NURS820: A Critical Analysis of Meleis's Nursing Transition Theory

This essay provides a comprehensive critique of Afaf Ibrahim Meleis's mid-range theory of nursing transitions, as per the guidelines for a NURS820 assignment. It begins by introducing the theory and its relevance to supporting individuals through various life transitions, particularly the move to a nursing facility. The critique follows Meleis's method, examining the theory's purpose, key concepts (types and features of transitions, conditions of transition, patterns of response), structure and function, diagram clarity, circle of contagiousness, usefulness in nursing, and external components. The analysis delves into how the theory relates to the author's area of interest and its potential to build scientific knowledge in nursing. Nursing therapeutics like readiness assessment and creating healthy environments are discussed, highlighting the theory's practical applications for nurses in facilitating healthy transitions and improving patient outcomes. The essay concludes by summarizing the theory's strengths and weaknesses and its overall contribution to the field of nursing.

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Nursing Transition
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ABSTRACT
Meleis’s theory of transition can be applied to different types of transformation since it focuses
on helping individuals. The purpose of the approach is to describe the importance of healthy
change by giving a framework that is easily understood by health experts such as nurses. There
are types of transitions which include; developmental, situational — illness and organizational.
Besides, the theory uses an empirical research study. It is useful in the nursing career since it
provides knowledge to the nurses regarding the transition. Meleis has been nominated for various
awards and nominations. The theory has enhanced and advanced the knowledge in science which
is vital o education and the administration.

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INTRODUCTION
The levels of frailty have increased in the aging population, many family care providers seek to
place their loved ones into a nursing facility. When the care providers help an older individual to
proceed into a nursing facility, they need support to attain a smooth transition. The move to a
nursing home speaks for a significant occurrence, and it can be traumatic. Melei’s theory of
development can apply to these life transitions and other major life transitions (Meleis, 2011).
The transition situation begins before an occurrence and has an end points that differs based on
many variables. Comprehending the responses and the nature of change, easing the situation and
paying attention to its various phases, and enhancing health and wellbeing before, during and at
the end of change occurrence is what causes the utilization of this theory.
Purpose of the theory
Melei’s theory of transition has a framework that is comprehensive and knows the importance of
transitions regarding health and tries to summarize the elements of the transition to advocate
nursing interventions (Bohner, 2017). Changing from home to nursing facility can be very
difficult and traumatic, but research has indicated that this kind of support can be the most
effective since it can explain triggers, anticipate situations, predict results and provide
recommendations. The following purpose is to endow people and their families for
enlightenment, experimental and health sickness changes and take care of them at the time of
transformation to improve their and the quality of their lives and wellbeing ( Meleis, 2011). This
theory seeks to inform how to understand the situation better of changing from home to a nursing
facility and how the nurses can create multifaceted recommendations to make the transition easy
for old people. Those situations and responses are referred by whether the change causes are

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developmental, sickness and health or organizational. It also seeks to explain how an individual
associates with his or her environment and health. It also fosters relations between caring and
transitions.
Concepts of the theory
The terms of Transition Theory are clearly written and give a comprehensive understanding of
the complicatedness of changes. A change in the surroundings or health can change an
individual’s role ( Malley & Kenner, 2016). A people to transition is influenced by internal
elements such as culture, attitudes and external elements like social support and socioeconomic
status. In addition, nurses play an important role in role supplementation where some actions can
no longer be done by the person alone or by other people who are involved. Role
supplementation can be preventive or therapeutic (Joly, 2016). A person’s transition can lead to
stress or growth. Health is categorized by having less symptoms, perceived well-being and an
capability to assume different responsibilities. The following are the concepts of transition
theory:
Types of transition
There are types of transition that include developmental which is birth, adolescence, aging, and
death. The second one is the illness that involves recovery procedure, acute sickness diagnosis
(Meleis, 2015). The third transition is situational which involves relocation and discharge from
the hospital. The fourth one is organizational that consists in changing environmental conditions.
The last type is a cultural transition that includes separation, liminality, and integration.
Patterns of transitions encompass multiplicity and complexity. Many individuals go through
various transitions simultaneously rather than experiencing only once, that cannot be easily

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differentiated from their daily lives’ contests. Research has shown that the basis of theoretical
development involved individuals who experienced concurrently two types of transitions on a
minimum basis that may not be opposite (Meleis, 2019). Hence, they proposed considering if the
changes are simultaneous, the extent of overlap in the transformations and the purpose of the
relations between the separation of occurrences that integrate changes for an individuals.
Features of transition
The features of transition encompass awareness which is referred to as the knowledge of
recognition of a transition happens. The awareness level is reflected frequently in the extent of
compatibility between the recognized information about the processes and the retaliation and
what makes an anticipated level of retaliation and the perception of people who are undergoing
the same transitions. An individual who is not aware of change would convey that the individual
might not have begun his or her transformation. Bohner, (2017) suggested that unawareness does
not show that the transition has not started. Secondly, there is engagement which is referred to as
the extent to which an individual is involved in the procedure of transition. There is no
engagement without awareness since the level of involvement is determined by the level of
reconsciousness. Change and differences are a feature of transition whereby changes that an
individual encounter in her recognition, responsibilities, capabilities, and actions are needed to
bring a sense of direction to inward and outward actions. Meleis, Sawyer, Im, Messias &
Schumacher (2011) suggested that all the transformations that relate to changes but not all
transformations are correlated with changes. To understand a transition completely, it is critical
to reveal and describe the meanings and influences of the transformations and the broads of the
changes.

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Furthermore, differences are also a characteristic of transition and could be shown by unsatisfied
anticipation, having a dissimilar feeling , being recognized as dissimilar or seeing the world in a
different way and a suggestion was made that the nurses are required to identify a client's
comfort and the level of mastery in regards to handling differences and transformations. The
time span is also a feature of transition that refers to positive boundaries of a transformation
situation and critical points and occurrences that are the critical markers of the transition process
and stability in skills, and wellbeing. Meleis noted that there would be an issue or a problem if
the time span of some transition situations is framed. There is also critical points and events
which is the final characteristic of transition which is referred to as markers like birth, death,
menstruation cessation or diagnosis of illness (Monk, Kimble, Gunby, & Ferguson, 2017). Also,
there was an acknowledgment of marker occurrences might not real for some changes, although
transitions always have critical points and happenings. This feature is usually integrated into
intensifying transition awareness or differences or effective engagement in the process of
transition (Transitions Theory: Middle Range and Situation Specific, n.d). This theory also
conceptualizes that a sense of counterpoise adapts final critical points in new schedules,
competence, lifestyles and self-care actions and that the uncertainty period featured by
variations, progressive changes, and interruptions that are existing.
Conditions of Transition
These are those situations that have influenced the persons move through the transformation and
supports or hinders progress towards attaining a healthy transition. The transition conditions
encompass personal characteristics (perceptions of and health-related meanings, beliefs in
culture, preparation, and knowledge). (Carvalho, & Cordeiro, 2018) Considered the meanings
that are linked to some occurrences causing transition and to the process of transition would

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accelerate or slow good transitions. The cultural beliefs and attitudes are related to a transition
experience. The second condition is the environmental characteristics that involve community
resources and societal conditions. Also, socioeconomic status might also have an influence on
the transition experiences on an individual transition. Lack of proper communication could
inhibit an individual's transition situations ( Korukcu, Deliktaş, & Kukulu, 2017). The
community conditions such as marginalization of immigrants in a nation facilitate transitions.
The subconcepts of the social conditions are likely to be underdeveloped.
Patterns of response and indicators of outcome
These are procedure indicators and outcome indicators. They feature strong responses. Process
indicators direct clients toward vulnerability and risks make the nurses do an assessment and
intervention to generate positive results. In addition, outcome indicators can be used to see if
there is a healthy transition or not, but Schumacher & Meleis (2010 ) warned that outcome
indicators might be related with irrelevant occurrences in the lives of the individuals if the
appraisal happens early in the process of transition. The process indicators encompass the feeling
of being connected, interactions, being experienced and attaining confidence and being able to
cope up. The requirement to feel connected feel and be connected is a process indicator of a
change that is healthy. If the immigrants increase their contacts to their old ones with their
relatives and other people, they are always in a change that is healthy (Rasmussen, Henderson,
Andrew & Conroy, 2018). Through these interactions, the meaning that is linked to the change
and the actions triggered by the transition can be displayed, explained and comprehended that
always produces a healthy transition. Location and being placed regarding space, relationships
and time are still vital in most transitions. The extent of the increased confidence that the
individual has in the transformation are undergoing is another essential process indicator of a

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healthy change. The outcome indicators recommended by Meleis encompass mastery and fluid
connective identities. A healthy change can be determined by the mastery of skills and activities
which individuals in transition show to manage their new experiences or surroundings. There is
also another representation of a healthy transition which is known as reformulation.
Nursing Therapeutics
These are three measures that are broadly applicable to therapeutic interventions in the time of
transition. The nursing therapeutics involve readiness assessment that requires to be
multidisciplinary efforts and according to a full comprehension of the client. It needs evaluation
of every transition conditions to make a personal sketch of the readiness of the client and allow
health experts and researchers to gauge different patterns of the transition situation, risk
assessment, transition preparation, role supplementation, creation of a healthy environment and
monitoring (Kralik, Visentin, & Van Loon, 2006 ). These are essential aspects of this theory
since it enables the nurses to understand their relationships with the patient (Tyndall, Firnhaber
& Scott, 2018). It is simple and easy to understand these concepts because they provide relevant
information to all the health experts and the patients.
Structure and function
The relationships among the main concepts are shown clearly in a simple diagram. The variables
are independent of each other, yet the interactive impacts among the variables are displayed
using the arrows (Meleis, 2010). There are universal characteristics in helping individuals going
through a transition and like results of the experiences of the transition. Recognizing transition as
a concern for nursing and making frameworks that are coherent to explain transition situations. It
also predict responses , gives the momentum for discovering strategies used by various

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individuals to experience various transitions in their lives that in turn leads to health-sickness
effects; some that are healthy and others are not healthy, and to develop knowledge in regards to
nursing therapeutics that facilitate the experience of transition and improve healthy healing and
coping ( Im, 2013). The framework identifies a procedure that is triggered by sickness, an
occurrence or an experience where people and families require care. The care should not only be
done during the incident but also rendered during the expected time and after the occurrence.
Throughout the transition process, nursing care is required to help individuals overcome the
challenges that they face.
Furthermore, there are essential points and occasions for which coherent care is needed
appropriately. These occasions need to be recognized and approaches of care that can be useful
in the transition period to be developed so that there can be a dissimilarities for such effects like
quality life, the sense of well being, putting together of responsibilities and the healing required
to be tested and cultivated ( Im, 2011 ). Working in a long-term care unit has particular staff
issues as the facilities are anticipated to give services for seriously sick residents and provide
assistance in a homelike atmosphere hence this theory provides the health professionals to
explore and explain various nursing staff activities during the previous transition. Szathmáry
(2015) argued that it is essential that older individuals who might undergo many transitions in
late life are given time to try out various ways and patterns of responses and to infuse them into
their range. The strategies that the nurses use might include new responsibilities, new skills, and
new relations. To facilitate proper transitional steps and effects, the focus must be on nursing
therapeutics and indicators of the process that allow early assessment and interventions. This
approach also stimulates logical thinking, models of response that are coherent and many
programs in research. It challenges researchers to be more cohesive and be systematic about

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practice and also enables student nurses to develop theories. However, the approach needs
adjustment to identify the contributions that the family makes to outcomes that are positive so
that the experiences can be fully reflected.
Health globally needs attention to what nurses tend to practice and provide diagnosis in various
nations. This theory is developed with a principle of specificity whereby it has explained and
predicted a phenomenon within a specific descriptive and explanatory content that is essential for
the nurses to comprehend and put it into practice (Joly, 2015). The theory is also explored and
also represent many realities about the same experiences with various populations. It helps in
illuminating the situations of the communities and the backgrounds for the nurses. It also
respects the wholeness of the mind and body and the surrounding-individual connection; it
allows for multiplication of truth, interpretation tentativeness, and the context complexity.
Transition theory is used to generate queries and answer queries within an environment (
Hanna, Kaiser, Brown, G., Campbell-Grossman, Fial, Ford, & Nelson, A. E. (2018 ). It assists
in describing experiences that are limited in the broad and focus. However, promoting the middle
range theory shows concerns regarding the degree to which arguments which evolve from and
reflect nursing are not supported.
Several empirical research studies are used in the transition theory. There is a critical analysis of
the findings comparing it to the other discovery that led it to be a more pure middle range theory.

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Diagram clarity
Circle of contagiousness
Meleis was born in Alexandria Egypt. Her mother was the first individual to get nursing Ph.D.
from an Egyptian university. She finished her degree in nursing at the University of Alexandria

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in Egypt. She later got a Master of Science in nursing from the University of California, Los
Angeles in 1964 and an MA in sociology in 1966 ( Meleis, 2019). Later, she obtained a Ph.D. in
medical and social psychology in 1968. She became an administrator and acting instructor of the
University of California, Los Angeles between 1966-1968. She was nominated and became the
dean of the school of Nursing at the University of Pennsylvania in 2002She received numerous
honors, awards, honorary doctorates and medals ( Hart & Swenty, 2016 ). Her research focuses
on health globally, international health and the theoretical development of the nursing discipline.
She later started to develop the transition theory in the mid-1960s when she was pursuing her
Ph.D. Her masters and Ph.D. probed planning pregnancy phenomena and the mastery of parental
responsibilities. She put her focus on spousal communication and the interaction inefficacious or
inefficacious planning of the children in families ( Arrowsmith, Lau‐Walker, Norman, &
Maben, 2016 ). Her research was based on individuals who make unhealthy transitions and the
discovery of interventions to have sharp transitions. Her philosophical thinking shifts led her to
role theories as seen in her publications. Currently, her research population focus was the
immigrants and their health.
Usefulness to the nurses
The theory helps the nurses to progress and advance in knowledge about caring individuals that
bring congruence to an area in nursing which is providing more attention to expecting,
undergoing, responding to coping and giving nursing care to individuals who are undergoing a
change ( Rossi, 2017). Nurses strive for outcomes such as improved wellbeing, maximized
functioning and mastering self-care actions. Hence it provides them with the required skills and
knowledge that helps them to relate well with the patients. Nursing therapeutics are aimed at
improving and restoring the aspects of a person, family, and organizational health.