Diabetes Mellitus and Stress

¶ … Chronic Sorrow Theory

The term 'chronic sorrow' may be described as sadness of a persistent, periodically severe, increasing, and lasting nature. This condition may be triggered in a person because of ongoing loss, arising from personal chronic disease, a loved one's illness, or personal disability (Isaksson, 2007, p. 18). Olshansky (1962) first put forward the "chronic sorrow" concept when working with children suffering from physical or mental disabilities and members of their family (parents, siblings, etc.). The researcher noted that these children' parents exhibited a persistent psychological response to their experience of being the parents of a physically or mentally disabled child (Monsson, 2010, p. 16). Through inductive reasoning, the chronic sorrow theory -- a middle range model -- was developed, which was corroborated using both qualitative research and literature review. (Peterson & Bredow, 2013, p. 98)

The chronic sorrow theory helps create a framework to comprehend individuals' reactions to diverse loss scenarios, in addition to a novel means to view loss experience (Eakes et al., 1998). Management techniques are one important component of chronic sorrow theory. The phrase is utilized for denoting individuals' personal coping techniques when experiencing chronic sorrow (internal) as well as supportive professional interventions (external). Sound external and internal management techniques facilitate improved comfort, and can prolong the duration between two chronic sorrow spells. (Peterson & Bredow, 2013, p. 98)

Description of Lazarus' Stress, Coping and Adaptation Theory

The model put forward by Lazarus focuses on an individual's tackling of stressful scenarios. Whilst Selye concentrates on the physiologic reactions of the human body, Lazarus emphasized on psychological reactions, which were perceived by the theorist as a distinct process. According to him, process-focused approaches were directed at what people really think and how they act, within a particular encounter's context; furthermore, they incorporate the transformations in these actions and thoughts as the given encounter develops. Lazarus claims the coping 'process' is marked by modifications and dynamics which are a function of constant evaluation and revaluation of the evolving individual-environment relationship. He hypothesized that the phenomenon of stress is much more than mere stimulus-response phenomenon; it is a lot more complex. His emphasis was on the notion that coping does not stem from anxiety itself; rather, it springs from how individuals perceive the threat. Through coping, individuals tackle the emotions and demands associated with the evaluated stress. That is, through coping, individuals manage the evaluation. The last component of this theory is adaptation, which ensues from effective coping. The term 'adaptation' is defined as an individual's ability of surviving and thriving. It impacts three key areas, namely: social functioning, physical health, and mental health (Mcewen & Wills, 2011, pp. 288-289).

Over the past few decades, health and behavioral scientists have given considerable attention to the concept of stress. This multifaceted health issue has been treated by employing a number of treatment procedures. The high occurrence of stress and the various forms it is seen in calls for a patient and careful assessment of the numerous issues potentially triggering it (i.e., interpersonal, familial, and professional problems), by all healthcare workers (including nursing staff). Effective stress-related nursing care implementation and psychological assistance is always essential, irrespective of the source of stress. (Papathanasiou et al., 2015, p. 48)

Origin of Lazarus' Stress, Coping and Adaptation Theory

Every theory that considers stress a transaction is derived from Lazarus' theory. The theorist's argument revolved around the differences among individuals when it comes to interpreting stress in the form of a stimulus/response. In Lazarus' view, no earlier theory was able to account for the factors precisely, potentially resulting in effective stress management by some individuals, and a failure to do so by others. Additionally, no adequate theories exist for interpreting factors that facilitate adjustment for longer duration in certain individuals, as compared to other individuals, to stress-giving stimuli. The cognitive evaluation approach of Lazarus addresses the person, environment, and combined cognitive assessment of stimulus-response choices and environmental demands. (Papathanasiou et al., 2015, pp. 46-47)

Lazarus' theory assumes the convergence of numerous internal and external facts on a recurring basis into the body's neurocognitive level, interpreted via the cognitive evaluation process. Stress's implications may be biological, mental, emotional, spiritual, and social. Often, mixed results ensue, as stress impacts people comprehensively. When a negative or positive emotional stimulation reaches heightened levels, it may affect the person's efficiency. Persistent high levels may affect health adversely (Papathanasiou et al., 2015, pp. 46-47).

Effective management of stressful scenarios and issues is commonly termed as "coping with stress." Coping techniques are acquired or natural reactions to evolving environments or to some particular scenario or issue. Lazarus and Folkman define coping as a behavioral and perceived attempt at adjusting in particular internal or external conditions, which go beyond the management resources of the person (as cited in Papathanasiou et al., 2015, p. 47). Stress theories have important applications in the nursing field. They offer nurses a framework for assessment of mental and physical impacts of stress on people and the stress management processes employed by them. Nursing professionals can facilitate cognitive restructuring or 'problem-solving' for better management and adaptation, and also help develop novel coping mechanisms (Mcewen & Wills, 2011, p. 289).

Literature review of Lazarus' Stress, Coping and Adaptation Theory

In the profession of nursing, stress theories have great significance; nursing professionals have applied them as effective frameworks to a number of studies. For instance, Puskar et. al. (2008) studied the influence of stress and its management on teen perceptions of weight and depression, among rural adolescents (cited in Mcewen & Wills, pp. 289-290). Williams, Mcghee, and Lobiondo-Wood (2004) investigated the coping mechanisms of people caring for child liver transplantation patients004), whilst Akintola's (2008) South Africa-based research work looked into the coping techniques adopted by volunteers who provide healthcare to AIDS patients (cited in Mcewen & Wills, pp. 289-290). Lastly, experimental research works that have applied Lazarus' model include a study of therapeutic play interventions' effectiveness in readying children for operations, and the effectiveness of telephone counseling and educational interventions in improving the physical, social, and emotional adjustments of breast cancer patients and their significant others (cited in Mcewen & Wills, 2011, pp. 289-290).

Meanwhile, Hazen and Cousino (2012) performed a critical review, analysis, and synthesis of literature pertaining to parenting stress in caregivers of children suffering from various diseases including cancer, asthma, epilepsy, cystic fibrosis, sickle cell disease, diabetes, and rheumatoid arthritis (juvenile). Those who care for children suffering from chronic ailments reported considerably higher overall parenting stress as compared to the parents of physically and mentally fit children. Increased stress among parents was linked to weaker psychological adjustment among caregivers and children diagnosed with chronic disease. (Cousino & Hazen, 2013)

Similarly, Pisula's (2014) research depicts numerous researches by other authors, who have proven that the parents of developmentally disabled children experience elevated stress levels compared to parents whose children are developing normally. The researcher also noted a link between parental stress levels and the kind of disability their child is diagnosed with. Several scholars have noted heightened stress levels among autistic children's mothers, as compared to the mothers of children having other developmental problems. (Pisula, 2014, p. 87)

Solomon and Azar's investigations highlighted differences in coping mechanisms employed by type 1 diabetic children's fathers and mothers. Study outcomes indicated that fathers as well as mothers engaged in organized problem solving, and positive revaluation, as well as pursued social assistance often; additionally, mothers employed more organized and efficient problem-solving mechanisms compared to fathers. (Azar & Solomon, 2001, p. 418)

Discussion of Application of borrowed theory & Implication

The presence of parenting stress has diverse impacts on both parents and their children. Several authors have noted linkages between parental stress and negative child and caregiver psychological "sequelae." They have performed meta-analyses comparing the parenting stress experienced by parents of children suffering from chronic diseases to that of stress experienced by parents of healthy children. Outcomes of random-effects meta-analyses suggested that chronically-ill children's parents reported more overall parenting stress compared too healthy children' parents. Coping mechanisms form a salient aspect of the central theory, but only two researchers have explored linkages between parent stress and the coping approaches adopted by parents. Rodenburg and coworkers (2007) discovered that employment of avoidance and other more feelings-focused coping mechanisms by caregivers was linked to heightened parenting stress, on the whole, among child epilepsy patients' caregivers (cited in Cousino & Hazen, 2013).

A key research discovery is that, relative to fathers, mothers appear more involved with their children's ailments. A second significant finding that appeared in a 'within-couple' study is that, the common coping technique employed by fathers was: distancing. Families, perhaps, run smoothly because of increased maternal involvement. However, paternal involvement is equally critical, as he offers instrumental and emotional support (in the form of, for instance, technical disease-related information) to the child's mother in the routine care of type 1 diabetes mellitus children (which formed the specific focus of the study). All healthcare practitioners and, especially, nurses must know of the above issue. One way to improve the situation would be by forging a trusting bond between the father and medical staff at the earliest possible opportunity, prior to discharging a child after his/her first diagnosis of type 1 diabetes mellitus. This would encourage the father to involve himself more in his child's healthcare. The authors applied Folkman and Lazarus' transactional stress and stress management model to offer insights into a few coping mechanisms parents employ when handling their child's type 1 diabetes mellitus. Lazarus' coping approach would profit by integrating into it elements like homeostatic regulation, derived from systemic familial models. It is only then that we more comprehensively understand parents' coping processes (Azar & Solomon, 2001, p. 426).

Discussion of applying both borrowed and Middle-Range theory

Overall, meta-analysis outcomes reveal that chronically-ill children' caregivers endorse heightened overall parenting stress compared to healthy children's' caregivers. This interesting piece of information reveals that generic caregiving elements, rather than disease-specific ones, lead to heightened stress among parents of children suffering from pediatric chronic ailments. Besides undergoing increased overall parenting stress, chronically-ill children's' caregivers display greater likelihood of experience illness-connected parenting stress (such as, tough treatment regimens, frequent physician/therapist appointments, etc.) (Cousino & Hazen, 2013)

Parents of children suffering from diabetes mellitus, cystic fibrosis, and cancer strive to accept their child's ailment, stay positive, continue hoping for a complete cure, continue routine family activities, and minimize undue attention to the disease. Hence, this research work might have comparable implications for nurses when it comes to other pediatric chronic ailments. In dealing directly with the ailing child or his/her parents, one must not forget the fact that complex bonds link different members of a family system. When any one member (particularly a child) is chronically ill, the entire family is affected (p. 427). Folkman and Lazarus' (1988a, b) stress and stress handling theory acts as a guide to most researchers who attempt to study the different reactions of individuals to challenging contexts and scenarios. People experiences stress only upon assessing the occurrence that tax their psychological resources. The application of the above fact to comprehending parental response to the ailment their child is diagnosed for, helps establish the fact that they feel threatened and vulnerable because of the disease (cited in Azar & Solomon, 2001, pp. 418-419).