Page 548 - Encyclopedia of Nursing Research

TRANSITIONS AND HEALTH n 515

Other ongoing work involves testing
the efficacy and effectiveness of transitional TransiTions and healTh
care among other older vulnerable popula- T
tions. The university of pennsylvania team
is exploring the TCM among hospitalized, Nursing has had a sustained and ever-grow-
cognitively impaired elder adults (National ing interest in transitions and health for more
Institute on Aging, R01Ag023116; Marian S. than 40 years. During this time, conceptual
Ware Alzheimer’s program, 2005–2010). The models have been developed, elaborated, and
primary goal of this project is to assess the refined (Chick & Meleis, 1986; Schumacher &
clinical and economic outcomes achieved by Meleis, 1994). Middle-range and situation-
nurse-led interventions of varying intensi- specific theories have been developed (Im &
ties, each designed to improve transitions in Meleis, 1999; Meleis, Sawyer, Im, Messias, &
care for these patients and their caregivers. Schumacher, 2000). Research-based evidence
Another ongoing study, Health Related Quality has demonstrated the benefits of transitional
of Life: Elders in Long-term Care, (National models of care for individuals and health
Institute on Aging and the National Institute systems (Naylor, 2002). Increasingly, theory,
of Nursing Research, R01Ag025524, Marian research, policy, and practice are integrated
S. Ware Alzheimer’s program, 2006–2011), is into a comprehensive scholarship of transi-
the first attempt to document the experiences tions and health. The establishment of the
of frail elders, including those with cognitive New Courtland Center for Transitions and
impairment, as they meet very challenging Health at the university of pennsylvania
care transitions in long-term settings, for School of Nursing is a milestone in this
example, community-based (participant’s regard.
homes) assisted living facilities or in nursing Transition is defined as a passage
homes (Naylor & Van Cleave, 2010). between two relatively stable periods of time.
In conclusion, the growing complexity In this passage, an individual moves from
in both the patient population and health one life phase, situation, or status to another
system will continue to challenge u.S. (Chick & Meleis, 1986; Schumacher, Jones, &
health care delivery, necessitating a con- Meleis, 1999). The need for nursing care is so
tinued need for transitional care services. often precipitated by a transition that transi-
The patient protection and Affordable Care tion is a concept central to the discipline of
Act, signed into law by president Obama nursing (Meleis & Trangenstein, 1994; Kralik,
in March 2010, contains a provision for Visentin, & van Loon, 2006).
community-based care transition programs Transitions are processes that occur over
targeting high-risk Medicare patients with time. They are initiated by significant marker
cognitive impairment, depression, history events or turning points that require new
of multiple readmissions, and unspecified patterns of response. Transition processes
chronic illnesses to be determined as the encompass the period of time from the first
law is implemented (u.S. Congress, 2010). anticipation of transition until a new iden-
Continuing research efforts, identifying tity is formed at the conclusion of the tran-
community settings and partnerships, and sition. Transitions often are conceptualized
translating evidence into practice, there- in terms of stages in order to capture their
fore, must continue to advance the science movement and direction as they evolve over
of quality, affordable transitional care for time. A classic description of transition stages
vulnerable populations. is found in Bridges (1991) work. He identified
three stages: (a) a period of ending or discon-
Janet H. Van Cleave nectedness from what had been there before,
Mary D. Naylor (b) a neutral period characterized by a sense