NUR302.wk11.transition theory & comfort theory

transition theory
-Afaf Ibrahim Meleis developed this.

-started in mid-1960s

-Phenomena of planning pregnancies and processes involved in becoming a new mother and mastering parenting roles

-Focused on people who do not make healthy transitions and interventions to facilitate transitions

-Defined transitions in relation to role attainment

-Developed transitions as a concept

Developed as a middle-range theory

-Used transitions theory to develop situation-specific theories

definition of transition theory
-an emerging middle range nursing theory that emphasizes the role of the nurse in facilitating healthy individual role sufficiency.

-explains the transition experience as a change from one role to another with individuals having unique circumstance that may facilitate or inhibit the ability to define and master a new role and integrate it into their identity (Meleis, 2007)

-formulated to promote healthy evolutions and well-being in individuals by using nursing and social support.

nurse’s role in transition theory
– prepare the patient to cope well with developmental, situational, and health transitions

-provide education, skills, and strategies for the patient and family to understand and cope with the experience of transition

-nurses do this by providing an understanding of the nature of transition, conditions that potentially facilitate or inhibit positive change, and patterns of response, the nurse has a framework for preventing role insufficiency and anticipating the patient’s physical and psychosocial needs required for successful transition.

components of theoretical framework with transition theory
-types and patterns of transitions
• properties of transition experiences
• transition conditions: facilitators and inhibitors
• process indicators
• outcome indicators
• nursing therapeutics

types of nature of transitions: developmental transition
occur in the normal process of growth and maturity and include milestones such as puberty, parenthood, and menopause. (birth – death)

types of nature of transitions: health and illness transition
involves a medical change such as a spinal cord injury, cancer, or autism (recovery, discharge, chronic illness)

types of nature of transitions: situational transition
may be unexpected (or more than expected) or sudden such as widowhood or a car accident (parenthood, college/nursing student)

types of nature of transitions: organizational transition
refer to changes in delivery systems including leadership, policy, and administration (environmental conditions)

PATTERNS of the nature of transitions: single
occur once (developmental milestone)

PATTERNS of the nature of transitions: multiple
can occur more than once (childbirth, marriage)

PATTERNS of the nature of transitions: sequential
one after another (collage years)

PATTERNS of the nature of transitions: simultaneous
mix of types at the same time (i.e.: getting married and being diagnosed with cancer)

PROPERTIES of the nature of transitions: awareness
recognition of transition

PROPERTIES of the nature of transitions: engagement
degree of involvement with the transition

PROPERTIES of the nature of transitions: change and difference
change in identity, role, relationship, abilities. Level of being perceived as different. All transitions involve change, not all change related to transition

PROPERTIES of the nature of transitions: time span
flow and move over time. Span of time with identifiable starting point, ending with a new beginning or period of stability

PROPERTIES of the nature of transitions: critical points and events
birth, death, diagnosis of illness. Final critical points – sense of stability in new routine

Transition Conditions: Facilitators and Inhibitors
Circumstances that influence the way a person moves through a transition that facilitate or hinder a healthy transition

Transition Conditions: Facilitators and Inhibitors: Personal conditions
Meanings of the transition(ie: Entry to Psych facility)

Cultural beliefs & Attitudes (ie: Birth Process)

Socioeconomic status (ie: Menopause)

Preparation & Knowledge (Nursing Home Entry)

Transition Conditions: facilitators and inhibitors: community condition
Community conditions (resources)- ie: productive and safe recreation outlets, educational facilities, and accessible health care

Transition Conditions: facilitators and inhibitors: societal condition
(marginalization of some individuals)- ie: federal and state programs, laws, and cultural norms; community with smoking bans and smoking cessation groups

Patterns of Response: Process indicators
-allow early assessment by nurse to help evaluate and predict the success of a transition and guide the nurse in developing interventions to help plan and meet goals. – move client in direction of healthy or toward vulnerability and risk

Feeling connected
Interactions
Location and becoming situated
Developing confidence and coping

Patterns of response: outcome indicators
– may be used to check if a transition is healthy or not

2 types:
-Mastery – mastery of skills and behaviors needed to manage new situation/environment (ie: coping with and accepting the diagnosis, treatment and remission of cancer demonstrates mastery of a role (ie: Valerie H)

-Fluid Integrative Identities – reformulation of identities, added baggage (ie: identifies oneself as a survivor, parent, spouse exemplifies role integration)

nurses intervention for patient’s transitions:
-assessment of readiness

-preparation for transition

-role supplementation

Nursing Therapeutics: Assessment of Readiness
-Multidisciplinary endeavor, requires a comprehensive understanding of the client

-In some instances a trial transition may be possible and provides a means for assessing readiness

Nursing Therapeutics: Preparation for transition
-Patient education

-Sufficient time is needed for gradual assumption of new responsibilities and implementation of new skills

-ask patient to teach back the skill after you teach something to a patient

Nursing Therapeutics: Role supplementation
-Any deliberative process whereby role insufficiency or potential role insufficiency is identified by the individual or others and the conditions and strategies of role clarification and role taking are used to develop a preventive or therapeutic intervention to decrease, ameliorate, or prevent role insufficiency (difficulty in behaviors or sentiments associated with role).

-May be preventive and therapeutic

-Conveying information

major assumptions (things that we/Meleise believe to be true) for transition theory
-Transitions are complex and multidimensional

-All transitions are characterized by flow and movement over time

-Transitions cause changes in identities, roles, relationship, abilities, patterns of behavior

-Transitions involve a process of movement and changes in fundamental life patterns, which are manifested in all individuals

-The daily lives of clients, environments, and interactions are shaped by the nature, conditions, meanings and processes of their transition experience.

-Vulnerability is related to transition experiences, interactions, and environmental conditions that expose individuals to potential damage, problematic or extended recovery, or delayed or unhealthy coping.

-Nurses are the primary caregivers of clients and their families who are undergoing transitions

Theory of comfort
by Kolcaba

-peaceful death in this theory is similar to the holistic model

comfort
is the immediate experience of being strengthened by having needs for relief, ease, and transcendence met in four contexts (physical, psychospiritual, social, and environmental)

types of comfort
-relief: state of a patient who has a specific need met

-ease: state of calm and contentment

-transcendence: state in which one rises above one’s problems or pain

-enhanced comfort: an immediate desirable outcome of nursing care, according to comfort theory. when comfort interventions are delivered consistently over time, they are theoretically correlated a trend toward increased comfort levels over time, and with desired health seeking behaviors

suffering
by Cassell 1982

-Suffering is experienced by persons not merely by bodies, and has its source in challenges that threaten the intactness of the person as a complex social and psychologic entity.

-Suffering is not synonymous with pain but is closely associated with it. Physical pain is closely related to psychological, social, and spiritual distress. Pain that persists without meaning becomes suffering.

-May include pain but is not limited to pain

-Health care workers have an obligation to relieve suffering

-Recognizing personal meaning is critical to understanding human illness and suffering

suffering in nursing practice
-Suffering is part of being human

-Often intensified during illness

-Common response to illness

-Suffering is common across phases of cancer; it is thoroughly individual and intensely personal.

-Nurses respond to suffering primarily through their presence.

-As witnesses to suffering, nurses serve as compassionate voices and advocates for patients and families.

-Nurses help patients regain control in the face of illness and cope with vulnerability and the uncertainty of life.

the nature of suffering
-Suffering is a loss of control that creates insecurity. Suffering people often feel helpless and trapped, unable to escape their circumstances.

-In most instances, suffering is associated with loss. The loss may be of a relationship, of some aspect of the self, or of some aspect of the physical body. The loss may be evident only in the mind of the sufferer, but it nonetheless leaves a person diminished and with a sense of brokenness

-Suffering is an intensely personal experience.

-Suffering is accompanied by a range of intense emotions, including sadness, anguish, fear, abandonment, despair, and myriad other emotions.

-Suffering can be linked deeply to recognition of one’s own mortality. When threatened by serious illness, people may fear the end of life. Conversely, for others, living with serious illness may result in a yearning for death.

-Suffering often involves asking the question “why?” Illness or loss may be seen as untimely and undeserved. Suffering people frequently seek to find meaning and answers for that which is unknowable

-Suffering often is associated with separation from the
world. Individuals may express intense loneliness and
yearn for connection with others while also feeling intense distress about dependency on others

-Suffering often is accompanied by spiritual distress. Regardless of religious affiliation, individuals experiencing illness may feel a sense of hopelessness. When life is threatened, people may conduct self-evaluation of what has been lived and what remains undone. Becoming weak and vulnerable and facing mortality may cause a person to reevaluate his
or her relationship with a higher being.

-Suffering occurs when an individual feels voiceless. This may occur when a person is unable to give words to his or her experience or when the person’s “screams” are unheard.

Transitions Theory -Afaf Meleis developed Transitions Theory over about four decades. -Began with observations of experiences faced as people deal with changes related to health, well-being, and ability to care for themselves -“Transitions” is a central concept in nursing -Nurses …

What is transition? -Any event, or non event, that results in changed relationships, routines, assumptions, and roles -The passage or movement from one state, condition or place to another Transitions… Processes that occur over time WE WILL WRITE A CUSTOM …

Comfort theory was developed by Dr Kolcaba in 1984. She begins by analyzing the concept, which I think is a very important aspect to understanding the theory. The theory is based on the philosophy of holism. She views the person …

Comfort theory was developed by Dr Kolcaba in 1984. She begins by analyzing the concept, which I think is a very important aspect to understanding the theory. The theory is based on the philosophy of holism. She views the person …

The comfort theory is one of reassurance which is a distinguishing feature of the nursing profession (Kolcaba 1994). The typical nursing definition of comfort is the satisfaction of health needs that are stressful to the patient (Kolcaba 1994). Comfort has …

The field of orthopedics involves the ongoing care and support of those patients experiencing acute bone trauma or chronic bone diseases. It also involves medical treatment and pain management of patients who must undergo surgeries, such as joint manipulations, repairs, …

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