Theoretical Foundation

in Nursing
Final Period
By:
Melinda L. Gonzales MAN RN
 Theory of Chronic Sorrow

Georgene Gaskill Eakes Mary Lermann Burke Margaret A. Hainsworth

1945 to present 1941 to present 1931 to present
 Theory of Chronic Sorrow
CHRONIC SORROW
is the presence of pervasive
grief-related feelings that have
been found to occur periodically
throughout the lives of
individuals with chronic health
conditions, their family
caregivers and the bereaved.
• The Theory of Chronic Sorrow was developed by Georgene
Gaskill Eakes, Mary Lermann Burke and Margaret A.
Hainsworth in 1998.
• This theory is considered as a Middle-Range Nursing Theory.
GEORGENE GASKILL EAKES
- worked in both acute and community-based
psychiatric and mental health settings.
- near death experiences heightened her awareness
of how ill prepared health care professionals and
lay people are to deal with individuals facing their mortality
and the general lack of understanding of grief reactions
experienced in response to loss situations.
MARY LERMAN BURKE
• practiced pediatric nursing
• became interested in the concept of chronic
sorrow while engaging in a clinical practicum.
MARGARET A. HEINSWORTH
• public health and psychiatric and mental health
nursing.
• her interest in chronic illness and its
relationship in sorrow began in her practice as a
facilitator for a support group of women with
multiple sclerosis.
MAJOR CONCEPTS:

• Chronic sorrow is the periodic recurrence of

permanent, pervasive sadness or other grief related
feelings associated with a significant loss.

• Disparity refers to the difference between the ideal

and the real situation due to some type of loss.

• Loss - a significant loss that may be ongoing or a single

event.
• Triggers are events which prompt the recognition of a
negative disparity in the disabled loved one or loss
which brings out sadness again.
• Management Methods
means by which individuals deal with chronic sorrow.
• Ineffective Management
results from strategies that increase the individuals
discomfort or chronic sorrow.
• Effective Management
results from strategies that lead to increase comfort of
the affected individual.
• Internal management methods consist of individualized
coping interventions initiated by the person experiencing it.
• External management methods of coping consist of
interventions provided by medical professionals to aid in
effective coping.
•Examples of external management methods:
• professional counseling,
• pharmaceutical interventions to treat symptoms of insomnia
or anxiety if necessary,
• pastoral care or spiritual support to assist with grieving,
• use of therapeutic communication, and
• referral services
MAJOR ASSUMPTIONS
NURSING
• nurses can provide anticipatory guidance to individual at risk.
PERSON
• compare their experiences both with the ideal and with others
around them.
HEALTH
• dependent on adaptation to disparities associated with loss.
ENVIRONMENT
• interactions occur within a social context, which includes
family, social, work and health care environments.
Conclusion
•Nurses caring for families need to be aware of the high potential
for chronic sorrow to occur in persons with chronic conditions,
their family caregivers, and bereaved persons.

•Nurses need to view chronic sorrow as a normal response to loss

and, when it is triggered, provide support by fostering positive
coping strategies and assuming roles that increase comfort.

•With an understanding of chronic sorrow, nurses can plan

interventions that recognize it as a normal reaction, promote
healthy adaptation, and provide empathetic support.
 THE TIDAL MODEL OF MENTAL
HEALTH RECOVERY
PHIL BARKER
• was born in Scotland by the sea.
• his early involvement in arts helped to
explain his view of nursing as the craft
of caring.
• during his tenure as professor of
psychiatric nursing practice at the
University of Newcastle he
developed the Tidal Model of Mental
Health Recovery.
 developed from a discrete focus on psychiatric nursing
in acute settings to a more flexible mental health
recovery and reclamation model.

 The main focus is on helping individual patients create

their own voyage of discovery.
 By participating in groups, the person develops
awareness of the value of social support, which can be
received from and given to others.

 This becomes the basis of the person’s appreciation of

the value of mutual support, which can be accessed in
everyday life.
 Ten Commitments of the Tidal Model
1.Value the voice. That is, the patient’s story is
paramount.
2.Respect the language, which means to let the patient
use his or her own language.
3.Develop genuine curiosity, or show interest in the
patient’s story.
4.Become the apprentice to learn from the person being
helped.
5.Use the available toolkit; the patient’s story contains
valuable information as to what works and what doesn’t.
6. Craft the step beyond. That is, the patient and nurse
work together to construct an appreciation of what needs
to be done in that moment.
7. Give the gift of time to foster change.
8. Reveal personal wisdom. Patients are experts in their
own stories.
9. Know that change is constant.
10. Be transparent. Nurses should model confidence by
being transparent and helping make sure the patient
always knows exactly what’s being done.
MAJOR ASSUMPTIONS
NURSING - is an enduring human interpersonal activity and involves a focus
on the promotion of growth or development.

PERSON - natural philosophers and meaning makers, devoting much of their

lives to establishing the meaning and value of their experience and to
constructing explanatory models of the world and their place in it.

HEALTH - is a personal task where success is in large part the result of self-
awareness, self-discipline and inner resources by which each person regulates
his own daily rhythm and action.

ENVIRONMENT - largely social in nature, the context in which persons

travel within their ocean of experience and nurses create space for growth and
development.
There are no absolutes in health
care. A patient’s health is fluid,
and nurses often have to adapt to
an individual patient’s situation
in order to help him or her get
healthy. What works for one
patient in his or her illness may
not work for another patient in
his or her illness.
 THEORY OF COMFORT
KATHARINE KOLCABA
• while in school, she job-shared a head
nurse position on a dementia unit, it was
in this practice that she began theorizing
about the outcome of patient comfort.
the definition of comfort was “to
strengthen greatly” This definition
provided a wonderful rationale for nurses
to comfort patients, because patients
would do better and nurses would feel
more satisfied.
Kolcaba's theory of
comfort explains comfort as a
fundamental need of all human
beings for relief, ease, or
transcendence arising from health
care situations that are
stressful. Comfort can enhance
health-seeking behaviors for
patients, family members, and
nurses.
 Kolcaba used ideas from three early Nursing Theorists
Types of Comfort:

1. Relief - synthesized from the work of Orlando (1961)

• The state of a patient who has had a specific need met
2. Ease - synthesized from the work of Henderson (1966)
• The state of calm or contentment who described 13 basic
functions of human beings
3. Transcendence was derived from Paterson and Zderad
(1975), who proposed that patients rise above their difficulties
like problems or pain with the help of nurses.
 Context in Which Comfort Occurs:
1. Physical: Pertaining to bodily sensations
2. Psychospiritual: Pertaining to internal awareness of self,
including esteem, concept, sexuality, and meaning in one’s
life; one’s relationship to a higher order or being
3. Environmental: Pertaining to the external surroundings,
conditions, and influences
4. Social: Pertaining to interpersonal, family, and societal
relationships
Taxonomic structure of comfort.
 MAJOR ASSUMPTIONS
PERSON – HUMAN BEINGS
– Comfort is achieved when the patient’s pain needs are met.
– Ease comfort is focused on the psychological state of the patient
– Transcendence happens when the patient is able to rise above their
challenge of health problems and pain
HEALTH
– health is considered to be optimal functioning, as defined by the patient,
group, family, or community
ENVIRONMENT
– A calm and comforting environment will allow the patient’s anxiety level
to decrease
NURSING
– The nurse addresses the patient’s comfort needs and creates a care plan.
 POSTPARTUM DEPRESSION THEORY
CHERYL TATANO BECK
• she recognized during her first clinical rotation
that obstetrical nursing was to be her lifelong
specialty.

• Beck identified Robert Gable as a particularly

important source of her work.

• Gable assisted Beck with theoretical

operationalization of her theory for practical use.
 Postpartum Depression Theory

“The birth of a baby is an

occasion for joy—or so the
saying goes . . . But for some
women, joy is not an option”
(Beck, 2006d, p. 40).
MAJOR ASSUMPTIONS
Nursing
• describes as a caring profession with caring obligations to persons
nurses care for.
Person
• described in terms of wholeness with biological, sociological and
psychological components.
Health
• is the consequence of women’s responses to the context of their
lives and their environment.
Environment
• includes events, situations, culture, physicality, ecosystems and
sociopolitical systems.
Postpartum depression
• a nonpsychotic major depressive disorder with distinguishing
diagnostic criteria, postpartum depression often begins as early
as 4 weeks after birth
Maternity blues or Post-Partum Blues or Baby Blues
• is a relatively transient and self-limited period of melancholy
and mood swings during the early postpartum period.
Postpartum psychosis
• a psychotic disorder characterized by hallucinations, delusions,
agitation, inability to sleep, along with desire and irrational
behavior.
Loss of Control- it was identified as the basic psychosocial
problem of Beck’s work. Loss of control was an aspect women
experience in all aspects of their lives.
Four stages:
– Encountering terror- consisted of horrifying attack,
enveloping fogginess, and relentless obsessive thinking.
– Dying of self- consisted of alarming un-realness,
contemplating and attempting self-destruction, isolating
oneself.
– Struggling to survive- consisted of battling the system,
seeking solace at support groups, praying for relief.
– Regaining control- consisted of unpredictable
transitioning, guarded recovery, mourning lost time.
 THEORY OF CARING
KRISTEN M. SWANSON
• was born in Providence, Rhode
Island.
• She studied psychosocial nursing
with an emphasis on the concepts of
loss, stress, coping, interpersonal
relationships, person and
personhood, environments and
caring.
 MAJOR CONCEPTS & DEFINITIONS

“Caring is a nurturing way of

relating to a valued other toward
whom one feels a personal sense
of commitment and
responsibility”
(Swanson, 1991, p. 162).
Caring Theory has sequence of five categories:
1. Knowing is striving to understand the meaning of an
event in the life of the other
2. Being with is being emotionally present to the other.
3. Doing For Doing for means to do for others what one
would do for self.
4. Enabling is facilitating the other’s passage through life
transitions and unfamiliar events
5. Maintaining belief is sustaining faith in the other’s
capacity to get through an event or transition and face a
future with meaning,
sequence of five categories:
 PEACEFUL END-OF-LIFE THEORY
CORNELIA M. RULAND
• Her early years as a nurse was focused
primarily in the pediatric field focuses on
aspects of and tools for decision making in
clinically challenging situations:
• patients confronted with difficult treatment or
screening decisions for which they need help to
understand the potential benefits and harm.
• preference-adjusted management of chronic or
serious long-term illness over time.
SHIRLEY M. MOORE
assisted in the development and
publication of theories.
she taught nursing theory and
nursing science and conducts a
program of research and theory
development that addresses
recovery after cardiac events.
Peaceful End of Life Theory
• A theory from a standard of care that focused on the
peaceful end of life for terminally ill patients.
• Nurses are integral to the creation of peaceful end of
life care, which includes freedom from suffering,
emotional support, closeness to and participation by
significant others, and treatment with empathy and
respect.
 MAJOR CONCEPTS & DEFINITIONS
(1)being free from pain - Pain is considered an unpleasant
sensory or emotional experience associated with actual
or potential tissue damage

(2)experiencing comfort - Comfort is defined as “relief

from discomfort, the state of ease and peaceful
contentment, and whatever makes life easy or
pleasurable”
(3) experiencing dignity and respect - each terminally ill
patient is “respected and valued as a human being”

(4) being at peace - Peace is a “feeling of calmness,

harmony, and contentment, (free of) anxiety,
restlessness, worries, and fear”

(5) experiencing a closeness to significant others and

those who care - Closeness is “the feeling of
connectedness to other human beings who care”
Thank You