The Theory of Chronic Sorrow is a middle range nursing theory first proposed by Olshansky in 1962. Chronic sorrow is defined as “a normal response to ongoing disparity due to loss” (Eakes, Burke, and Hainsworth, 1998). Chronic sorrow is very much related to grief, but extended over a long period of time, or it is a feeling of grief recurring over time. The grief feelings in chronic sorrow are permanent and pervasively sad, as occur in a significant loss. Nurses should, according to the authors, view chronic sorrow as a normal response to loss, as on a continuum of responses to significant loss, and when chronic sorrow is triggered, it is the nurses’ responsibility to provide support for the people experiencing chronic sorrow by helping them positively use coping strategies and by assuming nursing roles that increase comfort.
The Theory of Chronic Sorrow can be analyzed using the C-BaC model. This model asks interpreters to judge the model based on clear meaning, boundaries, understandable language that includes concepts and propositions, major concepts, the formulation of propositions, propositions and how they are related to the meaning of the theory, how theoretical knowledge helps explain and predict phenomena, and theoretical knowledge and how it influences nursing practice. Nursing theories must always pass this kind of rigorous analysis in order to be helpful to medical practitioners, and the Theory of Chronic Sorrow is no exception to this.
The theory has a very clear meaning. It was originally formulated as a way of describing the reactions of parents to ongoing losses associated with caring for a child who has a chronic illness or disability (Scornaienchi, 2003). The theory also describes the feelings people have when someone they care about is chronically ill, is debilitated in some way, or experiences death and the death is in many ways traumatic to the person and to the survivors. With regard to nursing, nurses should always be aware of cases in which chronic sorrow is manifested, because the reactions of nurses to that condition, as opposed to conditions in which grief is naturally felt, understanding that grief and chronic sorrow are, while they are similar, not the same and require different degrees of caring.
The meaning of boundaries in this case is that things are more clearly defined, as in the nursing care setting, the recipients of treatment, and the roles, especially that of nurse practitioner. Nursing care settings can include the hospital, primary care offices, urgent care offices, and the homes of the patient. Recipients can be and often are parents who live with and care for disabled children. Nurse practitioners are the leaders, caregivers, educators, and advocates for both the parents and for the children. The nurse’s role in this case is to recognize chronic sorrow and understand that it is a normal grief process.
Living with chronic illness can be incredibly stressful both for the children and the parents of the children, and stress over time produces much that we understand as sadness, or sorrow that becomes chronic. Parents of children who are chronically ill or disabled often feel periodic episodes of sadness when they are coping with this child, and it is these periodic episodes that we define as chronic sorrow (Gordon, 2009).
The language of the Theory of Chronic Sorrow is quite simple, and is easy to understand, and really needs no further comment.
In the Theory of Chronic Sorrow, there are five major concepts present: disparity, loss, antecedents, triggers, and internal and external management methods. Disparity refers to the difference between the perceived reality of an ideal situation against the actual situation that is associated with loss (Teel, 1991). Loss is a death or bereavement issue that can either be a single event or an ongoing event (Eakes et al., 1998). Antecedents are the things that a person remembers that occurred before the time of onset of chronic sorrow (these are the things to which a person clings, hoping that the condition will return to that time before everything became sorrowful).
Triggers are those events that help or make a person remember the reality of the disability or chronic illness, and they are reminders of the disability or illness, and are generally associated with exceptional milestones in the child’s life, such as a graduation, or entering the first grade. Internal and external management methods refer to coping strategies that nurses share with parents and the families of children that will help them deal with the ordinary, everyday complexities of chronic illness or disability. Internal methods refer to the reading of or use of literature related to the disability or illness, journaling, or joining support groups with parents of other children who have the same disability or illness. External methods are those in which a family member takes advantage of those in helping profession, such as counselors, those prescribing medication, medical professionals, those who provide spiritual advice or counseling, and other support services, such as referral services to specific agencies for help.
Propositions are stimulated by the formation of concepts in the theory. The main proposition of the Chronic Sorrow theory is that chronic sorrow is pervasive, permanent, and occurs in periods interspersed with periods of happiness (Teel, 1991). Propositions, for the purposes of theory, are those things that are used to describe the relationship between two concepts or to show a cause-and-effect relationship between two concepts (Johnson and Webber, 2001). In the Theory of Chronic Sorrow, concepts are named and then the relationship of these concepts to their management is expressed. For example, trigger events are events that bring sadness into consciousness, and remind the caretakers of the child that the child is chronically ill. Internal and external management strategies are propositions about how trigger events are handled. How these events become handled is the way in which joy again becomes part of the parents’ experience.
Knowing what chronic sorrow is, and the fact that it is a permanent condition, and that it will occur particularly at major milestones in the child’s life, is a part of theoretical knowledge that helps to predict that phenomena. Knowing for certain that trigger events will occur throughout the child’s lifetime will help parents learn to manage these feelings and to cope with them. In this way, theoretical knowledge helps to explain what will happen, and to predict it’s happening at certain specific times in the child’s life.
Parents learn to understand that chronic sorrow is associated with the daily dependence that a child has on his or her parents or caregivers, and that sometimes this dependence will be an irritant to both the child and the parents. A primary nursing role is to support the parents during these times, and that this kind of support is not a temporary goal, but a permanent goal related to comfort.