Progress in the application of Meleis transition theory in the nursing field

Lian-Jie Zhan,Yong-Chao He,Qing-Jun Liu,Meng-Yuan Pei,Lu-Xin Yu*,Xiao-Yu Liu

1The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai 264000, China. 2Northwest Minzu University, Lanzhou 730000, China. 3The Affiliated Children’s Hospital of Shandong University,Jinan 250022,China.

Abstract This paper reviews the development of Meleis transition theory, explores the trajectory of the development of transition theory, analyses of the transition theory at home and abroad and research status, discusses the research prospect of transition theory, in order to better apply Meleis transition theory to clinical nursing work, provide a certain basis for discipline development and nursing research.

Keywords:transition theory; situation-specific theory; nursing

Background

In the mid-1960s, Meleis introduced the concept of "transition" into the field of care to describe, interpret, and predict individual experiences in the variety of changes associated with care. Foreign transition nursing mode and use involve immigration transition,health transition, transition, nursing administrative transition,domestic research in the field of clinical transition nursing is limited to some specialized disease discharge and transfer, lack of exact theoretical support, model is relatively single, more simple health education, nursing continuity, the scope of providing services is limited [1]. Therefore, it is necessary to further localized Meleis transition theory.

A brief introduction to the Meleis transition theory

Origin

In 500 BC, the Greek philosopher Heraclitus proposed that "everything changes, nothing is still," indicating that change and transition can be seen as common phenomena occurring in changing social, cultural,economic and political contexts. However, to study changes and transitions in the field of care, it must be based on the concept of human, environment and health [2]. Since nursing began as a discipline, theorists have tried to explain what nursing is through a unified theory [3]. Initially, most nursing theories were based on the experience and intuition of nursing education and practitioners themselves [4]. Since the 1980s, nursing theorists have analyzed the central concept of developing nursing. Some theorists have proposed different conceptual development and conceptual analysis methods,including evolutionary concept analysis, mixed concept analysis model, Wilson conceptual analysis and Norris method [5]. In the 1990s and early 21st century, with nursing research has made certain progress, nursing theorists began to find easy applications to research theory, such as: borrowing the famous theory of other disciplines;some scholars began to consider easy hypothesis of nursing theory,and this is the beginning of the middle theory, such as: young master theory, Mischer's uncertainty theory, the unpleasant symptoms theory,Resnick's self-efficacy theory, the elasticity theory, etc [6]. Meleis and her colleagues have developed transition middle-level theory for nearly 20 years [7-9]. The transition phenomenon is incorporated into the theoretical system of the nursing profession.

Concept

Meleis and Chick explore the theoretical development of the concept of transition through conceptual analysis, which they define as a transition or transfer from one state, condition or place to another [7].Some scholars have found a basic assumption from the Meleis transition theory: the transition has an impact on health[10]. This is a prerequisite for transition as a subject used in the field of care, and understanding the concept of transition helps to clarify care goals,develop care plans, and optimize care workflow.

Main arguments

The Meleis transition theory suggests that people are more vulnerable to health risks during the transition, and care interventions can promote positive transitions, thus affecting the outcome of the transition. Meleis [11] point out: transition refers to the process and outcomes of complex human interactions with the environment.Transition theory is often popular with various types of transitions (e.g., immigration transition, health-disease transition, nursing administrative transition, etc.) in nursing research, education and practice. Transition theory provides a good lens for nursing care,through which transition-related care phenomena can be systematically and comprehensively observed. The Meleis study focuses on global health, migration [12], theoretical development of international health, women's health and nursing disciplines. In 2007,as dean of the School of Nursing at the University of Pennsylvania[13], Meleis received a $5 million donation to create the new Courtland Transition and Health Center, advancing the transition theory further.

Structure and frame

Transition theory includes four main concepts: (1) transition nature;(2) transition conditions (facilitation factors and suppressors); (3)response mode; (4) nursing therapy [8]. Each main concept includes several related sub-concepts. Transition properties include types,patterns, and attributes. Transition types include: developmental transition, situational transition, health and disease-related transition,histological transition. Development transition: caused by natural,biological, human changes in the life cycle, such as physical changes causedbyadolescentdevelopment,marriage,childbirth,father/mother, menopause, etc. Situational transition: caused by changes in social roles (excluding role changes due to developmental changes), changes in living or working place, changes in education,such as widowers, nursing homes, migration, relocation, etc.Transitions related to health and disease: caused by changes in health and disease status. Organizational transition: caused by changes in leadership, structure and process, such as adopting new policies, new models or new technologies. Transition conditions include:individuals, community, and society. Response patterns include:process indicators and outcome indicators, each sub-concept includes several related concepts; for example, the attributes of the transition include: consciousness, participation, change and differences, time span, key points, and events [8]. All these concepts and subconcepts are well defined and the connection between concepts and subconcepts is evident [14].

Advantage

The concept of transition has penetrated clinical nursing work and has many advantages in promoting the development of nursing discipline.(1) It provides an organizational framework emphasizing that the process is longitudinal and multidimensional and a model of care over time. An integrated conceptual framework makes it easier for nurses to use existing knowledge more freely. (2) It provides a general model that covers a large number of professional fields and professional roles, making the connecting between interprofessional fields and professional roles possible. (3) The transition period is not limited by the existing nursing theories. The challenge for nurses is finding out the influencing factors and developing interventions to maximize patient benefit [9].

Current application status of Meleis transition theory in the nursing field

Health maintenance and health promotion

The application of transition theory throughout life, such as pregnancy, childbirth, parenting, adolescence, menopause, aging and death, is also closely related to patient diagnosis, surgery and disease rehabilitation. Transitional care was initially served by very low body weight birth babies, cesarean section women, gestational diabetes patients, hysterectomy patients, and then extended to surgical and heart disease patients [15]. Korukcu O et al. [16], under the guidance of transition theory, the factors affecting the maternal transition to maternal role of congenital malformation were explored, and the promoting and inhibitory factors, transition response mode and nursing interventions were summarized. Joly E [17] the literature review explores the transition to adult care of adolescents with complex diseases, understands the complexity of disease development,focuses on meeting the health care needs of such adolescents,ensuring good quality of life, solving psychosocial problems, emphasizes the importance of respecting and guiding education, and provides advice for future research. Naylor MD et al. [18] a comprehensive discharge program and home follow-up intervention program designed for high-risk seniors with poor post-discharge outcomes and implemented by senior practice nurses can reduce readmissions, extend the first readmission, and reduce the cost of care. Fitzpatrick JM et al. [19]narrative care through Meleis transition theory identified potential facilitators and obstacles for elderly people placed in care centers.They found that effective transitional care is needed to improve the quality of life of elderly patients with chronic diseases and avoid the interruption of care and adverse events, providing a reference for the development of transitional interventions. Son YJ [20] proposed the application of Meleis transition theory as a framework for developing and implementing clinical practice and nursing education methods,nurses could play an important role in the health maintenance of elderly patients with chronic diseases and their families caregivers.Huiling Zhao et al. [21] explored the factors affecting the discharge willingness of Chinese patients with a laryngectomy. It was found that discharge health education and timely follow-up affect the discharge willingness and postoperative recovery, which provided a basis for accelerating the postoperative patient role transition, promoting patient rehabilitation and improving patient satisfaction. Transition theory is applied to surgical perioperative patients throughout the whole process of patient diagnosis and treatment care, improving the continuity and coordination of care. Case management is a continuity of care model that includes collaborative procedures for evaluating,planning, implementating, coordinating, monitoring, and evaluating selected treatments and services to meet individual health needs through communication with patients and coordinating available resources [22]. The application and research of case management model were carried out in Taiwan earlier [23, 24]. In the mainland region, the case management model is still in the primary stage of development [21].The case manager plays a leading role in the whole case management mode, responsible for the overall diagnosis and treatment plan, tracking, and responsible for the follow-up work after discharge, maximizing optimization resources, shorten the patients'hospital stay. This is consistent with Meleis transition theory continuity care model, can promote patients get better transition experience, so case management model has a lot of development space in China[25].

Social and cultural transformation

Transition theory has wide applications in social and cultural transformation, such as immigration, retirement and home care.Ozkaya M et al. [26] through the study of Syrian refugee women found that the factors affecting breastfeeding attitude and behavior include personal factors, economic factors, cultural beliefs,breastfeeding experience and social factors. The results make medical staff aware of the transition factors hinder refugee mothers breastfeeding, so as to develop interventions for effective intervention.Duggleby WD et al. [27] found that caregiver quality of life. Ploeg J et al. [28] applied Meleis transition theory to develop self-management and intervention measures for elder caregivers with dementia and multiple chronic diseases in the community to promote the caregiver's transition in role and life. Davies S et al. [29] found that at each stage of the transition, practitioners should focus to working with seniors and their family caregivers, realizing the stress family caregivers are experiencing and assisting in decompression, and ensuring that seniors and family caregivers receive timely medical and emotional support and help. Obviously, the application of transition theory to social and cultural transitions can enable individuals undergoing the transition to better realize self-management and role transitions, and guide medical staff to develop more precise interventions to achieve health promotion.

Discharge care

Health transition refers to each stage at which a patient moves or returns to a specific physical location, or contacts medical staff and receives medical care. Surgery means several changes in the patient care environment and postoperative autonomic recovery [30]. In all transitions, returning home after discharge is considered a critical stage in surgical rehabilitation, and postoperative patients are often overwhelmed because they sometimes have to care for themselves[31]. Ruel MC et al. [32] found that the transition of patients from hospital to family after colorectal surgery was complex, emphasized the current situation of patients who were often in a vulnerable state once they were discharged home, and proposed the necessity of making full use of medical resources to strengthen transition care. At the same time, they clarified that nurses played a key role in optimizing the transition experience. In the patient care plan for elective colorectal surgery under the ERAS (Enhanced Recovery After Surgery)model,incorporatingtransitioncareintothe re-hospitalization of patients and prevention of complications would achieve better results. Son YJ et al. [20] found that elderly patients usually have strong rehabilitation needs when they are discharged from hospital, and they must seek the support of family, friends, or professional medical resources to optimize the transition procedure.Understanding the changes in the needs of elderly patients in the early and late stages of discharge will help identify health risks or elderly patients who have undergone the transition from unhealthy family rehabilitation, formulate appropriate interventions to solve certain health problems of the patients and their families, reduce the occurrence of complications, and reduce the re-admission rate and medical expenses. Nurses playing key roles in medical institutions will help ensure a seamless care transition for elderly patients. Therefore,transition theory can help nurses recognize what they need to do to optimize home rehabilitation for discharged patients, especially for people with severe or chronic illness (including mental illness).

New nurses and new nursing managers

The role transitions of new incoming nurses and new care managers are sometimes complex, difficult and challenging, with organization departments needing to invest time, energy and even financial resources and be supported by the new staff management system.Hallaran AJ et al. [33] discover that reducing new nurses' role stress strategies help to promote their practice transition. Nursing educators can develop and provide more simulation and training guidance opportunities before new nurses graduate, hospital leadership level to recognize the complexity of nursing work, evaluate the ability of new nurses, provide reasonable workload for new nurses, gradually increase the number of patients allocated, give new nurses necessary learning support, and enhance the confidence of new nurses' career development. Pilat M et al. [34] found that caregivers' transition to care managers often lack clear expectations, necessary knowledge and skills leading to inadequate role competence. Therefore, the smooth transition from nurses to nursing managers needs to understand the needs of work, have the corresponding theoretical knowledge and skills, and get the support and help of leaders and colleagues, so as to work efficiently to have a sense of role control or comfort. The ideal approach is to receive a higher level of academic education before serving as a nursing manager, which can help broaden your vision,increase your personality charm, better think in others' shoes and feel the needs of nurses. Using Meleis transition theory to provide a reference for the nursing administrative transition of new nurses and new nursing managers, prompting the organization department to pay more attention to the entry process of new nurses and provide various support, which points out the direction for further improving the nursing administrative transition.

The shortcomings and development prospects of Meleis transition theory

Transition theory belongs to the category of middle-level theory [10].There is wide applicability in the care field, and the Meleis transition theory has been gradually recognized in recent years, but it has not been further developed since 2000. Moreover, nursing theorists have also found that Meleis transition theory is not applicable in certain areas, especially in qualitative research areas [34]. Because middle-level theory is essentially based on empiricism or post-empiricism, and researchers with different epistemological backgrounds (such as phenomenology, critical theory, etc.) believe that Meleis transition theory is difficult and complex.Thus, Meleis and Im EO [35] developed a new theoretical category based on the transition theory to overcome this concern, namely, the situation-specific theory. Situation-specific theory is defined as a theory focusing on specific nursing phenomena reflecting clinical practice and limited to specific populations or specific practice fields to explain the nursing phenomena or unique nursing situations of specific populations. Although there are many steps, it is not homogeneous [36]. Context-specific theory can combine the diversity and complexity of nursing phenomena and emphasize the contextual factors surrounding nursing, thus providing a comprehensive framework and guidelines for nursing practice and research, such as the context-specific theory of self-care for heart failure and the context-specific theory for the elderly [37, 38]. The scenario-specific theory derived from the transition theory promotes the development of the care discipline through diverse methods and strategies, and it is believed that the transition theory can be better developed and applied in the near future.

Conclusion

The research field of transitional care is still in continuous development and improvement. It emphasizes the importance of cooperation between nurses and other health care providers and family caregivers, conducts research on the results of best practices in the transformation of health care environment (including communities, families and pension institutions), develops programs that support role transformation to promote further development of transitional theory, opens up horizons, and deepens health education in various fields, such as sociology, psychology, political science,philosophy, ethics, ethnology, etc., in order to improve patients'self-care ability and quality of life, which puts high demands on the comprehensive quality of nursing staff. The application of case management model and the construction of transition nursing intervention plan under the guidance of Meleis transition theory will be the research direction in the future. It is recommended that in the future, combined with the domestic medical environment and the specific situation of patients, transition nursing intervention plan suitable for china's national conditions be continuously explored and formulated, and efforts be made to cultivate high-tech nursing staff,and optimize the transition nursing to the maximum extent, so as to affect the transition result positively. It is believed that Meleis transition theory will provide more specific guidelines for clinical practice through a transition perspective, and promote the continuous development of the nursing profession and health industry.