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.

Transition is a concept of interest to nurse researchers, clinicians, and theorists. This article builds on earlier theoretical work on transitions by providing evidence from the nursing literature. A review and synthesis of the nursing literature (1986-1992) supports the claim of the centrality of transitions in nursing. Universal properties of transitions are process, direction, and change in fundamental life patterns. At the individual and family levels, changes occurring in identities, roles, relationships, abilities, and patterns of behavior constitute transitions. At the organizational level, transitional change is that occurring in structure, function, or dynamics. Conditions that may influence the quality of the transition experience and the consequences of transitions are meanings, expectations, level of knowledge and skill, environment, level of planning, and emotional and physical well-being. Indicators of successful transitions are subjective well-being, role mastery, and the well-being of relationships. Three types of nursing therapeutics are discussed. A framework for further work is described.

Objective The decade from 2000–2010 was an era of tremendous growth in family caregiving research specific to the cancer population. This research has implications for how cancer family caregiving is conceptualized, yet the most recent comprehensive model of cancer family caregiving was published ten years ago. Our objective was to develop an updated and expanded comprehensive model of the cancer family caregiving experience, derived from concepts and variables used in research during past ten years. Methods A conceptual model was developed based on cancer family caregiving research published from 2000–2010. Results Our updated and expanded model has three main elements: 1) the stress process, 2) contextual factors, and 3) the cancer trajectory. Emerging ways of conceptualizing the relationships between and within model elements are addressed, as well as an emerging focus on caregiver-patient dyads as the unit of analysis. Conclusions Cancer family caregiving research has grown dramatically since 2000 resulting in a greatly expanded conceptual landscape. This updated and expanded model of the cancer family caregiving experience synthesizes the conceptual implications of an international body of work and demonstrates tremendous progress in how cancer family caregiving research is conceptualized.

The use of a psychoeducational intervention that incorporates nurse coaching within the framework of self-care can improve the management of cancer pain.

A high percentage of FCs experienced clinically meaningful levels of a variety of symptoms. These symptoms have a negative impact on the FCs' functional status and QOL.

Themes were identified that reveal experiences of living with recurrent symptomatic AF over time and how AF may diminish QOL. Themes included (1) finding the meaning of symptoms, (2) feeling uninformed and unsupported, (3) turning points, (4) steering clear of AF, (5) managing unpredictable and function limiting symptoms, (6) emotional distress, and (7) accommodation to AF tempered with hope for a cure. Participants experienced delays in diagnosis and minimization of their concerns by clinicians and others and did not receive counseling regarding the nature of AF and self-management. Strategies to manage AF and its symptoms were learned through trial and error and were transiently effective. Support for coping with the emotional burden of AF was lacking. Interventions to improve recognition of AF symptoms and promote prompt evaluation and treatment are needed. Psychoeducational programs to teach patients and families about the nature of AF, guide self-management, and address the emotional burden of AF need to be developed and tested.

One factor that seems to contribute to ineffective cancer pain management is poor adherence to the analgesic regimen.

Clinical assessment should include caregiving demand, the quality of the relationship between caregiver and patient, and preparedness for caregiving. Interventions could be tailored to meet caregiver needs in each area.