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CHAPTER 20 Afaf Ibrahim Meleis 383

MAJOR CONCEPTS & DEFINITIONS—cont’d
perceived importance or severity, personal, familial, transition, and that facilitate or hinder progress to-
and societal norms and expectations”). Differences ward achieving a healthy transition” (Schumacher
are also suggested as a property of transitions. Meleis & Meleis, 1994). Transition conditions include
and associates (2000) believed that challenging differ- personal, community, or societal factors that may
ences could be demonstrated by unsatisfied or atypi- expedite or bar the processes and outcomes of
cal expectations, feeling dissimilar, being realized healthy transitions.
as dissimilar, or viewing the world and others in Personal conditions include meanings, cultural
dissimilar ways, and they suggested that nurses would beliefs and attitudes, socioeconomic status, prepa-
need to recognize “a client’s level of comfort and mas- ration, and knowledge. Meleis , Sawyer, Im, and
tery in dealing with changes and differences.” colleagues (2000) considered that the meanings
Time span is also a property of transitions—all tran- attached to some events accelerating a transition
sitions may be characterized as flowing and moving and to the transition process itself would expedite
over time (Meleis , Sawyer, Im, et al., 2000). Based on or bar healthy transitions. Cultural beliefs and
the assertion by Bridges (1980, 1991), in the middle- attitudes such as stigma associated with a transi-
range theory of transition, transition is defined as tion experience (e.g., Chinese stigmatization of
“a span of time with an identifiable starting point, cancer) would influence the transition experience.
extending from the first signs of anticipation, percep- Socioeconomic status could influence people’s
tion, or demonstration of change; moving through a transition experiences. Anticipatory preparation
period of instability, confusion, and distress; to an or lack of preparation could facilitate or inhibit
eventual “ending” with a new beginning or period of people’s transition experiences. Community condi-
stability.” However, Meleis, Sawyer, Im, and colleagues tions (e.g., community resources) or societal condi-
(2000) also noted that it would be problematic or infea- tions (e.g., marginalization of immigrants in the
sible, and possibly even prejudicial, to frame the time host country) could be facilitators or inhibitors
span of some transition experiences. for transitions. Compared with personal transi-
Critical points and events are the final property of tion conditions, the subconcepts of community
transitions suggested by Meleis, Sawyer, Im, and asso- conditions and societal conditions tend to be
ciates (2000). Critical points and events are defined as underdeveloped.
“markers such as birth, death, the cessation of men-
struation, or the diagnosis of an illness.” Meleis and Patterns of Response or Process and Outcome
colleagues (2000) also acknowledge that specific Indicators
marker events might not be evident for some transi- Indicators of healthy transitions in the framework
tions, although transitions usually have critical points by Schumacher and Meleis (1994) were replaced by
and events. Critical points and events are usually patterns of response in the middle-range theory of
linked to intensifying awareness of changes or dissimi- transitions. Patterns of response are conceptualized
larities or to a more exertive engagement in the transi- as process indicatorsand outcome indicators. These
tion process. Also, Transitions Theory conceptualizes process indicatorsand outcome indicators character-
that final critical points are differentiated by a sense of ize healthy responses. Process indicators that direct
counterpoise in new schedules, competence, lifestyles, clients into health or toward vulnerability and risk
and self-care behaviors, and that the duration of uncer- make nurses conduct early assessment and interven-
tainty is characterized by variations, consecutive tion to expedite healthy outcomes. Also, outcome
changes, and interruptions in existence. indicators may be used to check if a transition is
a healthy one or not, but Meleis, Sawyer, Im, and
Transition Conditions associates (2000) warned that outcome indicators
Transition conditions are “those circumstances could be associated with irrelevant events in people’s
that influence the way a person moves through a lives if they are appraised early in a transition

Continued