Meleis’s Transition Theory in Gerontogeriatric Nursing and the Future Need for Specialized Care

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

This study seeks to make use of Meleis’ Transition Theory to reframe gerontogeriatric nursing to focus on transitions and transformative change in the quality of elderly care. According to the authors, by educating nurses in this theory, the approach to the elderly could become more nuanced. The authors see this use of Meleis’ Transition Theory as an important and pressing change to undertake in response to the aging population.

 

The work presents the issues in a logical and easy-to-read format. However, there is a major problem with the referencing. When writing a scientific article, unless citing a seminal work, all references should be published within the last five years. Of the 40 references in this submission, only 5 were published in the last five years and, of these, none from the last two years. In a field such as this, where there is a significant amount that has been published in the last few years, the authors’ referencing is lacking. This is especially so regarding the main theory discussed. Here is a Google Scholar search of Meleis’ Transition Theory published since 2020: https://scholar.google.ca/scholar?as_ylo=2020&q=Meleis%E2%80%99+Transition+Theory&hl=en&as_sdt=0,5. Notice that there are over 3000 returns. When this search is further refined to “Meleis’ Transition Theory in geronto geriatric nursing” since 2020, there are around 300 returns: https://scholar.google.ca/scholar?as_ylo=2020&q=Meleis%E2%80%99+Transition+Theory+in+geronto+geriatric+nursing&hl=en&as_sdt=0,5. In these searches, the authors can find research to reference for their work, and they are expected to do so. Furthermore, given the extent of research on this topic, the authors must explain how their work is novel and further advances the field.

 

Line by line suggested edits

2

Change “Unlocking the Potential: Meleis’ Transition Theory in Geronto-geriatric Nursing and the Future Need for Specialized Care” to “Meleis’ Transition Theory in Gerontogeriatric Nursing and the Future Need for Specialized Care”, this will eliminate the need for the hyphen in the title.

26 

Keywords should be found in the Abstract and be listed by the order in which they appear. Change “gerontogeriatric; gerontologic care; aged; nurses; nursing theory” to “older adults; Meleis’ Transition Theory; gerontogeriatric; elderly care; nursing therapeutics; nurses; nursing practices”. If the authors want to keep with their original keywords, the Abstract should be modified accordingly.

29-103 Except for the first two sentences of this Introduction, all of the references cited are out of date. As a result, this Introduction must be entirely rewritten in relation to current research. Seminal work can be referenced, but, in each case, it will require current supporting research to demonstrate that the cited work is still considered relevant today.

105-111 This paragraph does not reveal that there has been substantial research in nursing regarding Meleis’ Transition Theory. Instead, the paragraph makes it appear that nothing has been done in this area. That Meleis’ Transition Theory has been, and continues to be, investigated must be mentioned in this paragraph.

110-191  There are eight different citations in this section. Four of them are to current research. However, none of the articles cited concerns work that has been done on Meleis’ Transition Theory. This omission needs to be corrected.

168 For whatever citation the authors substitute for 32 in doing their revision, please remember to place an opening bracket before the citation.

193-224 Although the purpose of this section is to present the case for using Meleis’ Transition Theory framework for gerontogeriatric nursing, not one of the references cited concerns current research regarding Meleis’ Transition Theory. This must be corrected.

237 For whatever citation the authors substitute for 34 in doing their revision, please remember to place an opening bracket before the citation.

263-289 This conclusion is written in the style of either a newspaper article or a popular healthcare book. The conclusion offered must be scientific and be based on current research. Furthermore the conclusion will need to be novel regarding the value of Meleis’ Transition Theory in advancing the field for it to be valuable as a publication.

Comments on the Quality of English Language

The problem with the English is the style of writing is more appropriate for a popular healthcare publication than a scientific journal.

Author Response

We deeply thank the reviewers for their invaluable contributions to refining this manuscript. Their insightful comments and suggestions have significantly enhanced this study's clarity, accuracy, and depth. We sincerely appreciate each reviewer's time and expertise in reviewing our work and providing detailed feedback. Their thoughtful critiques have improved this paper and enriched our overall understanding and approach to the subject.

We are thankful for their guidance throughout this process, ensuring that our findings and discussions are presented as rigorously and beneficially as possible. Their efforts are greatly appreciated and have been instrumental in bringing this research to its fullest potential.

 

• The work presents the issues in a logical and easy-to-read format. However, there is a major problem with the referencing. When writing a scientific article, unless citing a seminal work, all references should be published within the last five years. Of the 40 references in this submission, only 5 were published in the last five years and, of these, none from the last two years. In a field such as this, where there is a significant amount that has been published in the last few years, the authors’ referencing is lacking. This is especially so regarding the main theory discussed. Here is a Google Scholar search of Meleis’ Transition Theory published since 2020: https://scholar.google.ca/scholar?as_ylo=2020&q=Meleis%E2%80%99+Transition+Theory&hl=en&as_sdt=0,5. Notice that there are over 3000 returns. When this search is further refined to “Meleis’ Transition Theory in geronto geriatric nursing” since 2020, there are around 300 returns: https://scholar.google.ca/scholar?as_ylo=2020&q=Meleis%E2%80%99+Transition+Theory+in+geronto+geriatric+nursing&hl=en&as_sdt=0,5. In these searches, the authors can find research to reference for their work, and they are expected to do so. Furthermore, given the extent of research on this topic, the authors must explain how their work is novel and further advances the field.

     Author’s Response: We appreciate the reviewer's attention to the detail and significance of referencing recent literature, especially in a dynamic field like gerontogeriatric nursing. We acknowledge the point raised regarding the need for more current references and have conducted a thorough review of recent publications on Meleis’ Transition Theory, particularly its application in gerontogeriatric nursing.

We have incorporated additional references, ensuring our citation base is up-to-date and relevant to the field's ongoing developments. While we continue to reference seminal works that laid the groundwork for understanding transitions in nursing, we agree that recent studies provide critical insights into the current and practical applications of these theories.

 

• Line by line suggested edits

2

Change “Unlocking the Potential: Meleis’ Transition Theory in Geronto-geriatric Nursing and the Future Need for Specialized Care” to “Meleis’ Transition Theory in Gerontogeriatric Nursing and the Future Need for Specialized Care”, this will eliminate the need for the hyphen in the title.

     Author’s Response: Changed

 

• 26 Keywords should be found in the Abstract and be listed by the order in which they appear. Change “gerontogeriatric; gerontologic care; aged; nurses; nursing theory” to “older adults; Meleis’ Transition Theory; gerontogeriatric; elderly care; nursing therapeutics; nurses; nursing practices”. If the authors want to keep with their original keywords, the Abstract should be modified accordingly.

     Author’s Response: Thank you for your observations regarding the keyword selection and their alignment with the abstract. We appreciate your suggestion to reorder and modify the keywords to better reflect the content and focus of our manuscript.

Regarding the order of appearance of keywords in the abstract, while we understand the intention behind ensuring that keywords directly reflect the manuscript's core topics, the guideline to have them in the order of appearance is not a standard practice in our field. Typically, keyword selection is guided by their relevance and descriptiveness to the central themes of the research, which may not necessarily coincide with their sequence of mention in the abstract.

We have adhered to using MeSH terms where applicable to ensure accuracy and utility in database searches. Given this and the specificity of terms like "Meleis’ Transition Theory" which are not standard MeSH terms but are essential to the context of our work, we opted to maintain our original keywords. These keywords are chosen based on their established relevance to the field and their role in effectively indexing and categorizing the study for academic and clinical utility.

We believe our selected keywords, including "gerontogeriatric" and "nursing theory," are reflective of the manuscript’s contributions and themes.

 

• 29-103 Except for the first two sentences of this Introduction, all of the references cited are out of date. As a result, this Introduction must be entirely rewritten in relation to current research. Seminal work can be referenced, but, in each case, it will require current supporting research to demonstrate that the cited work is still considered relevant today.

Author’s Response: We appreciate the reviewer's attention to the detail and significance of referencing recent literature, especially in a dynamic field like gerontogeriatric nursing. We acknowledge the point raised regarding the need for more current references and have conducted a thorough review of recent publications on Meleis’ Transition Theory, particularly its application in gerontogeriatric nursing.

We have incorporated additional references, ensuring our citation base is up-to-date and relevant to the field's ongoing developments. While we continue to reference seminal works that laid the groundwork for understanding transitions in nursing, we agree that recent studies provide critical insights into the current and practical applications of these theories.

 

• 105-111 This paragraph does not reveal that there has been substantial research in nursing regarding Meleis’ Transition Theory. Instead, the paragraph makes it appear that nothing has been done in this area. That Meleis’ Transition Theory has been, and continues to be, investigated must be mentioned in this paragraph.

     Author’s Response: Thank you for your insightful feedback. We have revised the relevant paragraph to reflect the substantial research on Meleis’ Transition Theory within nursing. This amendment ensures the paragraph accurately acknowledges this theory's ongoing investigations and contributions to gerontogeriatric nursing. We appreciate your guidance in enhancing the completeness of our discussion. Line 119-130.

 

• 110-191  There are eight different citations in this section. Four of them are to current research. However, none of the articles cited concerns work that has been done on Meleis’ Transition Theory. This omission needs to be corrected.

Author’s Response: As previously mentioned, changed.

 

 

• 168 For whatever citation the authors substitute for 32 in doing their revision, please remember to place an opening bracket before the citation.

     Author’s Response: Thank you, Changed.

 

• 193-224 Although the purpose of this section is to present the case for using Meleis’ Transition Theory framework for gerontogeriatric nursing, not one of the references cited concerns current research regarding Meleis’ Transition Theory. This must be corrected.

     Author’s Response: As previously mentioned, changed.

 

• 237 For whatever citation the authors substitute for 34 in doing their revision, please remember to place an opening bracket before the citation.

     Author’s Response: Thank you, Changed.

 

• 263-289 This conclusion is written in the style of either a newspaper article or a popular healthcare book. The conclusion offered must be scientific and be based on current research. Furthermore the conclusion will need to be novel regarding the value of Meleis’ Transition Theory in advancing the field for it to be valuable as a publication.

     Author’s Response: Thank you for your constructive feedback regarding the style and content of our original conclusion. We have revised the conclusion. The revised section now emphasizes the empirical and theoretical underpinnings of Meleis’ Transition Theory within gerontogeriatric nursing, highlighting its practical applications and the necessity for an integrated approach to elder care.

We have removed the narrative style elements and replaced them with a discussion that links the theory directly to actionable research outcomes and policy implications. This adjustment ensures that the conclusion reflects current research and advances the discourse on the application of Transition Theory in gerontogeriatric nursing, providing a clear call to action based on empirical evidence and theoretical analysis. We believe these changes address your concerns and enhance the manuscript's contribution to the field, grounding our call to action in scientific research and practical necessity.

Reviewer 2 Report

Comments and Suggestions for Authors

Dear authors,

thank you for presenting this theme, this topic is current and very interesting for international audience. There is only few items to address to improve your manuscript. I will analyse parts of manuscript. 

Title - from my point of view the title is too long. I suggest to reduce without this part ''and the future need for specialized care''

Abstract - please be precise in conclusion. 

Introduction - your structure of introduction is well done

Discussion - start discussion with your aim and identify your main finding in your literature review. 

 

Author Response

We deeply thank the reviewers for their invaluable contributions to refining this manuscript. Their insightful comments and suggestions have significantly enhanced this study's clarity, accuracy, and depth. We sincerely appreciate each reviewer's time and expertise in reviewing our work and providing detailed feedback. Their thoughtful critiques have improved this paper and enriched our overall understanding and approach to the subject.

We are thankful for their guidance throughout this process, ensuring that our findings and discussions are presented as rigorously and beneficially as possible. Their efforts are greatly appreciated and have been instrumental in bringing this research to its fullest potential.

 

Dear authors,

thank you for presenting this theme, this topic is current and very interesting for international audience. There is only few items to address to improve your manuscript. I will analyze parts of manuscript. 

• Title - from my point of view the title is too long. I suggest to reduce without this part ''and the future need for specialized care''

     Author’s Response: Thank you for your valuable feedback regarding the title of our manuscript. We appreciate your suggestion to shorten it for clarity and focus. We have indeed revised the title in response to comments from another reviewer. While considering your suggestion, we aimed to balance brevity with the necessity to reflect the core themes of our research.

The revised title has been streamlined to better capture the essence of our study while remaining comprehensive enough to reflect its scope and significance.

 

• Abstract - please be precise in conclusion. 

     Author’s Response: Thank you for your valuable feedback on the precision of the conclusion in our abstract. We have revised the concluding sentences to more directly reflect the core contributions and implications of our study regarding Meleis' Transition Theory in gerontogeriatric nursing. This revision aims to clearly convey the urgency and necessity of integrating this theoretical framework into current nursing practices, thereby setting a new standard for elderly care. We appreciate your guidance in enhancing the clarity and impact of our abstract.

 

• Introduction - your structure of introduction is well done

     Author’s Response: Thank you

 

• Discussion - start discussion with your aim and identify your main finding in your literature review. 

     Author’s Response: Thank you for your valuable guidance on structuring the Discussion section of our manuscript. We have revised the opening paragraph to clearly state the primary aim of our study and summarize the main findings from our literature review. This revision ensures that we directly address how Meleis’ Transition Theory can catalyze a paradigm shift in gerontogeriatric nursing and highlight the underexplored areas in its application, particularly in addressing developmental transitions. We believe this update improves the clarity and flow of the discussion, setting a solid foundation for exploring the practical implications and challenges discussed in subsequent paragraphs. Line 256-267

Reviewer 3 Report

Comments and Suggestions for Authors

Dear Authors,

The manuscript offers an author's perspective, grounded in Meleis's transition theory.

This paper can contribute to the reflection about this topic. There is a need for a more accurate explanation of the possible contribution of this perspective in terms of education, research and clinical practice. There are few concerns about this concept “gerontogeriatric nursing”.

Please make sure to define this concept, since it's unclear. Care for older adults' physical, psychological, spiritual, and other felt needs is the specialty of gerontological nurses (ANA, 2019). According to the American Nurses Association (ANA, 2019), gerontological nurses in the US are usually registered nurses (RNs) with advanced practice licensure. As a matter of practice, gerontological nurses must learn how to provide older adults and their families with person-centered, evidence-based healthcare in a variety of healthcare settings (ANA, 2019).

Because of the apparent differences between your country's core concepts of nursing and professionalised practice and those of the United States of America, this field is not recognised in your country. Yet, you have chronic care (medical and surgical patients) and family health nurses with expertise in life cycle perspective and developmental transitions. 

(Introduction) Do you think of people over 60 as elderly? You must modify the text.

You used the idea "fundamental transformation... conventional biomedical approach" a lot, but from your point of view, nursing should be specialised in a similar way to what a medical doctor is. you must be clear about this.  

Page 104: Recommendation to alter this title.

Page 242/243: This is the kind of work that family health nurses, visiting nurses, and community nurses do all over the world. Would you advocate for an equal approach? Perhaps you should clarify this and the need for care integration and multidisciplinary teamwork with other nurses and multi professional integration.

You have twenty-three references older than five years, and only six from recent years, despite having eight Meleis references. You should think about updating your list of references.

Congratulations! You have a significant paper in this field that will improve professional reflection.

 

Author Response

We deeply thank the reviewers for their invaluable contributions to refining this manuscript. Their insightful comments and suggestions have significantly enhanced this study's clarity, accuracy, and depth. We sincerely appreciate each reviewer's time and expertise in reviewing our work and providing detailed feedback. Their thoughtful critiques have improved this paper and enriched our overall understanding and approach to the subject.

We are thankful for their guidance throughout this process, ensuring that our findings and discussions are presented as rigorously and beneficially as possible. Their efforts are greatly appreciated and have been instrumental in bringing this research to its fullest potential.

 

Dear Authors,

The manuscript offers an author's perspective, grounded in Meleis's transition theory.

• This paper can contribute to the reflection about this topic. There is a need for a more accurate explanation of the possible contribution of this perspective in terms of education, research and clinical practice. There are few concerns about this concept “gerontogeriatric nursing”.

     Author’s Response: Following your suggestions, we have further enriched the conclusion to address more explicitly the theory's contributions to education, research, and clinical practice. We integrated a more detailed discussion of how the theory can be embedded in nursing curricula, influence clinical care strategies, and guide empirical research to ensure a comprehensive understanding and application of the theory in gerontogeriatric settings. Line 337-353

 

• Please make sure to define this concept, since it's unclear. Care for older adults' physical, psychological, spiritual, and other felt needs is the specialty of gerontological nurses (ANA, 2019). According to the American Nurses Association (ANA, 2019), gerontological nurses in the US are usually registered nurses (RNs) with advanced practice licensure. As a matter of practice, gerontological nurses must learn how to provide older adults and their families with person-centered, evidence-based healthcare in a variety of healthcare settings (ANA, 2019).

Because of the apparent differences between your country's core concepts of nursing and professionalized practice and those of the United States of America, this field is not recognized in your country. Yet, you have chronic care (medical and surgical patients) and family health nurses with expertise in life cycle perspective and developmental transitions. 

     Author’s Response: Thank you for your insightful suggestion to clarify the global variations in gerontological nursing practices. We have added a paragraph in the discussion section immediately following the mention of developmental transitions in gerontogeriatric nursing.Line 66-76

 

• (Introduction) Do you think of people over 60 as elderly? You must modify the text.

     Author’s Response: Thank you for your feedback regarding the characterization of individuals over 60 as 'elderly.' We recognize that the perception of who is considered elderly can vary significantly depending on cultural, social, and health perspectives.

 

• You used the idea "fundamental transformation... conventional biomedical approach" a lot, but from your point of view, nursing should be specialized in a similar way to what a medical doctor is. you must be clear about this.  

     Author’s Response: We have revised the text to more explicitly address how gerontogeriatric nursing, as a specialized discipline, complements yet remains distinct from the medical doctor's role. Also, we highlight and argue in favour of a vital cycle approach to nursing specializations (in line with some countries approach), which differs from a disease-type specialization approach. Thus, this revision articulates the unique contributions of nursing to holistic and developmental care, underscoring the transformative potential of specialized nursing roles in enhancing elderly care. Line 218-229

 

• Page 104: Recommendation to alter this title.

     Author’s Response:  To address this, we propose changing the title to "Reevaluating Gerontogeriatric Nursing: Insights and Gaps in Current Literature." This title aims to highlight the section’s focus on assessing the breadth of existing research while identifying the crucial gaps that our study aims to address.

 

• Page 242/243: This is the kind of work that family health nurses, visiting nurses, and community nurses do all over the world. Would you advocate for an equal approach? Perhaps you should clarify this and the need for care integration and multidisciplinary teamwork with other nurses and multi professional integration.

     Author’s Response: We have revised the section on community involvement to more clearly articulate the contributions of family health nurses, visiting nurses, and community nurses worldwide. We have also emphasized the importance of care integration and the collaborative nature of this field, which involves a broad spectrum of professionals working together to deliver comprehensive, patient-centered care. Line 283-291

 

• You have twenty-three references older than five years, and only six from recent years, despite having eight Meleis references. You should think about updating your list of references.

     Author’s Response: We appreciate the reviewer's attention to the detail and significance of referencing recent literature, especially in a dynamic field like gerontogeriatric nursing. We acknowledge the point raised regarding the need for more current references and have conducted a thorough review of recent publications on Meleis’ Transition Theory, particularly its application in gerontogeriatric nursing.

We have incorporated additional references, ensuring our citation base is up-to-date and relevant to the field's ongoing developments. While we continue to reference seminal works that laid the groundwork for understanding transitions in nursing, we agree that recent studies provide critical insights into the current and practical applications of these theories.

 

• Congratulations! You have a significant paper in this field that will improve professional reflection.

     Author’s Response: Thank you for the positive feedback.

Round 2

Reviewer 1 Report

Comments and Suggestions for Authors

Thank you to the authors for the changes they have made to their submission. To the extent of the changes, they have improved the submission. Thank you also to the authors for explaining the chosen placement of the keywords. Their reason for not making the change suggested is acceptable. Still lacking is the attention needed to improve the current citations. Although added are several, a significant portion of the paper depends on arguments presented in older research with no additional supporting research by current publications; furthermore, there are no references for much of the newly added material. Lastly, there is no limitations section; the discussion section requires its addition. The authors should also note that publications in the last five years begin in 2020, not 2019. Five of the citations presented as current are from 2019. Please find current supporting research for these citations.

 

Line by line suggested edits.

36 Please find a current reference to support the claim attributed to citation 5.

43 Please find a current reference to support the claim attributed to citation 10.

45 Please find a current reference to support the claim attributed to citation 11.

64 Please find a current reference to support the claim attributed to citations 15 and 16.

72 Please find a current reference to support the claim attributed to citation 20.

75-85 This new paragraph makes several claims—citations to current research do not support any of them. Please add citations to support each claim.

88 Please find a current reference to support the claim attributed to citation 21.

94 Please find a current reference to support the claim attributed to citation 24.

105 Please find a current reference to support the claim attributed to citation 20.

110 Please find a current reference to support the claim attributed to citation 26.

121 Please find a current reference to support the claim attributed to citation 11.

123 Please find a current reference to support the claim attributed to citation 15.

134 The Introduction should end by explaining how the research study differs from past research. The new paragraph that begins the discussion, lines 280-302, should be moved here.

145-162 Citation 27 is referenced three times in these lines. This outdated reference requires the support of a current reference.

185 Please find a current reference to support the claim attributed to citation 27.

193-243 This entire section is based on three references. Only one of them is current. Citations 30 and 31 will need the support of current references.

254-278 This entire section is based on three references—all of them outdated. These citations will require the support of current research.

280-302 As mentioned above, this new paragraph belongs as the final paragraph of the Introduction. Please move it there.

312-343 These paragraphs include only two current citations—36 and 1—the remainder are outdated and require the support of current references.

343 Please include a limitations section.

345-394 As it stands, this conclusion is too wordy and can be much reduced. Indicate the problem, what this study has demonstrated, why the results are novel, and future research directions. It requires four paragraphs, not the current eight.

Comments on the Quality of English Language

In the changes the authors have made, there are serveral instances where they have neglected to add spaces between the text and citations or they have added an extra space.

Author Response

Thank you for your continued engagement and feedback on our manuscript. We appreciate your recognition of the improvements made and your detailed comments.

 

• 134 The Introduction should end by explaining how the research study differs from past research. The new paragraph that begins the discussion, lines 280-302, should be moved here.
• 280-302 As mentioned above, this new paragraph belongs as the final paragraph of the Introduction. Please move it there.

 

                 Author’s Response: Thank you for your insightful suggestion to enhance the structural flow of our manuscript. We appreciate your guidance on positioning the key paragraph that begins the discussion section at the end of the Introduction. This paragraph introduces our study's primary aim and outlines how our research extends the existing applications of Meleis' Transition Theory in gerontogeriatric nursing, especially concerning developmental transitions.

To this end, we have relocated the paragraph to the end of the Introduction. This repositioning allows us to conclude the introductory section on a note emphasising our approach's novelty and significance, setting a clear expectation for the detailed analysis that follows in the discussion.

 

• 343 Please include a limitations section.

                 Author’s Response: Thank you for your suggestion to include a discussion on the limitations of our study. We have integrated a segment at the end of the discussion section that addresses the limitations related to the scope and nature of a Perspective article. This addition clarifies the theoretical focus and the reliance on seminal and recent works, aligning with the paper's aim to stimulate further academic inquiry rather than present exhaustive empirical validations.

We believe this enhancement strengthens the manuscript by providing a balanced view of its theoretical underpinnings and the scope of its contributions.

 

• 345-394 As it stands, this conclusion is too wordy and can be much reduced. Indicate the problem, what this study has demonstrated, why the results are novel, and future research directions. It requires four paragraphs, not the current eight.

                 Author’s Response: Thank you for your constructive feedback regarding the conclusion of our manuscript. We have revised the conclusion to be more concise and focused, reducing it to four clear paragraphs as suggested.

 

• In the changes the authors have made, there are serveral instances where they have neglected to add spaces between the text and citations or they have added an extra space.

                 Author’s Response: Thank you for seeing that, changed.

 

• Reference Updates

     Author’s Response: We understand the importance of including recent research to support our arguments and have indeed made substantial updates in previous revision rounds. However, it is essential to highlight that as a perspective piece, our manuscript aims to provide both historical context and a contemporary view of Meleis’ Transition Theory within gerontogeriatric nursing. This dual approach ensures a deeper understanding and appreciation of the theory's foundational principles and evolution over time.

Regarding the requests for updated references, we have thoroughly evaluated the possibility of incorporating additional current literature. In many cases, the seminal works cited are irreplaceable as they directly pertain to Meleis’ original writings and the foundational aspects of the Transition Theory, which are crucial to our analysis. We have supplemented these with current references, which significantly add value and support the manuscript's thematic narrative without overshadowing the theoretical underpinnings best illustrated by these foundational sources.

We believe that integrating references based solely on their recency could detract from the theoretical richness and dilute the thematic focus of our paper. Our revisions have been judicious, aiming to maintain the integrity and coherence of the article's argumentative structure.

Moreover, the existing blend of historical and recent references is deliberate, allowing us to comprehensively discuss the ongoing relevance of Transition Theory in gerontogeriatric nursing. This method also prevents the manuscript from becoming fragmented—a risk pointed out in scholarly discussions on the drawbacks of excessive citation updates, which could turn the paper into what is referred to as a "Frankenstein article" (https://www.jclinepi.com/article/S0895-4356(20)31137-9/fulltext?dgcid=raven_jbs_etoc_email).

We believe that the current set of classic and recent references appropriately supports the narrative and purpose of our perspective article. They provide the depth and breadth required to discuss the topic effectively, reflecting a balanced view of the theory's historical foundation and current applications.

We hope this clarifies our approach and rationale behind our manuscript's selection and update of references. Again, thank you for your insights, which are invaluable in enhancing the manuscript's quality and scholarly relevance.