Transition Theory

Afaf Meleis posits that nurse-patient encounters are frequently periods of health and illness transitions for the patient. Depending on his condition, the patient will discharged to different levels of care. There are properties common in every transition experience, namely awareness, engagement, change and difference, time span, and critical points and events. Personal, community and societal conditions can either facilitate or hinder effective transitions. Further, there are patterns of response with indicators to determine if there is progression towards wellness. The role of nurses is to ensure optimal outcomes with every transition by increasing patient knowledge regarding the change, engaging the patient to prepare for it and addressing the existing hindrances to effective transition.  

A problem with the application of the transition theory in the medical-surgical setting is its solid integration into practice. Nurses hold many incorrect notions of transitions. They may think that patient care effectively ends with discharge. They may provide general discharge education without realizing the need to tailor this based on the client’s situation in the setting where he is transitioning into. For example, nurses give education about wound care in general for the postoperative patient but do not assess if the patient can adequately manage this at home and if additional resources or education need to be given. Without clear standards, the quality of patient transitions will remain questionable which often translates to poorer patient outcomes such as rehospitalizations or noncompliance with therapy.      

Implementing a policy regarding the assessment, education and postdischarge follow-up of patients with regard to their transition is itself an organizational transition for nursing staff. Thus, the theory applies to both scenarios. The barriers to successful implementation are negative personal meanings attached by individual nurses to the change, inadequate knowledge and preparation for the transition, and lack of peer and management support. Negative personal meanings may relate to having to learn new skills or having another task added to the load. Inadequate knowledge and preparation mainly stem from a top-down approach to implementation. Lack of support for the transition means there is no group cohesion in the workplace and hints that management styles are authoritarian.

Using the same theory, the barriers are addressed by engaging the nursing staff about the new policy, increasing their awareness about its theoretical underpinnings and evidence base and preparing them by providing the knowledge and skills needed to comply with the policy. Open communication will elicit subjective meanings from nurses and facilitate clarification until they perceive the positive impact of the new policy once implemented. Finally, adopting a participative management style will open the door for increased management support and promote greater cohesion among nursing staff.