in the 1970’s and 1980’s.
• She initiated the development of role supplementation as a nursing FIRST UP
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THE DEVELOPMENT OF
TRANSITION THEORY

• Meleis’ Theory of role supplementation was used in her

studies on:
1. The new role of parenting (Meleis & Swendsen,
1978).
2. Post-myocardial infarction patients (Dracup, Meleis,
Baker, & Edlefsen, 1985)
3. Older Adults (Kaas & Rousseau, 1983)
• These studies using role supplementation theory led Meleis
to question the nature of transitions and the human
experience of transitions.
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TO FURTHER DEVELOPMENT
THE TRANSITION THEORY

• Meleis initiated extensive literature searches with

Karen Schumacher, a doctoral student at the
University of California, San Francisco, to discover
how extensively transition was used as a concept or
framework in nursing literature.
• They reviewed 310 articles on transitions and
developed the transition framework (Schumacher &
Meleis, 1994).

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TO FURTHER DEVELOPMENT
THE TRANSITION THEORY
Publication of transition framework was well received and tested by
scholars and researches who began using it as a conceptual framework
in these studies:
Description of the immigrant transitions (Meleis, Lipson, &
Dallafar, 1998)
Women’s experience of rheumatoid arthritis (Shaul, 1997)
Recovery from cardiac surgery (Shih, Meleis, Yu, et al., 1998)
Family caregiving role for patients in chemotherapy
(Schumacher, 1995)
Early memory loss for patients in Sweden (Robinson, Ekman,
Meleis, et al., 1997)
Aging transitions (Schumacher, Jones, & Meleis, 1998)
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African-American women’s transition to motherhood (Sawyer, CONSULTANTS
TO FURTHER DEVELOPMENT
THE TRANSITION THEORY

• By using the transition framework, a middle-range

theory for transition was developed by the
researchers who had used transition as a conceptual
framework. The collective work as published in
2000 (Meleis et al., 2000)
• In 2010, Meleis collected all the theoretical works
in the literature related to Transitions Theory and
published them in a book entitled:
Transitions Theory: Middle-Range and Situation-
Specific Theories in Nursing Research and Practice FIRST UP
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THEORETICAL SOURCES:
• Meleis’ background in nursing, sociology,
role theory and her educational background.
• A systematic, extensive literature review
suggested by Walker and Avant (1995,2005)
• During Meleis’ mentoring process
• Mentoring of Schumacher
• Collaborative efforts among researchers
used the transition theoretical framework
and middle-range Transitions Theory in their
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CONSULTANTS
 MAJOR
CONCEPTS
OF THE
MIDDLE- • Types and patterns of
transitions

RANGE • Properties of transition

experiences

THEORY OF • Transition conditions

(facilitators and inhibitors)

TRANSITION
• Patterns of response (process
indicators and outcome
indicators)

INCLUDE: • Nursing therapeutic

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TYPES OF TRANSITIONS:

1. Developmental transition – includes birth, adolescene,

menopause, aging, ane death
2. Health and illness transitions – include recovery
process, hospital discharge, and diagnosis of chronic
illness
3. Situational transitions – involve the addition of
subtractions of persons in a pre-existing constellations of
role and complements
4. Organizational transitions – to changing environmental
conditions that affect the lives of clients, as well as
workers within them FIRST UP
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PROPERTIES OF TRANSITION
EXPERIENCES
:
1. Awareness - defined as “perception, knowledge, and recognition of a transition
experience”.
2. Engagement - “the degree to which a person demonstrates involvement in the
process inherent in the transition.”
3. Changes and Differences:
• Changes – it is the person’s sense of movement or direction to internal as well as
external processes due to experiences in her or his identities, roles, relationships,
abilities, and behaviors. (Schumacher & Meleis, 1994), Transitions are both the
result of change and result in change (Meleis et al., 2000).
• Differences - challenging differences could be demonstrated by unsatisfied or
atypical expectations, feeling different or seeing the world and others in different
ways.
4. Time span - all transitions may be characterized as flowing and moving over time
5. Critical points and events - “markers intensifying awareness of changes or FIRST UP
dissimilarities; such as birth, death, the cessation of menstruation, or the diagnosis CONSULTANTS
TRANSITION CONDITIONS :

1. Personal Conditions – include meanings, cultural beliefs and

attitudes, socioeconomic status, preparation, and knowledge.
2. Community Conditions – (e.g., community resources) or
social conditions (e.g., marginalization of immigrants in the host
country).

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PATTERNS OF RESPONSE:

1. Process indicators– they direct clients into health or toward

vulnerability and risk, make nurses conduct early assessment and
intervention to expedite healthy outcomes. They include “feeling
connected, interacting, being situated, and developing confidence
and coping.”
“The need to feel and stay connected” is a process indicator of a
healthy transition.
2. Outcome indicators – may be used to check if a transition is a
healthy one or not. “A healthy completion of a transition” can be
decided by the extent of mastery of the skills and behaviors that
people in transition show to manage their new situations or
environments”. Outcome indicators could be associated with
irrelevant events in people’s lives if they are appraised early in a FIRST UP
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 NURSING THERAPEUTIC:

1. Assessment of readiness– needs to be interdisciplinary efforts and

based on a full understanding of the client; it requires assessment of
each of the transition conditions in order to generate a personal
sketch of client readiness, and to allow clinicians and researchers to
determine diverse patterns of the transition experience.
2. The preparation for transition – includes education as the main
modality for generating the best condition to be ready for a
transition.
3. Role supplementation - conveying of information or experience
and providing the support needed necessary to bring the role
incumbent and significant others to full awareness of the
anticipated behavior patterns, units, sentiments, sensations, and
goals involved in each role and its complement. FIRST UP
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HOW THE THEORY
Afaf Ibrahim Meleis

IS APPLIED
 MAJOR
Afaf Ibrahim Meleis

ASSUMPTIONS
NURSING

• Nurses are the primary

caregivers of clients and their
families who are undergoing
transitions

• Transitions both result in

change and are the result of
change
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PERSON
• Transitions involve a process
of movement and changes in
fundamental life patterns,
which are manifested in all
individuals
• Transitions cause changes in
identities, roles,
relationships, abilities, and
patterns of behavior
• The daily lives of clients,
environments, and
interactions are shaped by
the nature, conditions,
meanings, and processes of
their transtiotion experiences
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CONSULTANTS
HEALTH
• Transitions are complex and
multidimensional. Transitions
have patterns of multiplicity
and complexity.

• All transitions are

characterized by flow and
movement over time

• Change and difference are not

imterchangeable, nor are they
synonymous with transition
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ENVIRONMENT

• Vulnerability is related to
transition experiences,
interactions, and
environmental conditions that
expose individuals to potential
damage, problematic or
extended recovery, or
delayed or unhealthy coping
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SUMMARY OF THE
Afaf Ibrahim Meleis

THEORY
Current Health care systems are
characterized by changes, diversities and
complexities. The Transitions Theory, can
adequately direct nursing practice and
education in the current health care
system.

As Meleis began her theoretical journey in

the 1960’s her journey continues as the
Transition theory continues to be further
developed.

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SUMMARY OF THE THEORY
• Developmental, health and illness and organizational, transitions and central to
nursing practice.
• Patterns of Transition include;
• 1. Whether the clients is experiencing a single transition or multiple transitions;
• 2.Whether single transitions or multiple transitions are sequential or simultaneous
• 3. the extent of overlap among transitions
• 4. nature of the relationship between the different events that are triggering transitions for a
client

• The level of aware ness influences the level of engagement, in which engagement
may or may not happen.
• Humans’ perception of meanings attached to health and illness situations are
influenced by and in turn influence the conditions under which a transition
occurs
• Healthy transition is characterized by both process and outcome indicators
• Negotiating successful transitions depend on the development of an effective
relationship between the nurse and client (nursing therapeutic). This relationship
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is a highly reciprocal process that affects both client and nurse CONSULTANTS
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CONSULTANTS
THANK YOU
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PREPARED BY GROUP 4
(BSN - 1D)
PARILLA, Jacques REOLA, Alliah
PEÑAFLOR, Maureen QUINTO, Euva Shaira
PEREZ, Sarah Niña RAMON, Jonathan
PIGAR , Jo Marchianne ROBREDILLO, Joshua
PRESNILLA, Patricia SABEJON, JOHNRICK
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QUINA, Marie SARSOZA, Angelika