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It was at UCSF that Meleis developed Transition Theory, a now widely applied framework for assessing how to care most effectively for patients and their families. The first edition of her book on the topic, Theoretical Nursing: Development and Progress, was published in 1985. Now in its fourth edition, it’s used throughout the world. Scores of scholars hang their studies on the Transition framework that Meleis and her many mentees have used to investigate scenarios as varied as African-American women’s transition to motherhood, low-income Korean immigrant women in menopausal transition, and the roles of family caregivers looking after loved ones receiving chemotherapy.

The example she gives to illustrate the theory is one of a new mother for whom the healthcare system defines the “postpartum period” as six weeks. “Why is it six weeks?” she asks. “Because that’s when the uterus goes back to normal. All the reproductive organs are back in place—so we discharge people at six weeks. But that’s only the physiological point of view.” Studies using the Transition framework have found that the shift to motherhood actually takes closer to nine months—that’s when a mother understands her baby’s clues and cues. That’s the length of time it takes for a woman to grow comfortably into her new role.

In the American healthcare system, doctors schedule a postpartum visit with a new mom six weeks out and then she’s on her own until she chooses to check in. “If we take a Transition framework,” says Meleis, “then we see we need to bring the women in again at three months.” Research demonstrates that women who are supported in some way until nine months postpartum are less abusive to their babies and to their own bodies, because they are happier and more satisfied as wives and mothers.

Meleis applies the Transition framework every year to help new students at the School of Nursing. Like new moms, they’re assuming unfamiliar identities. There are ways to help them understand and adapt healthfully to their untried roles. These include providing a support network, which the school does in the form of a peer counselor; and identifying the point at which their self-doubt and regret is peaking. For new students, says Meleis, this is a month after arriving at school. This is when she throws the new students a pizza party.

“This is when you say [to the new students],‘Okay, you probably think at this point that you shouldn’t have been admitted, that everybody is smart but you are not smart,’” she explains. By having their fears named, the students are assured they’re not alone. Then Meleis reassures them further by telling them they’re doing a great job and that this transitional period won’t last forever. “This is what the research in transitions in healthcare is all about,” she says, “to identify those critical points for which patients and family need intervention from nurses.”

 
The “Campus Conversation” dinner parties that the dean hosts at her Delancey Street home are another ritual that grew from her research. While studying populations of women in work environments in San Francisco and in Egypt, she saw that a major factor in their satisfaction was whether they were making valued connections in the workplace. At Penn she forges these connections by inviting 12 faculty from across Penn’s schools and departments who have a shared interest in a topic such as globalization or violence for a roundtable discussion over dinner. In the course of a few hours, they get to know one another’s perspectives and work. Even though they’re on the same campus and their scholarship overlaps, most have never met.

Meleis always includes faculty from the School of Nursing. It’s her ulterior motive. “I think people possibly didn’t know so much about the fantastic productivity of this faculty and how they’re involved in so many initiatives,” she says, “And that we have faculty with different expertise—for example, bioethicists. This gives them a platform to showcase that expertise.”

FEATURE:
The Energizer Dean By Caroline Tiger

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