Advanced practice nurses subscribe to the ethical principle of beneficence because they must offer the kind of care, which benefits patients. Such a requirement calls for the application of evidence-based theoretical approaches, with Afaf’s transitions theory emerging as one of the preferred models. It is a broad theory, which identifies the fact that change defines all aspects of human life. The philosopher continues to note that people experience and respond to change positively and negatively based on the nature of such change. There are situational, health, illness, developmental, and environmental change triggers, each with a different set of effects. Applying this theory requires nurses to identify such triggers and offer the kind of care, which is patient-centered. The approach also recognizes the need to extend material resources while providing firm support systems. It is particularly applicable in psychiatric care because patients grapple with various forms of change, especially when they shift environments from psychiatric care facilities to the community. Key Words: Transitions theory, mental health, advanced practice nurses, change Transitions Theory by Afaf MeleisIntroductionAfaf’s transitions theory of nursing details the challenges associated with change, informed by the numerous critical events, which underscore the need to the required change. Health systems, families, and individual patients encounter various types of change, which prompt the development of coping processes and strategies. Transition experiences start before an event, with an endpoint, which varies depending on multiple variables. Utilization of the transitions theory facilitates the development of many responses to change. It is one of the approaches, which promote well-being and good health before, during, and at the end of a particular change event. It offers a framework for generating research questions meant to facilitate effective care in the process of transitions. Afaf’s transitions theory evolved from research in clinical practice, triggered by role insufficiency and the need for role supplementation in the nursing field. Analysis of the TheoryOverview of the Theory The theory is made up of two significant parts whereby the first section addresses interventions meant to facilitate seamless transition while promoting the well-being of individuals. The section highlights various conceptually supporting systems, including a caring team of experienced advanced practice nurses who must work in collaboration with the patients’ significant others. The goals of therapy, as stated in the part of this theory, include the clarification of what patients experience and what they may experience henceforth (Dennis & Long 2018). Such purposes provide the skills, knowledge, tangible psychological competencies, and strategies which aid in dealing with transition experiences. The theory’s second phase is the most essential because it insists on the need to understand the transition experiences. The framework defines transition as the process of shifting from one state to the next. According to Dennis and Long (2018), the responses and experiences which define people in the process depend on whether the transition triggers are good health, illnesses, organizational changes, situational changes, or developmental changes. The experiences also rely on a person’s state in life, including the nature of support systems available. Similarly, various factors improve people’s responses to change, and these include disruptions, discontinuity, levels of awareness, available capabilities and skills, and lack of support. Afaf insists that the goal of any intervention applying this framework is to develop a good transition process and ensure that patients exhibit meaningful outcome responses. Interventions vary from the provision of expertise to the identification of various coping milestones, provision of resources, debriefing, and the extension of rehearsal opportunities. The theory is widely applicable because it meets the major nursing goals. Researchers identify the primary nursing objective as the preparation of individuals and families to encounter situational, health, and developmental transitions (Lindgren, Söderberg, & Skär, 2014). Another goal is to ensure that patients cope with the health and environmental changes which they face, explaining why the theory is widely recognized in the profession.AnalysisAfaf’s model is built on the premise that an understanding of the transition process enhances the potential of advanced practice nurses to support emerging life patterns and prevent anxiety among patients. It is a profession that is defined by dynamic societies and systems, with the implication that effective therapeutics depends on the nurses’ ability to transform (Meleis, 2015). Identifying transition as a significant concern allows nurses to come up with coherent treatment frameworks. Such an admission also forms the impetus for understanding how different populations experience and cope with changes brought along by health-illness consequences (Meleis, 2015). The framework simulates theoretical thinking, research programs, and intervention models, rendering it essential in the field. It also contributes meaningfully to scientific research since it allows researchers to ask systematic and more coherent questions, which would enable upcoming nurses to pursue the development of other ingenious theories.Afaf states that transitions are complementary, underscored by role loss, role acquisition, or the simultaneous loss of one role while gaining another. According to Malley et al. (2015), role acquisition appears in the form of transition from dyadic to triadic constellations. A typical example entails the birth of a baby, whereby parents are introduced to new roles. Role loss appears whenever there is a loss of a loved one or some property that is dear to an individual. Simultaneous role loss and acquisition take numerous shapes, including expectant mothers losing their first child after undergoing a hysterectomy (Malley et al., 2015). Applying the theory in helping such people to deal with the transition takes numerous shapes, but the primary goal is to ensure that individuals have the required coping strategies. Evaluation of the TheoryThe Philosophical Foundation of the Theory is Congruent with Psychiatric Mental Health Nursing Roles The philosophical foundations of Afaf’s theory render it applicable to psychiatric mental health nursing roles. Young persons with severe psychiatric illnesses particularly undergo numerous transitions, making this theory helpful. As they grow older, for example, it is essential to transfer them from the care of adolescent and child psychiatry nurses to adult psychiatry nurses (Lindgren, Söderberg, & Skär, 2014). The growth period is a process within which they undergo numerous transitions developmentally as well, and the application of this theory becomes inevitable because it provides nurses with the foundation for offering the necessary transition resources. Afaf’s theory also adopts the Recovery Care Model, which insists on the need for patients to own up to their feelings, attitudes, roles, skills, and the entire recovery process. It enhances the theory’s applicability within the inpatient psychiatric unit because most of the patients in these facilities must move to their respective communities at some point (Dennis & Long, 2018). Applying this theory, therefore, patients must develop the skills and attitudes needed to transition smoothly from the inpatient care units to the community without necessarily experiencing severe psychological disturbances.The Congruent of the Goals of the theory and the Goals of my Chosen Advanced Nursing Practice RoleThe goals of the theory and those of my chosen advanced nursing practice role are congruent. The theory focuses on the identification of potential problems associated with change and the preparation of patients to cope with such changes. It also aims at preparing patients to respond to change with the right attitude, and such goals are congruent to provide psychiatric care (Meleis, 2015). Patients undergo numerous situational, environmental, health, and developmental changes. Whenever they take psychiatric medications, for example, there is a possibility of significant mental health disruption, and this change in health requires elaborate coping strategies. Just like the theoretical framework, which puts the interests of the patient first, prioritizing their needs in a bid to ensure that they experience the best outcomes.The Existence Research Evidence to Support the Usefulness of the TheoryThere is research evidence supporting the application of Afaf’s theory in the field of psychiatric care. Research conducted in the United States proves that the number of psychiatric care beds continues to decline since 1995 (Malley et al., 2015). However, the number of patients frequenting the psychiatric care section keeps growing. The plausible explanation for this is the reducing number of hours spent in admission because nurses learned the need to apply the theory of transitions. Clinicians continue to realize the need for an elaborate Rapid Recovery Care Model, an aspect that improves healthcare provision quality in the psychiatric care sector.How the Application of the Theory Support my Nursing PracticeThe application of the Afaf’s theory in my nursing practice will in many ways assist me with regards to making rational and appropriate decision that would lead to the betterment of my nursing delivery services to the patients. More importantly, in applying similar philosophical thinking in my nursing practice, it is essential to liaise with patient’s families and other social support systems. This action would help in providing the kind of care that is comprehensive and geared towards minimizing adverse psychological experiences. Application of the TheoryDiverse populations have different coping strategies whenever faced with transitions, but the transitions theory takes into account all their preferences. Applying this theory to the management of schizophrenia in psychiatric wards requires attention to the recovery care model in treatment planning. It is imperative to put in place modalities for cross-professional care involving psychiatrists, advanced practice nurses, social workers, and community support organizations (Meleis, 2015). Applying the theory also requires the inclusion of various strategies meant to ensure that treatment planning includes proper transition to the community. While dealing with schizophrenic patients, some populations will require interior house redesign to allow more daylight, enhance privacy, and provide security. In societies where collectivism is exercised, however, privacy may not suffice, a reason why family members will be sensitized to offer the emotional and material support that the patients need.SummaryConclusively, Afaf’s transitions theory is a robust framework that helps advanced practice nurses in developing treatment plans which take into account the adverse effects associated with change. It enables patients to gain knowledge and resources for coping and responding to change healthily. Its main emphasis is on the primary goal of offering patient-centered care and ensuring that there is inter-professional support for the patients. The theory also identifies various change triggers, which range from developmental changes to health and illness-related factors. Practitioners must determine the effects of these triggers as a means of devising appropriate treatment plans.
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