Chronic Sorrow Middle-Range Theory in Nursing Practice
This paper examines the middle-range theory of chronic sorrow, a concept first introduced by Olshansky (1962) to describe the persistent, pervasive grief experienced by parents of children with disabilities. The paper traces the theory's origins, its inductive development through qualitative research, and its evolution into a formally defined nursing framework. Secondary literature is reviewed to demonstrate the theory's applicability across diverse loss experiences, including parents of children with ADHD, cerebral palsy, and multiple disabilities, as well as patients living with multiple sclerosis. The discussion addresses internal and external management strategies, coping approaches, and the implications for nursing assessment and intervention, concluding that the theory provides substantive, functional, and structural support for professional nursing practice.
- Introduction to Chronic Sorrow: Defines chronic sorrow and its origins
- Application of a Middle-Range Theory: Applies middle-range theory to chronic sorrow
- The Origin of Middle-Range Theory: Traces historical development of the theory
- Secondary Literature Review: Reviews studies across clinical populations
- Discussion of Coping and Management Strategies: Examines internal and external coping approaches
- Implications for Nursing Practice: Outlines nursing intervention implications
- Conclusion: Evaluates theory's structural and functional value
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What makes this paper effective
- Grounds the theoretical discussion in historical context by tracing chronic sorrow back to Olshansky's (1962) original formulation, giving readers a clear developmental arc of the concept.
- Moves logically from theory definition to research evidence, using multiple independent studies (ADHD, multiple sclerosis, cerebral palsy, multiple disabilities) to demonstrate broad applicability.
- Balances internal and external management strategies, showing awareness of both patient self-coping and professional intervention roles.
Key academic technique demonstrated
The paper demonstrates the use of secondary literature synthesis to validate a nursing middle-range theory. Rather than relying on a single study, it draws on multiple peer-reviewed sources across different patient populations to build a cumulative argument for the theory's empirical breadth and clinical utility. Citations from Eakes et al. (1998) and Peterson & Bredow (2013) serve as conceptual anchors throughout.
Structure breakdown
The paper opens with a conceptual introduction defining chronic sorrow and its emotional characteristics. It then applies the middle-range theoretical framework, describes the theory's historical origins, and moves into a secondary literature review covering four distinct clinical populations. A discussion section synthesizes coping strategies and management approaches, followed by a brief implications section and a short conclusion that evaluates the theory's structural integrity for nursing practice.
Introduction to Chronic Sorrow
Chronic sorrow is a continuous, pervasive sadness that is permanent and intermittently intense. An individual often encounters a loss experience because of their own disability, that of a relative, or a chronic illness (Isaksson, 2007, p. 18). Chronic sorrow as a concept was introduced by Olshansky (1962) while he was working with children with various kinds of disabilities and their parents or relatives. He noted that the children's parents showed what he described as a pervasive psychological reaction to the predicament of parenting mentally disabled children (Monsson, 2010, p. 16).
Such grief, he observed, was not dissimilar to the type shown by parents who had lost a child. The parents of mentally disabled children have it worse because their pain is continuous. This is why he referred to the concept as chronic sorrow (Monsson, 2010, p. 16). It has been thought that chronic sorrow entails experiencing intermittent spans of distress and pain. It is pervasive and likely to be continuous. Chronic sorrow is, nevertheless, an understandable response to the difficult predicament of multiple losses (cited in Ahlstrom, 2007, p. 77).
There has been considerable effort by researchers to provide a detailed explanation of grief and loss since Olshansky (1962) first introduced the idea. There is a difference between the loss that evolves into chronic sorrow and the one triggered by bereavement, because it is not possible to resolve the former. Uncertainty about the future magnifies chronic sorrow. The grief reaction is heightened because those affected encounter the reality of losing control of their own future. Such loss of control is especially pronounced for parents who must continuously care for individuals with disabilities (Monsson, 2010, p. 16).
References
Ahlstrom, G. I. (2007). Experiencing loss and chronic sorrow in persons with severe chronic illness. Journal of Clinical Nursing, 16(3A), 76–83.
Borkon, D. A. (2008). Is chronic sorrow present in maternal caregivers of attention deficit hyperactivity disordered children? Adlerian Counselling and Psychotherapy.
Dozier, B. (2015). Application of middle-range theory. Professional Practices in Nursing. WordPress.com.
Eakes, G., Burke, M. L., & Hainsworth, M. A. (1998). Middle-range theory of chronic sorrow. Journal of Nursing Scholarship, 30(2), 179–184.
Isaksson, A-K. (2007). Chronic sorrow and quality of life in patients with multiple sclerosis. Orebro Studies in Caring Sciences 12.
Monsson, Y. (2010). The effects of hope on mental health and chronic sorrow in parents of children with autism spectrum disorder. University of Kansas.
Parrish, R. N. (2010). Mothers' experiences raising children who have multiple disabilities and their perceptions of the chronic sorrow phenomenon. University of North Carolina at Greensboro.
Peterson, S. J., & Bredow, T. S. (2013). Middle range theories: Application to nursing research. Lippincott Williams & Wilkins.
Rivier. (2008). Evaluation of the middle range theory of chronic sorrow. Rivier University.
Whittingham, K., Wee, D., Sanders, M. R., & Boyd, R. (2013). Sorrow, coping and resiliency: Parents of children with cerebral palsy share their experiences. Disability & Rehabilitation, 35(17), 1447–1452. https://doi.org/10.3109/09638288.2012.737081
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