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Copy of Copy of Transition Theory Based Assessment Tool

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Adzimi Gme

on 14 March 2014

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Transcript of Copy of Copy of Transition Theory Based Assessment Tool

Transition Theory: Utilization of a Theory –Based Assessment in the clinical setting

BY:Tasia A. Henderson, RN, BSN

Dr. Meleis is currently the Margaret Bond Simon Dean of Nursing at the University of Pennsylvania.
She was a professor of nursing for 34 years at the University of California Los Angeles and the University of California San Francisco
Dr. Meleis focus remains to be global health, immigrant and international health, women’s health, and the theoretical development of the nursing discipline
She is a member of committees such as the Robert Wood Johnson Foundation Nurse Facility Scholar National Advisory Committee and the George W. Bush Presidential Center Women’s Initiative Policy Advisory Council.
Overview
Dr. Meleis graduated from the University of Alexandria in 1961 with her BSN.
Afaf I. Meleis
Background of Nursing theorist
Overview of “Transition theory”
Major Concepts
Major Assumptions
Metaparadigm Concepts
Generic Assessment form
Re-designed “Transition theory” based assessment
Limitations of Assessment
Piloting of assessment
Results
Newly Gain Insight
Overview
Chick, N., and Meleis, A.I. (1986). Transitions: A nursing concern. University of Pennsylvania, Philadelphia.
Davies, S. (2005). Meleis’s theory of nursing transitions and relative’s experiences of nursing home entry. Journal of Advance Nursing, 52(6), 658-671. doi: 10.1111/j.1365-2648.2005.03637
McEwen, M., & Willis, M. E. (2012). Theoretical basis for nursing (3rd ed.). Philadelphia: Lippincott Williams & Wilkins.
Meleis, A.I. (2012). Penn Nursing Science: University of Pennsylvania School of Nursing. Retrieved from http://www.nursing.upenn.edu/faculty/profile.asp?pid=853.
Meleis, A.I., Sawyer, L.M., Im, E.O., Hilfinger, M., DeAnne, K., Schumacher, K. (2000). Experiencing Transitions: An emerging middle-range theory. Advances in Nursing Science, 23(1), 12-28.
Meleis, A.I. (2012). Theoretical nursing: Development and progress (5th ed.). Philadelphia: Lippincott Williams & Wilkins.
Schumacher, K.L. and Meleis, A.I. (1994). Transitions: A central concept in nursing. Journal of Nursing Scholarship, 26(2), 119-127. doi: 10.1111/j.1547-5069.1994.tb00929
Tomey, A. M., & Alligood, M. R. (2010). Nursing theorists and their work (7th ed.). St. Louis: Mosby Inc.
References
Our goals for patients as nurses are not necessarily congruent with patient’s goals.
It provided understanding about how the patient is absorbing the process of transitioning from the hospital back to the community.
This nursing scholar found it very enlightening, by way of this assessment tool, to see how patient’s concerns with transitioning back into the community have the ability to be silenced when they are verbalized prior to discharged and properly addressed
Newly Gained Insight
Time Limit

Level of understanding of the patient population

The abundance of information discussed in one encounter
Limitations of Assessment tool
During the Follow- up Phone Calls

Q- How did you regard your discharge from the hospital?
Q- Did the experience help you identify with your transition from the hospital back to the community?
Q-What concerns did the assessment tool address that seemed out of the ordinary from other assessment tool?
Q- Did the nurse answer your questions during your discharge assessment?
Patient Transition Assessment Tool
Patient Transition Assessment Tool
Assessment Findings:
Other themes were culturally geared, socioeconomically centered and involved “engagement”, another concept within Transition theory (1984).
The participants with increased faith responded to their transitions more favorably.
Patients with a connection to their community found their transitioning process to be smoother due to additional support received.
Patients who regarded socioeconomic factors as barriers within their transition were fearful, doubtful and apprehensive to their transition back into the community.
Those patients who could not identify with their movement back into the community as an actual transition in life while hospitalized raised more concerns during the phone interview after discharged.
Assessment Findings:
Older participants regarded illness as a process that occurred with age.
Some recognized their transition from the hospital setting to the community as a phase within their life they must acclimate too.
The reactions of the transition through the eyes of the family members were slightly different than that of the patients. Many of the patients loved-ones had difficultly familiarizing themselves with their own roles within the patient’s life as it related to the transition.
Patients with “awareness”, a property within the Transition theory (1984), regarded their transition more positively than those without “awareness”. these individuals were able to recognize their transition, they were likely to prepare for it.
Patient Transition Assessment Tool
Setting
Acute Surgical Rehabilitation Unit, Warwick, RI

Assessment Process
Patients were chosen from the daily Discharge Assignment Board on the unit
Implementation occurred over a week’s time.
The feedback was obtained a week after the participants discharge date.
Each nursing scholar involved discharged three patients using the Transition theory (1984) based instrument.
These patients were between the ages of 24 – 81years of age.
The patients were recovering from either hip surgery, a knee replacement or a partial knee replacement.
Patient Transitions Assessment Tool
Background of Nursing theorist
Overview of “Transition theory”
Major Concepts
Major Assumptions
Metaparadigm Concepts
Generic Assessment form
Re-designed “Transition theory” based assessment
Limitations of Assessment
Piloting of assessment
Results
Newly Gain Insight
Overview
Afaf Ibrahim Meleis’
Background of Nursing theorist
Overview of “Transition theory”
Major Concepts
Major Assumptions
Metaparadigm Concepts
Generic Assessment form
Re-designed “Transition theory” based assessment
Piloting of assessment
Limitations of Assessment
Results
Newly Gain Insight
Afaf Ibrahim Meleis
She earned a Masters in Nursing in 1964, a Masters in Sociology in 1966
and a PhD in medical and social psychology in 1968 from the University of California.
She is a professor of nursing and sociology as well as the director of the school’s WHO collaborating center for nursing and Midwifery
(University of Pennsylvania, 2012 ).
In addition to her obligations at the University of Pennsylvania, she is a fellow of the Royal College of Nursing in the UK, the American Academy of Nursing, and the College of Physicians of Philadelphia.
“Transition theory can provide a comprehensive perspective on transition experience while considering the contexts within which people are experiencing a transition” (Tomey & Alligood, 2010, p. 424). The comprehensiveness of the theory makes it applicable to many human phenomena such as illness, recovery, birth, death and loss (Tomey & Alligood, 2010).
“Passage or movement from one state, condition, or place to another.” ( Alligood & Tomey, 2010, p. 417).

Transitions are consistently related to the concepts of change and development (Meleis, 2012).

Transitions can be initiated by events beyond control or they can also be deliberately sought after (Meleis, 2012).
Transitions
Transitions Theory
MAJOR ASSUMPTIONS
Transitions are complex and multidimensional.
They also have patterns of multiplicity and complexity.
All transitions are characterized by flow and movement over time and can cause changes in identities, roles, relationships, abilities, and patterns of behavior.
Transitions involve a process of movement and changes in fundamental life patterns, which are manifested in all individuals.
Nurses are the primary caregivers of clients and their families who are undergoing transitions
The daily lives of clients, environments, and interactions are shaped by the nature, conditions, meanings, and processes of their transition experiences.
Vulnerability is related to transition experiences, interactions, and environmental conditions that expose individuals to potential damages, problematic or extended recovery, or delayed or unhealthy coping (Tomey & Alligood, 2010 pp. 423-424).
.
MAJOR CONCEPTS
Major concepts of the Transitions theory are:
types and patterns of transitions; properties of transition experiences; transition conditions such as facilitators and inhibitors; process indicators; outcome indicators and nursing therapeutics
MAJOR CONCEPTS
There are “types and patterns of transitions” that are incorporated into the Transitions theory. Types of transitions include developmental, health/illness, situational, and organization (Tomey & Alligood, 2010).
http://www.youtube.com/watch?v=xSn2qqmcwaA.
Developmental transition includes birth, adolescence, menopause, aging, and death..
Health and illness transitions include recovery process, hospital discharge and diagnosis of chronic illness (Tomey & Alligood, 2010).
Health/illness is the focus of this nursing scholar’s assessment tool redefined to include aspects of the Transitions theory
METAPARADIGM
Person as a concept refers to “a being composed of physical, intellectual, biochemical and psychosocial needs” (McEwen & Wills, 2011, p.39). In relation to Transitions theory, transition requires the person to incorporate new knowledge, to alter behavior and therefore to change the definition of self in social context (Meleis, 2012).
Health is the ability to function independently; successful adaptation to life’s stressor; achievement of one’s full life potential; and of mind, body, and soul (McEwen & Wills, 2011). Health is subjective. Meleis (2012) describes health as a continuum of health to illness. It is progression within health-care towards rehabilitation (Meleis & Schumacher, 1994).
Environment is a concept that typically refers to the external elements that affect the person; internal and external conditions that influence the organism (McEwen & Wills, 2011). Meleis et al. (2000) conceptualized environment as also external elements with the addition of facilitative resources within the contexts of Transitions. External facilitative resources were defined as the cyclic process of perceiving, building and evaluation the helpfulness and supportiveness of support outside the person that may help during transition (Meleis & Schumacher, 1994).
Nursing is a discipline that involves the science, art and practice of caring (McEwen & Wills, 2011). Meleis (2012) portrays nursing as all activities and actions deliberately designed to care for nursing clients (Meleis, 2012). It is the role of the nurse to facilitate transitions for patients through stages of life.
Our goals for patients as nurses are not necessarily congruent with patient’s goals.
It provided understanding about how the patient is absorbing the process of transitioning from the hospital back to the community.
This nursing scholar found it very enlightening, by way of this assessment tool, to see how patient’s concerns with transitioning back into the community have the ability to be silenced when they are verbalized prior to discharged and properly addressed
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