Select a Middle range theory · Identify the major concepts, model, and philosophical underpinning · Evaluated the heuristic value of the theory
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TheoryofChronicSorrowWk2.pptxTheory of Chronic Sorrow Eakes, Burke, Hainsworth
Georgene Gaskill Eakes
Born: New Bern, NC
1980: MSN @ University of NC at Greensboro.
1998: PhD from NC State University
1970: MVA- catalyst for chronic sorrow theory.
Burke & Hainsworth
Mary Lermann Burke
Born in Sandusky, OH
MSN from Boston University
PhD from Boston University
Catalyst in Theory Development: Interest in child development.
Worked with spina- bifida children and their mothers.
Developed the Burke Chronic Sorrow questionnaire.
Margaret Hainswroth
Born: Ontario, Canada
1974: MSN Boston College.
1986: PhD in Education Administration at University of Connecticut.
Catalyst: Worked in Mental Health, public health and led a women’s support group for women with MS.
Nursing Consortium for Research on Chronic Sorrow (NCRCS)
Nursing theorists began studying chronic sorrow in the 1980s after they had observed it in their nursing practice.
In 1989, nursing theorists Eakes, Burke, Hainsworth and Carolyn Lindgren established the Nursing Consortium for Research on Chronic Sorrow (NCRCS) to jointly study chronic sorrow.
Expanded the relevance of the concept to individuals experiencing a variety of loss situations, as well as to their family caregivers.
Eakes, Burke & Hainsworth, 1992
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Definition of Chronic Sorrow
A periodic recurrence of permanent, pervasive sadness or other grief- related feelings associated with ongoing disparity resulting from a loss experience.
A normal response to an ongoing loss situation.
Eakes, Burke & Hainsworth, 1998
Defining Characteristics of Chronic Sorrow
A perception of sadness or sorrow over time in a situation with no predictable end.
Sadness or sorrow that is cyclic or recurrent.
Sadness or sorrow that is triggered internally or externally and brings to mind a person’s losses, disappointments, or fears.
Sadness or sorrow that is progressive and can intensity.
Eakes, Burke & Hainsworth, 1998
History of the Theory
First documented as a middle range theory in 1998.
Explains how individuals may respond to both ongoing and single- loss events.
Created to characterize the recurring episodes of grief experienced by parents of children with disabilities (Olshansky, 1962).
Olshansky, 1962
Use and Development
Useful for analyzing individual responses of people experiencing ongoing disparity due to chronic illness, caregiving responsibilities, loss of the “perfect” child, or bereavement.
The theory was developed using concept analysis, critical review of research, and validation in 10 qualitative studies of various loss situations (196 interviews reviewed).
Inductively derived and validated through a series of 10 qualitative studies conducted by members of the Nursing Consortium for Research on Chronic Sorrow (NCRCS) and a critical review of existing research.
Provides a framework for understanding the reactions of individuals to various loss situations.
Offers a new way of viewing the experience of bereavement.
Eakes, Burke & Hainsworth, 1998
Use and Development
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.
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 .
With an understanding of chronic sorrow, nurses can plan interventions that recognize it as a normal reaction, promote healthy adaptation, and provide empathetic support.
Eakes, Burke & Hainsworth, 1998
Theoretical Assertions
Sorrow occurs to everyone at some point in life.
Chronic sorrow is a normal response to the ongoing disparity or void create by significant loss.
Different degrees of sorrow can occur over time.
Human response: natural and not pathological.
Cycles: Chronic sorrow occurs in periodic cycles.
Triggers: Different events that spark the feeling of sorrow.
Coping Strategies: Humans have an innate ability to cope.
Health Care Intervention: Nurses should provide assistance.
Ideal and Reality: Humans see a disconnect between the two.
Eakes, Burke & Hainsworth, 1998
Theoretical Model
Purpose: Useful for analyzing individual response of people experiencing ongoing disparity due to chronic illness, caregiving responsibilities, loss of the “perfect” child, or bereavement.
Provides alternative way of viewing the experience of grief.
Eakes, Burke & Hainsworth, 1998
“The pain will never completely go away, but like anything else, you just learn to live with it. You learn how to live with an amputated limb. You learn how to live with a broken heart”.
-Mary Lermann Burke
Burke, 1994
Antecedents
#1: A loss with no predictable end.
Birth of a disabled child
Diagnosis of chronic illness
Death of a loved one
#2: Ongoing disparity resulting from the loss.
A gap exists between the desired and the actual reality.
Lack of closure associated with ongoing disparity sets the stage for chronic sorrow.
Eakes, Burke & Hainsworth, 1998
Theoretical model
Eakes, Burke & Hainsworth, 1998
Concepts
Chronic Sorrow
Periodic recurrence of permanent, pervasive sadness or other grief related feelings associated with a significant loss
Disparity
The difference between the ideal and the real situation due to some type of loss.
Antecedents
Chronic illness (patient or caregiver)
A recognized negative disparity between the past and the present
The occurrence of events that bring the disparity into focus.
Eakes, Burke & Hainsworth, 1998
Concepts
Loss
Primary antecedent that must occur before the onset of sorrow.
Trigger events or milestones
Circumstances, situations, conditions that bring the negative disparity resulting from loss experience into focus.
Exacerbates the experience of disparity.
Effective Internal management
Action oriented strategies that increase feelings of control.
Used to cope with the recurrence of grief related feelings of chronic sorrow.
Cognitive “can do” and interpersonal (talking with someone close or, support group).
External management
Healthcare professionals (external management methods- therapy).
Based on premise that chronic sorrow is a normal response to a significant loss situation.
Eakes, Burke & Hainsworth, 1998
Concepts
Management methods (Internal/External)
Coping strategies used by a person with chronic sorrow (internal) and to interventions provided by professionals (external).
Internal management methods consist of individualized coping interventions initiated by the person experiencing chronic sorrow.
External management methods of coping consist of interventions provided by medical professionals to aid in effective coping.
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
Gordon, 2009
Other concepts
Other concepts related to the framework:
Coping - “Facing difficulties and acting to overcome them”.
Parents - “A mother or father who nurtures and raises a child” (initial focus of chronic sorrow theory).
Child - “A son or daughter, an offspring” (initial focus of chronic sorrow).
Olshansky, 1962
Meta- Paradigms/Major Assumptions
Person
Experiences sorrow in cycles and can experience periods of overwhelming sorrow.
Experience periods of normalcy and overwhelming grief in cycles.
Environment
Addresses if the person has a good social support.
Health
How well the person copes and uses coping mechanisms to deal with sorrow.
Nursing
Assessment of grief is an essential component of nursing (part of nursing assessment due to effects on wellness).
Incorporation of therapeutic communication can be beneficial to patient’s healing process.
Nurses should make provision for bereavement counseling when events trigger symptoms of chronic sorrow that can occur years after the loss.
Nurses should provide for anticipatory counseling for trigger events as well as reinforce effective internal and external coping mechanisms.
Eakes, Burke & Hainsworth, 1998
Philosophical Underpinnings
People may periodically re-experience the pervasive sadness or other grief-related feelings that occur when initially confronted with the loss.
Simon Olshansky:
Counselor to parents of handicapped children.
Introduced chronic sorrow in 1960s to describe normal pervasive physiological response in suffering of parents dealing with mentally disabled children
Encouraged professionals to recognize chronic sorrow as a natural response to a tragic situation in order to assist parents in achieving greater comfort living with and managing a child with a mental disability
Described chronic sorrow as ongoing yet periodic, as well as normal.
1980s and early 1990s- Nursing profession first introduced Olshanksky’s theory through concept analysis of Chronic sorrow.
Olshansky, 1962
Philosophical Underpinnings
Teel (Concept analysis):
Examined theories of time-bound grief and of chronic grief or mourning.
Teel used these concepts in adapting Olshansky’s definition of chronic sorrow for nurses.
Prolonged chronic grief or mourning results when adaptation is not made; it is considered an abnormal response.
Contrasted with Olshansky model of grief.
Teel defined chronic sorrow as: a pervasive psychic pain and sadness, stimulated by certain trigger events, which follows loss of a relationship of attachment.
Teel also described chronic sorrow as being precipitated by a permanent loss of a personal attachment that may ne ongoing with sadness of varied intensity that recurs for the lifetime of the disabled person.
Teel, 1991
Philosophical Underpinnings
Lazarus and Folkman
Model of Stress and Adaptation
Transaction (interaction) occurs between a person & the environment
Stress results from an imbalance between (a) demands & (b) resources.
We become stressed when demands (pressure) exceeds our resources (our ability to cope & mediate stress).
Freud
Grief work has it’s origins in Sigmund Freud’s Mourning and Melancholia.
Mourning is the “normal” response to death.
In grief the world becomes poor and empty.
A normal response of mourning entails working through the grief.
Lazarrus & Folkman, 1984, Freud, 1917
Newman Typology
Fawcett, 1999
World view
Fawcett, 1999
Analysis: Heuristic value
Parsimonious:
Presented in a clear and concise manner.
Well accepted by the nursing profession.
Used in many different specialties of the nursing profession.
Provides a framework for understanding the reactions of individuals to loss
Logically developed from 10 qualitative studies conducted by the Consortium for Research on Chronic Sorrow.
Theory aids in the understanding of the loss experience.
Authors are able to draw conclusions and make arguments that are well supported by clinical and research data.
Conceptualization of the model is easily displayed in the theoretical model.
Eakes, 1998, 2004
Use of the Theory
Analysis: Empirical Adequacy
Explains chronic sorrow.
Future research: identification of other conditions that commonly lead to chronic sorrow.
Research could generate hypotheses based on the theoretical model.
Theoretical model lends itself to research on effectiveness of interventions for caregivers and patients.
Can be used to determine what conditions are more likely to trigger an exacerbation of chronic sorrow and begin chronic sorrow experience (beneficial for nursing).
Easily applied in clinical settings.
Analysis: Critique of Theory
Does not address why some individuals do not experience sorrow.
Does not consistently demonstrated progressivity of the emotions associated with chronic sorrow
Should examine whether there are predictors of those who will not experience chronic sorrow.
Loss
That 2 year old toddler was actually 2 weeks away from turning two.
She died on March 28, 1998.
She was an amazing and beautiful little girl filled with adventure and filled with so much love.
She left behind her mother, father, 18 year old sister and 6 year old brother
Loss
41 year old found floating in Markham Park on November 15th 2005 (after Hurricane Wilma).
Woman found attached to a road bike
Woman reported missing by her husband on November 14th after he came home from work to find her keys, jewelry, car and everything she needed for work in the home but she was not there.
Conclusion
Chronic sorrow has been shown to explain the experience of people across the lifespan who encounter ongoing disparity because of significant loss. 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, 2007).
Appropriate for middle range theory because it has a scope that is limited to the explanation of a single phenomena, that of a response to loss.
References
Abbate, G. (2014). Theory of chronic sorry
Burke, M. L. (1989). Chronic sorrow in mothers of school-age children with myelomeningocele disability. Dissertations Abstract International, 50, 2334B.
Casework, 1962, 51:190-193.
Eakes, G.G., Burke, M. I., & Hainsworth, M. A. (1998). Middle range theory of chronic sorrow. Image: Journal of Nursing Scholarship, 30(2), 179-184.
Fawcett, J. (1999). Relationship of theory and research (3rd ed.). Philadelphia: F.A. Davis.
Hainsworth, M. A., Eakes, G. G., & Burke, M. L. (1994). Coping with chronic sorrow. Issues in Mental Health Nursing, 15, 59-66.
References
Lazarus, R.S., & Folkman, S. (1984). Stress, Appraisal and Coping. New York: Springer Publishing Company.
Olshansky, S. (1962). Chronic sorrow: A response to having a mentally defective child. Social Casework, 43(4), 190-193.
Peterson, S. J., Bredow, T.S. (2009). Middle Range Theories: Application to Nursing Research. Philadelphia, PA: Lippincott Williams & Wilkins.
Teel, C.S. (1991). Chronic Sorrow: analysis of the concept. Journal of Advanced Nursing 16, 13111-1319. Retrieved November 2013, from EBSCO database.
