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CHAPTER 31 Georgene Gaskill Eakes; Mary Lermann Burke; Margaret A. Hainsworth 615

themselves in relation to social norms (Eakes, Burke, Hainsworth, Burke, Lindgren, et al., 1993; Hainsworth,
& Hainsworth, 1998). Busch, Eakes, et al., 1995; Hainsworth, Eakes, Burke,
1994; Lindgren, 1996; Lindgren, Burke, Hainsworth,
et al., 1992). Suggestions are provided on how nurses
Theoretical Assertions may assist individuals and family caregivers to effec-
1. Chronic sorrow is a normal human response tively manage the milestones or triggering events.
related to ongoing disparity created by a loss More specifically, the work identifies nursing roles as
situation. empathetic presence, teacher-expert, and caring and
2. Chronic sorrow is cyclical in nature. competent professional (Eakes, Burke, Hainsworth,
3. Predictable internal and external triggers of height- et al., 1993).
ened grief can be categorized and anticipated.
4. Humans have inherent and learned coping strate- NCRCS-Derived Literature
gies that may or may not be effective in regaining The original NCRCS work is referenced in publica-
normal equilibrium when experiencing chronic tions in practice-focused journals. Several non-
sorrow. NCRCS nurse authors published articles that cite
5. Health care professionals’ interventions may or NCRCS studies directed to practicing clinicians
may not be effective in assisting the individual to (Gedaly-Duff, Stoger, & Shelton, 2000; Gordon, 2009;
regain normal equilibrium. Kerr, 2010; Krafft & Krafft, 1998; Scornaienchi, 2003).
6. A human who experiences a single or an ongoing Interdisciplinary practice-focused literature provided
loss will perceive a disparity between the ideal and guidance useful to nurses (Doka, 2004; Harris &
reality. Gorman, 2011; Miller, 1996).
7. The disparity between the real and the ideal leads The work listed above in the practice section is
to feelings of pervasive sadness and grief (Eakes, also educationally related. The next section presents
Burke, & Hainsworth, 1998). evidence of undergraduate, graduate, and continuing
education support of the NCRCS’s work on chronic
sorrow’s relevance in the educational community.
Logical Form
This theory is based on a series of qualitative studies. Education
Through the analysis of 196 interviews, the middle- Undergraduate Education
range Theory of Chronic Sorrow evolved. With the Standardized Nursing Languages. Literature on stan-
empirical evidence, the NCRCS theorists described dardized nursing languages reveals that chronic
the phenomenon of chronic sorrow, identified com- sorrow is a diagnostic category (NANDA, 2011) with
mon triggers of re-grief, and described internal coping related expected outcomes and suggested interven-
mechanisms and the role of nurses in the external tions (Johnson, Moorhead, Bulechek, et al., 2012).
management of chronic sorrow. Evidence of the Comparison of the definitions of chronic sorrow used
theoretical assumptions is clear in empirical data. by the North American Nursing Diagnosis Associa-
tion International (NANDA-I) and the NCRCS (Eakes,
Acceptance By the Nursing Community Burke, & Hainsworth, 1998) reveal essentially similar
dimensions. Several widely used nursing diagnosis
Practice textbooks (Ackley & Ladwig, 2011; Carpenito-Moyet,
NCRCS-Original Work 2010; Doenges, Moorhouse, & Murr, 2010) cite the
The series of NCRCS studies, which form the founda- work of the NCRCS and/or authors who used the
tion of the middle-range Theory of Chronic Sorrow NCRCS’s work to explicate linkages among chronic
(Eakes, Burke, & Hainsworth, 1998), are replete with sorrow as a diagnostic category, intervention, and
practice applications. Each article relates the findings to outcome. Linkages among diagnostic categories in the
clinical nursing practice (Burke, Eakes, & Hainsworth, North American Diagnostic Association International
1999; Eakes, 1993; Eakes, 1995; Hainsworth, 1994; (NANDA-I), the Nursing Outcomes Classification