Application of The Theory of Chronic Sorrow to A Case

The theory of chronic sorrow is a theoretical framework that seeks to explain and conceptualize chronic sorrow and how to cope with it. Chronic sorrow is defined as the periodic recurrence of pervasive, permanent grief-related feelings or sadness that is either associated with significant loss (Olwit et al., 2018). Chronic sorrow can also arise due to issues such as chronic illnesses significantly affecting a family member, especially in parents with children with illnesses that deny them the chance to be the ideal child (Schreier & Droes, 2017). Cerebral palsy, defined as non-progressive but frequently-mutating motor impairment syndromes that are secondary to brain abnormalities or lesions that occur during its initial stages, is the most frequently occurring permanent disability among children (Smith & Blamires, 2022). The syndromes cause children to lack the ability to conduct basic daily living activities which means that they are entirely dependent on their caregivers (Smith & Blamires, 2022). The burden on parents often leads to chronic sorrow and challenges the child’s care. This paper seeks to evaluate the theory of chronic sorrow and how it can be applied to the case of a family with a young child with cerebral palsy for patient care planning and resource identification.

The theory of chronic sorrow is a conceptualization of grief-related feelings or sadness that are caused by death or ongoing losses linked to caring for a disabled child or one with a chronic illness (Fernandez et al., 2021). The theory is a middle-range nursing theory that seeks to explain the feelings of grief and ongoing losses with the intention of informing nurses on how to better care for patients and their families (Fernandez et al., 2021). The theory of chronic sorrow is founded on six main concepts; chronic sorrow, disparity, loss, antecedents, trigger events, and internal and external management methods (Schreier & Droes, 2017). Chronic sorrow is defined as the regular recurrence of pervasive and permanent grief-related feelings or sadness that are attributed to a significant loss (Schreier & Droes, 2017). Chronic sorrow can arise from either death, debilitation, or a chronic illness or condition that significantly affects one’s way of life. The concept of disparity is used to refer to the variance between the ideal and actual situation because of some kind of loss (Schreier & Droes, 2017). The theory defines the concept of loss as a notable loss that could be the result of a single event or an ongoing one (Schreier & Droes, 2017). In this context, both death and disease are considered losses. Diseases such as cerebral palsy require significant patient care which may be associated with ongoing losses, either financially, emotionally, or physically.

The theory of chronic sorrow also applies the concept of antecedents, which are precursors to the chronic sorrow itself. The theory notes that there are two antecedents to chronic sorrow. The first antecedent is prompted when one event of a living loss is experienced such as during the time of diagnosis or onset of chronic diseases (Schreier & Droes, 2017). The first encounter with the living loss triggers the onset of chronic sorrow due to the grief and sadness related to the awareness of the living loss. The second antecedent before chronic sorrow is the unresolved disparity that arises due to the loss (Schreier & Droes, 2017). When the first antecedent is triggered and is not resolved, the unresolved disparity between the ideal situation and the real one prompts the development of chronic sorrow.

Triggers are also an important concept in the theory of chronic sorrow. Triggers are used to refer to the events which initiate the awareness of a negative disparity in the loss of a loved one or in the disabled loved one, which brings the sadness forth again (Olwit et al., 2018). For instance, in the case of a disabled loved one, parents or family may get triggered when the loved one is struggling to do something on their own but are unable to, or simply while caring for them and helping them to do basic daily living activities. Triggers occur after the development of the first and second antecedent, with their intensity increasing after chronic sorrow has been fully manifested.

Finally, the theory of chronic sorrow identifies the concepts of internal and external management methods. Management methods are coping interventions that are used to deal with the development and mitigation of chronic sorrow (Olwit et al., 2018). Internal management methods refer to the personal coping mechanisms initiated by the individual experiencing chronic sorrow, including cognitive and behavioral interventions such as acceptance, avoidance, positive thinking, suppression, praying, and getting closer to the loved one who is chronically ill (Olwit et al., 2018). External management methods of coping include interventions provided by healthcare practitioners to assist in effective coping such as pharmacological treatments to assist with signs and symptoms of anxiety and insomnia when necessary, professional counseling, pastoral or spiritual support and assistance to help with loss, referral services, and the use of therapeutic communication about the living loss (Olwit et al., 2018). Both internal and external coping mechanisms are critical in the management of chronic sorrow, especially in the context of living loss that is associated with chronic diseases like cerebral palsy.

The theory of chronic sorrow is founded on the perspective that nurses should be informed about the high probability for their patients to experience chronic sorrow especially if the patients themselves have chronic illnesses, which subsequently increases the probability of their families and caregivers experiencing chronic sorrow (Olwit et al., 2018). In this paper, the context is directed toward children with cerebral palsy, and how the theory of chronic sorrow can be used to plan patient care, identify the resources available to the family of the affected child, and increase their resilience against chronic sorrow in addition to dealing with the health needs of the child and the parents.

In the case study, the parents are the family caregivers of a child with cerebral palsy and therefore the ones at risk of chronic sorrow. Children with cerebral palsy require significant attention and help from their family caregivers and therefore significantly influence the feelings of living loss of the family members (Smith & Blamires, 2022). Nurses need to be aware of the concepts of disparity, loss, antecedents, triggers, and internal and external management systems and apply them when planning care and identifying family resources. First nurses need to be aware of the disparity between the ideal and actual situation resulting from the loss resulting from the ongoing event when planning patient care and identifying family resources. The family may have other children but may not have adequate resources to provide the best-hired care for the child with cerebral palsy.

Nurses need to be aware of this disparity even if the family is willing to care for the child and plan care around affordable methods such as the Child Health Insurance Programs in order to alleviate some of the financial stress associated with caring for the child (Chiluba & Moyo, 2017). Additionally, the nurse can involve the family in planning care in order to identify and resolve any existing disparities before they trigger chronic sorrow, and identify any family resources that can assist in providing care such as a family member with some clinical experience or the time to care for the child. The theory of chronic sorrow suggests that unresolved disparity from the child’s loss is the second antecedent before chronic pain (Schreier & Droes, 2017). Therefore, planning care around public insurance and identifying family resources that can assist in caring for the child can prevent the development of chronic sorrow by resolving disparities arising from the living loss.

Nurses also need to be aware of triggers and plan care to include internal and external management methods for the family caregivers. Carin for the child and performing some tasks like bathing the child may trigger the recognition of the disparity especially if there are other ideal children in the family.  It is important for nurses to plan for care to also address the physical, emotional, and psychological triggers that parents and family caregivers may experience in order to provide the child with a positive environment that enhances their development (Chiluba & Moyo, 2017). Nurses should identify family members who have better internal coping mechanisms as the main family resources both in patient care and in assisting others to deal with the living loss. Nurses should also plan for external management methods as part of the patient care so that the family caregivers can get professional counseling or therapeutic communication to assist them with dealing with the disparities positively, hence avoiding triggering chronic sorrow.

The theory of chronic sorrow has several implications for nursing practice when dealing with patients with cerebral palsy. The theory implies that nurses need to provide comprehensive coverage of the patient and their family’s needs during patient care, such that they aid the child with their health issues, while also assisting the family caregivers to positively cope with the living loss of the illness (Hirsch, 2021). Nurses will also need to teach families basic physical, occupational, and speech therapy so that they can provide the child extra support and reduce the feelings of helplessness that might trigger chronic sorrow. Additionally, this could also be necessitated for families with low incomes since the financial stress may hinder proper patient care if the family is unable to help. Nurses will need to factor in health education about the illness and coping mechanisms for the family in order to optimize the outcomes of patient care. Additionally, it seems necessary for nurses to assist families in developing internal and external support systems that address the stressful life of a child with cerebral palsy.

Cerebral palsy is the most common cause of disability among children. The syndrome causes significant loss for families due to the disparities caused by the illness and the challenges that are associated with caring for the child. The theory of chronic sorrow attempts to explain such pain and sorrow and how it is triggered after the two precursors of experiencing the loss and having unresolved disparities. The theory offers practical applications when planning care for a family with an affected child by considering their financial strain when planning for care and identifying family resources, and including the family in the care model to provide them with external management methods such as psychological counseling and therapeutic communication.

References

Chiluba, B. C., & Moyo, G. (2017). Caring for a cerebral palsy child: a caregivers perspective at the University Teaching Hospital, Zambia. BMC research notes, 10(1), 1-8. https://bmcresnotes.biomedcentral.com/articles/10.1186/s13104-017-3011-0

Fernandes, M. A., Nóbrega, M. M. L. D., Zaccara, A. A. L., Freire, M. E. M., Andrade, F. F. D., & Costa, S. F. G. D. (2021). Fawcett’s analysis and evaluation model applied to the theory of chronic sorrow. Texto & Contexto-Enfermagem, 30. https://doi.org/10.1590/1980-265X-TCE-2020-0010 

Hirsch, L. (2021). Caring for your child with cerebral palsy (CP): Birth to age 5. https://kidshealth.org/en/parents/cp-checklist-younger.html

Olwit, C., Mugaba, M., Osingada, C. P., & Nabirye, R. C. (2018). Existence, triggers, and coping with chronic sorrow: a qualitative study of caretakers of children with sickle cell disease in a National Referral Hospital in Kampala, Uganda. BMC psychology, 6(1), 1-11. https://bmcpsychology.biomedcentral.com/articles/10.1186/s40359-018-0263-y#citeas 

Schreier, A. M. & Droes, N. S. (2017). Theory of chronic sorrow. https://nursekey.com/31-theory-of-chronic-sorrow/

Smith, M. & Blamires, J.  (2022). Mothers’ experience of having a child with cerebral palsy. A systematic review. Journal of Pediatric Nursing, 64, 64-73. https://cerebralpalsy.org.nz/wp-content/uploads/2022/03/Published-systematic-review-JPN-12-Feb-2022.-Smith-Blamires.final_.pdf