Transition theory: concepts and applications

Transition Theory

A Discussion of Transition Theory as Explained by Afaf Ibrahim Meleis and the Implementation Thereof in the African-American Community

A little more than a decade ago, a student examined violence in the African-American community and named Detroit, Washington, D.C., Dallas, Jacksonville, and Baltimore the top five most lethal cities in the United States. At the time, most of these cities had an overwhelmingly high African-American population, according to the study. It was also stated that violence was, at that time, "the number one killer of children between the ages of 15-24," with statistics claiming that around 21,500 people died as the result of homicides during that year, which translated to about nine people for every 100,000. For young males in general the rate was about 22 per 100,000. However, for the African-American community, these rates increased tremendously to 85.6 people dying of homicides per every 100,000.

Eleven years later, these statistics have not improved, with many still claiming that violence plagues Black communities and that gang violence has made a comeback. According to one report, "gang killings have made a comeback […] The mistake that was made [in thinking gang violence if forever solved] was thinking gang violence is something you solve. You don't solve it. You only control it. And when you shift attention elsewhere, it comes back. It always comes back."

In light of the problems evidenced above, which are unabating, and especially because of the disaster they cause (i.e. violence and murder), within these specific communities, this study will aim to examine such incidence in their generality and with relation to Transition Theory as explained by Afaf Ibrahim Meleis. Transition Theory, when used in practice, can provide a "comprehensive perspective on transition experience while considering the contexts within which people are experiencing a transition."

For this reason, as a Molloy College Masters prepared nurse, I would like to examine, within this study, the potential development of a program to assist first time African-American mothers who have lost a child to this kind of violence, and also examine the implementation of such a program in a community setting with the hope that it can not only help those in transition, but also help understand where the violence in coming from and possibly help avoid or at least abate it, even if in the minimal sense. For this reason, in the sections below, I will examine at length transition theory, as well as apply it to this case.

Overview of Transition Theory

In order to best understand how this theory could help with the aforementioned development and implementation of a program to assist African-American mothers, one must first understand the theory and its elements. For this reason, this section will provide an overview of the author and the theory, and the next section will focus on the more specific elements of this theory.

To begin, it must be stated that the author of the theory, Afaf Ibrahim Meleis, is a globally celebrated researcher and social scientist, whose studies have had a lasting impact on the field. Transition Theory, in this case and according to the author, means to address "a core problem in nursing, psychology, and social sciences in which the person is unwittingly decontextualized and rendered ahistorical in many research methods, theories, and human science studies."

Meleis further explains, in this respect, that "technical rationality typically focuses on frozen moments in time and yields an unplanned presentism while ignoring changes in the situation and over time."

Transition theory, thus, is meant to offer a way in which to focus one's attention away from a prescribed process, and to instead concentrate upon enriching understanding, development, formation and responses to stressful problems. According to the author of the theory, these are the very facets upon which nursing ought to focus, in addition to focusing on growth, health promotion and coping with the stresses of human life, including experiences of illness and recovery.

Transition theory also introduces a view relating to the rationality that ought to be found in relationships, which can change or time, and expands upon the kind of understanding that should be offered to a person in such contexts. For instance, a woman can undergo many transitions over her life. She may become pregnant, give birth, and raise a child, and each of these stages necessitates undergoing a transition, which is not at all easy. Such stages merit attention, especially in terms of understanding, and transition theory can provide guidance towards giving such attention. It can therefore help people cope with new relationships, situations, demands and resources.

Elements of Transition Theory

Despite the relative ease with which one can understand the concepts of this theory, in practice, it is quite complex to apply. For this reason, this section will expand upon a variety of aspects of this theory, as following:

-types and patterns of transitions,

-properties of transition experiences,

-transition conditions (facilitators and inhibitors),

-process indicators,

-outcome indicators, and -nursing therapeutics.

The types and patterns of transitions can include developmental, health and illness, as well as situational and organizational factors, as partly mentioned in the above section. Developmental transition, for instance, includes those different stages beginning at birth, continuing with growth and finally ending with death, which can be differently experience by every individual. For a woman, these would be birth, adolescence, menopause, aging (senescence) and death. For a man, they would be similar, meaning birth, adolescence, mid-life to aging, and death. The details of these experiences, just as these stages, are also different. A woman can, as mentioned above, undergo changes in her body, as well as in her familial and personal structure and well being following various events (i.e. birth). A man will similarly undergo various transitions, especially in the case of marriage and the birth of a child, but may also experience violence due to war or the situations in which he may find himself (this is also applicable to a woman).

The next set of transitions, health and illness, are those that are experienced most often in life, though often times, especially in the later case, unexpectedly. Illness is a particular stage in life that necessitates transition theory implementation, for not only are individuals often times unprepared for this, but they must also be assisted in the process of recovery. In the case of terminal illness or even violent events leading to one's hospitalization, there are transitions experienced not only by the individual, but also by his or her family. In the case of hospitalization, the process can be painful (both in the figurative and literal sense), for all parties involved, and will include both admissions and discharge, as well as diagnosis of illness or injury.

Thirdly, organizational or situations transitions refer to the changes that occur in one's environment and that one experiences, as a result of the larger changes surrounding this individual. These changes can affect a person firsthand, or can affect his or her workers, friends and family, and such transitions will once again be experienced by many people and may have an after-effect on those not touched in the first place by various events. An example relating to a situational change would be a family affected by violence, as a result of which one of the family members was injured or killed. The situational change taking place here would be adjusting to no longer having that person around. Though this can be classified under many different types of changes, the situational change here not only took place externally, and not only affects one's environment, but can also have ramifications internally.

In addition to many types of transitions, there are many properties of a singular transition experience. First, it must be noted that some people experience so many transitions at once that they are no longer able to distinguish between status quo and status of transition. However, a singular experience is always exemplified by five factors, which can be easily recognized. These are: awareness, engagement, change and differences, time span and critical points and events. In this case, awareness refers to perception, knowledge or recognition of a transition experience and can also impact the level of awareness. Many individuals may or may not, as stated above, recognize this first part.

The second part, engagement, refers to the degree to which a person demonstrates involvement in the process of his or her transition. A person's level of awareness influences his or her level of perception and engagement throughout this process, and thus one aspect cannot take place without the other. Furthermore, changes are also a vital part of transitions. For instance, changes can be exemplified by changes in identities, roles, relationships, other abilities and patterns in life, and finally, behavior. These complex facets are meant to bring a sense of direction to one's internal process, but sometimes they are overwhelming. Assertive individuals will, often times, be able to cope with changes, but many will not. Furthermore, it must be noted that not all change is in relation to transition.

Differences are another property of the transitions process. Differences occur when an individual feels differently, especially when he or she feels as if he or she is perceived as different, or is seeing the world and others in different ways. Another facet, time span may be characterized as flowing and moving over a period of time. This is executed when an individual is moving through a period of instability, confusion and distress, but which will lead to an 'ending' and, once again, calm.

There are various points in the transition process that cannot be classified by types of processes. These are critical points and events, and are defined by 'markers' such as birth, death, the cessation of menstruation or the diagnosis of an illness. These critical points and events are usually associated with increasing awareness of changes or differences, or more active engagement in dealing with transition experiences. There are also transition conditions that come into play at such times, which especially influence the way a person moves through a transition and may facilitate or hinder progress toward achieving a healthy transition. These conditions include personal community, or societal factors that may facilitate or obstruct the process and outcomes of healthy transition.

It is important to recognize this latter point made, in light of critical points and events. For instance, in order for the project to work, and in order to implement transition theory successfully, one must first and foremost think about the kind of transitions an individual has experience, and generalize to include a community which one can help. In the case of African-American mothers whose lives have been altered by some sort of violence, it is important to recognize and speak about these critical points, but it is also vital to be aware of transition conditions, with a stress upon how community can get involved in the healing process. Lastly, in order to successfully implement such a process, one must understand the transitions on a personal level, as well as personal and community patterns of response.

One must check, firstly, whether outcome indicators are healthy, and whether the community is indeed one in which the said individual can grow and heal properly. Nursing indicators can help in this case greatly. This concept involves three measures that are applicable to the therapeutic intervention during transitions. The first is Assessment of Readiness, which requires a comprehensive understanding of the client. This is done by assessing each transition condition in order to create client readiness. The second measure is preparation for transition by using education as the primary method for creating optimal conditions in preparation for transition. The third measure is role supplementation, a facet introduced solely by Meleis in 1975, which is essentially taking on other roles.

Further Development of Transition Theory

The previous sections have described transition theory and have explained, in a rudimentary fashion, both an overall application, as well as a specific application to the case at hand. There are, of course, many more studies that must be done, and much research undertaken before one can truly apply this theory successfully to the said community. However, further development of transition theory must also be undertaken.