BARIATRIC NURSING AND SURGICAL PATIENT CARE
Volume 5, Number 1, 2010
ª Mary Ann Liebert, Inc.
DOI: 10.1089=bar.2009.9940
Original Articles
Applying Middle-Range Nursing Theory
to Bariatric Surgery Patients: Experiencing Transitions
Shannon Reedy, MS, CRNP,1 and Kay Blum, PhD, CRNP 2
Abstract
Obesity has reached epidemic levels in the United States, and bariatric surgery is becoming an increasingly
prevalent intervention. Nurses play an integral role in the care of these patients before, during, and after
surgery. Using theory in practice provides a systematic, organized space that promotes a comprehensive
yet individualized approach to patient problems. Middle-range theories, such as the theory of experiencing
transitions, can easily be used for research and practice development. The theory was described and
evaluated for substantive foundations, structural integrity, and functional adequacy. The evaluation
demonstrates the use of the theory in nursing practice and research with patients experiencing the transitions associated with bariatric surgery.
aspects affected by obesity such as well-being,
quality of life, and social stigmatization.7–9
Multiple studies, as demonstrated in a 2005
meta-analysis, have shown the safety and efficacy of bariatric surgery as a treatment for
morbid obesity.10 The rate of bariatric surgery
increased from 26.8 to 43.7 per 100,000 covered
lives between 2001 and 2006.11 In 2006, estimated rates of bariatric surgery were around
180,000 and are expected to steadily rise.3
Introduction
Significance of the problem
O
besity has reached epidemic levels in
the United States. According to the Center
for Disease Control’s 2007 statistics, Colorado
was the only state with obesity prevalence rates
less than 20% and three states had obesity rates
at 30% or higher.1 From 2005 to 2006, 34.3% of
adult Americans were obese.2 From 2003 to
2004 the prevalence of extreme obesity (defined
as a body mass index higher than or equal to
40 kg=m2) was 4.8%, approximately 15 million
Americans.3 Projections are that 51.5% of
adults will be obese by 2030 and that 100% of
adults will be obese by 2102.4
Obesity has been linked to numerous chronic
health conditions including hypertension, hyperlipidemia, sleep apnea, type 2 diabetes, and
heart disease.5 Obesity-associated conditions
significantly increase hospital length of stay,
mortality, and overall healthcare costs.6 In addition, there are a multitude of psychosocial
Physical outcomes of surgery
Studies have shown that bariatric surgery is
more effective than nonsurgical weight-loss
treatments for patients with a body mass index
(BMI) of 40 kg=m2.10,12 Bariatric surgery results
in dramatic weight loss over a very short time. A
2004 meta-analysis examined 136 studies with a
total of 22,094 patients found that the overall
percentage of excess weight loss for bariatric
procedures was 62.1%.13 Patients commonly
experience weight loss of 100 pounds or more
1University of Maryland Medical System, Adult and Gerontological Nurse Practitioner Program, University of Maryland School
of Nursing, Baltimore, Maryland.
2University of Maryland Medical System, University of Maryland School of Nursing, Baltimore, Maryland.
35
36
during the first year. The physical changes are
intricately interwoven with the psychological
changes. Much like a small tap will shatter a
glass that is already cracked, the dramatic
weight loss may shatter one or more relationships that were already strained.
Psychosocial outcomes of surgery
Well-designed bariatric surgery programs include psychological evaluation and counseling
designed to help potential surgical candidates
develop realistic expectations about the effects
of weight loss on their happiness and their relationships. While bariatric surgery patients
typically report increased quality of life, improved relationship satisfaction, and improved
sexual satisfaction, untoward consequences may
result.14 For example, disease-related deaths are
reduced after bariatric surgery, yet deaths from
accidents and suicide increase by a factor of
1.58.15 A preoperatively dysfunctional marriage
will likely still be dysfunctional postoperatively
and after weight loss. Well-meaning friends and
family members may sabotage the change in
eating patterns out of habit, out of the need to
control, or as a deliberate attempt due to personal gain in maintaining the patient’s obesity.
The loss of friends, loss of family support, or
divorce may result. These losses may also sabotage the weight loss.
Theory-Guided Nursing Care
A nurse’s role in helping patients with the
positive outcomes and potential negative outcomes of bariatric surgery is significant. Incorporating theory into practice is vital for the
future of bariatric nursing, but selecting a theory that is fitting to the practice problem is
essential. Using theory in practice provides a
systematic, organized space that promotes a
comprehensive yet individualized approach to
patient problems. Middle-range theories can
easily be used for research and practice development. This article looks at the use of one
middle-range theory, the theory of experiencing transitions (ET), and its applicability to
bariatric nursing practice and research. As
leaders in patient care, nurses need to continue
to develop guidelines for the care of this vulnerable population. Incorporating nursing
Bariatric Nursing, vol. 5, no. 1, 2010
REEDY AND BLUM
theory into this process involves investigating
themes. Change is a recurrent theme in bariatric nursing care. Change is endless in
healthcare, and change, regardless of the type,
has an impact on the patient. Subsequently,
change is often associated with transition; therefore, transition may be viewed as a central
concept in nursing of bariatric patients.
Meleis and colleagues16 developed ET to
help describe how individuals experience the
multiple transitions each person goes through
during a lifetime. The theory of ET proposes
that a key role of nurses is to assist patients in
managing life transitions. With every surgical
intervention, every birth and every death, there
are a multitude of transitions. Bariatric surgery,
with the dramatic weight loss, the profound
changes in eating and approach to food, as well
as the resulting changes in body image—all of
which affect relationships—must be considered
a transition and not merely a change. The person
who undergoes this dramatic transformation
experiences multiple transitions. The role of the
bariatric nurse is to help that person draw on
personal and professional resources that assist
in a positive and satisfying transition.
Theory of Experiencing Transitions
Transitional theory has its origin in sociology
and anthropology. Van Gennep discussed transitions in his book The Rites of Passage long
before the middle-range nursing theory ET
emerged.17 The theoretical framework for ET
(Figure 1) can be divided into three areas: nature of transitions, transitional conditions, and
patterns of response.16 Types, patterns, and properties are considered the nature of transitions.
Transition conditions can be either facilitating or
inhibiting. Process indicators and outcome indicators are considered patterns of response.16
Nature of transitions
Types of transitions include developmental,
health=illness, situational, and organizational.
Developmental transitions include life span
transitions such as adolescence, aging, pregnancy, childbirth, and death. Diagnosis of disease, surgical procedures, and rehabilitation
are health=illness transitions. Persons undergoing bariatric surgery often have one or more
MIDDLE-RANGE THEORY AND BARIATRIC SURGERY PATIENTS
Nature of Transitions
Types
Transition Conditions
Patterns of Response
Personal
Patterns
Properties
37
Process
Indicators
Society
Outcome
Indicators
Community
NURSING THERAPEUTICS
FIG. 1.
Experiencing transitions.
comorbidities that, over time, have led them to
identify with that chronic disease process or to
identify themselves by their obesity. These
changes in identify are the product of previous
transitions but are amenable to change with the
right help. Situational transitions are transitions
such as divorce resulting from the changes in
interpersonal dynamics in the family now that
the formerly obese individual has changed the
way they see the world and their role in it.
Organizational transitions could be those associated with change in leadership within the
family or other social or professional groups.16
A once passive, obese wife may now find her
voice after her weight loss and disrupt the
family’s status quo.
Patterns of transitions are many. They can be
single, multiple, sequential, simultaneous, related, or unrelated.16 When the transition occurs singly, it occurs in absence of any other
transition. Multiple transitions are likely more
common. This means that at least two transitions are occurring at once. An example of
multiple transitions is transitioning from morbid obesity to normal weight, a new body image as well as a new interpersonal dynamic.
The transitions can occur sequentially, one after
the other or they can occur simultaneously. The
transitions can be related to each other, such as
the transition from obesity to normal weight.
The transitions could be unrelated, such as
losing weight and completing a college degree.
In addition to varying types and patterns, the
experience of a transition also has many properties. Awareness, engagement, change and
difference, transition time span, and critical
points and events are all properties of a transition. Awareness refers to a person’s recogni-
tion of the transition. Awareness is considered
an important property of a transition.16 Chick
and Meleis purported that if a person was not
aware of the transition that they may not actually be going through a transition.18 There is
some discourse over the idea. In 2000, Meleis
et al. posed that awareness by the person is not
a necessity for a transition to begin.16 They
suggested that someone else, such as a nurse,
could be aware of the transition, which could
then serve as the starting point of the transition.
Engagement is another property of a transition and refers to active, deliberate involvement in the transition. Engagement relies very
heavily on awareness. A person is unable to
become engaged in their transition if they are
unaware of the transition. Engagement involves seeking out information and being active in the transition process. Someone who has
decided to undergo bariatric surgery would be
transitioning to a nonobese body image. Engagement for this person would be seeking
professional help to deal with the change in
interaction with others, to deal with people
who would sabotage their weight loss, or just
to discuss their own inner changes. These are
deliberate activities that require awareness of
both the transition and the day-to-day issues
that determine the success of the transition.
Engagement in the strategies improves the
likelihood of that success.
A third property of transitions is change and
difference. Meleis and colleagues16 note the
lack of reciprocity between change and transition. They state that change and difference
cannot by thought of synonymously with transition. All transitions involve change, but not
all change is related to transition. Transitions
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38
are both the result of change and result in
change.16 Change should be thought of as an
occurrence that precipitates a transition or that
occurs because of a transition. In contrast, difference refers more to perception than an occurrence. Feeling different or having a different
expectation is not the same as a change. For
instance, a 100-pound weight loss is a dramatic
change, but some people look in the mirror and
perceive no difference because they still see the
obese person in the mirror.
Time span as a property of transitions refers
to the period from when the transition began
until it ended. Placing a time span on a transition is difficult. It can be particularly difficult
to determine the end of a transition in many
cases. The end of a transition typically occurs
when a new period of stability occurs.16 When
a person loses all the weight they can after the
procedure, the physical change is complete, but
the transition continues until the weight change
is incorporated into the self. For a period, they
may have trouble dealing with the changes to
their life, their body, and their health. Determining exactly when the transition ends
may prove to be difficult. One could say when
a person reaches a point where they have stabilized and have come to terms with the weight
loss and the other associated changes is when
the transition has ended. Meleis and colleagues
also indicate that a transition may lie dormant
and reemerge.16 Alternatively, patients may
experience several transitions surrounding the
same type of transition. If someone transitions
from obese to normal weight, stabilizes, and
then regains the expected 10% of body weight
several months later, you could say that they
had a reemergence of an old transition or have
begun a new transition.
Critical points and events are the final
property of transitions and are not apparent in
every transition. They are specific markers that
identify a point in the transition. Often critical
points are either the beginning or the end of the
transition.16 The decision to undergo bariatric
surgery is a critical point in embracing a permanent solution for obesity. Often this decision
takes place in the presence of a history of unsuccessful attempts or very successful weight
loss that could not be maintained. Knowledge
of occurrences, feelings, symptoms, and changes that typically occur around critical points
Bariatric Nursing, vol. 5, no. 1, 2010
REEDY AND BLUM
in a transition allow a nurse to help patients
through transitions.
Transitional conditions
Many conditions affect a transition. Personal,
community, or society conditions can either facilitate or inhibit a transition. Personal conditions include meanings, cultural beliefs and
attitudes, socioeconomic status, and preparation
and knowledge. Meanings may have positive or
negative influence over a transition. Meaning
refers to the perception the person experiencing
the transition has about the transition. The person undergoing bariatric surgery and the change
in eating understands the difficulty of the choice
and may be hurt when others dismiss the surgery as ‘‘the easy way out.’’ Cultural belief and
attitudes play a large role in transitions. In a
culture where women feel they are valued based
on their weight and appearance, they may
choose bariatric surgery to achieve the acceptance they desire only to experience marginalization for some other reason, thereby decreasing
the perceived value of the sacrifice related to the
demands of the surgery and eating changes that
are required. Perhaps this explains why some
persons regain all their weight.19,20 Socioeconomic status is an important condition in a
transition because it may impact how people
handle their transition. If a person does not have
an automobile, they may not seek out support
groups that could help them deal with unmet
expectations. Preparation and knowledge regarding an impeding or current transition may
be facilitative or inhibitory. In nursing we choose
to believe that planning and preparation reduces
or eliminates these unrealistic expectations, but
the individual may or may not modify expectations based on the information they are given.
An example might be acknowledgement of the
information, but the refusal or inability to personalize the information. Lack of knowledge
may inhibit transition.16
Community conditions can influence transitions as much as personal conditions. The
community resources in some areas are much
greater than in others.16 If a bariatric surgery
patient lives near a hospital that has a postoperative support group, she may experience her
transition very differently than a woman who
does not have that available in her community.
MIDDLE-RANGE THEORY AND BARIATRIC SURGERY PATIENTS
Societal conditions can also facilitate or inhibit
transitions. Meleis and colleagues use gender
inequity as an example of how a transitional
event can be affected by society.16 A woman
may place her healthcare needs below those of
her family in some societies. Women are more
empowered, in some societies, to seek care for
conditions such as obesity than in others.
Patterns of response
Process indicators and outcome indicators
describe how a person moves through and arrives at the end of a transition. These indicators are often thought of as consequences of
a transition, but they can occur at any time
throughout the transition. An outcome need
not happen at the end of the transition. Nursing
assessment of these indicators should occur to
determine whether a person is making a healthy or unhealthy transition. Nursing interventions and therapeutics can then take place to
facilitate the transition.16
Process indicators include feeling connected,
interacting, location and being situated, and
developing confidence and coping. Feeling
connected refers to personal contacts and connections to friends, family, and health professionals.16 Feeling connected to friends and
family offers social support, where feeling connected to healthcare workers can provide a
source of information. Interacting with others is
important in the process of the transition. How
people interact with each other differs greatly
and can have an enormous impact on transitioning. There may also be groups or individuals
who have a vested interest in the individual remaining obese, and they may actively or passively try to sabotage that person’s success with
weight loss. There may be others who are simply
afraid for the patient to have surgery. If it is a
family member or close friend, the individual
who has chosen bariatric surgery may have to
choose between losing weight and harming
the relationship with their family or friends. The
nurse can help to increase awareness of the
outcomes for the individual if they continue in
the self-defeating patterns versus actively engaging in a new pattern of interaction.
Location and being situated can be important
when a patient experiences a transition. Hospitalization versus staying at home during an
39
illness has an affect on how someone transitions. This also refers to a person’s comfort
with where they are in their transition. Confidence and coping show how a person has
developed strategies for managing their condition. Meleis and colleagues describe it as the
accumulation of experiences and thought
transformation that results in wisdom.16
Outcome indicators include mastery and fluid
integrative identities. The time at which the
outcome indicators are assessed is important.16
Outcome indicators examined too early may
not be complete, and those examined too late
may be influenced by other transitions. Mastery indicates the skills that have developed to
deal with the situations. Mastery of the transition in the self or body image might include
knowledge of its effect on eating patterns,
monitoring weights, taking vitamins properly,
and making appropriate medical appointments. Fluid, integrative identity describes the
restructuring of the person’s identity to include
the transition. The person’s being actually
changes as part of or because of the transition.
This change is a dynamic process.
Experiencing Transitions in Terms
of Bariatric Surgery
Transition is a concept that has broad nursing applications as well as specific application
to bariatric surgery patients. The ET theory
provides a framework to examine how bariatric
surgery patients transition and how nursing
interventions might affect them.
Bariatric surgery patients experience a multitude of transitions. Bariatric surgery can be
viewed as a health=illness type of transition but
may also encompass situational and organizational transitions. Long before surgery, patients
may begin to experience a transition as single,
multiple, sequential, or simultaneous. At some
point they surrender to the fact that they are
not able to lose weight without surgical intervention. Personal, community, and societal conditions may have an impact on their decision to
have surgery. The process of thinking about
weight loss may be the beginning of their first
transition. Awareness of the transition that they
will go through is paramount. Successful
weight loss and maintenance of that weight
loss requires active engagement on the part of
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40
the patient and cannot be achieved by a passive
subject. A critical event, one of the properties of
a transition, may be their first visit with the
bariatric surgeon. Or, surgery may be seen as
the critical event. Preparation and knowledge is
instrumental in the success or failure of
bariatric surgery. Massive weight loss causes
changes that are incomprehensible to the patient and their family. Massive weight loss is
not just a physical change; it is well documented that some patients suffer from family
crises after weight-loss surgery. Occasionally a
spouse becomes jealous and insecure about
themselves when their spouse loses weight.
Weight loss increases the self-esteem of the
bariatric surgery patient, and they may be unwilling to put up with belittling behavior that
they previously felt they deserved. These psychosocial issues may create other transitions
for the patient to go through. Not only could
ET theory be used to examine the transitions of patients, it could be used to examine
the transitions of their family members and
how nursing interventions could assist them
as well.
Evaluation of Experiencing Transitions Theory
Theories are not inherently good or bad.
Their value lies in the ability to help a researcher or provider apply a systematic
framework to the evaluation and=or solution
for a particular problem. By evaluating theories, we can determine the usefulness of a theory and determine areas where further work
can be done to improve it. Using Smith’s
framework, ET theory was evaluated for substantive foundations, structural integrity, and
functional adequacy.21
Substantive foundations
The assessment of substantive foundations is
based on four criteria. The first criterion evaluates whether the theory is within the focus
of the discipline of nursing. Although transition
theories are rooted within the discipline of anthropology, ET theory is certainly within the
discipline of nursing. If one defines nursing as
caring for and about human beings throughout
their life span as they experience health and
illness, then exploring and assisting individuals
Bariatric Nursing, vol. 5, no. 1, 2010
REEDY AND BLUM
through transitions would seem to exemplify
that definition. The ability of the theory framework to suggest interventions that help guide
nurses working with bariatric surgery patients
as they transition from obese to normal weight
supports the focus of the discipline of nursing.
The theory then meets this criterion.
The second criterion requires that the assumptions are specified and are congruent with
the focus. The assumptions of ET theory are not
explicitly mentioned in the description of the
model; however, they can be inferred from the
discussion. They are: 1) transitions are complex
and multidimensional, 2) awareness of the transition is a requirement for the process, and 3)
each individual brings their own personal
meanings and resources to common transitions
making each transition process unique. These
assumptions are consistent with the focus of
nursing practice in bariatric surgery.
The third criterion requires that the theory
provide a substantive description, explanation,
or interpretation of a named phenomenon at
the middle-range level of discourse. The named
phenomenon is transition. The theory of ET
provides an excellent description, explanation,
and interpretation of the transitional process. It
clarifies concepts from previous works, distinguishes transition from change, guides practice,
and poses questions for further research.
Transition is at the middle-range level in that it
is defined in a measurable way and can be
operationalized in both research and practice
settings.
The fourth criterion requires that the origins
are rooted in practice and research experience.
Schumacher and Meleis performed an extensive review of the literature in their 1994 article
on transitions.22 Meleis and colleagues again
searched the literature for studies using nursing transition theory to develop and define concepts of ET.16 Kralik et al. identified a multitude
of papers published on transitions between
1994 and 2004 by searching CINAHL, Medline,
SocioFile, and Psychlit (www.lib.uidaho.edu=
tutorial=psychlit_database.htm) databases.23
Many studies have used transition theory in
their research and practice.
Skärsäter and Willman used ET theory to
gain a deeper understanding of the concept of
transition in the recovery process associated
with major depression and to suggest nursing
MIDDLE-RANGE THEORY AND BARIATRIC SURGERY PATIENTS
interventions to support the recovery process.24
Weiss and colleagues used Meleis’ theory to
identify predictors and outcomes of adult
medical-surgical patients.25
In practice, Wilkins and Woodgate used ET
theory to provide a framework for how nurses
could assist with transitions in siblings of children with cancer.26 Davies evaluated whether
ET theory could be used to assist relatives of
patients admitted to nursing home with their
transition.27
Structural integrity
The first criterion of structural integrity is
that the concepts are clearly defined. The concepts in ET theory are very easy to understand.
They are individually described and defined. In
addition, they are used in examples so that they
can be understood in context.
The second criterion of structural integrity is
that the concepts within the theory are at the
middle-range level of abstraction. The main
concepts of ET theory—transition, personal facilitators and inhibitors of transition, patterns
of response, and nursing therapeutics—are
middle-range concepts because they can be
operationalized and measured.24
The third criterion of structural integrity is
that there are no more concepts than needed to
explain the phenomena. Overall, the concepts
adequately explain the phenomena of transitions. In the concept of transition conditions,
there is some interaction. The three main areas
are personal, community, and society. Even
though there are separate categories for community and society, personal conditions include
cultural beliefs and attitudes and socioeconomic status. These three concepts could be
delineated a bit further as could nursing therapeutics, which is not addressed in the discussion.16
The forth criterion of structural integrity is
that the concepts and relationships among
them are logically represented with a model.
Experiencing transitions theory uses a logical
flowchart-type model. Meleis and colleagues
developed a concept map and included it with
their 2000 publication ‘‘Experiencing Transitions: An Emerging Middle-Range Theory.’’16
The model is easily understood and outlines all
of the key concepts of the theory.
41
Functional adequacy
The four criteria of functional adequacy are
the following:
1. The theory can be applied to a variety of practice
environments and client groups.
2. Empirical indicators have been identified for concepts of the theory.
3. There are published examples of use of the theory in
practice.
4. There are published examples of research related to
the theory, and the theory has evolved through
scholarly inquiry.
The criteria have significant overlap and will
be analyzed jointly below.
The ET theory has been used in many practice environments and with many patient
populations. There are multiple published examples of research and use in practice although
none have been done with bariatric surgery
patients. Of particular relevance to bariatric
surgery is the identification of empirical indicators that can be applied consistently. This
will lead to better plans of care and more
generalizable research results that will impact
large numbers of patients.
One salient point to note about the evolution
of this theory through scholarly inquiry is that
one or more of the authors have revised the
theory several times. After the theory was used
in nursing research, researchers reexamined the
theory and built on the new knowledge. This
shows the optimal use of a theory and appropriate use of research to support and improve a
theory. It has certainly developed through
scholarly inquiry about patient transition.
Conclusion about utility and appropriateness
The theory of ET meets most of the criteria
for evaluation of a middle-range theory. This
evaluation has demonstrated the use of the
theory in nursing practice and research with
patients experiencing the transitions associated
with bariatric surgery.
Application to Research and Practice
in Bariatric Surgery Patients
Once the utility and appropriateness of ET
theory has been established through objective
critique, it must be applied to actual research
and clinical problems to be useful. A problem
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42
that can be addressed both from a research
standpoint and in practice is the problem of
postoperative weight gain that approaches or
exceeds preoperative weight.28 A potential research question that can be addressed using the
ET model is: Does preparation and knowledge
decrease the incidence of weight gain to preoperative weight in Roux-en-Y gastric bypass
patients?
A qualitative study might ask, ‘‘What are the
lived experiences of Roux-en-Y gastric bypass
patients who regained their preoperative
weight?’’ Those answers could guide the development of programs to prepare patients to
deal with the issues postoperatively or perhaps
create a better way of screening patients who
are appropriate for the procedure.
A quantitative study might hypothesize that
a perioperative standardized counseling and
education intervention about the pitfalls of
postoperative weight gain will result in a 10%
weight gain at the 2-year follow-up. The design
for the study might be a randomized control
group trial of a standardized education and
counseling program preoperatively, in addition
to counseling in the preoperative waiting period prior to surgery. It may also include
patient-driven access to a counseling provider
postoperatively while the control group receives usual care. The primary endpoint for the
study would be weight gain at the 2-year
follow-up visit.
A related practice problem might be that a
number of postoperative patients who are
gaining weight have noticed a sense of loneliness and disconnection at 1 year after surgery
when the frequency of office visits decreased,
family support has leveled off with acceptance
of the patient’s weight loss, and eating patterns
have become routine and several friends have
ended relations. The model predicts that this
outcome pattern is an expectation of the successful transition from obese to normal weight.
Although this is an expected outcome, it is a
problem for the patient and could impact further weight gain as old eating habits creep back
in. Counseling for this patient that incorporates
cultural beliefs, personal meaning, and supportive connections is directed toward mastery—
operationalized as developing skills in making
new connections and developing confidence that
obesity had eroded. Nursing therapeutics are a
Bariatric Nursing, vol. 5, no. 1, 2010
REEDY AND BLUM
‘‘black box’’ in that they have not been elaborated. Specific research into interventions hypothesized from propositions from the model
has not been reported. Using the model and
testing hypotheses about interventions with patients experiencing the transitions of bariatric
surgery will inform both the care of these patients and the model itself.16 The provider is left
then with the opportunity to define the intervention specific to that patient or group of patients
based on emerging research and individual
strengths.
Conclusion
Much of how bariatric surgery patients
transition and how nurses and other providers
assist them is left unresearched. Nurse researchers need to use well-established theories
such as ET theory to provide evidence for the
care that we provide these patients. In addition,
ET can be used jointly by many other healthcare disciplines whose practice includes psychiatry, medicine, sociology, and rehabilitation
in the care of these patients.
Overall, research needs to be done using this
middle-range theory in the care of bariatric
surgery patients. Having a theoretical basis for
research and practice will make treatment more
uniform and research more comparable. This
will lead to a more comprehensive and holistic
approach to the care of patients who have
bariatric surgery. More research will increase
our knowledge of transitions and how we, as
nurses, can help patients manage their transition and anticipate future transitions. In addition, further qualitative research may help find
gaps in the theory and allow us to build upon
an already comprehensive theory.
Disclosure Statement
No competing financial interests exist.
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Address reprint requests to:
Shannon Reedy, MS, CRNP
University of Maryland School of Nursing
655 W. Lombard St., Rm 332
Baltimore, MD 21201
E-mail: [email protected]
Bariatric Nursing, vol. 5, no. 1, 2010