Paulo António Ávila do Couto Rocha
Meleis‘ Transitions Theory gives a plan and means to understand, communicate and interpret what families experience when facing changes that affect their wellbeing. Meleis provides structure to evaluate the nature of disconnections from valuable relationships in the family, and changes in their daily life routines (Meleis, 2010). These changes require an adjustment process, recalibration and development of new abilities and skills to respond to the new demands imposed by change. Nurses are in the center of those changes and in the process of transition.
Communication represents the base and the foundation of a nurse-family relationship in the ICU, sharing feelings and perceptions as well as providing clarification, interaction and knowledge. Here is an example of this kind of situation:
Another busy afternoon in the unit! Mid-shift we admitted a young patient, victim of a car accident, already brain dead. After stabilizing the patient and as an integral part of the process, it’s time to call the family members who do not yet know the severity of the situation. In that moment I questioned myself: do I have what it takes o receive this family member? I felt emotionally fragile.
My priority was family support, so all I had to do was face it firmly and make myself available to listen in an active and intimate manner. I was able to establish a therapeutic relationship and give the support that family member needed and that only I could give. For a few moments I felt my legs shaking and inside I was crying for that father’s pain.
It is experiences like these that put us to the test as nurses, experiences that make us stronger and that show those who need us that this is our mission, and that we are there for them no matter what. Intensive Care Unit admission is an unexpected event that leads to several changes to the patient as well as the family. When a person is admitted to the ICU in a critical state, it is fundamental that the nurse involves the family as the focus of care, identifying and fully understanding what they are experiencing, and establishing a therapeutic relationship based on effective communication — above all being available to provide the help they need in going through this experience.
This sudden change in their family may cause alterations in the family life cycle, with role changing and calling forth an adapting process. Faced with this reality it becomes essential the intensive care unit nurse to understand the uniqueness of each family, identify their true needs and help mobilize coping strategies, to better adjust to this new phase in their lives. The family should be considered as continuity of the patient, also in need of care that will minimize their anxiety, discomfort and insecurity so that they can give back the support their hospitalized family member needs. This requires thinking about nursing in logical, ethical and holistic perspectives and implies recognizing the importance of communication in the scope of the therapeutic relationship established with the patient’s family.
I see the knowledge of human transitions as increasingly key to nursing. Meleis and her colleagues (2000) view nurses as the main caregivers for patients and their families and that our care is based on understanding the transition processes that they are experiencing — watching things change and the demands transitions make in their lives, helping them prepare for imminent transitions and facilitating the skills learning process. Understanding the properties and conditions inherent to a transition process will help develop nursing interventions that result in positive outcomes.
The assumptions that accompany nursing care strategies for a patient in transition are based on understanding the transition from the perspective of those who are experiencing the transition, and identifying the needs for care with that support their transition. It is also necessary to consider the factors that intervene in transition processes, individual, environmental and nursing interventions that include prevention and intervention strategies throughout the event. (Meleis and colleagues, 2000).
Nursing intervention must be as focused on facilitating the transition process and promoting the patient’s wellbeing.
Based on Meleis’ Transitions Theory, one of the main objectives of nursing care in the ICU is understanding the condition of the critical patient’s family. This includes identifying the family needs by communication with them, using communication strategies that promote their adjustment to the health condition of their family member, and making the best use of the therapeutic relationship established with the family. It becomes fundamental to humanize the nursing care through communication with family with the intention to minimize the negative effects from the hospital admission. In this respect, the focus of nursing care given to a transition family on ICU is grounded in caring, giving support, encourage the family to use their own coping mechanisms and create the environment for a healthy transition. And always considering the person and family are changing as holistic and integral beings.
Meleis, A. I., Sawyer, L. M., Im, E.-O., Messias, D. K. H., & Schumacher, K. (2000). Experiencing Transitions: An Emerging Middle-Range Theory. ANS. Advances in Nursing Science, 23, 12–28.
Meleis, A. I. (2010). Transitions Theory: Middle Range and Situation Specific Theories in Nursing Research and Practice. Springer Publishing Company.
About Paulo António Ávila do Couto Rocha
I have been a nurse for almost 11 years, the past 6 years of my career have been in the Intensive Care Unit of Hospital do Santo Espírito da Ilha Terceira (HSEIT), being this my preferred field, this is where I feel professionally fulfilled as a nurse. I developed this Post in the scope of Teorias de Enfermagem, from my master’s degree in Enfermagem Médico-cirúrgica: Patient in critical situation, at Instituto de Ciências da Saúde da Universidade Católica Portuguesa (Lisboa), under the educational guidance of Professor Zaida Charepe.