Engaged mothering: the transition to motherhood for a group of African American women

Resilient Mothering: An Application of Transitions Theory From Pregnancy to Motherhood Among Women Living With HIV in Western Kenya

Efficacious strategies can now prevent the transmission of HIV from mother to child. However, transmission rates remain unacceptably high, especially in sub-Saharan Africa. Understanding women's perinatal transitions can inform interventions to support adherence to preventive strategies. Therefore, we applied Transitions Theory in a longitudinal qualitative study to explore perinatal transitions among women living with HIV in western Kenya. We conducted in-depth interviews with 30 women living with HIV at 3 key time points and, using our findings, described the theory's concepts in terms of participants' experiences. We then proposed theory-based interventions that could support smooth transition processes and positive outcomes.

Transition to Motherhood of Mothers Receiving Continuity of Child-Rearing Support

Clarifying the transition to motherhood based on the experience of mothers receiving continuity of child-rearing support is expected to promote the transition, and enhance nursing support. This study clarifies the transition process by which mothers recognize and adapt to new roles with continuity of child-rearing support in Japan. Semi-structured interviews were conducted with 13 mothers who received continuity of child-rearing support. Directed content analysis based on Meleis’s Transition Theory was used to analyze the results and define a framework for analyzing the transition. A theoretical framework was identified based on the Transition Theory themes. Engagement in terms of proactive involvement in pregnancy, childbirth, and child-rearing was a transition property. Maintaining the mother’s well-being, building new relationships and connections, and reflecting on child-rearing in the community were transition conditions. For patterns of response, the process indicators comprised having a sense of connection with the community and reflecting on one’s child-rearing objectively. Increased readiness for child-rearing and identity re-shaping were outcome indicators. The results suggest that it is important to enhance mothers’ readiness for child-rearing for transition to motherhood, and to promote the reshaping of their identities through continuity of support from pregnancy to postpartum child-rearing.

Dimensions of Culture Care for Substance-Dependent African American Women

Substance abuse, now in epidemic proportions in many cultures, is of major concern nationally and transculturally. It is important for nurses and other health care providers working with an increasingly multiculturally diverse client population to understand the cultural implications of caring for clients with alcohol and drug dependence. The purpose of this ethnonursing research study was to discover meanings and expressions of care for substance-dependent African American women in the research context of an inner-city transitional home. A convenience sample of 12 key and 18 general participants was included in this study. The study was conceptualized within Leininger’s culture care theory. Ethnonursing techniques of participant observation and focused in-depth interviews were used to collect data. Results included four universal care themes discovered in this study. Gender/cultural-specific care needs in relation to social structure, ethnohistory, and cultural context were discovered to influence the women’s health/well-being as they moved through recovery.

State of the science: does the theory of maternal role attainment apply to African American motherhood?

INTRODUCTION

This article reviews the current state of knowledge of the theory of maternal role attainment (MRA) and its relevance in describing African American motherhood. EBSCOhost Research Databases that included PubMed, CINAHL plus, MEDLINE, PsycINFO, SCOPUS, and Web of Science were searched for journal articles that examined maternal identity and MRA. Keyword searches included maternal identity, maternal role attainment, becoming a mother, prenatal attachment, maternal-fetal attachment, and maternal-infant attachment. Inclusion criteria for this review were published journal articles of studies conducted in the United States, with a clear delineation of the theoretical framework of MRA. Journal articles that measured MRA among women with depression or medically fragile infants were excluded. Two hundred and twelve studies were reviewed; 25 studies, published between 1975 and 2007, met the inclusion criteria. Nine articles described the theory of MRA, 11 articles measured variables thought to influence MRA, and 6 articles described maternal-fetal attachment, a construct of MRA.

METHODS

Studies were reviewed, categorized, and analyzed to determine current knowledge of how the theory of MRA describes African American motherhood. Categories included studies describing the theoretical framework of maternal identity and MRA, studies measuring key variables thought to impact MRA, and studies measuring maternal-fetal attachment and maternal-infant attachment.

RESULTS

The studies were limited by homogenous samples of upper-middle-class white women and low-income, single, African American adolescents. Study results of MRA cannot be generalized to African American women.

DISCUSSION

Further research is essential to identify attributes influencing MRA, specifically among larger samples of African American women with demographics similar to that of the white populations that have been included in studies thus far.

Stressors, resources, and stress responses in pregnant African American women: a mixed-methods pilot study

This research aimed to develop an initial understanding of the stressors, stress responses, and personal resources that impact African American women during pregnancy, potentially leading to preterm birth. Guided by the ecological model, a prospective, mixed-methods, complementarity design was used with 11 pregnant women and 8 of their significant others. Our integrated analysis of quantitative and qualitative data revealed 2 types of stress responses: high stress responses (7 women) and low stress responses (4 women). Patterns of stress responses were seen in psychological stress and cervical remodeling (attenuation or cervical length). All women in the high stress responses group had high depression and/or low psychological well-being and abnormal cervical remodeling at one or both data collection times. All but 1 woman had at least 3 sources of stress (racial, neighborhood, financial, or network). In contrast, 3 of the 4 women in the low stress responses group had only 2 sources of stress (racial, neighborhood, financial, or network) and 1 had none; these women also reported higher perceived support. The findings demonstrate the importance of periodically assessing stress in African American women during pregnancy, particularly related to their support network as well as the positive supports they receive.

Access to Maternity Services for Women With a Physical Disability: A Systematic Review of the Literature

BACKGROUND:Women with a disability are one of the most disadvantaged groups in society.

OBJECTIVE:To identify challenges and facilitators to accessing maternity services experienced by women with a physical disability during pregnancy, childbirth, and early motherhood.

DESIGN:Literature review.

FINDINGS:Challenges to accessibility included location and models of care, transport difficulties, and moving around the environment. Challenges to accommodation (health professionals’ adaptation to women’s needs) centered on lack of suitable health and parent education information. Challenges to acceptability were caused by poor knowledge and negative staff attitudes.

IMPLICATIONS FOR PRACTICE:Improving access to maternity services for women with a disability requires improved access to buildings, provision of sensitive antenatal classes, and development of health professionals’ knowledge and attitudes toward disability and pregnancy.

Primigravid and multigravid women: prenatal perspectives

A paucity of prenatal data is available concerning prenatal experiences of primigravid women compared with those of multigravid women. Therefore, the objectives of this study were twofold: to compare prenatal personal (demographic and other descriptive elements, including self-esteem) and psychosocial variables (maternal-fetal attachment, marital satisfaction) and to describe perceived pregnancy experiences for both primigravid and multigravid women. Both quantitative and qualitative data were collected using a descriptive mixed-methods design. The data were part of a larger, longitudinal study focused on adjustment to parenthood in military and civilian couples. Married pregnant women who resided on the east and west coasts of the United States were recruited from prenatal care facilities. Participants included 50 pregnant primigravid and 50 multigravid married women recruited during the last trimester of a healthy, uncomplicated pregnancy. The main outcome measures included personal and psychosocial variables (demographics, self-esteem, maternal-fetal attachment, marital satisfaction) and perceived pregnancy experiences. Multigravid women had significantly lower levels of maternal-fetal attachment (p < .00) and marital satisfaction (p < .00) than did primigravid women during their third trimester of pregnancy. The pregnant women's responses clearly reveal that unique and distinct differences exist between the needs of primigravid women and those of multigravid women. Innovative prenatal educational interventions tailored to meet the distinct needs of primigravid and multigravid women are suggested.

African American Women's Preparation for Childbirth From the Perspective of African American Health-Care Providers

Preparation for birthing has focused primarily on Caucasian women. No studies have explored African American women's birth preparation. From the perceptions of 12 African American maternity health-care providers, this study elicited perceptions of the ways in which pregnant African American women prepare for childbirth. Focus group participants answered seven semistructured questions. Four themes emerged: connecting with nurturers, traversing an unresponsive system, the need to be strong, and childbirth classes not a priority. Recommendations for nurses and childbirth educators include: (a) self-awareness of attitudes toward African Americans, (b) empowering of clients for birthing, (c) recognition of the role that pregnant women's mothers play, (d) tailoring of childbirth classes for African American women, and (e) research on how racism influences pregnant African American women's preparation for birthing.

Clinically identified postpartum depression in Asian American mothers

OBJECTIVE

To identify the clinical diagnosis rate of postpartum depression (PPD) in Asian American subgroups (Asian Indian, Chinese, Filipino, Japanese, Korean, Vietnamese) compared to non-Hispanic Whites.

DESIGN

Cross-sectional study using electronic health records (EHR).

SETTING

A large, outpatient, multiservice clinic in Northern California.

PARTICIPANTS

A diverse clinical population of non-Hispanic White (N = 4582), Asian Indian (N = 1264), Chinese (N = 1160), Filipino (N = 347), Japanese (N = 124), Korean (N = 183), and Vietnamese (N = 147) mothers.

METHODS

Cases of PPD were identified from EHRs using physician diagnosis codes, medication usage, and age standardized for comparison. The relationship between PPD and other demographic variables (race/ethnicity, maternal age, delivery type, marital status, and infant gender) were examined in a multivariate logistic regression model.

RESULTS

The PPD diagnosis rate for all Asian American mothers in aggregate was significantly lower than the diagnosis rate in non-Hispanic White mothers. Moreover, of the six Asian American subgroups, PPD diagnosis rates for Asian Indian, Chinese, and Filipino mothers were significantly lower than non-Hispanic White mothers. In multivariate analyses, race/ethnicity, age, and cesarean were significant predictors of PPD.

CONCLUSION

In this insured population, PPD diagnosis rates were lower among Asian Americans, with variability in rates across the individual Asian American subgroups. It is unclear whether these lower rates are due to underreporting, underdiagnosis, or underutilization of mental health care in this setting.

The relationships of social support, uncertainty, self-efficacy, and commitment to prenatal psychosocial adaptation

AIMS

To report a study of the relations of prenatal psychosocial adaptation, social support, demographic and obstetric characteristics, uncertainty, information-seeking behaviour, motherhood normalization, self-efficacy, and commitment to pregnancy.

BACKGROUND

Prenatal psychosocial assessment is recommended to identify psychosocial risk factors early to prevent psychiatric morbidities of mothers and children. However, knowledge on psychosocial adaptation and its explanatory variables is inconclusive.

DESIGN

This study was non-experimental, with a cross-sectional, correlational, prospective design.

METHODS

The study investigated Hong Kong Chinese women during late pregnancy. Convenience sampling methods were used, with 550 women recruited from the low-risk clinics of three public hospitals. Data was collected between January-April 2007. A self-reported questionnaire was used, consisting of a number of measurements derived from an integrated framework of the Life Transition Theory and Theory of Uncertainty in Illness. Explanatory variables of psychosocial adaptation were identified using a structural equation modelling programme.

RESULTS

The four explanatory variables of the psychosocial adaptation were social support, uncertainty, self-efficacy, and commitment to pregnancy. In the established model, which had good fit indices, greater psychosocial adaptation was associated with higher social support, higher self-efficacy, higher commitment to pregnancy, and lower uncertainty.

CONCLUSION

The findings give clinicians and midwives guidance in the aspects to focus on when providing psychosocial assessment in routine prenatal screening. Since there are insufficient reliable screening tools to assist that assessment, midwives should receive adequate training, and effective screening instruments have to be identified. The explanatory role of uncertainty found in this study should encourage inquiries into the relationship between uncertainty and psychosocial adaptation in pregnancy.

[Life transition of mothers of children with autism]

PURPOSE

While there are a number of studies on children with disabilities, there have been few studies on mothers of children with autism. The purpose of this study was to explore the process of life transition of mothers who have children with autism.

METHODS

From June 2007 to May 2009, the researcher interviewed 15 mothers of children with autism living in Seoul City, Gyeonggi or Chonbuk Provinces, and then analyzed the data gathered using the constant comparative method of grounded theory.

RESULTS

"Living together holding a string of fate" was a core category showing along the continuum of life. The basic social process of life transition encompassed 5 stages: stages of denying, wandering, devoting, mind controlling, and finally accepting. These five stages proceeded in phases, though returned back to the wandering stage occasionally.

CONCLUSION

This study has opened the door to understanding how mothers of children with autism experienced life transition. The findings suggest that differentiated support and care at each stage should be given and there is the need to develop transition assessment tools for mothers of children with autism.

The concept of motherhood among three generations of African American women

PURPOSE

To provide an understanding of the experiences of three generations of African American women in the transition to motherhood.

DESIGN AND METHODS

Hermeneutic phenomenology from an Afrocentric feminist perspective is the methodological approach used in this study. Using the snowball technique, a purposive sample of 18 African American women from three generations who were mostly middle class, partnered, and educated was recruited. Individual open-ended interviews were used to identify information-rich cases that would provide an in-depth understanding of the phenomenon. Generation 1 included seven women, between the ages of 65 and 83 years, who became mothers between 1950 and 1970, prior to the Civil Rights Movement. Generation 2 included five women, between the ages of 51 and 58 years, who became mothers between 1971 and 1990, after the Civil Rights Movement. There were six women in Generation 3, between the ages of 30 and 41 years, who became mothers between 1991 and 2003.

FINDINGS

Three constitutive patterns and their associated themes were identified. The first pattern, It Took Me a Minute, had three themes: Finding Out, Realizing What Mothers Do, and Way Tricked! The second pattern, Preserving Our Home, had four themes: Mothering Within the isms: Racism, Classism, and Sexism, I Did the Best I Could, Mothers and Others, and Spiritual Mothers. Eat the Meat, Throw Away the Bone, the third pattern, had two themes: The Ways in Which We Learn and Someone Who Looks Like Me.

CONCLUSIONS

The results of this study reveal some consistency with current descriptions of maternal identity and becoming a mother and add to our understanding of the complexities that racism, classism, and sexism play in the lives of African American mothers and their families. The data from this study also suggest that future development of theoretical frameworks and analytical tools, used to assess the effects of stress and other psychosocial factors on health, need to be grounded in a historic understanding of the African American experience and of the African influence on family and cultural knowledge. Additionally, this study demonstrated the impact that the media, both professional and mass media outlets, have in defining and perpetuating our beliefs and feelings of the "good mother-bad mother" dualism. The description of motherhood for this group of African American women illustrates that motherhood is a source of power and provides significant meaning, satisfaction, and respect within the family and the larger community. It also highlighted the communal role that "othermothers" and spiritual mothers have in facilitating the transition to motherhood and providing strong social support.

CLINICAL RELEVANCE

Analysis of the stories in this study adds to the current literature on becoming a mother and Black feminist descriptions of motherhood. This study adds to our understanding of how negative portrayals of African American mothers and the lack of representation in the media perpetuate negative stereotypes of African American motherhood. The stories, told by the 18 women in this study, provide a positive description of African American motherhood.

Maternal identity negotiations among low-income women with symptoms of postpartum depression

In this study, we used a constructivist grounded theory approach to explore maternal identity negotiations among low-income ethnic minority mothers with postpartum depression (PPD) symptoms. Nineteen mothers were recruited from Women, Infant, and Children clinics located in two coastal cities in the United States to participate in in-depth interviews. Constant comparative analysis revealed that mothers experienced their PPD symptoms and poverty as evidence of maternal failure, but also drew on discourses of maternal self-sacrifice, engagement with their children, and pleasure in mothering to construct a positive sense of self. To negotiate these conflicting versions of self, mothers positively appraised their own mothering in relation to stigmatized "others" and framed their depression as a foreign entity, one that stood outside of a core, authentic sense of self. Through our consideration of the intersecting contexts of poverty and postpartum depressive symptoms, this article adds to the literature on PPD and mothering.

Voices from the battlefield: reports of the daily experiences of urban Black mothers

There are persistent disparities in maternal child health in the United States. In this study I used an ethnographic design to portray the everyday lives of 130 Black, low-income, urban mothers. The women described daily battles related to a lack of material and human resources. To deal with these challenges, they assumed the role of soldiers, developed new tactical maneuvers, trusted in God for justice, shared their resources with their comrades, took short-lived breaks when they were wounded in action, and used escape mechanisms. Public health interventions are needed to deal with infrastructural deficits and support the women's defenses.

Contemporary Mothering in a Diverse Society

The contextual and environmental factors that may affect mothering and perceptions of the maternal role in today's increasingly diverse society are described. Following a historical overview of the development of maternal role theory within the nursing literature, the influence of images and myths in Western society, race/ethnicity, cultural background, and employment status are discussed. Guidelines for nursing interventions that allow for individual and cultural differences are provided.

Transition: a literature review

AIM

This paper reports a comprehensive literature review exploring how the term 'transition' has been used in the health literature.

BACKGROUND

The meaning of transition has varied with the context in which the term has been used. The last 3 decades have seen altered understandings in the concept of transition in the social science and health disciplines, with nurses contributing to more recent understandings of the transition process as it relates to life and health.

METHOD

The CINAHL, Medline, Sociofile and Psychlit databases were accessed and papers published between 1994 and 2004 were retrieved to answer the questions 'How is the word transition used?' and 'What is the concept of transition informing?' Transition theoretical frameworks were also explored.

FINDINGS

Widespread use of the word 'transition' suggests that it is an important concept. Transitional definitions alter according to the disciplinary focus, but most agree that transition involves people's responses during a passage of change. Transition occurs over time and entails change and adaptation, for example developmental, personal, relational, situational, societal or environmental change, but not all change engages transition. Reconstruction of a valued self-identity is essential to transition. Time is an essential element in transition and therefore longitudinal studies are required to explore the initial phase, midcourse experience and outcome of the transition experience.

CONCLUSION

Transition is the way people respond to change over time. People undergo transition when they need to adapt to new situations or circumstances in order to incorporate the change event into their lives. Transition is a concept that is important to nursing; however, to further develop understandings, research must extend beyond single events or single responses. Longitudinal comparative and longitudinal cross-sectional inquiries are required to further develop the concept.

Meleis's theory of nursing transitions and relatives' experiences of nursing home entry

AIM

This paper explores the extent to which Meleis's mid-range theory of nursing transitions is supported by the findings of a study exploring relatives' experiences of the move to a nursing home.

BACKGROUND

Mid-range nursing theories are useful tools in helping to understand the scope of nursing practice in a range of contexts and situations. However, as yet, many formal mid-range theories have not been adequately tested.

METHODS

Findings from a constructivist study of relatives' experiences of nursing home entry were re-analysed in relation to the extent to which they reflected the domains of the theory of nursing transitions. Data for the original study were generated during 37 qualitative interviews involving 48 close family members of older people who had recently moved to a nursing home, and in observational case studies in three nursing homes.

FINDINGS

All domains of the theory of nursing transition were supported by the data generated within the study. However, the model failed to represent adequately the interactive and dynamic nature of relationships between formal and informal caregivers in the nursing home context.

CONCLUSIONS

The theory of nursing transitions has the potential to assist nurses in identifying appropriate strategies for supporting relatives throughout the period of an older person's relocation to a nursing home. However, in order to reflect fully the experiences of relatives at this time, the theory requires adjustment to recognize the contribution made by relatives themselves to positive outcomes. This therefore raises questions as to whether the relative absence of this reciprocal and interactive dimension is an element of Meleis's theory that requires further exploration in relation to other forms of transition.

Assessing mothers' concerns in the postpartum period: methodological issues

AIM

This paper reports a study evaluating the sensitivity of a semi-structured interview schedule and card sort methods in assessing postpartum concerns of women.

BACKGROUND

Several methods have been used to assess postpartum maternal concerns and the process of becoming a mother, but few studies have evaluated the methods with respect to their sensitivity for obtaining information.

METHOD

A cohort of mothers was followed-up at one (n = 110) and 6 weeks (n = 83) after childbirth in Dar es Salaam, Tanzania. Women with a minimum of 7 years of primary education were interviewed and they also sorted cards. Those with less fewer than 7 years of primary education were interviewed only. The methods were used in alternate order to assess method interaction.

RESULTS

In the interviews at 1 week, mothers more often expressed worry and interest related to the baby or themselves when they had sorted cards first. The extent to which women expressed worry and interest about specific baby- and mother-related topics was generally higher for women who had sorted cards before the interview at both 1 and 6 weeks. Independent of whether they were interviewed only, interviewed after sorting cards or before, mothers more often expressed a higher degree of interest than of worry about the baby and self at both 1 and 6 weeks. The order of the data collection methods did not influence the way women sorted cards as being worries and interests.

CONCLUSION

Compared to interview using a semi-structured interview schedule, our findings suggest that the card sort is more sensitive in obtaining information about women's concerns. Although the interview method has the advantage of reaching less educated people, the card sort is a technique that is associated with fewer barriers and is a more participatory method for those who can use it.

Making Meaning: Women’s Birth Narratives

Birth stories are personal narratives grounded in the pivotal life experience of giving birth. Richly descriptive birth narratives from culturally diverse childbearing women document the importance of listening to the voices of women. Benefits of sharing birth stories include the opportunity for integration of a major event into the framework of a mother's life; the opportunity to share a significant life experience; the opportunity to discuss fears, concerns, "missing pieces" or feelings of inadequacy or disappointment; the opportunity for the woman to gain an understanding of her strengths; and the opportunity to connect with other women. Providing women with the opportunity to share their birth stories is an important nursing intervention.

Transition to motherhood

OBJECTIVE

To synthesize the results of nine qualitative studies related to the transition to motherhood, using Noblit and Hare's method of meta-synthesis development.

DATA SOURCES

CINAHL, MEDLINE, PsycINFO, Sociological Abstracts, and Dissertation Abstracts, using the keywords transition, adaptation, motherhood, and mother.

STUDY SELECTION

Studies were evaluated for inclusion related to study focus and comparability of findings. Nine studies were included in the final sample, four using a grounded theory methodology and five using either a phenomenologic or phenomenologic/hermeneutic method.

DATA EXTRACTION

A series of overlapping, repeating steps as outlined by Noblit and Hare were followed in conducting this meta-synthesis. Detailed tables of metaphors, themes, concepts, and phrases from each study were constructed and studies were compared by means of reciprocal translations.

DATA SYNTHESIS

Two processes inherent in maternal transition emerged: engagement and growth and transformation. In addition, five thematic categories signifying areas of disruption present in the maternal transition and 13 underlying themes were revealed.

CONCLUSIONS

To facilitate maternal transition, nurses must remain sensitive to the maternal insecurity of primiparae and encourage their maximum maternal engagement, particularly during periods of forced mother-infant separation such as the newborn's admission to the intensive-care unit. In addition, prenatal discussion of realistic expectations for the transitional period, ongoing support through the first 6 months postpartum, and the use of role models should be integrated into postpartum support programs to assist mothers in negotiating typical areas of disruption during maternal transition.

African American women describe support processes during high-risk pregnancy and postpartum

OBJECTIVE

To explore social support processes in low-income African American women during high-risk pregnancy and postpartum.

DESIGN

A qualitative grounded theory approach. Interview was the primary data collection technique and was combined with observation, medical chart review, and literature review.

SETTING

A high-risk pregnancy clinic and participants' homes.

PARTICIPANTS

Ten pregnant women, 3 social network members, and 11 health care providers. Four of the women at high risk tell their in-depth stories in this article: Yolanda, coping with gestational diabetes; Frances, participating in drug rehabilitation; Trista, waiting to deliver a fetus with severe congenital anomalies; and Beatrice, HIV positive and carrying her seventh child.

RESULTS

The substantive theory of support developed in the study was termed mutual intentionality. Narratives illustrate the mutual roles that women at high risk and support givers played in the helping process. Support themes included being there, caring, respecting, sharing information, knowing, believing in, and doing for the other.

CONCLUSION

The theorsy of mutual intentionality suggests that social support is a process or transaction involving intentionality. For support to happen, the therapeutic relationship must be valued as a mutual resource.

Developing a theoretical framework on postpartum care from Tanzanian midwives' views on their role

OBJECTIVES

to describe a theoretical framework developed from the views of midwives in relation to provision of systematic postpartum care.

DESIGN

qualitative focus group study using grounded theory approach.

SETTING

Dar es Salaam, Tanzania.

PARTICIPANTS

49 nurse-midwives in five focus group discussions each having 9-11 participants.

FINDINGS

the components of the Basic Social Process of 'Becoming a good resource and support person for the postpartum woman' consisted of 'reflection' as an entry point into the process. Integration, networking, balancing, and dealing with reality, emerged as categories related to process activities. The category of 'defining abilities' required that midwives become aware of their competency and their limitations in reflection and all process activities, so that improvement can be part of 'getting ready', a category that describes what needs to be done at individual and health system level to prepare for systematic postpartum care programmes. The 'caring' category was linked to an outcome of the process 'doing things in the right way', which means providing quality postpartum care. The conditional matrix shows the midwife as an individual affected by several micro and macro conditions.

CONCLUSIONS

the proposed theoretical framework can be used in understanding the dynamics of work situations and in assisting midwives to achieve the goal of being good resource and support persons for postpartum women. Interventions for midwives should focus on the major components of the framework but also on the concepts that relate the proposed framework to other central concepts in midwifery and nursing, issues in the theory-practice gap, empowerment, political awareness, involvement in policy making, decision making and dealing with job stress.

Experiencing transitions: an emerging middle-range theory

Changes in health and illness of individuals create a process of transition, and clients in transition tend to be more vulnerable to risks that may in turn affect their health. Uncovering these risks may be enhanced by understanding the transition process. As a central concept of nursing, transition has been analyzed, its components identified, and a framework to articulate and to reflect the relationship between these components has been defined. In this article, the previous conceptual analysis of transitions is extended and refined by drawing on the results of five different research studies that have examined transitions using an integrative approach to theory development. The emerging middle-range theory of transitions consists of types and patterns of transitions, properties of transition experiences, facilitating and inhibiting conditions, process indicators, outcome indicators, and nursing therapeutics. The diversity, complexity, and multiple dimensionality of transition experiences need to be further explored and incorporated in future research and nursing practice related to transitions.