What facilitates and prohibits using theory-based practice?
This week you studied Middle Range Theories and focused on Afaf Meleis” Transitions Theory, explain one way in which Transitions Theory can be used in your practice. What facilitates and prohibits using theory-based practice? What are the advantages or disadvantages to using Transitions Theory in the caring of your patients, in the teaching of your courses, or in the managing of your administrative responsibilities?
Concepts structured within transitions theory are utilized in my practice as a pediatric primary care nurse. Within primary care, the interdisciplinary team is monitoring and providing support throughout every major milestone of a patient’s life, starting at birth. My role as a primary care nurse includes following the journey and developments that originate from birth throughout adolescence, concluding at the point in which they are transitioning to an adult health care team. Meleis describes transitions theory as coordinating the experience of changes and responding to the varying segments of an individual’s life as it is affected by such a change (2020). A patient’s perception of healthcare is formulated during interactions with various health care professionals, such as with a nurse during an annual physical exam. The perception framed within an individual related to how to respond to personal health and developmental needs is shaped by early interactions and relationships formed with providers during childhood. Our text discusses transitions theory as a guide to care related to an individual “confronting, living with, and coping with an event, a situation, or a stage in growth” (2020). Primary care plays a significant role in relation to characterizing health care as it is usually an individual’s first foundational introduction into health care along with its potential contributions within their life.
While very relatable, vague presumptions may be determined throughout transitions theory within its aim to convey universal awareness with regard to changes. Bohner distinguishes health to be defined as a “state of complete physical, mental, and social well-being and not merely the absence of disease” (2017). Transitions theory is vital to the realm of nursing in that it forces healthcare to focus on centering patients’ needs as a whole throughout their lifespan. Bohner determines “change and transition as universal phenomena” (2017). This refers to the collective understanding that as humans, we all encounter transitions that modify our lives for better or worse. Transitions theory aligns with the notion that patients’ needs change as they develop and cope with life experiences, requiring comprehensive care and support.
References
Bohner, K. (2017). Theory Description, Critical Reflection, and Theory Evaluation of the Transitions Theory of Meleis et al according to Chinn and Kramer (2011). Advances in Nursing Science, 40 (3), E1-E19. doi: 10.1097/ANS.0000000000000152.
Meleis, A. (2020). Afaf Meleis’ Transitions Theory. In Nursing Theories and Nursing Practice (Fifth, p. 354). essay, F.A. Davis.
This week we learned about Transitions Theory and how it can be applied to nursing and used to aid patients and their families overcome triggering change events. Nurses can help patients and their families through their transitions by using a series of interventions with the goal of facilitating and inspiring healthy processes and outcome responses (Smith, 2020). Meaning that as nurses we have the ability and skills to help our patients transition through their changes and reach their goals whether that is physically or emotionally. For example, as nurses, we can help to identify milestones from a nursing perspective when our goals are self-care, quality of life, role mastery, and managed care (Smith, 2020). As nurses, we can make a difference in how our patients deal with stressful situations and distress. Identifying milestones or turning points is essential in the trajectory of managing and facilitating transitions (Smith, 2020). By being objective we can see aspects of a situation that our patients might not, that is how we can identify milestones even when they can not.
Other interventions that nurses can do include mobilizing partnerships, resources, and support groups to help patients in specific situations(Smith, 2020). As nurses, we have the resources and information needed to help our patients and we need to be ready to connect our patients to those resources. Another intervention is debriefing, which is the process of communicating to others the experiences that a person or group encountered around a critical event (Smith, 2020). This is a well-researched, core nursing intervention used at critical points during transition experiences and is very useful when helping patients understand the situation.
The use of Transitions Theory enhances nurses’ understanding of patient and caregiver transitions and leads to the development of nursing therapeutics, interventions, and resources that are tailored to the unique experiences of clients and their families in order to promote successful, healthy responses to transition (Smith, 2020). This explanation encapsulates the essence and meaning of this theory because it recognizes the effect that this theory has not only on the patient but also on the nurse. One way I have used this theory in my practice has been with a patient who had a new diagnosis of diabetes and thus needed family teaching on the use of insulin and a weekly injection for diabetic patients. I was able to help this patient transition into this new chapter of their life by educating them on the use of medication, nutrition, and exercise. I also educated their family members who were present because they will also be affected by this new change and needed to learn the lifestyle changes that their loved ones will need to start. I also assessed the patient’s feelings and thoughts about the new diagnosis in order to help them advance forward.
Theory-based practice is facilitated by leaders who value the research behind the theory. When nurses are supported and encouraged to use theory-based practice, they are able to perform to the best of their abilities. There are many benefits to using the Transitions Theory in caring for patients. As mentioned earlier we are able to guide patients through their milestones and turning points. Without us, patients would be dealing with hard situations on their own and with no support. Difficult times are already hard enough, but if we provide the necessary interventions our patients can overcome those situations. Transitions Theory is a general middle-range theory with applicability in populations that are “cross-cultural” and across “all age groups (Bohner, 2017). This means that as nurses we can use this theory to help our patients regardless of their race, ethnicity, or age.
References
Bohner K. (2017). Theory Description, Critical Reflection, and Theory Evaluation of the Transitions Theory of Meleis et al according to Chinn and Kramer (2011). ANS. Advances in nursing science, 40(3), E1–E19. https://doi.org/10.1097/ANS.0000000000000152
Smith, M. C. (2020). Nursing theories and nursing practice (5th ed.). F.A. Davis Company.
Middle-range nursing theories are a sub-division of nursing discipline that focuses on potential knowledge of the discipline by expanding the phenomenon related to the health care of patients. In reference to nursing, the Transitions Theory is being used to advance nursing knowledge about the experiences and responses of many transitions that have been applied in practice by nurses to aid clients, families, and communities in preparing for, navigating through, and adapting to transition experiences to enhance health outcomes (Smith, 2020). I worked in the cardiac telemetry unit where we care for severe cardiac patients and experienced positive outcomes in assisting transition phases and we extensively use transition theory in practice that includes assisting patients, and families during hospitalization, and post-hospitalization transitions. We aid clients, and families transitions in hospital by providing floor orientation, instrument handling instructions, rules and regulations on the floor (including, doctor/nurse visit frequency, guest hours, and so on), providing educational disease-specific pamphlets, easing patients and families by explaining the plan of care during treatment, and followed by, providing discharge instructions, post-hospitalization transition instructions including VNA, Cardiac rehabilitation therapy, support groups, and follow up visit appointments. So, Transition Theory can be used as an intervention framework for an effective care plan in practice as people are more vulnerable to health risks during transitions and that nursing interventions can facilitate positive transitions, which impact the outcome of a transition. (Bohner, 2017, p. E1).
Transitions Theory facilitates nurses to provide healthy transition and achieve healthy outcomes. Academic and organizational training and management/organization policy are among some of the factors to facilitate theory-based practice, and a theoretical perspective allows the nurse to plan and implement care purposefully and proactively. When nurses practice purposefully and systematically, they are more efficient, have better control over the outcomes of their care, and are better able to communicate with others (Raudonis & Acton, 1997). So, nursing theory-based practice helps improve the quality of nursing care because it allows nurses to articulate what they do for patients and why they do it. In adverse, inadequate resources and increase workloads for health care professionals is one of the common problems hindering theory-based practice. In my experience, the hospitals are struggling to manage resources and so do the nurses struggling to allocate enough time to patient interactions. The more nurse-patient interactions, the better nurses will provide transitional care and facilitate transitions to enhance a sense of well-being (Smith, 2020).
Transitions Theory provides a framework that guides effective care prior to, during, and after the transition by guiding nurses which enhances nurses’ understanding of patient and caregiver transition and leads to the development of nursing therapeutic, interventions, and resources that are tailored to unique experiences of clients and their families to promote successful healthy responses transition (Smith, 2020, p. 364). Further, middle-range theory as Transitions Theory concept states that the basis of middle-range theory can be operationalized by describing or defining empirically testable indicators. Risjord (2019) states, middle-range theories can be better understood as a model and are intended to be abstract enough to extend beyond a given place, time, or population but specific enough and sufficiently close to empirical data to permit testing and generate distinctive questions for study or specific interventions for practice (p. 4). So, transitions theory provides an operational frame for health care providers to create empirically testable indicators or questionnaires for interventions that can be used as reference guidelines for patients. The only concern with this theory is that the information in the text and the information depicted in the model referred to should be congruent because otherwise, it remains unclear which information is right (Bohner, 2017) and will lack structural clarify.
References
Bohner, K. (2017). Theory Description, Critical Reflection, and Theory Evaluation of the Transitions Theory of Meleis et al according to Chinn and Kramer (2011). ANS. Advances in Nursing Science, 40(3), E1–E19. https://doi.org/10.1097/ANS.0000000000000152
Raudonis, B. M., & Acton, G. J. (1997). Theory-based nursing practice. Journal of Advanced Nursing, 26(1), 138-145. https://doi.org/10.1046/j.1365-2648.1997.1997026138.x
Risjord, M. (2019). Middle-range theories as models: New criteria for analysis and evaluation. Nursing Philosophy, 20(1). https://doi.org/10.1111/nup.12225
Smith, M. C. (2020). Nursing Theories and Nursing Practice (5th ed.). F. A. DAVIS.
Week 12 Discussion- Stephanie Savarese
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Patients don’t come to us in silos. Their health outcomes are shaped by a myriad of factors including their past experience, relationships, communities and their spirituality. The intersect of these factors is touched on in several nurse theories we’ve discussed in class as we think about more holistic ways to approach our care. Afaf Meleis’ Transitions Theory adds another element to consideration with a focus on how nurses can support patients, staff and families through transitional moments that shape how we all interact with the healthcare system (Smith, 2020). This theory is accessible with applications across many disciplines.
I particularly engaged with the importance Meleis’ places on caregivers in her examples of Transitions Theory and I can see the value of implementing this in practice. I have witnessed a scenario in acute care play out multiple times around death and dying whereby the dying patient, facing the loftiest type of transition, is able to come to a place of peace only to be rebutted by a caregiver who is not yet ready. Implementing Transition Theory as a nurse would prompt me to not only support the patient, but to also be there for the loved ones who face their own transitions from spouse to widow, child to mourner, etc. These role transitions of caregivers can “take a heavy toll” on their own health, a ripple effect no patient would want to leave behind after their passing (Smith, 2020). In this respect, caring for the caregiver isn’t separate from caring for the patient, it’s all one in the same.
Patients on prolonged mechanical ventilation (PMV) create caregiver transition moments with an elongated timespan. These situations, at their extreme, end up hospital board of ethics, or in some cases on main stream news media. Melies’ points about supporting and understanding caregivers (Smith, 2020) encourage us to look deeper and attempt to understand the transition needs of the caregivers in PMV situations. These caregivers carry an enormous burden and are tasked with making medical decisions that threaten their very identity. One of the few studies looking on the caregiver burden related to PMV found significant “restriction to almost all parts of life: career, finances, hobbies, and leisure” with many caregivers of these terminally ill patients hardly leaving the house at all (Liu, et al 2017). These caregivers need to be supported.
Unfortunately, the nurses best equipped to support caregivers often lack their own structures of support. This lack of nursing support is one of several challenges when implementing theory-based nursing in practice. Resources, time and money are often scant in healthcare administration. However, focusing on nursing theory is a refreshing shift away from the empirical thinking of medicine and a crucial shift that sets our nursing practice apart. Middle range theories, in particular Transitions Theory, can be applied to numerous situations across multiple settings, including patient care, academia and administration, making them ideal for institutions looking to bring nursing theory into their care delivery without disrupting the systems already in place (Bohner, 2017).
References
Bohner, K. (2017). Theory Description, Critical Reflection, and Theory Evaluation of the Transitions Theory of Meleis et al according to Chinn and Kramer (2011). ANS. Advances in Nursing Science, 40(3), E1–E19. https://doi-org.umasslowell.idm.oclc.org/10.1097/ANS.0000000000000152
Liu, Jui-Fang; Lu, Man-Chi; Fang, Tien-Pei; Yu, Hong-Ren; Lin, Hui-Ling; Fang, Der-Long (2017). Burden on caregivers of ventilator-dependent patients, Medicine: July 2017 – Volume 96 – Issue 27 – p e7396. doi: 10.1097/MD.0000000000007396
Smith, M. C. (2020). Nursing theories and nursing practice (5th ed.). F.A. Davis Company.
Transitions are an inevitable component of the human experience. The passage from one life experience to another is a complex situation which considers many components such as process, time span and perception. The Transitions Theory provides a framework for the experiences of individuals who are confronting, living with, and coping with an event or stage of growth and the development of new skills, goals, behaviors and functions (Smith, 2019). I believe the Transitions Theory would greatly apply to my practice setting. The patients I work with are constantly going through transitions. The greatest transition is going from the hospital back home. From our reading, we understand that how a person responds to change greatly affects their outcome. For my patients, it is of the utmost importance they become active participants in their care to avoid further complications and readmissions. The measurement of the degree of engagement in a change event as well as the action and intervention plans are a vital component of care management (Smith, 2019). I would be able to measure the degree of engagement through asking questions and evaluating the patient’s responses as well as through goal setting and evaluating the congruency of my actions with that of the patient’s. I could also assess the patient’s level of engagement by their follow-through with directions, their perception of information and the degree of involvement in all aspects of the transition process.
Utilizing theory-based practice requires a conscientious effort on the part of the nurse. Theories are central to scientific understanding as they articulate a comprehension that goes beyond the observed patterns and explains phenomena (Risjord, 2018). However, it is often difficult to use theory-based practice in the clinical setting. While research has shown that theory-guided interventions improve quality of life, self-efficacy, and self-care there are still many barriers and pitfalls to their use. In order to implement theory-based practice, there must be strong professional support. The clinicians should have the support of upper management to carry out these interventions as they may take longer to implement than standard interventions but yield better outcomes. This ties closely into ensuring there are adequate resources available to support this type of practice. Lastly, I believe there must be more emphasis placed on theory-based practice in all our educational programs. According to Hashemiparast et al., evidence has shown that students in clinical learning environments are often unable to match the theoretical content learned in classrooms with what they are doing in practice and consequently, they cannot provide the care competently for patients (2019). In order to close this gap, we must ensure our preceptors are properly trained and have the tools necessary to create a practice environment conducive to theory-based interventions.
Transitions Theory poses many benefits to the care of patients. In an ever-changing environment, transitions create a very vulnerable time. During these periods, patients may be more susceptible to the development of adverse health effects. As such, the Transitions Theory presents a way for nurses to inject interventions that will lead to positive outcomes. Not only does the Transitions Theory allow nurses to guide patients on their healthcare journeys, but it also permits the promotion of adaptation, allowing the patient to master the various demands of the processes and thus leads to a feeling of empowerment in the transition process (Bohner, 2017). The patient can then take what was learned and apply it to future situations, thus promoting a better quality of life.
References
Bohner, K. (2017). Theory Description, Critical Reflection, and Theory Evaluation of the Transitions Theory of Meleis et al according to Chinn and Kramer (2011). Advances in Nursing Science, 40(3), E1–E19. https://doi.org/10.1097/ans.0000000000000152
Hashemiparast, M., Negarandeh, R., & Theofanidis, D. (2019). Exploring the barriers of utilizing theoretical knowledge in clinical settings: A qualitative study. International Journal of Nursing Sciences, 6(4), 399–405. https://doi.org/10.1016/j.ijnss.2019.09.008
Risjord, M. (2018). Middle-range theories as models: New criteria for analysis and evaluation. Nursing Philosophy, 20(1), 1–10. https://doi.org/10.1111/nup.12225
Smith, M. C. (2019). Nursing Theories and Nursing Practice (Fifth ed.). F.A. Davis Company.
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