Ms Geya George1,2, Professor Davina Porock1,3, Professor Deborah Kirk1,4, Dr Kylie McCullough1
1edith Cowan University, Joondalup, Australia, 2Latrobe University, Bundoora, Australia, 3 Mahasarakham University, Mahasarakham, Thailand, 4Federation University, Ballarat, Australia
Biography:
Geya George is a Registered Nurse, Lecturer at Latrobe University, and PhD candidate at Edith Cowan University. Her doctoral research, *Orchestrating Transitions*, develops and validates a micro theory explaining how nurses guide patients from curative to palliative care. A recipient of the “Carol Cameron Memorial Scholarship”, Geya has implemented the “SPICT tool” in a South-Eastern private hospital to support early identification of palliative needs. With extensive experience in oncology, palliative care, and education, she is committed to advancing nursing leadership, compassionate communication, and workforce frameworks that recognize the invisible emotional and cultural labour of nurses.
Abstract:
Background:
Transitions from curative to palliative care in advanced cancer remain one of the most sensitive and uncertain stages of healthcare. Nurses often stand at the centre of this shift, guiding patients and families through emotional and ethical challenges. Much of their relational and emotional labour, however, remains unseen or undervalued. This study aimed to bring visibility to this hidden work through the development of the Orchestrating Transitions theory.
Aim:
To construct and validate a micro-level, substantive, nursing theory that explains how nurses orchestrate transitions from curative intent to palliative care through visible and invisible roles.
Methods:
Using Turner’s nine-step theory synthesis method (2018) within a critical realist framework, data were drawn from an integrative review and validated through Lynn’s Content Validity Index (CVI) with nine international nursing scholars. Quantitative CVI results were merged with qualitative comments to refine the conceptual structure and ensure cultural sensitivity and clarity.
Results:
The theory identifies seven interlinked nursing roles. The visible roles, advocate, organiser, and communicator, represent clinical and procedural aspects, while the invisible roles—hope-instiller, emotion juggler, protector of cultural obligations, and informal communicator express the moral and emotional dimensions of nursing. Represented through the Boab tree metaphor, the visible work forms the sturdy trunk, while the invisible labour acts as the nourishing roots that sustain compassionate, person-centred transitions.
Conclusion:
Orchestrating Transitions makes the invisible work of nurses visible. It gives theoretical language to the emotional, cultural, and communicative labour that underpins quality transition care. This micro theory offers a strong base for education, leadership, and policy initiatives that value relational competence alongside technical expertise, and it holds promise for future empirical testing.