Mary Lermann Burke

Mary Lermann Burke was born in Sandusky, Ohio, where she received her elementary and secondary education. She was awarded her initial nursing diploma from Good Samaritan Hospital School of Nursing in Cincinnati in 1962, followed later that year by a postgraduate certification, from Children’s Medical Center in District of Columbia. After several years of work experience in pediatric nursing, Burke graduated Summa Cum Laude from Rhode Island College, Providence, with a bachelor’s degree in nursing. In 1982, she received her master’s degree in parent-child nursing from Boston University. During this program, she was also awarded a Certificate in Parent-Child Nursing and Interdisciplinary Training in Developmental Disabilities from the Child Development Center of Rhode Island Hospital and the Section on Reproductive and Developmental Medicine, Brown University, in Providence. Her doctorate of nursing science in the Family Studies Cognate from Boston University followed this in 1989.

Burke was inducted as a member of Theta Chapter, Sigma Theta Tau, during her master’s program at Boston University in 1981 and as a charter member of Delta Upsilon Chapter-at-Large of Sigma Theta Tau at Rhode Island College in 1988. She received a Doctoral Student Scholarship Award from the Theta Chapter in 1988. She received the 1996 Delta Upsilon Chapter-at-Large Louisa A. White Award for Research Excellence.

During the period from 1991 through 1996, Burke received four Rhode Island College Faculty Research Grants for studies in the area of chronic sorrow. In 1998, she was awarded a grant from the Delta Upsilon Chapter-at-Large for initial quantitative instrument development for the study of chronic sorrow. Burke was principal investigator on the Transition to Adult Living Project, funded by a grant from the Department of Health and Human Services, Maternal and Child Health Bureau, Genetics Services Branch, from 1992 through 1995. A New England Regional Genetics Group Special Projects Grant, The Transition to Adult Living Project—System Dissemination of Information, supplemented this in 1995. Burke was co-principal investigator.

In her early career, Burke practiced in the pediatric nursing specialty in both acute and primary settings. She joined the faculty of Rhode Island College Department of Nursing as a clinical instructor in 1980 and became a full-time instructor in 1982, assistant professor in 1987, associate professor in 1991, and professor in 1996. During this period, she taught pediatric nursing in both theory and clinical courses. She also developed and taught a foundation nursing curriculum course encompassing nutrition, pharmacology, and pathophysiology. She retired from her Rhode Island College faculty position in December 2002.

Burke became interested in the concept of chronic sorrow during her master’s degree program while engaged in a clinical practicum at the Child Development Center of Rhode Island Hospital. While working there with children with spina bifida and their parents, she developed the clinical hunch that the emotions displayed by the parents were consistent with chronic sorrow as first described by Olshansky (1962). Her master’s thesis, The Concerns of Mothers of Preschool Children with Myelomeningocele, identified emotions similar to chronic sorrow. She then developed the Burke Chronic Sorrow Questionnaire for conducting her doctoral dissertation research, Chronic Sorrow in Mothers of School-Age Children With Myelomeningocele.

In June 1989, Burke presented her dissertation research at the Sigma Theta Tau International Research Congress in Taipei, Taiwan, where she interacted with Dr. Eakes of East Carolina University and Dr. Hainsworth of Rhode Island College. Subsequently, this group became the NCRCS, joined briefly by Dr. Carolyn Lindgren of Wayne State University. Together they developed a modified Burke/NCRCS Chronic Sorrow Questionnaire and conducted individually a series of studies that were analyzed collaboratively. Burke’s individual studies in this series focused on chronic sorrow in infertile couples, adult children of parents with chronic conditions, and bereaved parents. The collaboratively analyzed studies resulted in the development of a middle range Theory of Chronic Sorrow, published in 1998. Members of the Consortium, both individually and collaboratively, presented numerous papers on chronic sorrow at local, state, national, and international conferences and wrote 10 articles published in refereed journals, receiving the Best of Image Award in the Theory Category from Sigma Theta Tau International for their article, “Middle-Range Theory of Chronic Sorrow.” Most recently, Burke has collaborated with Dr. Eakes in the development of the Burke/Eakes Chronic Sorrow Assessment Tool.

Burke is active in numerous professional and community organizations. She is a member of the St. Joseph’s Health Services of Rhode Island Board of Trustees. She has been awarded the Outstanding Alumna Award for Contributions in Nursing Education by Rhode Island College Department of Nursing and the Rhode Island College Alumni Honor Roll Award (L. Burke, personal communication, 2005).

Margaret A. Hainsworth

Margaret A. Hainsworth was born in Brockville, Ontario, Canada. She received her early elementary and secondary education in her hometown of Prescott, Ontario. Following high school graduation in 1949, she entered the diploma school of nursing at the Brockville General Hospital, Brockville, Ontario, graduating in 1953. In 1959, she immigrated to the United States to attend George Peabody College for Teachers in Nashville, Tennessee, receiving a diploma in public health nursing. In 1974, she continued her education at Salve Regina College, Newport, Rhode Island, and received a baccalaureate degree in nursing in 1973 and a master’s degree in psychiatric and mental health nursing from Boston College in 1974. She received a doctoral degree in education administration from the University of Connecticut in 1986. In 1988, she was board certified as a clinical specialist in psychiatric and mental health nursing.

She was inducted into Sigma Theta Tau, Alpha Chi Chapter in 1978 and Delta Upsilon Chapterat-Large in 1989. In 1976, she was awarded an outstanding faculty award at Rhode Island College. In 1992, she was selected to attend the Technical Assistance Workshop and Mentorship for Nurses in Implementation of the National Plan for Research in Child and Adolescent Mental Disorders that was sponsored by the National Institutes of Health. In 1991, she was selected to review manuscripts for the journal, Qualitative Health Research, an Interdisciplinary Journal, a Sage publication. In 1999, Hainsworth was accepted at the Royal Melbourne Institute of Technology in Melbourne, Australia, as a visiting fellow on a faculty exchange program.

Her practice in nursing was in the specialties of public health and psychiatric and mental health nursing. In 1974, she was accepted as a lecturer in the Department of Nursing at Rhode Island College and was promoted to full professor in 1992. Her major area of teaching was psychiatric care that consisted of both classroom lectures and clinical practice. She taught a course entitled “Death and Dying” that became an elective in the college’s general studies program. Hainsworth always maintained her practice and was employed for 13 years as a consultant at the Visiting Nursing Association. She entered into a private practice at Bay Counseling Association in 1993 and maintained this practice for 5 years.

Her interest in chronic illness and its relationship to sorrow began in her practice as a facilitator for a support group for women with multiple sclerosis. This practice led to her dissertation work, An Ethnographic Study of Women With Multiple Sclerosis Using a Symbolic Interaction Approach. This research was accepted for a presentation at the Sigma Theta Tau Research Congress in Taipei, Taiwan, in 1989. At this conference, she became familiar with the research on chronic sorrow after attending a presentation by Burke.

Building on Burke’s work, the NCRCS was established in 1989 to expand the understanding of chronic sorrow. Hainsworth was one of the four co-founders and remained an active member until 1996. The research began with four studies that focused on chronic sorrow in individuals in chronic life situations, and the members of the consortium analyzed the data collaboratively. During the 7 years that she was a member, the consortium published 13 manuscripts and presented the findings from their studies at international, state, and regional conferences. In 1999, they were awarded the Best of Image Award in Theory from Sigma Theta Tau International (M. Hainsworth, personal communication, 2005).

Triggers

Using the empirical data from these series of studies, the NCRCS theorists identified primary events or situations that precipitated the re-experience of initial grief feelings. These events were labeled chronic sorrow triggers (Eakes et al., 1993). The NCRCS compared and contrasted the triggers of chronic sorrow in individuals with chronic conditions, family caregivers, and bereaved persons (Burke, Eakes, & Hainsworth, 1999). For all populations, comparisons with norms and anniversaries were found to trigger chronic sorrow. Both family caregivers and persons with chronic conditions experienced triggering with management crises. One trigger unique for family caregivers was the requirement of unending caregiving. The bereaved population reported that memories and role change were unique triggers.

Management Strategies

The NCRCS posited that chronic sorrow is not debilitating when individuals effectively manage feelings. The management strategies were categorized as internal or external. Self-care management strategies were designated as internal coping strategies. The NCRCS further designated internal coping strategies as action, cognitive, interpersonal, and emotional.

Action coping mechanisms were used across all subjects—individuals with chronic conditions and their caregivers (Eakes, 1993, 1995; Eakes et al., 1993, 1999; Hainsworth, 1994, 1995; Hainsworth et al., 1995; Lindgren, 1996). The examples are like distraction methods commonly used to cope with pain. For instance, “keeping busy” and “doing something fun” are given as examples of action-oriented coping (Eakes, 1995; Lindgren et al., 1992). It was found that cognitive coping was used frequently, and examples included “thinking positively,” “making the most of it,” and “not trying to fight it” (Eakes, 1995; Hainsworth, 1994; Lindgren, 1996). Interpersonal coping examples included “going to a psychiatrist,” “joined a support group,” and “talking to others” (Eakes, 1993; Hainsworth, 1994, 1995). Emotional strategy examples included “having a good cry” and expressing emotions (Eakes et al., 1998; Hainsworth, 1995). A management strategy was labeled effective when a subject described it as helpful in decreasing feelings of re-grief.

External management was described initially by Burke as interventions provided by health professionals (Eakes et al., 1998). Healthcare professionals assist affected populations to increase their comfort through roles of empathetic presence, teacher-expert, and caring and competent professional (Eakes, 1993, 1995; Eakes et al., 1993, 1999; Hainsworth, 1994, 1995; Hainsworth et al., 1995; Lindgren, 1996).

In summary, an impressive total of 196 interviews resulted in the middle range Theory of Chronic Sorrow. The theorists summarized a decade of research with individuals with chronic sorrow and found that this phenomenon frequently occurs in persons with chronic conditions, in family caregivers, and in bereaved persons (Burke et al., 1999; Eakes et al., 1998).