Teoria De Las Transiciones

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Experiencing Transitions: An Emerging Middle-Range Theory
Changes in health and illness of individuals create a process of transition, and clients in transition tend to be more vulnerable to risks that may in turn affect their health. Uncovering these risks may be enhanced byunderstanding the transition process. As a central concept of nursing, transition has been analyzed, its components identified, and a framework to articulate and to reflect the relationship between these components has been defined. In this article, the previous conceptual analysis of transitions is extended and refined by drawing on the results of five different research studies that have examined transitionsusing an integrative approach to theory development. The emerging middle-range theory of transitions consists of types and patterns of transitions, properties of transition experiences, facilitating and inhibiting conditions, process indicators, outcome indicators, and nursing therapeutics. The diversity, complexity, and multiple dimensionality of transition experiences need to be further exploredand incorporated in future research and nursing practice related to transitions. Key words: middle-range theory, research based theory, transition

Afaf Ibrahim Meleis, PhD, FAAN Linda M. Sawyer, PhD, RN Eun-Ok Im, PhD, RN DeAnne K. Hilfinger Messias, PhD, RN Karen Schumacher, PhD, RN

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HANGES in health status may provide opportunities for enhanced well-being and expose individuals toincreased illness risks, as well as trigger a process of transition. Vulnerability may be conceptualized as a quality of daily lives uncovered through an understanding of clients’ experiences and responses during times of transition. In this sense, vulnerability is related to transition experiences, interactions, and environmental conditions that expose individuals to potential damage, problematic orextended recovery, or delayed or unhealthy coping. Clients’ daily lives, environments, and interactions are shaped by the nature, conditions,

Meleis: Professor, Department of Community Health Systems, School of Nursing, University of California, San Francisco, California; Sawyer: Assistant Clinical Professor, Department of Community Health Systems, School of Nursing, University of California, SanFrancisco, California; Im: Assistant Professor, School of Nursing, University of Wisconsin-Milwaukee, Wisconsin; Messias: Associate Professor, Women’s Studies and Nursing, University of South Carolina, Columbia, South Carolina; Schumacher: Assistant Professor, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania. Adv Nurs Sci 2000;23(1):12–28 © 2000 Aspen Publishers, Inc.12

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Experiencing Transitions

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meanings, and processes of transition experiences. Transitions are both a result of and result in change in lives, health, relationships, and environments. Nurses often are the primary caregivers of clients and their families who are undergoingtransition. They attend to the changes and demands that transitions bring into the daily lives of clients and their families. Furthermore, nurses tend to be the caregivers who prepare clients for impending transitions and who facilitate the process of learning new skills related to clients’ health and illness experiences. Examples of transitions that may make clients vulnerable are illness experiencessuch as diagnosis, surgical procedures, rehabilitation and recovery; developmental and lifespan transitions such as pregnancy, childbirth, parenthood, adolescence, menopause, aging, and death; and social and cultural transitions such as migration, retirement, and family caregiving.1,2 As a central concept in nursing, transition has been analyzed and a framework has been defined to articulate and...