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380 UNIT IV Nursing Theories

The gist of Meleis’ works published in the 1970s transition framework was well received by scholars
defined role supplementation as any deliberate pro- and researchers who began using it as a conceptual
cess through which role insufficiency or potential role framework in studies that examined the following:
insufficiency can be identified by the role incumbent • Description of immigrant transitions (Meleis,
and significant others. Thus, role supplementation Lipson, & Dallafar, 1998)
includes both role clarification and role taking, which • Women’s experience of rheumatoid arthritis
may be preventive and therapeutic. (Shaul, 1997)
With these changes in Meleis’ theoretical thinking, • Recovery from cardiac surgery (Shih, Meleis, Yu,
role supplementation as a nursing therapeutic entered et al., 1998)
her research projects. Her main research questions • Family caregiving role for patients in chemotherapy
were to further define components, processes, and (Schumacher, 1995)
strategies related to role supplementation, which she • Early memory loss for patients in Sweden (Robinson,
proposed would make a difference by helping patients Ekman, Meleis, et al., 1997)
complete a healthy transition. This led Meleis to • Aging transitions (Schumacher, Jones, & Meleis,
define health as mastery, and she tested that definition 1999)
through proxy outcome variables such as fewer symp- • African-American women’s transition to mother-
toms, perceived well-being, and ability to assume hood (Sawyer, 1997)
new roles. Using the transition framework, a middle-range
Meleis’ theory of role supplementation was used theory for transition was developed by the researchers
not only in her studies on the new role of parenting who had used transition as a conceptual framework.
(Meleis & Swendsen, 1978), but in other studies They analyzed their findings related to transition
among post–myocardial infarction patients (Dracup, experiences and responses, identifying similarities
Meleis, Baker, & Edlefsen, 1985), older adults (Kaas & and differences in the use of transition; findings were
Rousseau, 1983), parental caregivers (Brackley, 1992), compared, contrasted, and integrated through exten-
caregivers of Alzheimer’s patients (Kelley & Lakin, sive reading, reviewing, and dialoguing, and in group
1988), and women who were unsuccessful in becom- meetings. The collective work was published in 2000
ing mothers and who maintained role insufficiency (Meleis, Sawyer, Im, et al., 2000) and has been widely
(Gaffney, 1992). These studies using role supplemen- used in nursing studies. See Figure 20–1 for a diagram
tation theory led Meleis to question the nature of of the middle-range Transitions Theory.
transitions and the human experience of transitions. Based on the early works of Transitions Theory,
During this period, her research population interests situation-specific theories that Meleis (1997) had
shifted to immigrants and their health. This shift led called for were developed, including specifics in level
Meleis to review and question transitions as a concept. of abstraction, degree of specificity, scope of context,
Norma Chick’s visit to the University of California, San and connection to nursing research and practice (Im
Francisco, from Massey University in New Zealand & Meleis, 1999a; Im & Meleis, 1999b; Schumacher,
accelerated the development of the concept of transi- Jones, & Meleis, 1999). For example, Im and Meleis
tions (Chick & Meleis, 1986) and Meleis’ first transitions (1999b) developed a situation-specific theory of low-
article as a nursing concept. income Korean immigrant women’s menopausal
To further develop this theoretical work, Meleis transition based on research findings, using the tran-
initiated extensive literature searches with Karen sition framework of Schumacher and Meleis (1994).
Schumacher, a doctoral student at the University of Schumacher, Jones, and Meleis (1999) developed
California, San Francisco, to discover how extensively a situation-specific theory of elderly transition.
transition was used as a concept or framework in Im (2006) also developed a situation-specific theory
nursing literature. They reviewed 310 articles on tran- of Caucasian cancer patients’ pain experience. These
sitions and developed the transition framework situation-specific theories were derivative of the
(Schumacher & Meleis, 1994), which was later devel- middle-range Transitions Theory. In 2010, Meleis
oped as a middle-range theory. Publication of the collected all the theoretical works in the literature