Health Transitions Their Types Types and Uses of Health Transitions
What is Transition
Transition is defined as the passage between two relatively stable periods. During this passage, an individual moves from one life phase, situation, or status to another.
Transitions are often conceptualized in terms of stages to capture their movement and direction as they develop over time. Bridge’s (1991) classic description of transition stages includes three phases:
- A period of ending or disconnectedness from what had been before
- A neutral period characterized by a sense of disruption and disorientation as well as discovery
- A period of new beginnings in which the individual finds new meanings and a sense of control and challenge
Additionally, transitions can be viewed in terms of critical points, which are turning points that can lead to either healthy or unhealthy outcomes.
Identifying stages, critical points, and coping strategies during the transition experience forms the foundation for nursing therapeutics aimed at supporting healthy transition processes and outcomes while preventing unhealthy transitions.
What are Transitions in Health
Nurses provide care to patients and families undergoing various types of transitions. These include:
- Developmental transitions: Pregnancy, birth, parenthood
- Situational transitions: Immigration, widowhood, relocation
- Health/illness transitions: Diagnosis of a chronic disease, recovery from surgery, rehabilitation
Transitions also occur within the nursing work environment and can be classified as organizational transitions. Examples include changes in leadership, new staffing patterns, implementation of new nursing care models, and structural reorganization.
The focus on transitions is so central to nursing practice that it has been argued that the mission of nursing is to facilitate transitions (Meleis & Trangenstein, 1994).
Transition in Healthcare Systems and Their Properties
When applying a transition framework in clinical practice or research, several universal properties of transitions must be considered:
- Precipitating Events: Transitions are triggered by significant marker events or turning points that require new response patterns. These markers prompt the recognition that new strategies are needed to manage familiar daily life experiences.
- Process Over Time: Transitions are ongoing processes that span from the initial anticipation of a transition until a new identity is established upon its completion. During this period, the individual’s context, history, and future are important factors.
- Sense of Disconnectedness: A universal property of transition is the feeling of disconnection from one’s familiar world. There is often a sense of loss or alienation from what was once familiar and valued.
- Fundamental Changes in Self and Worldview: Transitions involve significant changes in one’s perception of self and the world. This includes changes in identity, roles, and behavior patterns, as well as the development of new skills, relationships, and coping strategies.
Responses to Transitions
Individuals undergoing transitions experience a wide range of responses, which may include:
- Losses or Gains: Experiencing both positive and negative changes
- Physical Debilitation: Suffering from reduced physical capabilities
- Immune Responses: Changes in immune system functioning, either heightened or diminished
- Spiritual Shifts: An emergence or loss of spirituality
- New Meanings: Discovering new purposes or interpretations of life
- Traumatic Stress Symptoms: Experiencing symptoms related to traumatic stress
Indicators of Healthy Transitions include:
- A sense of well-being
- Development of a new identity
- Mastery of new roles
- Well-being in relationships
- Harmony with the environment
- Renewed energy
- Positive quality of life
Indicators of Unhealthy Transitions may involve:
- Prolonged transitional periods
- Continuation of negative responses such as role insufficiency or isolation
- Maintenance of previous life patterns that are incongruent with new identities and life patterns
Goals for Knowledge Development about Transitions include increasing understanding of:
- The processes and experiences of individuals in transition
- The nature of life patterns and new identities that emerge during transitions
- The processes or conditions that promote healthy transition outcomes
- Environments that constrain, support, or promote healthy transitions
- The structure and components of nursing therapeutics that address transitions (Meleis, 1993)
Transitional Theories
Numerous theories from family dynamics, ecology, problem-solving, and self-care can be utilized to facilitate knowledge development about transitions. Research has begun to contribute to understanding transitions through these theoretical frameworks.
Transition frameworks have been employed in research to explore the experiences of individuals living with chronic illness, new mothers, patients recovering from surgery, and those assuming caregiving roles.
Nursing therapeutics tested in research include:
- Debriefing
- Transition services
- Role supplementation
Further research is necessary to identify the types and dimensions of transitions and their consequences for individuals, families, and communities. Given that transitions are processes, appropriate research methods include qualitative and longitudinal approaches.
Nursing Concerns and Human Experience
Nursing as a discipline is concerned with the processes and experiences of individuals undergoing transitions, where health and perceived well-being are the outcomes (Meleis & Trangenstein, 1994).
The concept of transition was developed as a framework particularly suited for viewing nursing phenomena from a human science and practice-oriented perspective. A transition framework allows for understanding human responses to events that affect growth, development, health, and person-environment interactions.
Additionally, a transition framework provides a focus for understanding the content and timing of nursing interventions. From this perspective, both the timing and duration of nursing interventions are crucial. The transition perspective emphasizes clients and nurses as dynamic, evolving beings within environments that may be healthy or unhealthy.
During the transition process, clients experience both losses and gains. They need to develop new skills to create new lifestyles or modify existing ones, prevent illness or live with illness, and enhance or maintain well-being. Nurses and their actions play a pivotal role in developing these skills.
In Summary, utilizing transition as a framework facilitates the development of knowledge related to changes in individuals, health, and environment. Within this framework, scholarship should focus on uncovering and explaining patterns of responses and critical points in transitions that necessitate nursing interventions.