Ulrika LindmarkpersName, Pia H. BülowpersName, Jan MårtenssonpersName, Helén RönningpersName (2019date). “The use of the concept of transition in different disciplines within health and social welfare: An integrative literature review..” Nursing Opentitle·j.
Object of study — the use of the concept of transitionterm·dom across health and social welfare disciplines
Research question — whether Meleis' four typologies of transitionterm·dom apply in occupational therapyterm·key, oral healthterm·key, social workterm·key and interdisciplinary studies
Contribution — the concept of transitionterm·dom is useful, flexibly, across health and social welfare research
phenomenon · claim-type · cross-domain-transfer · mechanism · claim-relation · replication-status · limitation — grounded in the full text| phenomenon | transition, a nursing concept, in use across other health and welfare fields — “The concept of transition embodies an important issue and seems currently to be commonly used in various fields outside nursing.” | |
| claim-type | existence — “The main result is that all included articles, except five, could be categorized according to Meleis et al. ( 2000 ) and that all types of transitions were found in all disciplines included, except for development, which was not found for oral health.” | |
| method — evidence | — “This integrative literature review (Whittemore & Knafl, 2005 ) of transition as a concept was used to examine the literature in various disciplines in health and welfare.” | |
| object of study — evidence | — “This integrative literature review (Whittemore & Knafl, 2005 ) of transition as a concept was used to examine the literature in various disciplines in health and welfare.” | |
| research question — evidence | — “Research questions: Are the four typologies (developmental, situational, health‐illness and organizational) elaborated by Meleis et al. ( 2000 ) applicable for the studied disciplines and if, which differences and/or similarities are found?” | |
| contribution — evidence | — “Our main conclusion is that the concept of transition appears useful in health and social welfare research in a broad perspective and in diverse ways.” | |
| mechanism | long nursing tradition Nursing dominates transition research because the concept has long been developed there. — “This dominance could be explained by the fact that transition has been used in nursing research for a long time and has developed as an important concept in nursing (Chick & Meleis, 1986 ; Meleis et al., 2000 ).” | mechanisms[0] |
| mechanism | lack of a transition theory Other disciplines use transition less, possibly because they lack a theory with transition as a core concept. — “This might be a consequence of these disciplines' lack of a developed theory using transition as a core concept.” | mechanisms[1] |
| extends | Kralik et al. (2006), review of transition in health literature — “This analysis continues the quest of Kralik et al. ( 2006 ) beyond the mere scoop of nursing research by exploring how the concept of transition is used in occupational therapy, oral health and social work, as well as in nursing and interdisciplinary studies.” | claim_relations[0] |
| builds-on | Meleis et al. (2000), typologies of transition — “The results from this study show that although there were differences between various disciplines, few articles could not be categorized in the four types of transitions identified and explored in nursing.” | claim_relations[1] |
| replication | not-applicable | |
| no type for this | transition → career — in sociology the phenomenon of transition is captured by other concepts, such as career — “However, in sociology and in relation to illness, the phenomenon of transition has been captured by concepts such as career (Davis, 1963 ; Roth, 1963 ), change (Watzlawick, Weakland, & Fisch, 1974 ), illness trajectories (Glaser & Strauss, 1968 ) and biographical disruption (Bury, 1982 ).” | unhoused_relations[0] |
| limitation | The review followed a theoretical framework and was not a systematic review. — “However, this review was performed by systematic steps guided by a theoretical framework and not a systematic review, which may be a limitation.” | limitations[0] |
| limitation | Only four disciplines were included. — “Another possible limitation is that only four disciplines are included in the study.” | limitations[1] |
finding · quantity · variable · definition · key-term — grounded in the full text| finding | Health-illness transition was the type most often described, then situational, developmental and organizational. — “In all, health‐illness transition was the type of transition (41.7%) most often described, followed by situational (36.9%), developmental transition (10.3%) and organizational (9.7%).” | content_tags.findings[0] |
| finding | Nursing research viewed transition mainly from the professional's point of view. — “However, in nursing research, the transition process was regarded mainly from the point of view of the professional.” | content_tags.findings[1] |
| quantity | 475; 125; 350 — — “After this screening, 475 full‐text articles were assessed for eligibility and 125 of them were excluded, resulting in 350 articles included for analysis (Figure 1 ).” | content_tags.quantities[0] |
| quantity | 68%; 84% — — “Good concurrence was reached in 68%. In step two, after a discussion of the reviewed articles and the differences in grading, 25 articles were assessed in a similar way and concurrence was reached in 84%.” | content_tags.quantities[1] |
| key-terms | transition, nursing, social work, occupational therapy, oral health, situational transitions |
| concept | transition — The concept of transition, as described in nursing, is complex and multidimensionally identified as awareness, engagement, change and difference, time span, critical points and events (Meleis et al., 2000 ). — “The concept of transition, as described in nursing, is complex and multidimensionally identified as awareness, engagement, change and difference, time span, critical points and events (Meleis et al., 2000 ).” | concepts[0] |
| concept | developmental transition — The developmental category involves responses of stages in the life cycle such as parenthood, mainly focusing on the individual perspective. — “The developmental category involves responses of stages in the life cycle such as parenthood, mainly focusing on the individual perspective.” | concepts[1] |
| concept | situational transition — Situational transitions consist of various changes in educational and professional roles (Schumacher & Meleis, 1994 ). — “Situational transitions consist of various changes in educational and professional roles (Schumacher & Meleis, 1994 ).” | concepts[2] |
| concept | health‐illness transition — Health‐illness transitions focus on how individuals and families experience different illness contexts but also on transitions among levels of care during the course of illness (Schumacher & Meleis, 1994 ). — “Health‐illness transitions focus on how individuals and families experience different illness contexts but also on transitions among levels of care during the course of illness (Schumacher & Meleis, 1994 ).” | concepts[3] |
| concept | organizational transition — not defined in this paper's own words; the fourth, most recently added typology, which the paper gives only in Schumacher and Meleis's quoted words — “Another reflection is that the most recently added typology—organizational transition—constitutes the third largest transition type (13.2%) in nursing, twice as big as the developmental transition.” | concepts[4] |
| concept | double transitions — double transitions, that is, between two contexts and at the same time a transition to adulthood — “Such situational changes were sometimes explicitly described as double transitions, that is, between two contexts and at the same time a transition to adulthood.” | concepts[5] |
| concept | leaving care — could mean the transition between foster care and residential care or between out‐of‐home care and independent living — “Most of these articles concerned youngsters or young adults and leaving care; “leaving care” could mean the transition between foster care and residential care or between out‐of‐home care and independent living (Daining & DePanfilis, 2007 ; Höjer & Sjöblom, 2010 )” | concepts[6] |
| concept | lifestyle transition — not defined in this paper's own words; a new transition typology reported by Munck et al. (2018) — “However, a new transition typology has recently been found in a review, named as the lifestyle transition (Munck et al., 2018 ), indicating that the concept of transition in adulthood is developing.” | concepts[7] |
| concept | career — not defined in this paper's own words; a sociological concept that captures the phenomenon of transition — “However, in sociology and in relation to illness, the phenomenon of transition has been captured by concepts such as career (Davis, 1963 ; Roth, 1963 ), change (Watzlawick, Weakland, & Fisch, 1974 ), illness trajectories (Glaser & Strauss, 1968 ) and biographical disruption (Bury, 1982 ).” | concepts[8] |
| concept | integrative literature review — not defined in this paper's own words; the review design used, guided by a theoretical framework rather than a systematic review — “This integrative literature review (Whittemore & Knafl, 2005 ) of transition as a concept was used to examine the literature in various disciplines in health and welfare.” | concepts[9] |
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The use of the concept of transitionterm·dom in different disciplines within health and social welfare: An integrative literature reviewterm·mth.
Abstract To continuing the quest of the concept of transitionterm·dom in nursingterm·key research and to explore how the concept of transitionterm·dom is used in occupational therapyterm·key, oral healthterm·key and social workterm·key as well as in interdisciplinary studies in health and welfare, between 2003–2013.
An integrative literature reviewterm·mth.
PubMed, CINAHL, PsycINFO, DOSS, SocIndex, Social Science Citation Index and AMED databases from 2003–2013 were used. Identification of 350 articles including the concept of transitionterm·dom in relation to disciplines included. Assessment of articles are in accordance to Meleis' typologies of transitionterm·dom by experts in each discipline. Chosen key factors were entered into Statistical Package for the Social Sciences (SPSS).
Meleis' four typologies were found in all studied disciplines, except development in oral healthterm·key. The health‐illness type was the most commonly explored, whereas in social workterm·key and in occupation therapy, situational transitionsterm·key dominated.
INTRODUCTION In nursingterm·key research, transitionterm·dom has been described as the “passage from one life phase, condition, or status to another,” as “periods in between fairly stable states” (Chick & Meleis, 1986 , p. 238) and as “processes that occur over time,” which can be divided “into stages and phases” (Schumacher & Meleis, 1994 , p. 121). From the work of various researchers, transitionterm·dom has been presented as a central concept in the discipline of nursingterm·key for the last four decades, (Meleis, 1975 ; Suva et al., 2015 ). During this period of time, the components of transitionterm·dom have been identified and described (Chick & Meleis, 1986 ), expanded by one additional typology (Schumacher & Meleis, 1994 ) and the concept has been further extended and redefined (Meleis, Sawyer, Im, Messias, & Schumacher, 2000 )—all in nursingterm·key research.
The prominent figure in defining transitionterm·dom in nursingterm·key research is Afaf Ibrahim Meleis, who first wrote about the concept in relation to role insufficiency and role supplementation (Meleis, 1975 ). In addition to being educated in nursingterm·key, Meleis has a graduate education in sociology, as well as medical and social psychology (Im, 2010 ), which probably influenced the development of the transitionterm·dom theory. Meleis drew on theories that are now considered as classical sociological theoretical approaches, such as role theory (Turner, 1962 ) and symbolic interactionism (Blumer, 1969 ). Additionally, Kralik, Visentin, and Van Loon ( 2006 ) noted anthropology as the discipline where transitionterm·dom historically has been described. This makes the concept of transitionterm·dom adaptable and interesting also to other disciplines in health and welfare such as occupational therapyterm·key, oral healthterm·key and social workterm·key (Munck, Björklund, Jansson, Lundberg, & Wagman, 2018 ).
Transitionterm·dom, in the mentioned research areas, is not highlighted as the main element of a theoretical framework, as in nursingterm·key. However, in sociology and in relation to illness, the phenomenon of transitionterm·dom has been captured by concepts such as careerterm·dom (Davis, 1963 ; Roth, 1963 ), change (Watzlawick, Weakland, & Fisch, 1974 ), illness trajectories (Glaser & Strauss, 1968 ) and biographical disruption (Bury, 1982 ). Nevertheless, transitionterm·dom as a concept has been used in health and social welfare since at least the 1930s (Proehl, 1938 ).
Background To demonstrate the diversity of the concept in nursingterm·key, four typologies of transitionterm·dom are described: developmental, situational, health‐illness and organizational (Chick & Meleis, 1986 ; Schumacher & Meleis, 1994 ). The developmental category involves responses of stages in the life cycle such as parenthood, mainly focusing on the individual perspective. Meleis ( 1975 ) emphasized two kinds of developmental transitionsterm·dom, which in particular are associated with health problems—the transitionterm·dom from childhood to adolescence and the transitionterm·dom from adulthood to old age. Situational transitionsterm·key consist of various changes in educational and professional roles (Schumacher & Meleis, 1994 ). Other studied situational transitionsterm·key are changes in the family, for example widowhood, or transitionsterm·dom due to migration, homelessness and leaving an abusive relationship. Health‐illness transitionsterm·dom focus on how individuals and families experience different illness contexts but also on transitionsterm·dom among levels of care during the course of illness (Schumacher & Meleis, 1994 ). In their work, Schumacher and Meleis, ( 1994 added organizational transitionsterm·dom as the fourth type of transitionterm·dom, which represents “changes in the wider social, political, or economic environment or by intraorganizational changes in structure or dynamics” (p. 21).
In an attempt to broaden the knowledge of the concept, Kralik et al. ( 2006 ) reviewed articles from diverse professional fields published between 1994–2004, where transitionterm·dom was used. They described these as “health literature” but also included a social focus. In their reviewterm·mth, only research with qualitative methodologies was included.
The concept of transitionterm·dom, as described in nursingterm·key, is complex and multidimensionally identified as awareness, engagement, change and difference, time span, critical points and events (Meleis et al., 2000 ). Future research might identify other factors important for understanding the complexity of transitionterm·dom to prevent and minimize risks for unhealthy transitionsterm·dom. This research will probably be found in other disciplines in health and welfare, which provides an opportunity to discover transitionterm·dom processes in other diverse populations and contexts as suggested (Meleis et al., 2000 ). The concept of transitionterm·dom embodies an important issue and seems currently to be commonly used in various fields outside nursingterm·key. However, to the best of our knowledge, the concept is not explored and reviewed in relation to other disciplines in the field of health and social welfare.
AIM To continuing the quest of the concept of transitionterm·dom in nursingterm·key research and to explore how the concept of transitionterm·dom is used in occupational therapyterm·key, oral healthterm·key and social workterm·key, as well as in interdisciplinary studies in health and welfare, between 2003–2013.
Research questions: Are the four typologies (developmental, situational, health‐illness and organizational) elaborated by Meleis et al. ( 2000 ) applicable for the studied disciplines and if, which differences and/or similarities are found? Where contexts are the concept of transitionterm·dom used in the various disciplines? Who underwent the transitionterm·dom and from what perspectives are the transitionterm·dom regarded in different disciplines?
METHOD Design This integrative literature reviewterm·mth (Whittemore & Knafl, 2005 ) of transitionterm·dom as a concept was used to examine the literature in various disciplines in health and welfare.
Inclusion and exclusion The primary criteria for inclusion in this reviewterm·mth were scientific articles published between 2003–2013, original papers written in English and articles that illuminated the concept of transitionterm·dom as a part of the results in the context of nursingterm·key, oral healthterm·key, occupational therapyterm·key, social workterm·key, or interdisciplinary studies in health and social welfare. Exclusion criteria were if the participants were predominantly <18 years old, if it was a reviewterm·mth article, if there was a meeting abstract or if the abstract was missing, if the article did not focus on transitionterm·dom and if the transitionterm·dom concerned another area than the above‐mentioned disciplines or did not focus on the outcome of the person(s) in transitionterm·dom.
Literature search This literature reviewterm·mth used PubMed, CINAHL, PsycINFO, DOSS, SocIndex, Social Science Citation Index and AMED databases. The following Medical Subject Heading (MeSH) terms were used in the search: Transitionterm·dom AND nurs*, OR transitionterm·dom AND car*, OR transitionterm·dom AND social workterm·key*, OR transitionterm·dom AND social car*, OR transitionterm·dom AND occupational therap*, OR transitionterm·dom AND oral healthterm·key*, OR transitionterm·dom AND dental hygien*. To make the data manageable, each search was performed for both title and abstract. If the number of articles in one search for abstracts (e.g., transitionterm·dom AND nurs*) exceeded 300, the number of hits in the title was selected instead.
Search outcome After duplicates ( N = 2,365) were removed, 2,523 unique references were found in the databases and were screened (PubMed 580, CINAHL 132, PsycInfo 255, DOSS 119, SocIndex 381, Social Sciences Citation Index 882, AMED 174).
Article selection All retrieved titles and abstracts were screened to determine the eligibility by an interdisciplinary reviewterm·mth team of 11 researchers, all an “expert” in at least one of the studied disciplines. The interrater reliability was tested in two steps. First, 50 articles were assessed using a template as fulfilling the criteria, doubtful fulfilling the criteria or as not meeting the criteria. Good concurrence was reached in 68%. In step two, after a discussion of the reviewed articles and the differences in grading, 25 articles were assessed in a similar way and concurrence was reached in 84%.
After this, the abstracts ( N = 2,523) were distributed to the reviewterm·mth team (200–250/reviewer) in accordance with each researcher's expertise to be assessed according to the inclusion and exclusion criteria. Most excluded articles were primarily based on transitionsterm·dom outside the health and welfare sector. After this screening, 475 full‐text articles were assessed for eligibility and 125 of them were excluded, resulting in 350 articles included for analysis (Figure 1 ).
Flow diagram of the systematic reviewterm·mth process Analysis To make the analytic work more systematic and manageable, chosen key factors were entered into Statistical Package for the Social Sciences (SPSS), according to variables included in the analysis (Figure 2 ). The results are presented regarding the typology of transitionterm·dom, the context of transitionterm·dom in studied disciplines, who performed the transitionterm·dom and from what perspective the transitionterm·dom was regarded. Presented results are exemplified by one or two articles.
Key factors from the included articles which formed the variables included in the analysis. (a) Other: type of transitionterm·dom other than those described by Meleis et al. ( 2000 ) or included in more than one type. (b) Other: mixed research context or undefined context. (c) Person: in this study, “person” was considered as an individual without any categorized title. (d) Other: several people or groups underwent the transitionterm·dom, organization or were difficult to define Ethics Research Ethics Committee approval.
RESULTS Of the 350 articles included, most studies were conducted in North America (60%) and Europe (22%). In nursingterm·key ( N = 106) and occupational therapyterm·key ( N = 39), the pattern for methods used in research was similar (Table 1 ). Almost half of these studies used qualitative methods (mainly interviews), about a quarter used quantitative methods (mostly questionnaires), a fifth part was described as “theoretical summaries,” and approximately 10% combined qualitative and quantitative methods. In social workterm·key ( N = 42), the qualitative methods dominated and there were less theoretical summaries. In oral healthterm·key ( N = 11), no studies had a qualitative design and more than 80% used quantitative design (mostly questionnaires). In interdisciplinary research, ( N = 152) quantitative and qualitative methods were used equally and fewer studies were described as theoretical summaries compared with other studied research areas. Table 1 describes different aspects of the concept of transitionterm·dom in relation to the five disciplines included in this study.
The articles description of the research areas in relation to transitionterm·dom ( N = 350) Typologies of transitionterm·dom All articles considered as research on transitionterm·dom could be coded into one of the four types of transitionterm·dom defined by Meleis and her colleagues except five (1.4%), (Schumacher & Meleis, 1994 ) (Table 1 ). In all, health‐illness transitionterm·dom was the type of transitionterm·dom (41.7%) most often described, followed by situational (36.9%), developmental transitionterm·dom (10.3%) and organizational (9.7%). In oral healthterm·key, interdisciplinary studies and nursingterm·key, the health‐illness type of transitionterm·dom was the most common (54.5%, 51.3% and 41.5%, respectively), whereas in social workterm·key and in occupational therapyterm·key, situational transitionsterm·key dominated (64.3% and 46.2%, respectively) (Table 1 ).
Health‐illness transitionsterm·dom were most often due to removals in the healthcare system (Brennan, Spencer, & Roberts‐Thomson, 2012 ; Kirsebom, Wadensten, & Hedström, 2013 ), or the transitionterm·dom occurred in specialist care, such as for HIV (Fair, Sullivan, & Gatto, 2010 ) and in palliative care (Crighton, Coyne, Tate, Swigart, & Happ, 2008 ), or during a time period between in‐/outpatient care and home (Brauer, Hay, & Francisco, 2011 ; Foust, Vuckovic, & Henriquez, 2012 ).
Situational transitionsterm·key mainly regarded conditional changes focusing on caregivers (Cook, Pierce, Hicks, & Steiner, 2006 ; Eriksson & Sandberg, 2008 ), out‐of‐home care such as foster care (Daining & DePanfilis, 2007 ), becoming a professional (Johnstone, Kanitsaki, & Currie, 2008 ; Yan, Gao, & Lam, 2013 ), professional practices (Höjer & Sjöblom, 2011 ) or retiring (Jonsson, 2011 ; Manski et al., 2011 ).
Organizational transitionsterm·dom illuminated, for instance, programs or strategies to facilitate the changeover from newly qualified professionals to practice (Boehm & Tse, 2013 ), social changes in the society (Monden, 2005 ) and improvements (Page, Martin, & Loeb, 2004 ), or changed working roles and routines (Damianakis, Climans, & Marziali, 2008 ).
Developmental transitionsterm·dom mostly concerned individual development such as the transitionterm·dom from childhood to adulthood (Wilson, Cunningham‐Burley, Bancroft, & Backett‐Milburn, 2008 ), transitionsterm·dom during menopause (Mishra, Brown, & Dobson, 2003 ), becoming a parent (Klingberg‐Allvin, Binh, Johansson, & Berggren, 2008 ; Reeves, 2006 ) or different transitionsterm·dom in late middle‐age (Salovaara, Lehmuskallio, Hedman, Valkonen, & Näsänen, 2010 ).
Contexts of transitionsterm·dom Among the disciplines, the prominent context of transitionterm·dom varied. “Between different contexts” was the most common category in nursingterm·key (39.6%), social workterm·key (42.9%) and in interdisciplinary research (31.6%), whereas “in daily life” dominated occupational therapyterm·key (35.9%). In oral healthterm·key, almost two out of three studies concerned transitionterm·dom in “outpatient care” (Table 1 ). To further understand how the concept of transitionterm·dom is used, these three most commonly used contexts are elaborated for the studied disciplines.
Between different contexts Social workterm·key included most articles focusing on transitionterm·dom between contexts. Most of these articles concerned youngsters or young adults and leaving careterm·dom; “leaving careterm·dom” could mean the transitionterm·dom between foster care and residential care or between out‐of‐home care and independent living (Daining & DePanfilis, 2007 ; Höjer & Sjöblom, 2010 ), or it could mean young people's transitionterm·dom to homelessness forced by a premature home‐leaving (Mayock, Corr, & O'Sullivan, 2011 ). Such situational changes were sometimes explicitly described as double transitionsterm·dom, that is, between two contexts and at the same time a transitionterm·dom to adulthood. In health and illness, social workers often had the role of facilitator for young patients during the transitionterm·dom from paediatric to adult medical care (Shanske, Arnold, Carvalho, & Rein, 2012 ) and for older people's transitionterm·dom from hospital to home (Watkins, Hall, & Kring, 2012 ).
For nursingterm·key, transitionterm·dom between contexts mainly was related to transfers in the hospital. Examples are room neonatal intensive care to a special care nursery, that is the transitionterm·dom from curative to palliative care (Thompson, McClement, & Daeninck, 2006 ) and the transitionterm·dom from paediatric care into adult care in special units, such as diabetes care (Scott, Vallis, Charette, Murray, & Latta, 2005 ) and kidney transplantation (Remorino & Taylor, 2006 ). Other transitionsterm·dom described in nursingterm·key were moving from institutional care to community care (Fields, Anderson, & Dabelko‐Schoeny, 2011 ). For instance, communication and coordination were studied during the transitionterm·dom of older persons between nursingterm·key homes and hospitals (Kirsebom et al., 2013 ). Becoming a nurse (Costa, Merighi, & Jesus, 2008 ) or advancing in the nursingterm·key careerterm·dom (Delaney & Piscopo, 2007 ) was other transitionsterm·dom between contexts.
In occupational therapyterm·key, transitionterm·dom between contexts concerned, for instance, the retirement process, that is from working life to retirement (Jonsson, 2011 ). Other examples were the transitionterm·dom from secondary education into further education and/or payed employment for young adults with physical disabilities (Bjornson, Kobayashi, Zhou, & Walker, 2011 ) and the transitionterm·dom from hospital to home (Brauer et al., 2011 ).
For oral healthterm·key, only one article was found highlighting the transitionterm·dom from working life to retirement and its effects on dental care use (Manski et al., 2011 ).
In daily life Daily life included transitionsterm·dom at home and at the workplace. For occupational therapyterm·key, the context in daily life was the most common. For instance, Suto ( 2009 ) studied migrant women and resettlement, and Sabata, Bruce, and Sanford ( 2006 ) investigated home health discharge planning for transitionterm·dom to work for people with disabilities.
In nursingterm·key, the most common transitionterm·dom in daily life considered working life; this transitionterm·dom could include the move from the status of a recent graduate to that of an experienced nurse (Lee & Carter, 2012 ; Tapping, Muir, & Marks‐Maran, 2013 ) and it could include a promotion or a changed role during a transfer from one professional role to another (Robinson, Kellett, King, & Keating, 2012 ; Schmitt, 2006 ).
In interdisciplinary research, transitionterm·dom in daily life mostly concerned the management of long‐term diseases such as diabetes (Rasmussen, O'Connell, Dunning, & Cox, 2007 ), the transitionterm·dom to adulthood with disabilities or diseases (Magill‐Evans, Wiart, Darrah, & Kratochvil, 2005 ), or the transitionterm·dom from pregnancy to postpartum (Olshansky & Sereika, 2005 ).
In social workterm·key, transitionsterm·dom in daily life dealt with developmental or relational changes connected to social workterm·key practice or in social problematic situations, such as challenges for adoptive parents due to unplanned contacts with the birth family (MacDonald & McSherry, 2013 ) and unsupported transitionsterm·dom to independent living for young people due to parental substance abuse (Wilson et al., 2008 ).
For oral healthterm·key, two different contexts in daily life were found, one concerning the volume of dental care in relation to self‐reported oral healthterm·key changes (Crocombe, Brennan, & Slade, 2013 ) and the other highlighting transitionsterm·dom after oral healthterm·key recommendations based on a theoretical oral healthterm·key behaviour change model (Schüz, Sniehotta, Mallach, Wiedemann, & Schwarzer, 2009 ).
Outpatient care Transitionterm·dom in outpatient care for oral healthterm·key most often considered changes after different oral healthterm·key treatments, described by self‐reported oral healthterm·key and oral healthterm·key‐related quality of life (Allen, O'Sullivan, & Locker, 2009 ; McMillan et al., 2005 ) and the use of dental service and settings (Anderson, Thomas, & Phillips, 2005 ; Brennan et al., 2012 ).
Regarding nursingterm·key, transitionsterm·dom in outpatient care concerned a change in care, such as transferring youths with diabetes mellitus to adult care (Nakhla, Daneman, To, Paradis, & Guttmann, 2009 ), transitionsterm·dom of care as experienced by close relatives of traumatic brain injury (Engström & Söderberg, 2011 ) or chronic illnesses (Wong et al., 2010 ).
In interdisciplinary research, outpatient care investigated transitionsterm·dom from paediatric care to adult care for cancer survivors (Granek et al., 2012 ) and youths with cystic fibrosis (Iles & Lowton, 2010 ), sexual desire during menopausal transitionterm·dom (Woods, Mitchell, & Smith‐DiJulio, 2010 ) and professional role transitionsterm·dom in primary care (Holt, 2008 ).
In social workterm·key, outpatient care usually concerned social worker's roles in transitionsterm·dom of care, such as the transitionterm·dom to adult care for young people living with HIV (Fair, Albright, Lawrence, & Gatto, 2012 ) or social workterm·key interventions for older people discharged from an acute care setting to home (Fabbre, Buffington, Altfeld, Shier, & Golden, 2011 ). In one case, outpatient care referred to social services and the transitionterm·dom to fatherhood for young male service users (Reeves, 2006 ).
For occupational therapyterm·key, transitionterm·dom in outpatient care was only found in one article evaluating information of self‐care needs for patients at home after stroke (Cook et al., 2006 ).
Who underwent the transitionterm·dom?
Regarding who went through the transitionterm·dom, the patient–client was the most common category in all disciplines, except for social workterm·key (Table 1 ). In interdisciplinary studies, this was the case in eight out of ten articles, while about half of the studies for oral healthterm·key, occupational therapyterm·key and nursingterm·key belonged to this category.
In interdisciplinary studies, patients‐clients underwent the youths' transitionterm·dom to adulthood (Ruck & Dahan‐Oliel, 2010 ), elders transitionterm·dom in changing housing (Choi, 2004 ; Heliker & Scholler‐Jaquish, 2006 ), menopause transitionterm·dom (Woods et al., 2010 ) and palliative care patients' experiences (Larkin, De Casterlé, & Schotsmans, 2007 ).
In oral healthterm·key, patients reporting outcomes using different dental services (Anderson et al., 2005 ; Brennan et al., 2012 ), patients' experiences of oral healthterm·key related to quality of life after dental treatments (Allen, Savadatti, & Gurmankin Levy, 2009 ; Tsakos et al., 2010 ) and changes in dental coverage status in relation to oral status (Manski et al., 2011 ) were found.
For occupational therapyterm·key, the patient‐client experienced, for example, quality in rehabilitation (Lindahl, Hvalsoe, Poulsen, & Langberg, 2013 ), accommodation transitionsterm·dom for individuals with acquired brain injury (Sloan, Callaway, Winkler, McKinley, & Ziino, 2012 ), occupational transitionsterm·dom after injury or disease (Shaw, MacAhonic, Lindsay, & Brake, 2009 ; Švajger & Winding, 2009 ), mental illness (McKay, 2010 ) and transitionterm·dom from the hospital to home care (White, Magin, & Pollack, 2009 ).
In social workterm·key, the “person” was the predominating category, followed by “the professional” and “several perspectives.” The “person” as a category most often referred to young adults who were, or had been in, out‐of‐home care, such as foster care (Collins, Spencer, & Ward, 2010 ), followed by young people in different types of socially difficult situations, such as homelessness (Mayock et al., 2011 ). Transitionsterm·dom were also viewed both from clients (mostly youth) and professionals (Tilbury, Creed, Buys, & Crawford, 2011 ).
In nursingterm·key, almost three of ten studies concerned the transitionterm·dom of professionals, which was rarely or never the case in the other disciplines. Often, this regarded the transitionterm·dom from nursingterm·key student to staff nurse (Pearson, 2009 ; Walker, Earl, Costa, & Cuddihy, 2013 ) or from one nursingterm·key role to another (Delaney & Piscopo, 2007 ; Robinson et al., 2012 ). Moreover, in nursingterm·key, 8.5% of those who performed the transitionterm·dom were relatives. This category was rarely mentioned in other disciplines. In occupational therapyterm·key, students and employees/job seekers (12.8% for each group) more often were those who performed the transitionterm·dom compared with those in other disciplines (Table 1 ).
From which perspective was transitionterm·dom seen?
Depending on the disciplines, the perspectives on transitionterm·dom varied. Still, in total, the viewpoint most often was from the patient's/client's perspective (28.0%) followed by the person's perspective (13.1%) (Table 1 ).
In occupational therapyterm·key, the patient/client perspective and the professional perspective were almost equal, while in oral healthterm·key, more than half of the studies (54.5%) considered the patient/client perspective. This perspective was the most common also in interdisciplinary, although to a less degree (38.2%). In nursingterm·key, however, the professional perspective was twice as common as the second most used perspective, which was from the patient's/client's point of view. In social workterm·key, transitionterm·dom from the perspective of the person was used in 38.1% of the studies. In oral healthterm·key, studies focused on the patients' view of oral healthterm·key (McMillan et al., 2005 ), oral treatments (Allen, O'Sullivan et al., 2009 ; Anderson et al., 2005 ), dental service and coverage (Manski et al., 2011 ).
In occupational therapyterm·key, transitionterm·dom viewed from the patient/client's perspective considered, for instance the clients' perspective on the return to work (Bergmans et al., 2009 ; Švajger & Winding, 2009 ), recovery patterns (Prvu Bettger, Coster, Latham, & Keysor, 2008 ) and the experience of mental illness (McKay, 2010 ). Transitionterm·dom viewed from the professional perspective in this discipline focused on home‐based rehabilitation (Cook et al., 2013 ) and school involvements (Michaels & Orentlicher, 2004 ).
In interdisciplinary studies, articles taking the patient's/client's perspective explored, for instance, the menopause transitionterm·dom (Smith‐DiJulio, Woods, & Mitchell, 2008 ), patients' transitionterm·dom between care settings (Toscan, Mairs, Hinton, Stolee, & Team, 2012 ) or transitionsterm·dom to a community‐based setting (Nishita, Wilber, Matsumoto, & Schnelle, 2008 ).
In social workterm·key, many studies taking the perspective of the person concerned young people in out‐of‐home care or the leaving careterm·dom processes (Reimer, 2010 ). In many of these cases, the youngsters went through a double transitionterm·dom as their living conditions changed in parallel with their transitionterm·dom from childhood to “instant adulthood” (Rogers, 2011 ).
In nursingterm·key, compared with other disciplines, the perspective was more often taken from the professionals and focused mostly on the transitionterm·dom from nursingterm·key student to occupational nurse (Goodwin & Candela, 2013 ), as well as when shifting from one role to another, such as becoming CEO/president of their organization (Patton, 2012 ) or becoming a nurse specialist (Robinson et al., 2012 ).
Of those patients/clients who underwent the transitionterm·dom ( N = 209), the transitionterm·dom was regarded from the patient's/client's perspective in 45% of the cases (not shown in Table 1 ). This relationship was the case in the disciplines of nursingterm·key (43.1%), occupational therapyterm·key (47.6%) and interdisciplinary research (44.2%). In oral healthterm·key, most articles (85.7%) showed this relationship, whereas for social workterm·key, the corresponding figures were 20%.
The transitionterm·dom of patients/clients was regarded from a professional perspective in almost one fourth (22%) of the studies (not shown in Table 1 ). In social workterm·key, all these studies considered the social worker's role in clients' transitionterm·dom in an institutional framework and focused on interventions (Fabbre et al., 2011 ), procedures (Höjer & Sjöblom, 2011 ) or assessments (B. R. Lee, Shaw, Gove, & Hwang, 2010 ).
Among all examined articles ( N = 350), 37 reported on the professional who underwent the transitionterm·dom (not shown in Table 1 ). In 95% of these, the transitionterm·dom was also described from a professional perspective. All except three were found in nursingterm·key.
DISCUSSION This analysis continues the quest of Kralik et al. ( 2006 ) beyond the mere scoop of nursingterm·key research by exploring how the concept of transitionterm·dom is used in occupational therapyterm·key, oral healthterm·key and social workterm·key, as well as in nursingterm·key and interdisciplinary studies. The main result is that all included articles, except five, could be categorized according to Meleis et al. ( 2000 ) and that all types of transitionsterm·dom were found in all disciplines included, except for development, which was not found for oral healthterm·key. Those five articles categorized as another typology than those described by Meleis et al. ( 2000 ) were not further analysed in our study. However, a new transitionterm·dom typology has recently been found in a reviewterm·mth, named as the lifestyle transitionterm·dom (Munck et al., 2018 ), indicating that the concept of transitionterm·dom in adulthood is developing.
In relation to the literature reviewterm·mth by Kralik et al. ( 2006 ), our study indicates that the concept of transitionterm·dom has been used in a larger extent during 2003–2013 compared with the previous 10 years. This could be explained by differences in study design. Our study shows that the concept of transitionterm·dom is used in both qualitative and quantitative studies, as well as in theoretical summaries.
In this reviewterm·mth, nursingterm·key research is the discipline presenting most articles on transitionterm·dom, except for interdisciplinary studies, which, however, also include the research area of nursingterm·key. This dominance could be explained by the fact that transitionterm·dom has been used in nursingterm·key research for a long time and has developed as an important concept in nursingterm·key (Chick & Meleis, 1986 ; Meleis et al., 2000 ).
In nursingterm·key, the health‐illness type of transitionterm·dom dominates in combination with the transitionterm·dom of patients regarded from the professionals' perspective. This finding is interesting because the notion of healthy transitionterm·dom processes versus unhealthy has been described as the core of the transitionterm·dom and of special concern for nurses (Schumacher, Jones, & Meleis, 1999 ). Meleis et al. ( 2000 ) argued that there are two reasons for this: 1) nurses often are the primary caregivers of people undergoing transitionsterm·dom associated with health problems and 2) nurses tend to be involved in preparing clients for impending transitionsterm·dom and to be those “who facilitate the process of learning new skills related to clients' health and illness experiences” (Meleis et al., 2000 , p. 13). Another reflection is that the most recently added typology—organizational transitionterm·dom—constitutes the third largest transitionterm·dom type (13.2%) in nursingterm·key, twice as big as the developmental transitionterm·dom. This could be interpreted as a sign of nurses showing greater interest in doing research on organizations and organizational changes, thereby showing the importance to study this level of transitionterm·dom at the individual, couple and family level.
Although Meleis and her colleges introduced and developed the concept of the transitionterm·dom in relation to nursingterm·key research and practice, they have presented transitionterm·dom as “a multiple concept embracing the elements of process, time span and perception” (Chick & Meleis, 1986 , p. 239). Such broad aspects are useful in various disciplines and with these disciplines, the current study demonstrated how the concept of transitionterm·dom is used in occupational therapyterm·key, oral healthterm·key and social workterm·key, as well as in interdisciplinary research in health and welfare. However, the concept is used less in occupational therapyterm·key, oral healthterm·key and social workterm·key compared with nursingterm·key. This might be a consequence of these disciplines' lack of a developed theory using transitionterm·dom as a core concept. Moreover, in disciplines other than nursingterm·key, such as social workterm·key, the influence from sociology might imply that other concepts such as careerterm·dom (Davis, 1963 ; Roth, 1963 ), change (Watzlawick et al., 1974 ) and trajectory (e.g., Glaser & Strauss, 1968 ) are used in parallel to transitionterm·dom.
Although the concept of transitionterm·dom is used in all studied disciplines, there are interesting differences, such as that in oral healthterm·key, organizational transitionsterm·dom are the second most frequently used type of transitionterm·dom. However, in this discipline, the total number of studies is few and the concept seems to be used more often in the last five years of the study period.
Further, the results show considerable differences between disciplines regarding which contexts the examined transitionterm·dom occurred in, even when the same category was used. For instance, in social workterm·key and nursingterm·key, the category “between different contexts” was used differently. In nursingterm·key, the in‐between stages often appeared in the hospital context, while in social workterm·key, “between contexts” reflected the transferal from one “home” to another, commonly referring to young people in foster care or residential treatment. These differences seemed to reflect the different type of work where social workers and nurses are engaged in (for instance child welfare and nursingterm·key, respectively). Similarly, the context of “daily life” was most commonly used in occupational therapyterm·key and “outpatient care” was most frequent in oral healthterm·key, corresponding to the various working conditions of these professionals.
The utility of transitionterm·dom, as a concept in research in health and welfare, is further strengthened by how the diversity in professional assignment is also noticeable by the category “who underwent the transitionterm·dom.” For all disciplines in health care (i.e. nursingterm·key, occupational therapyterm·key and oral healthterm·key), the “patient” was the one who went through the transitionterm·dom most often. This finding corresponds to these professionals' work in healthcare institutions, such as hospitals or outpatient clinics. In social workterm·key, on the other hand, the category of “person” reflects the work with people in the community. Consequently, this study demonstrates the usefulness of the concept of transitionterm·dom for studies in various disciplines which is in line with Kralik et al. ( 2006 , p. 324), who raised the importance of “understanding the transitionterm·dom of the process to assist people to move through it” in a healthy direction. Thus, the use of the concept of transitionterm·dom is important for all professionals to understand various changes in health and well‐being, as well as in relation to professional, personal or organizational development.
Nevertheless, this study also shows an interesting disciplinary difference, which could not be explained from variations of working conditions. Regarding which perspective the transitionterm·dom was viewed, the “patient/client” or the “person” was the most prominent in occupation therapy, oral healthterm·key and social workterm·key. However, in nursingterm·key research, the transitionterm·dom process was regarded mainly from the point of view of the professional. This self‐reflecting focus on the nurse as a professional could not be understood clearly by the specific working conditions for nurses compared with other professionals. However, it might be explained by the long tradition of using transitionterm·dom in research and, in particular, the concept's usefulness for providing “directions for nursingterm·key practice,” as well as for the “development of nursingterm·key therapeutics” (Im, 2010 , p. 425). In other studied disciplines, such a theoretical framework is lacking.
Limitation Adoption of a systematic reviewterm·mth approach enhances the scientific rigour of a reviewterm·mth. However, this reviewterm·mth was performed by systematic steps guided by a theoretical framework and not a systematic reviewterm·mth, which may be a limitation. Several researchers from different disciplines were included in the analysis, which could be seen as a possible limitation concerning inter‐reliability, but also a strength related to the study aim. Another possible limitation is that only four disciplines are included in the study. In health and social welfare, also other disciplines such as medicine, psychology and social pedagogy could have been considered. This reviewterm·mth included articles published at latest 2013, an extension by including also the more recent years would probably have further enhanced the value of the analysis. At the same time, our study points to the need to continuously study concepts such as transitionterm·dom to investigate how it develops in disciplines where the term is well established as well as its dissemination to and use in other subject fields such as medicine and psychology to name a few important disciplines in health and social welfare not yet included in reviewsterm·mth on the concept of transitionterm·dom.
CONCLUSIONS The results from this study show that although there were differences between various disciplines, few articles could not be categorized in the four types of transitionsterm·dom identified and explored in nursingterm·key. Further, the most recently added typology—organizational transitionterm·dom—was in our data and was used almost as much as developmental transitionterm·dom. This outcome indicates that the decision to extend the concept with the “new” typology was well founded.
Our main conclusion is that the concept of transitionterm·dom appears useful in health and social welfare research in a broad perspective and in diverse ways. This implies its flexibility but also the usefulness of the concept to explore various changes.
CONFLICT OF INTEREST No conflict of interest has been declared by the authors.