1. Chapter Three
Transitions

2. Introduction
Transitions: the moments between what was old and what is new
As nurses we may think/feel that there are too many challenges & not enough time to deal with the issues of transition/spirituality
What are some of these challenges? Pg.38
Transitions are a consistent part of life
Ability to make transitions from one situation to another is a healthy aspect of aging.

3. Significance of Transitions & Spirituality
Transitional moment is the time of the unknown, marked by stress provoked by the change
Choosing to attend school
Youth is a period of constant learning; crawling>walking>standing up>walking>tricycle>bicycle
Marriage
Having children
As people reach older adulthood it’s a time when more of life’s changes include loss
What is the author referring to? Pg.39
No one experiences only one transition in a lifetime pg.39

4. Significance of Transitions & Spirituality
Spirituality is often part of the process of transition for older people
Most people have a belief in God, the Divine, or a greater power
Spirituality is comforting; can provide a method for understanding the losses that are being experienced
How can spirituality result or lead to an improved quality of life & death? Pg.39
Does the nurse need to believe in God or pray in order to accommodate a patient’s spirituality? Pg.39

5. Understanding Transitions
Transitions are interconnected with the growth of the person
Holistic nurse: your objective is to assist the older person in your care to be successful in making the transition and managing the stress.
By doing this, nurses promote the developmental task of old age, which is_______?

6. Common Transitions
What are some of the common transitions listed on pg.40?
Patients often face health-illness transitions as a result of changes in health status, this can lead to:
Changes in role relations
Changes in expectations
Changes in abilities
When multiple transitions occur simultaneously, it can be particularly challenging for patients and their loved ones
What is an example of this listed in your book? Pg.40
A transitional period can last weeks or months

7. Priority Setting
What is the priority for this chapter? (Priority Setting Pg.41)
Homework 3: Examine your own life and critically consider what has happened to you in terms of transitions. How did you manage your last 3 transitions? Were they effective coping skills? What would assist you in the future? When you understand this concept on a personal level, you will be able to apply it to elderly people. Remember, you also want to achieve gerotranscendence, so now is a good time to begin working toward it.

8. Four Common Features of Transitions
Transitions are serious, life-altering experiences; they require the person to work hard to survive the change
Transitions warrant the attention of health-care professionals
What are 4 common features to transitions? Pg. 41
These 4 characteristics are commonly seen in older adults in health-care facilities
Nurses can play a strong role in assisting a person to make sense of the change & to manage it with minimal symptoms
With application of transition theory, you can assist the older people in your care to achieve integrity & improve the quality of life and death

9. How to Influence a Transitional Outcome
Give people a degree of choice & respect their decisions
Choice is an essential part of being human; it should be honored and respected
What is the example the author gives? Pg.42
Make the extent or degree of change more manageable
Transitions can be made smoother if the apparent obstacles are removed and the changes are manageable
What example is provided? Pg.43
Help prepare people for the transition
Often people fail to prepare for a transition even though it is expected
What does the author say about death? Pg.43

10. How to Influence a Transitional Outcome
Consider the characteristics of the individual
What characteristics specifically must we consider when helping a person through a transition? Pg.43
Learn how the person perceives the transition
Do not assume that you know what a person is thinking
Use communication skills to listen to how a person perceives a transition
Help improve environmental characteristics
What type of environments does the author compare and contrast? Pg.44
Which one do you want for your patients?

11. Progressively Lowered Stress Threshold
PLST theory:
People perceive they have lost freedom/control leads to stress/anxiety which leads to frustration/anger
What are 5 common stressors that tend to result in the highest level of stress for older adults? Pg.45
What needs to be the objective every day that you go to work? Pg.45
Transition is challenging, the role of the nurse is to do everything possible to make these realities less stressful & enhance the quality of life for older adults.

12. Common Transitions for Older Adults
Job changes and retirement
Loss of identity
Family role changes
Parenting for parents
Death of a spouse
Health changes
Illness and disability
Acute diseases

13. Resolving Transitional Problems
Nurses who believe in holistic care need to be able to assist older adults who may be under the stress of insurmountable transitions
If older adults are assisted in resolving transitional problems they move toward integrity and eventually gerotranscendence
One way to help older adults: Life Review
What are the 3 ways older adults can complete a life review? Pg.51-52

14. Questions?