Page 636 - alligood 8th edition_Neat

CHAPTER 31 Georgene Gaskill Eakes; Mary Lermann Burke; Margaret A. Hainsworth 617

Although most of the authors were from the are defined, and the middle-range theory describes
United States, the literature reflects an international the proposed relationship among the concepts that
interest with publications by nurses from Australia make intuitive sense. For example, it is clear that
(Maltby, Kristjanson, & Coleman, 2003), Sweden effective management, whether internal or external,
(Ahlstrom, 2007; Isaksson & Ahlström, 2008; Pejlert, will lead to increased comfort, and, conversely, inef-
2001), and the United Kingdom (Bowes, Lowes, fective management will lead to increased discomfort
Warner, et al., 2009; Lowes & Lyne, 2000). Several and intensity of chronic sorrow. As a middle-range
studies were written by occupational therapists, and theory, the scope is limited to explanation of a single
one was written by sociologists, supporting the asser- phenomenon, that of response to loss, and is congru-
tion that NCRCS work is the basis for international ent with clinical practice experience. As Eakes has
and interdisciplinary research. Application of this stated, “the beauty of this middle range theory is that
middle-range theory to research is seen in current it rings true with practitioners, students, and educa-
nursing literature (Eakes, 2013). tors, as is evident from the continued communication
nationally and internationally” (G. Eakes, personal
communication, May 2012).
Further Development Some, albeit few, of the NCRCS’s interviewees
To date, most of the research efforts related to did not experience the symptoms labeled as Chronic
the middle-range Theory of Chronic Sorrow used Sorrow. This one unclear aspect of the theory
qualitative methods and focused on identifying the remains—that is, why not all individuals with unre-
concept’s occurrence in new populations. Instrument solved losses experience chronic sorrow. No further
development studies designed to measure the intensity data have been reported about these individuals.
of chronic sorrow at the interval or ratio level will Although chronic sorrow is unique to each person
enhance further development of the theory. Current and their situation, do individuals who do not experi-
instruments—the Burke/Eakes Chronic Sorrow ence chronic sorrow have different personality
Assessment (Eakes, 2013) and the Kendall Chronic characteristics? Are they more resilient, or did they
Sorrow Instrument (Kendall, 2005)—yield data at receive effective health care interventions at the time
the nominal or ordinal levels. Ratio or interval chronic of their loss? What would these individuals suggest
sorrow–intensity understanding would enhance about ongoing coping with loss?
studies designed to measure evidence of the effective- This and a clarification of the categories of internal
ness of nursing roles and interventions to achieve management strategies point to future work on this
outcomes identified in the NOC system, for example, theory. How problem-oriented and cognitive strate-
“Acceptance: Health Status . . . Depression Level . . . gies differ and the emotive-cognitive, emotional, and
Hope . . . Mood Equilibrium” (Johnson, Moorhead, interpersonal strategies are not clearly described. The
Bulechek, et al., 2012, p. 220–221). This type of overlap between external versus internal management
research would contribute empirical support for raises a question when the word interpersonal is used
evidence-based or theory-based nursing practice. to describe seeking professional help.
Finally a concept that needs clarification is pro-
Critique gression of chronic sorrow. Although chronic sorrow
is described as potentially progressive, the nature of
Clarity the progression and the pathology associated with it
This theory clearly describes a phenomenon observed is not clear.
in the clinical area when loss occurs, and it is evident
that it is highly accepted in nursing practice. The Simplicity
nursing diagnosis of Chronic Sorrow is included in The Theoretical Model of Chronic Sorrow (Figure 31–1)
the standardized languages of NANDA-I. It is defined enhances the understanding of the relationship among
as cyclical, recurrent, and potentially progressive, and the variables. With this model, it is clear that chronic
it is consistent with the NCRSC definition. In each of sorrow is cyclical in nature, pervasive, and potentially
the published works of these theorists, key concepts progressive. Further, with the subconcepts of internal