Chronic Sorrow and Lazarus Stress Theory in Nursing Practice
This paper examines two nursing theories — the middle-range Chronic Sorrow Theory and Lazarus' Stress, Coping, and Adaptation Theory — and their combined application to understanding parental responses to pediatric chronic illness. Beginning with Olshansky's original concept of chronic sorrow and its development into a formal nursing framework, the paper then describes Lazarus' cognitive appraisal model and traces its theoretical origins and empirical applications. A literature review synthesizes research on parenting stress, coping mechanisms, and chronic sorrow in caregivers of children with conditions such as diabetes, autism, and cancer. The paper concludes by discussing how both theories together offer nurses a more comprehensive framework for supporting families affected by chronic pediatric illness.
- Overview of Chronic Sorrow Theory: Definition, origins, and management techniques of chronic sorrow
- Lazarus' Stress, Coping, and Adaptation Theory: Psychological stress model focusing on cognitive appraisal and coping
- Origins of Lazarus' Theory: Theoretical basis and development of Lazarus' stress model
- Literature Review of Lazarus' Theory: Empirical nursing studies applying Lazarus' stress framework
- Application of Borrowed Theory and Implications: Parenting stress, coping differences, and nursing implications
- Applying Both Theories Together: Integrating both theories to understand chronic illness caregiving
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What makes this paper effective
- The paper clearly distinguishes between two complementary theoretical frameworks and then synthesizes them, showing how each enriches the other when applied to a clinical population.
- Each section is grounded in specific empirical studies, lending credibility to the theoretical claims and demonstrating familiarity with the nursing research literature.
- The discussion sections move logically from theory description to application, showing how abstract nursing models translate into concrete clinical recommendations for nurses working with families.
Key academic technique demonstrated
The paper demonstrates effective theoretical triangulation — using two distinct mid-level theories simultaneously to analyze a single phenomenon (parental stress in pediatric chronic illness). By reviewing Lazarus' cognitive appraisal model alongside the Chronic Sorrow framework, the author shows how borrowed theories from psychology and indigenous nursing theories can be integrated to produce richer clinical insight than either theory provides alone.
Structure breakdown
The paper opens with a definition and origin of Chronic Sorrow Theory, then shifts to a full description and historical development of Lazarus' theory. A dedicated literature review section surveys empirical applications of Lazarus' model. Two application/discussion sections then bring both theories to bear on research about parenting stress, coping strategies, and chronic illness caregiving, closing with implications for nursing practice.
Overview of Chronic Sorrow Theory
The term chronic sorrow may be described as sadness of a persistent, periodically severe, and lasting nature. This condition may be triggered in a person by ongoing loss arising from a personal chronic disease, a loved one's illness, or personal disability (Isaksson, 2007, p. 18). Chronic sorrow as a concept was first put forward by Olshansky (1962) when working with children suffering from physical or mental disabilities and their family members. The researcher noted that these children's parents exhibited a persistent psychological response to their experience of raising a physically or mentally disabled child (Monsson, 2010, p. 16). Through inductive reasoning, the chronic sorrow theory — a middle-range model — was developed and subsequently corroborated using both qualitative research and literature review (Peterson & Bredow, 2013, p. 98).
The chronic sorrow theory helps create a framework for comprehending individuals' reactions to diverse loss scenarios, as well as offering a novel means to view the experience of loss (Eakes et al., 1998). Management techniques are one important component of chronic sorrow theory. The phrase is used to denote individuals' personal coping techniques when experiencing chronic sorrow (internal management) as well as supportive professional interventions (external management). Sound external and internal management techniques facilitate improved comfort and can prolong the duration between two chronic sorrow episodes (Peterson & Bredow, 2013, p. 98).
Lazarus' Stress, Coping, and Adaptation Theory
The model put forward by Richard Lazarus focuses on an individual's response to stressful scenarios. Whereas Selye concentrated on the physiological reactions of the human body, Lazarus emphasized psychological reactions, which he perceived as a distinct process. According to Lazarus, process-focused approaches are directed at what people actually think and how they act within a particular encounter's context; furthermore, they incorporate the transformations in these actions and thoughts as a given encounter develops. Lazarus claimed that the coping process is marked by modifications and dynamics that are a function of constant evaluation and revaluation of the evolving individual–environment relationship. He hypothesized that stress is far more than a mere stimulus–response phenomenon — it is considerably more complex.
His central argument was that coping does not stem from anxiety itself; rather, it springs from how individuals perceive the threat. Through coping, individuals manage the emotions and demands associated with the evaluated stress. The last component of this theory is adaptation, which ensues from effective coping. The term adaptation is defined as an individual's ability to survive and thrive. It impacts three key areas: 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 addressed through a number of treatment procedures. The high occurrence of stress and the various forms it takes calls for a patient and careful assessment of the numerous issues potentially triggering it — including interpersonal, familial, and professional problems — by all healthcare workers, including nursing staff. Effective stress-related nursing care and psychological assistance are always essential, irrespective of the source of stress (Papathanasiou et al., 2015, p. 48).
Origins of Lazarus' Theory
Every theory that considers stress as a transaction is derived from Lazarus' work. His argument revolved around the differences among individuals when it comes to interpreting stress as a stimulus or response. In Lazarus' view, no earlier theory was able to account precisely for the factors potentially resulting in effective stress management by some individuals and failure to cope by others. Additionally, no adequate theories existed for explaining why certain individuals adjust for longer durations to stress-producing stimuli compared to others. The cognitive appraisal approach of Lazarus addresses the person, the environment, and the 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 factors on a recurring basis at the body's neurocognitive level, interpreted through the cognitive appraisal process. The implications of stress 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 a person's efficiency. Persistently high stress levels may also affect health adversely (Papathanasiou et al., 2015, pp. 46–47).
Effective management of stressful scenarios is commonly termed "coping with stress." Coping techniques are acquired or natural reactions to evolving environments or to particular scenarios or issues. Lazarus and Folkman define coping as a behavioral and cognitive attempt at adjusting to particular internal or external conditions that go beyond the management resources of the person (as cited in Papathanasiou et al., 2015, p. 47). Stress theories have important applications in nursing. They offer nurses a framework for assessing the mental and physical impacts of stress on patients and the stress management strategies employed by them. Nursing professionals can facilitate cognitive restructuring or problem-solving for better management and adaptation, and can also help develop novel coping mechanisms (McEwen & Wills, 2011, p. 289).
References
Azar, R. & Solomon, C. R. (2001). Coping strategies of parents facing child diabetes mellitus. Journal of Paediatric Nursing, 16(6), 418–428. doi:10.1053/jpdn.2001.27878
Cousino, M. K. & Hazen, R. A. (2013). Parenting stress among caregivers of children with chronic illness: A systematic review. Journal of Paediatric Psychology. doi:10.1093/jpepsy/jst049
Eakes, G., Burke, M. L., & Hainsworth, M. A. (1998). Middle-range theory of chronic sorrow. Journal of Nursing Scholarship, 30(2), 179.
Isaksson, A-K. (2007). Chronic sorrow and quality of life in patients with multiple sclerosis. Orebro Studies in Caring Sciences 12.
McEwen, M. & Wills, E. M. (2011). Theoretical basis for nursing. Lippincott Williams & Wilkins.
Monsson, Y. (2010). The effects of hope on mental health and chronic sorrow in parents of children with autism spectrum disorder. University of Kansas.
Papathanasiou, I. V., Tsaras, K., Neroliatsiou, A., & Roupa, A. (2015). Stress: Concepts, theoretical models and nursing interventions. American Journal of Nursing Science, 4(2-1), 45–50. doi:10.11648/j.ajns.s.2015040201.16
Peterson, S. J. & Bredow, T. S. (2013). Middle range theories: Application to nursing research. Lippincott Williams & Wilkins.
Pisula, E. (2014). Parenting stress in mothers and fathers of children with autism spectrum disorders. In M.-R. Mohammadi (Ed.), A comprehensive book on autism spectrum disorders. InTech.
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