Theory of Chronic Sorrow

Introduction

• Theory of chronic sorrow was developed by Georgene Gaskill  Eakes, Mary Lermann Burke and Margaret A. Hainsworth in 1998.
• Other related theories - Kubler-Ross (1969), Bowlby (1980)
• Theory of chronic sorrow is considered as a a middle-range nursing theory.
• Theory explains the ongoing feelings of loss that arise from illness, debilitation, or death.
• This theory provides a framework to describe the reaction of parents to the ongoing losses associated with caring for a child with chronic illness or disability (Scornaienchi JM, 2003).
• Nurses caring for families need to be aware of the high potential for chronic sorrow to occur in persons with chronic conditions, their family caregivers, and bereaved persons.(Eakes GG, 1999).

Concepts

• Major concepts
  • chronic sorrow
  • disparity
  • loss
  • antecedents
  • trigger events, and
  • internal and external management methods.
• Chronic sorrow is the periodic recurrence of permanent, pervasive sadness or other grief related feelings associated with a significant loss. (Eakes GG, 1998).
• Disparity refers to the difference between the ideal and the real situation due to some type of loss.
• Loss - a significant loss that may be ongoing or a single event.
• The model explains two antecedents: (Gorden J, 2009)
  • First antecedent is initiated when a single event of a living loss is experienced e.g. onset or time of diagnosis of chronic illness
  • Second antecedent to chronic sorrow is unresolved disparity resulting from the loss.
• Triggers are events which prompt the recognition of a negative disparity in the disabled loved one or loss which brings out sadness again.
• Internal management methods consist of individualized coping interventions initiated by the person experiencing chronic sorrow (Gordon J, 2009).
• External management methods of coping consist of interventions provided by medical professionals to aid in effective coping (Gordon J, 2009).
• Examples of external management methods (Gordon J, 2009) are
  • professional counseling,
  • pharmaceutical interventions to treat symptoms of insomnia or anxiety if necessary,
  • pastoral care or spiritual support to assist with grieving,
  • use of therapeutic communication, and
  • referral services
• Other concepts related to the framework are:
  • Coping - “Facing difficulties and acting to overcome them”.
  • Parents - “A mother or father who nurtures and raises a child”.
  • Child - “A son or daughter, an offspring”.
• The theory provides a framework for understanding and working with people following a single or ongoing loss (Eakes GG, 1998).

Conclusion

• Theory is useful for analyzing individual responses of people experiencing ongoing disparity due to chronic illness, caregiving responsibilities, loss of the "perfect" child, or bereavement (Eakes GG, 1998).
• Nurses need to view chronic sorrow as a normal response to loss and, when it is triggered, provide support by fostering positive coping strategies and assuming roles that increase comfort (Eakes GG, 1998)
• With an understanding of chronic sorrow, nurses can plan interventions that recognize it as a normal reaction, promote healthy adaptation, and provide empathetic support.

References

1. Eakes, G.G., Burke, M.L., & Hainsworth, M.A. (1998). Middle range theory of chronic sorrow. Image: Journal of Nursing Scholarship, 30(2), 179-183.
2. Eakes, G.G., Burke, M.L., & Hainsworth, M.A. 1999) Milestones of Chronic Sorrow: Perspectives of Chronically Ill and Bereaved Persons
   and Family Caregivers. Journal of Family Nursing, 5(4), 374-38
3. Scornaienchi JM (2003) . Chronic sorrow: one mother's experience with two children with lissencephaly. J Pediatr Health Care. Nov Dec;17(6):290-4.
4. Gordon J ( 2009). An evidence-based approach for supporting parents experiencing chronic sorrow. Pediatr Nurs.35(2):115-119.