Scholarly Assignment: Theory of Chronic Sorrow Paper

Chronic Sorrow

More than 30 years ago, chronic sorrow was brought into the medical research literature to describe the repeated episodes of melancholy witnessed by parents of toddlers with mental defects as they fought to come to terms with the loss of a “perfect child” (Batchelor, 2019). Olshansky’s pervasive, recurring melancholy as chronic grief was regarded as a typical reaction to deviations in expected normalcy (Yumoto & Yokoi, 2020).

Subsequent research confirmed the presence of chronic sorrow among parents of disabled children and broadened the range of emotions frequently encountered by parents to include sadness, sorrow, fear, helplessness, distress, and despair (Fernandes et al., 2021). These researchers concluded that the never-ending character of the loss of the “ideal” child precluded grief resolution and induced recurring sadness.

Case Scenario

Oliver was born 7 years ago and his mother was told that there could be a chance that he could have cerebral palsy. Oliver’s mother, Mrs. Stone, was 45 at the time and had struggled with infertility for 15 years. She had another son whom she delivered at 15 and was okay. Mrs. Stone described Oliver as having many difficulties resulting from severe cerebral palsy. His chief diagnosis is spastic quadriplegia, which affects all of his four limbs, the trunk, and the face (Patel et al., 2020).

Oliver typically cannot walk and frequently has additional developmental difficulties such as intellectual incapacity, seizures, and visual, hearing, and speech issues. He also has an unexplained condition, according to a neurologist, since he has hyper-extensible joints, a high arched palate, a missing arch on his feet, an aberrant hairline, and scapular prominences, symptoms described by Rudebeck (2020). He has experienced persistent digestive problems since he was a toddler.

He spent most of his life battling ailments such as chickenpox and colds, but also ophthalmic staphylococcal infections. He also had an antibiotic prescription on file due to recurring pneumonia and bronchitis. He began infant stimulation physical therapy at the age of one year. However, it was insufficient for specialists to detect substantial development, and he is still unable to walk or communicate (Patel et al., 2020).

He was diagnosed with developmental delay at the age of two, with little possibility of walking or speaking. Mrs. Stone claims she has been physically working out with him. His health and cognitive ability have declined, and he has a flat affect and is unable to respond to voices or his environment. Mrs. Stone was advised to always speak to him, verbalizing colors and surroundings.

Analysis of the Philosophical Underpinnings of Chronic Sorrow

Parents must cope with the deinstitutionalization of their children who have intellectual disabilities (ID). Intellectual impairments are often identified at birth or in early life. Because the ID level does not alter throughout time, parents of people with ID face identical issues (Olwit et al., 2018). In the interview, Mrs. Stone was asked whether she felt she suffered chronic sadness, and she described the sense of coming and passing.

Mrs. Stone’s experiences of chronic sadness differed in terms of whether it had risen, diminished, or remained the same, and it had increased through time for her. Mrs. Stone expressed her exhaustion at the persistent sensation of melancholy and the feelings she felt, such as dread, despair, sadness, depression, irritation, and uncertainty.

Wijaya et al. (2022) note that it is critical for nurses to identify and diagnose the triggering events that initiate chronic grief, which typically involve delayed developmental milestones. Another triggering event is the comparison of their children to other children of comparable age or siblings (Olwit et al., 2018). APRNs must recognize that most of the time, there is a loss of social support because of the degree of care their kid demands and a lack of respite hours, which causes the mother’s social life to contract.

Management and Coping Strategies of The Mother

People use a range of coping mechanisms to deal with the recurrent re-grief in conjunction with chronic sadness. Positive coping strategies adopted by persons suffering from chronic grief are consistent among afflicted individuals, family caregivers, and bereaved individuals and are compatible with patterns found in known stress and coping theories (Batchelor, 2019). People who use action tactics to help them feel more in command of their life are more likely to cope effectively with chronic grief.

These tactics include continuing to participate in personal hobbies and activities, seeking respite opportunities, and gathering knowledge about one’s loss experience (Chang et al., 2018). Cognitive coping approaches are also commonly employed to address the feelings linked with chronic grief. These tactics include having an “I’m able to” attitude and focusing on one day at a time, which is applied by Mrs. Stone.

Methods of External Management of Chronic Sorrow by APRN

It is vital to stress that the APRN health care practitioners’ management strategies should be founded on a view of chronic grief as normal rather than abnormal. The cornerstone for further treatments is the normalization of the experience (Wijaya et al., 2022). Knowing what events and scenarios are likely to cause chronic grief offers anticipatory counseling. APRNs can evaluate personal coping styles by asking about their usual coping strategies.

Positive coping skills should be strengthened and encouraged after they have been found. Strategies found beneficial in dealing with persistent sadness can be taught to persons who lack appropriate coping capacities (Wijaya et al., 2022). Furthermore, various activities taken by health care practitioners are beneficial in lowering the emotional anguish of chronic grief. These interventions can be classified as roles that APRNs can play in their interactions with people suffering from chronic grief.

Interventions demonstrating an empathic presence and a caring nurse are most beneficial for persons diagnosed with chronic diseases. Typical empathic presence treatments include spending time to listen, giving support and reassurance, acknowledging and concentrating on feelings, and valuing the uniqueness of each individual and family (Chang et al., 2018). Being attentive, courteous, nonjudgmental, tactful, patient, and compassionate in interactions with persons facing chronic grief exemplifies the complementary role of a caring professional (Rahayu, 2019).

Interventions that represent the nurse and expert roles are useful to afflicted persons. Interventions associated with the role of APRN, such as the allocation of precise, situation-specific data in a fashion that can be heard and understood, and practical suggestions for coping with the issues of providing care, benefit the most family members of young children with disabilities and other family caregivers (Faramarzi et al., 2019). As previously outlined, an empathetic presence helps the mother and the caregivers to cope with the feeling of chronic grief.

Applications of Chronic Sorrow

The chronic grief hypothesis contributes to the development of a framework for understanding people’s emotions to various loss scenarios, as well as a fresh way of viewing loss experiences. One major component of chronic grief theory is management strategies (Rahayu, 2019). The term refers to people’s coping strategies while dealing with chronic grief (internal) as well as supporting professional treatments (external) (Heidary & Shirdelzade, 2021). Effective external and internal management approaches increase comfort and can extend the time between two chronic grief periods.

Nurses play an integral role in alleviating the melancholy problem through various approaches to theory or action. Chronic sorrow studies do not address, support, or accept the fact that parents continue to be parents of disabled children (Faramarzi et al., 2019). Their problems may differ vastly from those that preoccupied them while their child was smaller.

The dynamics and structure of families have evolved over time (Rahayu, 2019). Ways of coping with the problems and strains in their lives as a result of their child’s disability may have emerged. Their outlook on life may have shifted as a result of the passage of time, and this is where the theory can be applied: through growing with the child and the parent.

Conclusion

Nurses and other health care workers should be aware that chronic grief is widely experienced by people of all ages who have endured substantial loss or are experiencing persistent loss. Furthermore, it is critical that they recognize the repeated periodic periods of grief and other feelings associated with sorrow as a natural reaction to the ongoing discrepancy caused by the loss and give required assistance when chronic sorrow is aroused.

References

Batchelor, L. L. D. (2019). Chronic sorrow in parents with chronically ill children. Pediatric Nursing; Pitman, 45(4), 163–173.

Chang, K.-J., Huang, X.-Y., Cheng, J.-F., & Chien, C.-H. (2018). The chronic sorrow experiences of caregivers of clients with schizophrenia in Taiwan: a phenomenological study. Perspectives in Psychiatric Care, 54(2), 281–286. https://doi.org/10.1111/ppc.12235

Faramarzi, S., Siadatian, S. H., Rashidi, A., Kardan, Z., Associated Professor, Department of Psychology and Education of Children with Special Needs, Faculty of Education and Psychology, University of Isfahan, Isfahan, Iran., & B.S in Educational Sciences, Payame Noor University, Aran and Bidgol, Iran. (2019). The comparative study of chronic sorrow and feelings of entrapment in mothers that have children with intellectual disabilities and without. Journal of Research in Behavioural Sciences, 17(1), 120–129. https://doi.org/10.52547/rbs.17.1.120

Fernandes, M. A., Nóbrega, M. M. L. da, Zaccara, A. A. L., Freire, M. E. M., Andrade, F. F. de, & Costa, S. F. G. da. (2021). Fawcett analysis and evaluation model applied to the theory of Chronic Sorrow. Texto & Contexto Enfermagem, 30. https://doi.org/10.1590/1980-265x-tce-2020-0010

Heidary, A., & Shirdelzade, S. (2021). Chronic sorrow: concept analysis using Rogers’ approach. Navid No, 24(77), 143–154. https://doi.org/10.22038/nnj.2021.54172.1252

Olwit, C., Mugaba, M., Osingada, C. P., & Nabirye, R. C. (2018). Existence, triggers, and coping with chronic sorrow: a qualitative study of caretakers of children with sickle cell disease in a National Referral Hospital in Kampala, Uganda. BMC Psychology, 6(1), 50. https://doi.org/10.1186/s40359-018-0263-y

Patel, D. R., Neelakantan, M., Pandher, K., & Merrick, J. (2020). Cerebral palsy in children: a clinical overview. Translational Pediatrics, 9(Suppl 1), S125–S135. https://doi.org/10.21037/tp.2020.01.01

Rahayu, D. (2019). “Chronic sorrow theory application” to overcome the feeling of loss due to infant mortality in post-partum women. Journal of Maternity Care and Reproductive Health. https://doi.org/10.36780/jmcrh.v2i1.70

Rudebeck, S. R. (2020). The psychological experience of children with cerebral palsy. Paediatrics and Child Health, 30(8), 283–287. https://doi.org/10.1016/j.paed.2020.05.003

Wijaya, Y. A., Yudhawati, N. L. P. S., Andriana, K. R. F., & Ilmy, S. K. (2022). Middle range theory: Understanding perspective theory of Chronic Sorrow nursing presented by Georgene Gaskill Eakes. https://doi.org/10.31219/osf.io/zfw7e

Yumoto, A., & Yokoi, T. (2020). Aspects of the minds of mothers of children with developmental but no intellectual disabilities and the nature of these disabilities. Journal of Physical Therapy Science, 32(10), 686–690. https://doi.org/10.1589/jpts.32.686

THEORY OF SORROWS INSTRUCTIONS

Chronic Sorrow:

Historical Background
Current Research on Chronic Sorrow

Middle Range Nursing Theory of Chronic Sorrow

Research Applications of Chronic Sorrow

NCRCS Chronic Sorrow Instrument Development Summary