Afaf Ibrahim Meleis

Health professionals for a new century: transforming education to strengthen health systems in an interdependent world

Harvard School of Public Health, Boston, MA, USA (Prof J Frenk MD); China Medical Board, Cambridge, MA, USA (L Chen MD); Aga Khan University, Karachi, Pakistan (Prof Z A Bhutta PhD); George Washington University Medical Center, Washington, DC, USA (Prof J Cohen MD); Independent member of House of Lords, London, UK (N Crisp KCB); James P Grant School of Public Health, Dhaka, Bangladesh (Prof T Evans MD); US Institute of Medicine, Washington, DC, USA (H Fineberg MD, P Kelley MD); School of Public Health Universidad Peruana Cayetano, Heredia, Lima, Peru (Prof P Garcia MD); Peking University Health Science Centre, Beijing, China (Prof Y Ke MD); National Health Laboratory Service, Johannesburg, South Africa (B Kistnasamy MD); School of Nursing, University of Pennsylvania, Philadelphia, PA, USA (Prof A Meleis PhD); University of Toronto, Toronto, ON, Canada (Prof D Naylor MD); The Rockefeller Foundation, New York, NY, USA (A Pablos-Mendez MD); Public Health professionals for a new century: transforming education to strengthen health systems in an interdependent world

Experiencing Transitions: An Emerging Middle-Range Theory

Changes in health and illness of individuals create a process of transition, and clients in transition tend to be more vulnerable to risks that may in turn affect their health. Uncovering these risks may be enhanced by understanding the transition process. As a central concept of nursing, transition has been analyzed, its components identified, and a framework to articulate and to reflect the relationship between these components has been defined. In this article, the previous conceptual analysis of transitions is extended and refined by drawing on the results of five different research studies that have examined transitions using an integrative approach to theory development. The emerging middle-range theory of transitions consists of types and patterns of transitions, properties of transition experiences, facilitating and inhibiting conditions, process indicators, outcome indicators, and nursing therapeutics. The diversity, complexity, and multiple dimensionality of transition experiences need to be further explored and incorporated in future research and nursing practice related to transitions.

Marginalization: a guiding concept for valuing diversity in nursing knowledge development.

This article explicates marginalization as a guiding concept for the development of nursing knowledge that values diversity. The seven key properties of marginalization as it applies to the domain of nursing are (1) intermediacy, (2) differentiation, (3) power, (4) secrecy, (5) reflectiveness, (6) voice, and (7) liminality. Through examination of each of these properties, the relationship between marginalization and vulnerability is clarified, and by this means the relevance of marginalization for health is established. The implications for shaping future nursing research, theory, and practice related to the health of diverse populations are discussed.

Facilitating transitions: Redefinition of the nursing mission

here have been numerous dia- logues in nursing about its mis- sion and definition, but a refinement of existing definitions has yet to be of- fered. This article is written with the goal of maintaining a vigorous dis- course. The phenomena of concern to the discipline of nursing that have been described by various theorists, and gen- erally accepted by members of the dis- cipline, are health, person, environ- ment, and nursing therapeutics. Yet the multiplicity of viewpoints regard- ing these concepts and the paucity in their systematic development has prompted many to question their util- ity in providing the discipline with a coherent definition. The extent to which the mere identification of these concepts as central has helped in fur- thering the development of nursing knowledge is also questionable. The challenge members of the discipline face is to define the mission of nursing. The mission, then, could give more substance to these central concepts. Recently, defining the mission has been advocated by many in nursing.

Women and Health: the key for sustainable development

Executive summary Girls’ and women’s health is in transition and, although some aspects of it have improved substantially in the past few decades, there are still important unmet needs. Population ageing and transformations in the social determinants of health have increased the coexistence of disease burdens related to reproductive health, nutrition, and infections, and the emerging epidemic of chronic and non-communicable diseases (NCDs). Simultaneously, worldwide priorities in women’s health have themselves been changing from a narrow focus on maternal and child health to the broader framework of sexual and reproductive health and to the encompassing concept of women’s health, which is founded on a life-course approach. This expanded vision incorporates health challenges that aff ect women beyond their reproductive years and those that they share with men, but with manifestations and results that aff ect women disproportionally owing to biological, gender, and other social determinants. The complexity of the challenges faced by women throughout the life course needs an increased focus on health systems, which heavily rely on the many contributions of women to care as members of the health workforce, in which their numbers are rapidly increasing, and in their traditional roles as primary caregivers at home and in communities. Women and Health—the focus of this Commission—is a novel concept that refers to the multifaceted pathways through which women and health interact, moving beyond the traditional and exclusive focus on women’s health to address the roles of women as both users and providers of health care, and highlighting the potential for synergy between them. We envision a virtuous cycle that builds on the premise that women who are healthy throughout their lives experience gender equality and are enabled, empowered, and valued in their societies, including in their roles as caregivers, are well prepared to achieve their potential and make substantial contributions to their own health and wellbeing, to that of their families and communities, and, ultimately, to sustainable development. Such thinking needs an interdisciplinary, cross-sectoral perspective to identify women-centred solutions to the unique obstacles that girls and women face as both consumers and providers of health care. In this Commission, we analyse existing and original evidence about the complex relations between women and health. We examine the major economic, environ mental, social, political, demographic, and epide miological transitions happening worldwide, their implications on the health system, and their eff ects on women and health. The health status of girls and women is analysed using a life-course approach to show the breadth of women’s health beyond the reproductive role. We estimate the fi nancial value of the paid and unpaid health-care-related duties that women undertake in health systems and in their homes and communities, which are a hidden subsidy to health systems and societies. We conclude that gender-transformative policies are needed to enable women to integrate their social, biological, and occupational roles and function to their full capacity, and that healthy, valued, enabled, and empowered women will make substantial contributions to sustainable development (key messages). In view of these issues, we propose crucial actions for development partners, governments, civil society, advocates, academics, and professional associations that are needed to advance the women and health agenda (panel 1).

Health is empowerment

A consideration of health in relation to global and diverse social and economic contexts forces nurses to reexamine the centrality of health in the discipline of nursing and to confront the issue of whether health is a personal matter. In this article, the authors review development of the concept of health in nursing science, discuss the limitations of some current definitions in addressing diverse clients, and challenge members of the discipline to develop a contextualized definition of health congruent with societal needs and the mission of nursing.

Between two cultures: Identity, roles, and health

Population shifts and migration are increasing worldwide, and with it there is a renewed interest in maintaining uniqueness and cultural heritage. Immigrants are constantly attempting to balance the values of their cultural heritage with those of the new host society. To deal with immigrant womens health-care needs, scientists from the host country need to understand the delicate interplay between several dynamic properties inherent in being a woman and an immigrant and to develop ways to describe the health-care needs and responses that are congruent with the properties of immigrant womens situations. Properties selected for this article are uniqueness versus stereotyping, permanence versus temporariness, and host-country values versus country-of-origin values. Appropriate methods of research discussed are involvement, lived experiences, and satisfaction and stress in roles. Proposed agendas for future study of immigrant women include identifying high-risk populations among immigrant women and developing appropriate methodological strategies and population-specific interventions.

Women and Health: the key for sustainable development. The Lancet Commissions.

Executive summary Girls’ and women’s health is in transition and, although some aspects of it have improved substantially in the past few decades, there are still important unmet needs. Population ageing and transformations in the social determinants of health have increased the coexistence of disease burdens related to reproductive health, nutrition, and infections, and the emerging epidemic of chronic and non-communicable diseases (NCDs). Simultaneously, worldwide priorities in women’s health have themselves been changing from a narrow focus on maternal and child health to the broader framework of sexual and reproductive health and to the encompassing concept of women’s health, which is founded on a life-course approach. This expanded vision incorporates health challenges that aff ect women beyond their reproductive years and those that they share with men, but with manifestations and results that aff ect women disproportionally owing to biological, gender, and other social determinants. The complexity of the challenges faced by women throughout the life course needs an increased focus on health systems, which heavily rely on the many contributions of women to care as members of the health workforce, in which their numbers are rapidly increasing, and in their traditional roles as primary caregivers at home and in communities. Women and Health—the focus of this Commission—is a novel concept that refers to the multifaceted pathways through which women and health interact, moving beyond the traditional and exclusive focus on women’s health to address the roles of women as both users and providers of health care, and highlighting the potential for synergy between them. We envision a virtuous cycle that builds on the premise that women who are healthy throughout their lives experience gender equality and are enabled, empowered, and valued in their societies, including in their roles as caregivers, are well prepared to achieve their potential and make substantial contributions to their own health and wellbeing, to that of their families and communities, and, ultimately, to sustainable development. Such thinking needs an interdisciplinary, cross-sectoral perspective to identify women-centred solutions to the unique obstacles that girls and women face as both consumers and providers of health care. In this Commission, we analyse existing and original evidence about the complex relations between women and health. We examine the major economic, environ mental, social, political, demographic, and epide miological transitions happening worldwide, their implications on the health system, and their eff ects on women and health. The health status of girls and women is analysed using a life-course approach to show the breadth of women’s health beyond the reproductive role. We estimate the fi nancial value of the paid and unpaid health-care-related duties that women undertake in health systems and in their homes and communities, which are a hidden subsidy to health systems and societies. We conclude that gender-transformative policies are needed to enable women to integrate their social, biological, and occupational roles and function to their full capacity, and that healthy, valued, enabled, and empowered women will make substantial contributions to sustainable development (key messages). In view of these issues, we propose crucial actions for development partners, governments, civil society, advocates, academics, and professional associations that are needed to advance the women and health agenda (panel 1).

The Stress of Immigration and the Daily Lived Experiences of Jordanian Immigrant Women in the United States

Literature specifically focused on women as immigrants and on the nature and quality of the immigrant experience is limited. Similarly, in spite of early Arab immigration to the different regions of the world, there is a limited knowledge base regarding the dynamics and problems involved in their integration into their new society. In this article we describe the lived experiences of Jordanian women who immigrated to the United States and the focus is on providing an in-depth account of their perceived stressors as related to their immigration experience. Thirty Jordanian American women, all wives and mothers with a mean age of 45, were interviewed. Three major themes of the sources and contexts of stress emerged from the narrative and qualitative data analyses of their responses. Women experienced many challenges and stressors surrounding their work in the daily living of settling in, in their quest for ethnic continuity, and in their attempts to re-create familiarity. Social and health support resources cannot be created without careful attention to these themes.

Compliance: an interactionist approach.

Compliance is central to health care, but by its very nature it remains problematic to health care providers and health care receivers. In this article an interactional approach, the utilization of role theory, in the study of compliance is proposed. Rationale for the need for such a framework is provided through the presentation and critique of currently used models and theories, such as the medical model, the health belief model, control theory, and learning theory. Assumptions of the proposed framework are presented, and four components are identified when considering compliance enactment from an interactional perspective. These are: self-concept, role enactment, complementary roles, and periodic evaluation of role enactment by self and others. Several theoretical propositions evolve as central to the development of a unified framework for compliance. The propositions can be considered potential hypotheses. This article demonstrates one approach to theory development in nursing.