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CHAPTER 31 Georgene Gaskill Eakes; Mary Lermann Burke; Margaret A. Hainsworth 619

practitioners are able to normalize the experience. As
Eakes stated, “chronic sorrow is like the pregnancy her primary caregiver. Mrs. Jones complains of
experience, it is a normal process in which clients can difficulty sleeping and has frequent headaches.
benefit from guidance and support of health care profes- As the nurse, you suspect that Mrs. Jones may be
sionals” (G. Eakes, personal communication, May 2012). experiencing chronic sorrow.
Using the Burke/NCRCS Chronic Sorrow
Questionnaire (caregiver version) as an interview
Summary guide, you find evidence of chronic sorrow (Eakes,
Loss is an experience common to all individuals. This 1995). Mrs. Jones describes frequent feelings of
middle-range theory describes the phenomenon of being overwhelmed. She expresses that she feels
chronic sorrow as a normal response to the ongoing both angry at times and heartbroken that her
disparity created by the loss. The major concepts are daughter will never have a normal life. She indi-
described and include disparity, triggers, and manage- cates that she has had these feelings off and on
ment strategies (internal and external). The theoretical since her daughter’s accident. Further, she tells you
sources and empirical evidence are described. There is that she sees no end to her caregiving responsi-
abundant evidence that the theory is accepted and used bilities. These feelings are strongest when her
in practice, education, and research. It is referenced friend’s children get married and get jobs away
internationally by nurses and those in other disciplines. from home. She copes with these feelings by trying
Suggestions for further development and research are to focus on the positive (her daughter is alive and
presented. A thorough critique describes the clarity of her sons are doing well) and talking with a few
the concepts and the simplicity and the usefulness of close friends.
the theory for evidence-based research. You reassure Mrs. Jones that she is not alone in
her situation, and that it is normal to have these
feelings. In the course of the interview, you find
that Mrs. Jones has not sought professional coun-
CASE STUDY seling. Mrs. Jones tells you that she feels better
because this is the first time a health professional
Susan Jones is a 21-year-old woman who sustained has asked her about her feelings. With Mrs. Jones,
a spinal cord injury at 14 years of age as a result you begin to strategize on finding respite care and
of a diving accident. She is quadriplegic and a regular mental health counselor to assist her in
attends a local college. Her mother, Mary Jones, is
coping with chronic sorrow.

CRITICAL THINKING ACTIVITIES
1. Using the middle-range Theory of Chronic Sorrow 3. Compare and contrast the middle-range Theory
as a framework, devise one or more hypotheses of Chronic Sorrow with Kubler-Ross’s stages of
about parents of children with diabetes who do grief and Bowlby’s theory of loss. What is alike
or do not attend a support group. and different among them?
2. What outcome measures or objective evalua- 4. Based on the theoretical assertions of the middle-
tion could be used to validate the effectiveness range theory, consider a clinical situation in which
of interventions in a chronic sorrow support the Theory of Chronic Sorrow was or could be
group? applied in your practice. State your rationale.