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382 UNIT IV Nursing Theories

MAJOR CONCEPTS & DEFINITIONS
Here, the major concepts and definitions from the (3) change and difference; (4) time span; and
most current Transitions Theory—the middle- (5) critical points and events. Meleis , Sawyer, Im,
range theory of transition suggested by Meleis, and colleagues (2000) asserted that these properties
Sawyer, Im, and colleagues (2000)—are presented. of transition experience are not fundamentally dis-
Some concepts are defined in greater detail based connected, but are interrelated as a complex process.
on the transition framework by Schumacher and Awareness is defined as “perception, knowledge,
Meleis (1994). and recognition of a transition experience,” and
Major concepts of the middle-range theory of tran- level of awareness is frequently reflected in “the
sition include: (1) types and patterns of transitions; degree of congruency between what is known about
(2) properties of transition experiences; (3) transition processes and responses and what constitutes an
conditions (facilitators and inhibitors); (4) patterns of expected set of responses and perceptions of indi-
response (or process indicators and outcome indica- viduals undergoing similar transitions”(Meleis,
tors); and (5) nursing therapeutics. Sawyer, Im, et al., 2000). While asserting that a
person in transition may be somewhat aware of
Types and Patterns of Transitions the changes that they are experiencing, Chick and
Types of transitions include developmental, health and Meleis (1986) posited that a person’s unawareness of
illness, situational, and organizational. Developmental change could mean that the person may not have
transition includes birth, adolescence, menopause, began his or her transition yet; Meleis, Sawyer, Im,
aging (or senescence), and death. Health and illness and associates (2000) later proposed that this lack of
transitions include recovery process, hospital dis- awareness does not necessarily mean that the transi-
charge, and diagnosis of chronic illness (Meleis & tion has not begun.
Trangenstein, 1994). Organizational transitions refer Engagement is another property of transition
to changing environmental conditions that affect suggested by Meleis, Sawyer, Im, and colleagues
the lives of clients, as well as workers within them (2000). Engagement refers to “the degree to which a
(Schumacher & Meleis, 1994). person demonstrates involvement in the process
Patterns of transitions include multiplicity and inherent in the transition.” The level of awareness is
complexity (Meleis, Sawyer, Im, et al., 2000). Many considered to influence the level of engagement;
people experience multiple transitions simultane- there is no engagement without awareness. Meleis
ously rather than experiencing a single transition, and colleagues (2000) suggested that the level of
which cannot be easily distinguished from the con- engagement of a person who has this awareness of
texts of their daily lives. Indeed, Meleis, Sawyer, Im, changes is different from that of a person who does
and colleagues (2000) noted that each of the studies not have this awareness.
that were the basis for the theoretical development Changes and differences are a property of transi-
involved people who simultaneously experienced a tions (Meleis, Sawyer, Im, et al., 2000). Changes that
minimum of two types of transitions, which could a person experiences in her or his identities, roles,
not be disconnected or mutually exclusive. Thus, relationships, abilities, and behaviors are supposed
they suggested considering if the transitions happen to bring a sense of movement or direction to inter-
sequentially or simultaneously, the degree of overlap nal as well as external processes (Schumacher &
among the transitions, and the essence of the asso- Meleis, 1994). Meleis and associates (2000) asserted
ciations between the separate events that initiate that all transitions associate changes, although not
transitions for a person. all changes are associated with transitions. They
then suggested that to comprehend a transition
Properties of Transition Experiences completely, it is essential to disclose and explain the
Properties of the transition experience include meanings and influences of the changes and the
five subconcepts: (1) awareness; (2) engagement; scopes of the changes (e.g., “nature, temporality,