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CHAPTER 20 Afaf Ibrahim Meleis 385

findings of these five studies provided the theoretical Person
basis for the concepts of the middle-range theory of • Transitions involve a process of movement and
transition, and the concepts and their relationships changes in fundamental life patterns, which are
were developed and formulated based on a collab- manifested in all individuals.
orative process of dialogue, constant comparison of • Transitions cause changes in identities, roles,
findings across the five studies, and analysis of find- relationships, abilities, and patterns of behavior.
ings. For example, one of the personal conditions, • The daily lives of clients, environments, and
meanings, was proposed based on the findings from interactions are shaped by the nature, condi-
two studies (Im, 1997; Sawyer, 1997). According to tions, meanings, and processes of their transition
Meleis Sawyer, Im, and colleagues (2000), although experiences.
Korean immigrant midlife women had ambivalent
feelings toward menopause in Im’s study, menopause Health
itself did not have special meaning attached to it. Im • Transitions are complex and multidimensional. Tran-
found that most participants did not connect any sitions have patterns of multiplicity and complexity.
special health/illness problems/concerns they were • All transitions are characterized by flow and move-
having to their menopausal transitions. Rather, ment over time.
women went through their menopause without • Change and difference are not interchangeable,
perceiving any health/illness problems/concerns, nor are they synonymous with transition.
which means that “no special meaning” might have
facilitated the women’s menopausal transition. Yet, Environment
Sawyer’s study reported that African-American • Vulnerability is related to transition experiences,
women related intense enjoyment of their roles interactions, and environmental conditions that
as mothers and described motherhood in terms of expose individuals to potential damage, problematic
being responsible, protecting, supporting, and or extended recovery, or delayed or unhealthy coping.
needed. Thus, Meleis, Sawyer, Im, and colleagues
(2000) proposed meanings as a personal transition
condition because, in both studies, neutral and posi- Theoretical Assertions
tive meanings might have facilitated menopause Theoretical assertions in Transitions Theory were
and motherhood. The middle-range theory of tran- inferred in the early works of Meleis. This includes
sition has been used in studies to develop situation- her work on role supplementation, the transition
specific theories (Im, 2006; Im, 2010; Im & Meleis, framework by Schumacher and Meleis (1994), and
1999b; Schumacher, Jones, & Meleis 1999) and to the middle-range theory of transitions by Meleis,
test the theory in a study of relatives’ experience of a Sawyer, Im, and colleagues (2000). Following are the
move to a nursing home (Davies, 2005). theoretical assertions made in the theoretical works:
• Developmental, health and illness, and organiza-
tional transitions are central to nursing practice.
Major Assumptions • Patterns of transition include (a) whether the client
Based on Meleis’ former works on role supplementation, is experiencing a single transition or multiple transi-
the transition framework by Schumacher and Meleis tions; (b) whether multiple transitions are sequential
(1994), and the middle-range theory of transitions by or simultaneous; (c) the extent of overlap among
Meleis, Sawyer, Im, and colleagues (2000), the following transitions; and (d) the nature of the relationship
assumptions of Transitions Theory may be inferred. between the different events that are triggering tran-
sitions for a client.
Nursing • Properties of transition experience are interrelated
• Nurses are the primary caregivers of clients and parts of a complex process.
their families who are undergoing transitions. • The level of awareness influences the level of en-
• Transitions both result in change and are the result gagement, in which engagement may not happen
of change. without awareness.