See discussions, stats, and author profiles for this publication at: https://www.researchgate.

net/publication/333489132

Transition Theory Applications --"Wishes"

Article · May 2019

DOI: 10.11648/j.ajeit.20190301.13

CITATIONS READS

0 1,218

2 authors, including:

Angela Halpin
University of California, Irvine
11 PUBLICATIONS   3 CITATIONS   

SEE PROFILE

Some of the authors of this publication are also working on these related projects:

Respiratory medications - nurses need to know View project

All content following this page was uploaded by Angela Halpin on 30 May 2019.

The user has requested enhancement of the downloaded file.

American Journal of Education and Information Technology
2019; 3(1): 12-16
http://www.sciencepublishinggroup.com/j/ajeit
doi: 10.11648/j.ajeit.20190301.13

Transition Theory Applications -- “Wishes”

Angela Pauline Halpin1, Felicia Schanche Hodge2
1
Department of Case Management, University of California, Irvine Medical Center, Orange, United States
2
Department of School of Nursing and Fielding School of Public Health Faculty, University of California, Los Angeles, United States

Email address:

To cite this article:

Angela Pauline Halpin, Felicia Schanche Hodge. Transition Theory Applications -- “Wishes”. American Journal of Education and
Information Technology. Vol. 3, No. 1, 2019, pp. 12-16. doi: 10.11648/j.ajeit.20190301.13

Received: March 6, 2019; Accepted: April 25, 2019; Published: May 20, 2019

Abstract: The aim of exploring transition theory is outlined in its concepts and application uses in nursing practice.
Literature review methods applied precepts to demonstrate the theory’s usefulness in care management. Results validate
transition knowledge identifies wishes of patients and families as a method of joint communicating and decisions on choices
for healthcare. The process of making decisions for transition post discharge requires knowledge of the theory. In conclusion,
identifying patient/family needs and clarifying what is required to resume self-care after treatments incorporates either
immediate or long-term identified needs. Nursing and medical scholars have added transitions to processes within acute care
hospitals to address the needs of patients and families.
Keywords: Transition Theory, Concepts, Nursing, Client/Patient

congruence for nurses as a way to conceptualize the term

1. Introduction “transition” into practice. [1, 2] Depending on the transition
Transition is defined as: “As a passage or movement from event, a response is based on the dimension of health-illness
one state, condition or place to another and has universal within the patient’s life. [1, 2, 3]
properties and conditions which help to explain person- The theory of transition is central to the study of effects of
environment, in terms of developmental, situation, health communication on the perceptions of patients’ experiences on
illness, organizational processes, and outcomes. [1, 2] Social the continuum of health events. Recently, noted to be
science opens the plethora of information on this topic, with measured by readmission rates, as well as, patients
Meleis over the past decade our expert. [3] When someone is reflections on meaning of the hospital stay, and choices for
sick, experience a mishap, or accident, the immediate post-hospital care. Furthering knowledge on transition begins
oversight to wellness requires help by experts, family, and with an analysis of transition theory. Therefore this paper
friends. Nurses are on the first line in the care and planning. provides information on transition theory, applications, and
Identifying desires for care and clarifying what is required to the contribution of transition theories in the larger realm of
resume self and incorporate either immediate or long-term nursing theory, concluding how it has now become its own
needs or care. Nursing and medical scholars have added practice within acute care hospital in health care departments
transitions to processes within acute care hospitals to address such as case management nursing (CMN).
the needs of patients and families. Models vary as, research
on transitions have occurred over the past four decades. 2. Methods
Beginning in 1980’s with research in obstetrics, transitions
have advanced multiple practice roles, in hospitals, managed Review of the literature evaluates the theory’s
care, insurance entities, and outpatient case management. [4] characteristics and the phenomenon of transitions, defined as
The theorist Meleis, systematically created a tapestry for categories to frame the transition in terms of time span,
illustrating the meaning of transitions within the human process, and perceptions. [1] The foundation is outlined with
experience by illustrating using timing, scope, or duration of characteristics such as “perceptions, events, patterns of
the experiences. [1, 2, 5] The model extrapolates much from response, and dimensions of transitions,” each of which was
other nursing theorists’ concepts while establishing grouped with subsets to establish context. [1] The theory
 American Journal of Education and Information Technology 2019; 3(1): 12-16 13

became a way to profile a patient’s ability to move through environment and cultural aspects and therefore is part of the
the human experiences that arise during the transition event. nursing domain. Additionally, it draws from combinations of
[3, 5] The model’s characteristics become descriptors to sociology models as well as multidiscipline and systems
assist patients’ and nurses’ understandings of the extent of a models. [3, 5] To remedy the questions on transition
transition. Nursing and medical scholars have added a evaluation, researchers began by examining healthy
communication strategy known as message framing to the transitions. [3]
transition phenomena, and this framing can be a significant
factor in determining the outcomes of care. [6, 7, 8, 9] 2.2. Concepts
Inadequate or poor management of the transition from First, the phenomenon of transitions was evaluated and
hospital to home results in a greater incidence of inclusive of characteristics identified in concepts. [1] The
readmissions to the hospital and increased hospital costs. [6, ensued concepts were defined by grouping them in
10, 11] Other adverse effects for hospitals include loss of categories, to frame the model and thus define and test the
government funds, and most important of all, the cost to the model. The model outlines perceptions, events, patterns of
health of the patient and subsequent impact on family, response, dimensions of transitions each of which were
friends, and other caregivers. [12] Politicians and policy categories with subsets to establish context. [1] Through this
makers understand the critical role transition from hospital to method nurses could profile clients, which is an ability to
home exerts upon patients and significant others, and demand apply the transition to human situations. Further these
that readmissions be avoided. [13, 14] groupings and their characteristics become descriptors to
Those who oppose transitional care models (TCM) and assist clients and nurses understanding of the depth of a
construct of the theory reinforce hospital to home as costly transition. Meleis and colleagues systematically creates a
utilization of resources argues that TCMs, as they currently tangible fabric for illustrating the meaning of transitions
exist, do not significantly reduce readmission rates. [15, 16, within the human experience by its timing, scope or duration
17] The Health Research and Educational Trust (HRET) of the experience. [1, 3] Depending on the event, a response
suggests that multiple strategies noted as “foundational is based on the dimension of health-illness within one’s life.
actions” in hospital interventions can prevent readmission. The initial model extrapolates much from other nursing
One such strategy is supporting mutual decisions. [18] theorist establishing congruence for nurses, to conceptualize
Mutual decision-making between patients/families and the term “transition” into practice. Three main concepts are
primary providers includes establishing communication with framed within the model and include “transitions, transitions
“patients, families, primary providers” and “interdisciplinary conditions, and indicators (outcomes)” [3, 5]
teams” [18] Recently, researcher explored use of templates to The main concept of the transition theory is the process or
promote smooth transitions from skilled nursing facilities phases, such as sequences over a time span. [1, 3, 5] One
(SNF) to home, the tools used electronic medical records example of the concept of ‘health’ is in context of maternal-
(EMR) assist in transition planning. [19] The innovations child episodes. Childbirth was one of the early dimensions
considered personal needs to further the theory applications evaluated, because it allows for the theory explanations of
with positive findings. perceptions, anticipatory, expected durations as some aspects
2.1. Analysis within the framework of dimensions. The concept described
is related to health. A birth often is viewed as a healthy event
In review of the literature, analysis demonstrated the and pleasant; that is if the baby is healthy and the mother
transition theory has evolved and matured over the past four does not have problems. However, the nurse’s knowledge of
decades. Nursing pathfinders, including Norma Chick, the concept prepares him/her to manage or assist a client
Dorothy Brooten, Alfa Meleis, Dorothy Schumacher, and through the event whatever the presentation or outcome. And
others laid its foundations in the 1980’s. [3, 5] Each pursued thus discuss nursing therapeutics and the nursing clients.
effort to explain transitions in health care by observations in Nursing therapeutics was an initial interest of nursing
practice, asking questions and developing concepts while researchers [1, 3, 5] Understanding how a nurse evaluates the
practicing nursing. Meleis took the theory to its full fruition clients meaning of the event. This part of the nursing process
by explaining and publishing the theory in its entirety. [5] offers a frame for a nurse’s insights and ability to interact
Paradigmatic origins consider the thinking and rationale for effectively with the client. The theorist addressed the
establishing transitions theory and its importance to nursing movement toward the outcomes such as maintenance, or
practice. [3, 5] From the nursing perspective, transitions are health promotion. Timing is an element that later is a concept
an aspect of nursing care from a premise that clients require that can be tested in practice. For example, if the pregnancy
assistance through the health or illness experiences. This results in a healthy birth the nurse provides education to
movement across and through changes is the essence of support wellness. Health promotion is key in nursing process
nurses using their expert knowledge in human science to and a characteristic of the therapeutic exchange between the
benefit the client/patient experience. The paradigm of nurses and client; described in the model as a nursing
transitions is built on several aspects of humans/clients’ therapeutic. Today, CMN assist nurses in the transition of
reactions to their own scenario within health and illness. It moms and babies to promote health and community wellness.
considers the physiological, psychological, socio- Nursing Clients as concepts is central to the domain of
14 Angela Pauline Halpin and Felicia Schanche Hodge: Transition Theory Applications -- “Wishes”

nursing. [1, 3, 5] Defined by Meleis, a client is “patient and a unique to each client because the client attaches an assigned
consumer of care;” and the ‘who’ that has needs and interacts meaning that is individualized for their situation. A result can
with the environment to adapt, but due to illness is at risk and be relief, distress, or be neutral response by the client. The
vulnerable and may be at risk for disequilibrium. [3, 5] The intricacies of the responses may reflect a conglomeration of
nurse evaluates the human experience and meaning of the many theories within nursing as most theories attribute
transition event. The freedom of client to perceive their illness with the patterns of responses. [3]
unique situation is essential in the nursing process. For When expressed during the nursing evaluation the nurse
example: the case manager nurse (CMN) can facilitate the can assess the client’s responses the meaning, expectations or
client’s expression of the event in terms of their perceptions, level of knowledge in relation to the event and the
meaning, expectation or knowledge. environment in which nurses carry out their practice. Each
Each of these characteristics enhances the encounter concept within transition theory: have unique contributions to
between the case manager nurse and client; and is aimed for the structure of the transition theory; however each must be
the case manager nurses to therapeutically support the client considered in totality with each other. Theorist expects
from a starting point of the event. This is where the client’s further study of the concepts in application of transitions
pivotal point begins, and it is followed by the CMN who can events. [2, 3, 5]
measure indicators/ outcomes based on interventions and the
client’s mastery. However, through clients subjective views 4. Discussion
multidisciplinary teams and nurses may themselves react
with their own biases on the situation experienced by the The structure and function of the transition theory is sound
patient a type of stereotype or transference. Nurses, as do if used more in the terms than in its purity. Each hospital
case managers, require intrinsic self-directed insight to transition event result requires an understanding and
remain within the context of the client’s perceptions and integration of the case managers, nurse, and multidisciplinary
meaning of events rather than their own. Upholding CMN’s teams-based assessments. Many researchers have morphed
role is to facilitate the client’s movement based patients’ own the transition model while focusing on specific pieces of the
interpretation to guide the transitions without the bias of the transition. The time of the transition and type has been easier
nurse. This is important insight that translates the value of to break into pieces and study. Yet its conditions, such as
center care on the client for their well-being during the planning and response to experiences remain steadfast
transition. The adjustment is in allowing new knowledge to elements within application. The transition theory identifies
contribute to nursing because each event identifies variations its use both as a measurable independent and with dependent
in client responses. variables. [9, 10] In the initial studies on the transition theory
the independent variable mentioned is the health-illness
3. Results condition and transitions is the dependent variable. [1]
Encouraged as a design it is a model that provides structure
Transition concepts are broad yet narrow in scope by the for furthering multidisciplinary case management and
subsets/characteristics that personalize the Meleis model nursing study to ensure knowledge advancement.
framework which diagrams the event and factors influence
on the client’s response within the situations. [3, 5] In early 4.1. Scope and Parsimony
rendition of the theory’s development of dimensions were Transition scope is broad and able to be applied to life
used as structures. Ranking degrees of the transitions into span events within clients’ experiences. Its sensitivity to the
phases experienced by the clients and in sequences. [1, 3, 5] environment relationship enhances its usability. Ones’ health
Such as durations, the length of the transition, and/or the and illness most always occurs with the universal properties
degree of the transition have an effect on the magnitude of in play. The changes in a client’s role or abilities secondary to
client life situations. It becomes a personal, clearly the event of a transition make the theory comprehensive
understood method to measure types and degrees as clients application in various nursing practice environments.
adjust to the transition within a health illness experience. Nursing care is inclusive of all aspects of health or illness,
When faced with the news of an illness a client that is includes participation of nurse in industries, psychology,
informed can process information and respond based on the health policy, sociological aspects of care and more. [3, 5]
dimension for example if it is a temporary or permanent Clarity and Consistency
condition, a pleasant or unpleasant experience. [3, 5] This middle range nursing transition theory provides a
The theory has a high utility in nursing and as it framework for nursing process as part of its structure.
contributes to the core interest of nursing, and hospital case Research studies in nursing require a theoretical foundation
managers which is care of the client. It was developed to and the transition theory offers a clear streamlined model. Its
accentuate nursing process, therapeutics, and to facilitate the types of transitions (developmental, situational, health-
client’s movement in a transition. [5] Meaning is a illness, and organizational) area a (developmental,
characteristic within transitional conditions, the result of situational, health-illness, and organizational) signal to apply
clients’ interpretation and response to an event. [3, 5] The it to a client’s situation. The universal properties that includes
consequences of one’s response to the transition event are process, direction and the transition conditions (meaning,
 American Journal of Education and Information Technology 2019; 3(1): 12-16 15

expectations, level of knowledge and its indictors permit the theory because it can be applied in practice. Yet it still has
transcending. This permits the model’s application to various broad concepts and offers an opportunity for further research
transition types within the continuum of health-illness. It can in its scope in various client situations in health – illness
then be uses in various nursing specialties. Meleis provides experiences. Testing has occurred of various concepts and it is
an example of a situation specific study that choses transition a phenomenon well thought of due to its level of applicability
theory in situation-specific research related to menopausal to reality in a life span.
transition. [3, 5] Any transition, as when moving from one home to another
Simplicity and Complexity by choice is unsettling. The transition theory offers guidepost
Transitions as a concept are simple to understand as for understanding the phenomenon and offers structures for
everyone goes thorough challenges or situations in our lives. adaption in multi-discipline practices. An example, are case
Some are expected while others are new and unexpected. Its managers and nurses, whom implement nursing process
complexity is in relationship to the nursing therapeutics which is essential to the facilitation and management for
application to the environment with the client health-illness those individuals/patient/families who have transition
movement. The complexity is the many responses that may experiences in many settings, such as hospital or skilled
occur within the scope of the event, the loss of support or nursing center. The nurse’s consciousness of the Meleis
treading on unfamiliar grounds. Losses ensue and the transition model may find it useful in best practice
experience can be froth with time and duration dimensions. applications and client outcomes in multiple settings. Patient
In early rendition of the theory development of dimensions engagement continues to be relative to outcomes. [3, 5, 21]
were used as structures. Ranking is degrees of the transitions From the perspective of nursing, and case management it is
into phases experienced by the clients and in sequences. [1, necessary to validate all variables of transition, with its many
3, 5] Such as durations, the length of the transition, and/or the characteristics. The interactions of the patient vary in unique
degree of the transition on the magnitude of client life transitions and predictions are not always visible. Success of
situation. It becomes a personal, clearly understood method the theory is in testing and studying its utility in practice to
to measure types and degrees as clients adjust to the develop new knowledge about transition events in clients.
transition within a health illness experience. When faced with Finally, transition theory is of interest to organizations,
the news of an illness a client that is informed can process because admissions to a hospital require interdisciplinary
information and respond based on the dimension for example communication to affect the patient’s responses to their care
if it is a temporary or permanent condition, a pleasant or management. The conditions in the theory’s model,
unpleasant experience. [3, 5] demonstrates the importance of what illness directly means to
Tautology/Teleology, Logical Coherent the patients’ perceptions of the illnesses impact on their
The transition theory is logical, and as a tautology is true wellbeing and life. Thus, relating to their response to the
in every possible interpretation. A formula is set in the illness. Together with the health care team, nurses and case
framework by key types of conditions. Proposition and the managers, the transition theory is an important theory in
concept of transitions to extract further meaning are suitable practice. Transition plans can affect client and change
in nursing studies. [3, 5] behaviors or health seeking that reduces patients’ possibility
of readmission and aims to improve health behaviors. Finally,
4.2. Application understanding the elements of transition theory assist in
Evidence of current situated-specific studies has confirmed applying therapeutic interventions, and prevent risk while
transitions coherency as a theory is applicable to practice. promoting wellness.
The ‘business of nursing’ is caring for clients during various
types of transitions, demonstrating the strength and teleology
of transition theory and its contributions to training nurses. References
[3, 4, 5] Transitions are passages in health as in the [1] Chick, N. & Meleis, A. I. (1986). Transitions: A Nursing
challenges of illness. Concern. In P. L. Chinn, Nursing Research Methodology:
Issues and Implementation (pp. 237-255). Maryland: Aspen
Publishers Dictionary.com, LLC. (2012, March 13). Retrieved
5. Conclusion from http://dictionary.reference.com/
Without proper transitions clients are subjected to an [2] Meleis, A. I., & Trangenstein, P. A. (1994). Facilitating
inability to adjust to the health illness experience. Nurses, case transitions: Redefinition of the nursing mission. Nursing
manager nurses (CMNs), and other designated industry agents Outlook, 42(6), 255-259.
participate in the transitions of clients daily. [3, 5, 20] It is [3] Meleis, A. I. (2012). Theoretical Nursing Development and
essential that all providers determining with patients/families’ Progress. (5th ed.). Philadelphia, PA: Wolters Kluwer,
transition goals use a comprehensive review of the physical, Lippincott Williams & Wilkins. Meleis, A. I.
social, and psychological aspects must consider the unique
[4] Brooten, D., Brown, L. P., Munro, B. H., York, R., Cohen, S.
concerns while reaching consensus on goals. An embedded M., Roncoli, M., Hollingsworth, A., (1988). Early discharge
process is needed from all vantage points to be effective in and specialist transitional care. Image: Journal of Nursing
assisting in the transition. Transition theory is a middle range Scholarship, 20(2), 64-68.
16 Angela Pauline Halpin and Felicia Schanche Hodge: Transition Theory Applications -- “Wishes”

[5] Meleis, A. I. (2010). Transitions Theory Middle Range and [13] Joynt, E. K, Orav, E. J., & Jha, A. K. (2011). Thirty-day
Situation Specific Theories in Nursing Research and Practice. readmission rates for Medicare Beneficiaries by Race and Site
New York, NY: Springer Publishing. of Care. Journal of American Medical Association JAMA,
305, 675-681.
[6] Goldberg, L. R., Koontz, J. S., Rogers, N., & Brickett, J.
(2012). Considering accreditation in gerontology: The [14] Braes, T., Moons, P., Lipkens, P., Sterckx, W., Sabbe, M.,
importance of interprofessional collaborative competencies to Flaming, J.... Milisen, K. (2009) Screening for risk of
ensure quality health care for older adults. Gerontology & unplanned readmission in older patients admitted to hospital:
Geriatrics Education, 33(1), 95-110. doi: predictive accuracy of three instruments. Aging Clinical and
10.1080/02701960.2012.639101. Experimental Research, 22(4), 345-351.

[7] Kahneman, K. (2011). Thinking, Fast and Slow. Chapters 28, [15] Halpin, A. P., Hodge, F. S. (2016). Framed messages effects
p. 302, 304; Chapter 26, 1st ed, New York, NY: Farrar, Straus on readmissions. Journal of hospital administration. 8(2), 95-
& Giroux. 102. ISSN 1927-6990(Print) ISSN 1927-7008(Online);
http://www.sciedupress.com/jha
[8] Brooten, D., Brown, L. P., Munro, B. H., York, R., Cohen, S.
M., Roncoli, M., & Hollingsworth, A. (1988). Early discharge [16] Epstein, A. M., Jha, A. K., Orav, E. J. (2011). The relationship
and specialist transitional care. Image: Journal of Nursing between hospital admission rates and rehospitalizations. New
Scholarship, 20(2), 64-68. England Journal of Medicine, 365(24), 2287-2295.

[9] Brooten, D., Kumar, S., Brown, L., Butts, P., Finkler, S. A., [17] Epstein, R. M., & Gramling, R. E. (2013). What is shared in
Bakewell-Sachs, S.,... Delivoria Papadopoulos, M. (1986). A shared decision making? Complex decisions when the
randomized clinical trial of early hospital discharge and home evidence is unclear. Medical Care Research and Review,
follow-up of very-low-birth-weight infants. New England 70(Suppl 1), S94S112. doi: 10.1177/1-7758712459216.
Journal of Medicine, 315(15), 934-939.
[18] Health Research & Educational Trust (HRET report, 2010)
[10] Naylor, M. D., Bowles, K. H., McCauley, K. M., Maccoy, M. Health Care Leader Action Guide to Reduce Avoidable
C., Maislin, G., Pauly, M. V., & Krakauer, R. (2011). High Readmissions, affiliates of the American Hospital Association
value transitional care: transition of research into practice. (AHA), The Commonwealth Fund and The John A. Hartford
Journal of Evaluation in Clinical Practice, International Foundation. Retrieved from:
Journal of Public Health Services Research March 16, 1-7 http://www.commonwealthfund.org/~/media/Files/Publication
[published online Wiley data base, retrieved 11. 7. 2011]. s/Fund%20Report/2010/Jan/Readmission%20Guide/Health%
20Care%20Leader%20Readmission%20Guide_Final.pdf
[11] Naylor, M. D., Brooten, D., Campbell, R., Jacobson, B. S.,
Mezey, M. D., Pauly, M. V., & Schwartz, S. J. (1999). [19] Naylor, M. D., Leeman, J., Colon C. Hanson L. (2018).
Comprehensive discharge planning and home follow-up of Implementing a standardized transition care plan in skilled
hospitalized elders: A randomized clinical trial. Journal of the nursing facilities. Journal of Applied Gerontology, doi:
American Medical Association, 281(7), 613-620. 10.1177/0733464818783689.

[12] Centers for Medicare and Medicaid Services (CMS). (2010). [20] Lown, B. A., & Manning, C. F. (2010). The Schwartz center
HHS Conditions of Participation: Discharge planning 42 CFR rounds: Evaluation of an interdisciplinary approach to
Ch. IV (10-1-10 edition Conditions of Participation Discharge enhancing patient-centered communication, teamwork and
Planning. HHS § 482. 43 23-25. Centers for Medicare & provider support. Academic Medicine, 85(6), 1073-1077.
Medicaid Services (1994, 2004). 23-24.) Retrieved from:
http://www.gpo.gov/fdsys/pkg/CFR-2010-title42- [21] Ulrich, C. Marcantonio, S., Coburn, K, Naylor M., Moriarty,
vol5/pdf/CFR-2010-title42-vol5 sec482-13.pdf H. (2012). “In our corner” A qualitative study on patient
engagement in a community-based care coordination program.

View publication stats