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Understanding of Chronic Sorrow

The Middle Range Nursing Theory of Chronic sorrow

Min Jung Hong

on 30 October 2013

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Transcript of Understanding of Chronic Sorrow

Understanding of Chronic Sorrow
The Bottom Line is...

The Core of Chronic Sorrow :
"the Aching Disparity" Cased by "Trigger events"

The Gallagher family includes parents, John and Lynn, and children Bobby, 11, Mark, 10, Sarah, 4 and Billy, 2. Bobby and Billy both have lissencephaly, a defect in brain formation in which the cortex is smooth instead of convoluted. Seizures and severe developmental delay are associated with this disorder.

Bobby experienced a prolonged seizure at the age of 21⁄2 years that further complicated his illness course. After that seizure, Bobby could no longer swallow food effectively or handle his own secretions. He required a gastrostomy tube for feedings and oral suctioning to maintain his air- way patency. Bobby has received home care nursing services since then. Over the years, Bobby has been hospitalized numerous times for pneumonia. At the age of 9 years, he had surgery to correct severe scoliosis. Bobby’s daily care includes bathing, diapering, dressing, turning, lifting, and the administration of tube feedings, medications, nebulizer treatments, and oxygen. When Bobby is well enough, he attends school in a special education classroom for children with multiple handicaps. Bobby’s home care nurse must accompany him to school.
At age 2 years, Billy is able to roll over and pull himself to a sitting position. He eats pureed foods by mouth. Although he experiences seizures and is developmentally delayed, his course has not been as complicated as Bobby’s thus far. Billy receives in-home physical, occupational, and speech therapies through an early intervention program. John is self-employed and works long hours. Lynn is a homemaker and is the primary caregiver for Bobby and Billy.

Presented by:
Min Jung Hong

1. Understanding of various "Loss Experience"

2. Core of Chronic Sorrow : "the Aching Disparity"

3. Their sadness is resolvable : about "Trigger events"

4. Healing can be our Goal : about "coping management"

current research on chronic sorrow
parents of children
with cerebral palsy
share their experiences.(Whittingham et al., 2013)
chronic sorrow in caring for an adolescent
with a progressive neurodegenerative disease
. (Bettle et al., 2009)
Chronic sorrow in parents of children
with type 1 diabetes
.(Bowes et al., 2009)
Chronic sorrow and depression in parents of children
with neural tube defects
.(Hobdell, 2004)
The experience of chronic sorrow in African American caregivers of children
with sickle cell disease
.(Northington, 2005)
current research on chronic sorrow
The presence and meaning of chronic sorrow in patients
with multiple sclerosis
.(Isaksson et al., 2007)
Chronic Sorrow in
the Habitual ED Patient
.(Joesph, 2012)
Distinguishing the concept of chronic sorrow from standard grief: an empirical study of
infertile couples
.(Casale, 2009)
Sorrow and Solace: Neglected Areas in
Research(Klass et al., 2013)
Significant Loss
ongoing in nature with no predictable end
the birth of disabled child,
diagnosis of a debilitating illness,
the death of a loved one
current reality differs markedly from the idealized
a gap exist b/w the desired and the actual reality
periodically re-experienced.
Cyclical and continues as long as...
Understanding of Chronic Sorrow
Understanding of various "significant loss"
Understanding of various "significant loss"
Trigger Events
Missed developmental milestones

Crisis associated with management of the illness

Recognition of the never-ending nature

Anniversary dates

Recurrences, worsening of the loved one's condition

Changes in roles and responsibilities
Chronic Sorrow
Management method
Life Span
Why this events affect their emotions?
Management Method
"Companioning" with empathic support and help with problem solving
Background of Chronic Sorrow
The recurring episodes of grief experienced by parents of children with disabilities(Olshansky, 1962)
Action-oriented strategies
: continuing to pursue involvement in interest and activities, gathering information and seeking out respite opportunities
Cognitive strategies
: "can do" attitude and focusing on positive elements of one's life

Interpersonal strategies
: Talking with someone, interacting with support group
As a Nurse..(External management)
It must be based upon Chronic Sorrow is
a normal response
to a significant loss situation.
1. Sensitivity with Respectfulness.
3. Intervention as the role of "teacher/Expert"
2. Empathic Presence with Non-judgemental acceptance
Situation-Specific Information
Effective Internal management(Burke, 1989)
Chronic sorrow among parents of disabled young children(Initial research in the 1980')
a normal response to an ongoing loss situation
a pervasive sadness that was permanent, periodic, and progressive in nature
Family caregiver alliance
: caregiver support program
Chronic Sorrow was redefined as
Permanent, Periodic recurrence
Pervasive sadness or other grief-related feelings

associated with
ongoing disparity
resulting from
significant loss
(Eakes, Burke, & Hainsworth, 1998)
Dick Hoyt pushing his son, Rick, in their first Boston Marathon (1981)
As a result of oxygen deprivation
to Rick's brain at the time of his birth,
Rick was diagnosed as
a spastic quadriplegic
with cerebral palsy.

Chronic Sorrow
Management method
Life Span

Chronic Sorrow
Management method
Life Span
ineffective =>
Chronic Sorrow versus Depression
Chronic Sorrow
Natural reaction
Response to ongoing loss
Reaction to multiple losses over time
Does not interfere with daily functioning
Permanent Periodic
Pathologic Reaction
Often no precipitation loss
Mood disturbance
Can interfere functioning
Can be temporary
Can be linear
Data from Lindgren, Burke, Hainsworth, & Eakes, 1992
Using interventions for Chronic Sorrow.
Recognize chronic sorrow as a natural reaction
Assist parents in finding and using effective coping strategies
Provide accurate information and practical caregiving tips
Teach problem-solving strategies
Provide holistic, individualized care
Recognize differences in adaptation among men and women
Provide empathy, support, and active listening
Identify sources of support and respite
Assist parents in maintaining hope and finding meaning in their experience
Act as an advocate for the child and family
Data from Eakes, Burke, & Hainsworth, 1998.
One research of Kearney and Griffin (2001) explored..
the experiences of parents who have children with significant developmental disabilities.

They found that the parents’ experiences of joy were derived from their relationships with their children, while sorrow was often a response to the parents’ dealings with other people.
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