AFAF IBRAHIM MELEIS: Transitions theory
Credentials and Background
• Born in Alexandria, Egypt
• Completed her Nursing degree at the University of Alexandria, Egypt
• Pursued her graduate education as a Rockefeller Fellow to become an academic nurse.
• MS in nursing in 1964 from University of California, Los Angeles
• PhD in medical and social psychology in 1968.
• Worked as administrator and acting instructor at the University of California, Los
Angeles from 1966 to 1968 and as assistant professor from 1968 to 1971.
• In 1971, moved to University of California, San Francisco where she spent the nest 34
years and where Transition Theory was developed.
Major Concepts
• Types and Patterns of Transitions:
• Types
• Developmental – birth, adolescence, menopause, aging, and death
• Health and illness – recovery process, hospital discharge, and diagnosis of
chronic illness
• Situational
• Organizational – changing environmental conditions that affects the lives
of clients, as well as workers within them.
• Patterns
• Multiplicity
• Single
• Multiple
• Complexity
• Sequential
• Simultaneous
• Related
• Unrelated
Major Concepts: Properties of transition experiences
• Properties of Transition Experiences
• Awareness – “perception, knowledge, and recognition of a transition
experience”
• Engagement – “the degree to which a person demonstrates involvement in the
process inherent in the transition”
• Change and difference –
• changes that a person experiences in her or his identities, roles,
relationships, abilities, and behaviour are supposed to bring a sense of
movement or direction to internal as well as external processes.
• Challenging differences could be demonstrated by unsatisfied or atypical
expectations, feeling dissimilar, being realized as dissimilar, or viewing
the world and others in dissimilar ways
• Time span – all transitions may be characterized as flowing and moving over time
• “a span of time with an identifiable starting point, extending from the
first signs of anticipation, perception, or demonstration of change;
moving through a period of instability, confusion and distress; to an
eventual ‘ending’ with new beginning or period of stability.
• Critical points and events
• “markers such as birth, death, cessation of menstruation, or the diagnosis
of an illness”
Transition conditions
• “those circumstances that influence the way a person moves through a transition, and
that facilitate or hinder progress toward achieving a healthy transition.
• Includes:
• PERSONAL CONDITIONS –meanings, cultural beliefs and attitudes, socioeconomic
status, preparation and knowledge.
• COMMUNITY CONDITIONS could be facilitators or inhibitors for transitions
• SOCIETAL CONDITIONS
Patterns of Response or Process and Outcome indicators
• Process indicators that directs clients into health or toward vulnerability and risk make
nurses conduct early assessment and intervention to expedite healthy outcomes.
• Feeling connected
• Interactions
• Locating and being situated
• Developing confidence and coping
• Outcome indicators may be used to check whether a transition is a healthy one.
• Mastery
• Fluid integrative identities
Nursing therapeutics
• “three measures that are widely applicable to therapeutic intervention during
transitions.
• Assessment of readiness
• Preparation for transition
• Role supplementation
Metaparadigm
• 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.
• 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 behaviour.
• The daily lives of clients, environments, and interactions are shaped by the
nature, conditions, meanings, and processes of their transition.
• 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 interchangeable, nor are they synonymous with
transition.
• Environment
• Vulnerability is related to transition experience, interactions, and environmental
conditions that expose individuals to potential damage, problematic or extended
recovery, or delayed or unhealthy coping.
