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Archives of Psychiatric Nursing 29 (2015) 43–48

Contents lists available at ScienceDirect

Archives of Psychiatric Nursing

journal homepage: www.elsevier.com/locate/apnu

Research Paper

Chronic Sorrow: Lived Experiences of Caregivers of Patients Diagnosed

With Schizophrenia in Butabika Mental Hospital, Kampala, Uganda

Connie Olwit a,⁎, Seggane Musisi b, Sebalda Leshabari c, Ingvar Sanyu d

a Department of Nursing, College of Health Sciences, Makerere University, Kampala, Uganda
b Department of Psychiatry, School of Medicine, Mulago Hospital, Makerere University College of Health Sciences, Kampala, Uganda
c Muhimbili University of Health and Allied Sciences, Salaam, Tanzania
d Infectious Disease Research Collaboration, Kampala, Uganda

a b s t r a c t

During the experience of chronic sorrow, people feel emotional discomfort, and hopelessness. It may progress to
pathological grief, depression or trigger some of the psychiatric disorders in individuals who are vulnerable. The
study explored the experience of chronic sorrow among caregivers of patients diagnosed with schizophrenia. A
descriptive qualitative design using focus groups and indepth interviews was used. Most caregivers experienced
chronic sorrow and identified trigger factors and coping strategies. The findings may enlighten psychiatric nurses
in the care of mentally ill patients, caregivers and family members. The results may also help policy makers to
prioritize mental health in the country.

© 2014 Elsevier Inc. All rights reserved.

Worldwide, severe mental illnesses (schizophrenia, bipolar disorder,
psychotic depression) take on a chronic course with frequent relapses,
deterioration in function and a downward social drift (Caqueo-Urízar,
Gutiérrez-Maldonado, & Miranda-Castillo, 2009; Nasr & Kausar, 2009;
WHO, 2011; Yusuf & Nuhu, 2009). Severe mental illness (SMI) is often
associated with lost economic production and inability to relate with
loved ones (Eakes, 1995; Talwar & Matheithua, 2010). In low income
countries like Uganda, mental illness is also often associated with lack
of proper care resulting in gradual deterioration in social functioning of
the individual and finally demanding total care (Aboo, 2011).

Family members are consequently challenged to assume responsi-
bilities of taking care of individuals diagnosed with the SMI such as
schizophrenia. The resulting grief which is experienced by the family
and caregivers of the severely dysfunctional mentally ill has been
described as chronic sorrow. Chronic sorrow has thus been defined as
the “periodic recurrence of a permanent, pervasive sadness or other
grief-related feeling associated with ongoing disparity resulting from a
loss experience” (Eakes, Burke, & Hainsworth, 1998, p.180). Chronic
sorrow has been explored in developed countries among family
caregivers especially parents caring for young children with physical
or mental disorders (Burke, 1989; Clubb, 1991; Dammsch & Perry,
1989; Fraley, 1986; Fraley, 1990; Golden, 1994; Hummel & Eastman,
1991; Mallow, 1994; Olshansky, 1962; Phillips, 1991; Seideman &
Kleine, 1995; Shumaker, 1995; Wikler et al., 1981).

Chronic sorrow may be viewed as a normal response to a major loss.
However when complicated, it may progress to a pathological grief
state, depression or complicated grief (Eakes et al., 1998; Gordon,

⁎ Corresponding Author: Connie Olwit, MSN, BSN, RN.
E-mail addresses: connieliz09@gmail.com (C. Olwit), segganemusisi@yahoo.ca

(S. Musisi), seolesh@yahoo.com (S. Leshabari), ingvarsanyu@gmail.com (I. Sanyu).

http://dx.doi.org/10.1016/j.apnu.2014.09.007
0883-9417/© 2014 Elsevier Inc. All rights reserved.

2009). Grief, itself has been described as a central experience by people
diagnosed with mental illness, their families or their friends (Young,
Bailey, & Rycroft, 2004). There is limited information, however, on the
experience of grief-related feelings of caregivers of mentally ill patients,
especially in developing countries including Uganda. Chronic sorrow
may trigger psychiatric disorder, such as depression, in caregivers
with genetic vulnerability.

This study sought to explore chronic sorrow as an expression of grief
as seen among the caregivers of patients diagnosed with schizophrenia
in Butabika Mental Hospital in Uganda. Specifically, the study was
designed to (i) describe the feelings, emotions and distresses translating
as chronic sorrow among the caregivers of patients diagnosed with
schizophrenia at Butabika Mental Hospital, Uganda; (ii) identify the
triggers of chronic sorrow among these caregivers; and (iii) identify
the coping strategies used by these caregivers. In the end suggestions
were made regarding strategies that can be adapted by health workers
in helping caregivers of patients diagnosed with schizophrenia to cope
with their chronic sorrow.

METHODS

This study was conducted at the Butabika National Mental Hospital
in Kampala, Uganda. Participants were recruited from the outpatient
department and inpatient wards where relatives of patients came to
visit the patients. Butabika Mental Hospital is the only national psychi-
atric referral hospital in Uganda, a country of about 32 million people.
It has a bed capacity of 900 and admits more than 6000 patients with
mental health illnesses annually (Ministry Of Health, 2010). The inter-
views were carried out in a room at the outpatient department that
was specifically allocated to the researcher in order to provide privacy
to the study participants.

http://crossmark.crossref.org/dialog/?doi=10.1016/j.apnu.2014.09.007&domain=pdf

http://dx.doi.org/10.1016/j.apnu.2014.09.007

mailto:connieliz09@gmail.com

mailto:segganemusisi@yahoo.ca

mailto:seolesh@yahoo.com

mailto:ingvarsanyu@gmail.com

http://dx.doi.org/10.1016/j.apnu.2014.09.007

http://www.sciencedirect.com/science/journal/

44 C. Olwit et al. / Archives of Psychiatric Nursing 29 (2015) 43–48

The study employed a descriptive qualitative design using focus
group discussions (FGDs), and in-depth interviews. These two data col-
lection methods were used in order to get more detailed information
from the participants. There were 10 in-depth interviews and two
FGDs. The FGDs were divided by sex as it has been reported that the
experience of chronic sorrow differs in the two sexes (Atkinson, 1994;
Eakes, 1995). The focus group of female caregivers consisted of 7
members and that of the males consisted of 5 members. There were 2
withdrawals from the male focus group discussion because of the dete-
rioration of their patients’ mental health illness and one withdrawal
from the in-depth interviews because of a family emergency. The care-
givers who participated in the in-depth interviews were different from
those who participated in the FGDs.

The participants who were involved in the in-depth interviews were
from the outpatient clinic while those who participated in the focus
group discussions were visiting patients in the wards. The sample size
was based on the principle of data saturation for qualitative studies
where saturation is the point when no new or relevant information is
emerging (Wood & Haber, 1994). In this specific study, chronic sorrow
was defined as “periodic recurrence of a permanent, pervasive sadness
or other grief-related feeling associated with ongoing disparity resulting
from a loss experience” (Eakes et al., 1998). The loss experience was
considered to be someone diagnosed with schizophrenia since it is a
chronic illness with some disabling effects.

Ethical clearance was sought and obtained from the Muhimbili
University of Health and Allied Sciences (MUHAS) Ethical and Publica-
tions Committee. Approval was obtained from Uganda National Council
of Science and Technology (UNCST) for the research to be carried out in
the country. Permission was then obtained from the Butabika Mental
Hospital research committee before data collection was begun. The
study participants were fully informed about the purpose of the study,
the procedures of data collection as well as risks and benefits. Confiden-
tiality was maintained throughout the research process. Participation
was voluntary and the participants were told that they were free to
withdraw their participation at any time without prejudice or with-
drawal of medical services.

Purposeful sampling was employed so that the researcher was able
to interview people who were knowledgeable about their patients,
articulate and willing to talk at length so that details of the feelings,
emotions and distress could be obtained. It is acknowledged that, such
purposive sampling as a non-probability sampling technique might
give less chance of obtaining a representative sample and hence intro-
duce bias (Polit & Beck, 2006). Sampling was done with the caregivers
who were caring for the patients who had been diagnosed with schizo-
phrenia either at the outpatient clinic or those who had inpatients at the
time of the study. The first 10 participants who consented to participate
in the study were interviewed and the next participants were scheduled
for the FGD.

The informants were selected if they were living with a patient who
had been diagnosed with schizophrenia for more than 1 year; and were
responsible for taking care of that patient; were at least 18 years of age;
and were able to speak Luganda, the most commonly spoken language
in the central region of Uganda.

Data Collection and Procedure

Ethical clearance and permissions were granted before the data
collection process commenced. A registered nurse (RN) was trained to
be a research assistant. The research assistant identified potential
participants and the researcher then explained the purpose of the
study including risks and benefits to the participants. Written informed
consent from those willing to participate was obtained. Consent included
permission for the interview to be audio taped. The study participants
were told that the interview would take approximately 20–30 minutes.
The face to face in-depth interviews and the FGDs were conducted in a
closed room ensuring privacy for the study participants.

Instruments and Study Variables

Socio-demographic characteristics including age, gender, occupa-
tion, religion, marital status, relationship to the patient and level of ed-
ucation were collected using a standardized questionnaire. The face-to-
face in-depth interviews were guided by a modified version of the
Burke/Eakes chronic sorrow questionnaire (Burke/NCRS, 1998) which
was first piloted among 3 caregivers who were not included in the
study. It was then modified accordingly before data collection. The mod-
ifications that were made involved the social demographics in order to
fit the setting in Uganda and part (V) and (VI) stated below were
added to the questionnaire. The Burke/NCRCS (Caregiver Version) con-
sists of 16 open-ended questions for caregivers and was translated into
Luganda. This questionnaire is designed to evaluate (i) the occurrence of
chronic sorrow, (ii) the intensity of the sorrow, (iii) milestones at which
chronic sorrow occurs, (iv) the individualized coping factors, (v) advice
given by caregivers and (vi) advice care givers would give to healthcare
professionals. The tool was modified with the help of two experts: one
in qualitative study design and another senior researcher.This tool has
not been validated in the Ugandan setting although it is the ideal tool
to explore the phenomenon of chronic sorrow. For the focus group dis-
cussions, the following questions were asked: (i) Describe the feelings
and emotions that you experience when caring for your patient?
(ii) What distresses do you encounter that bring back the sadness and
grief related feelings when caring for your patient? (iii) What do you
do to overcome these distresses? (iv) What can health workers do in
order to help you deal with the feeling, emotions and the distresses
you encounter?

During the interviews, the non-verbal communication of study par-
ticipants was noted in a note book. On completion of the discussions/in-
terviews, the study participants were thanked for participating in the
study and were reassured that all the information and their contacts
or their identities would remain confidential. The memory card and
note books were then locked up in the box until they were transcribed
and translated from Luganda to English. The taped focus group discus-
sions were transcribed and then translated from Luganda to English.
There were four questions that were discussed, these involved describ-
ing feelings, emotions and distresses that the caregivers experienced;
the coping strategies they used and finally the advice they wanted to
give the health workers.

Data Analysis

Data were analyzed using the content analysis technique described
by the Graneheim and Lundman (2004) framework for both in-depth
interviews and focus group discussions. Audio taped in-depth inter-
views were transcribed verbatim and translated to English. These
were then typed directly into a Microsoft word program. The infor-
mants’ words were captured word for word and were checked against
the recorded interviews to ensure no information was missed. The in-
terview transcripts were printed out for ease of analysis. The interviews
were read several times to obtain the sense of the scripts and the text.
The caregivers’ experiences were brought into one text, which consti-
tuted the unit of analysis. The texts were divided into condensed mean-
ing units, abstracted and labeled with codes. The codes were compared
based on similarities and differences and sorted into categories and sub
categories. Finally, the categories were formulated into themes which
were documented.

Trustworthiness

To increase the credibility of the study, the researcher included two
different methods of data collection where participants with various
perspectives for example various genders were involved. This contrib-
uted a richer variation of the phenomenon. The time that was taken to
build rapport and trust with informants was sufficient. This helped the

45C. Olwit et al. / Archives of Psychiatric Nursing 29 (2015) 43–48

participants to feel at ease and shared their experiences freely and in
depth. There was also persistent observation during the interviews to
cross check whether the body expressions were persistent with
information that was being shared. Data source triangulation was also
used in the study in order to improve credibility. Member checks were
also done after the data were collected and analyzed. Some of the
study participants were called back, the findings were shared with
them and they reacted to them. Some of the member checks were
done at the end of the interviews by summarizing the information
shared the participant.

To facilitate transferability, a clear and distinct description of charac-
teristics of study participants, data collection and process of analysis
was done. A rich and vigorous presentation of the findings with appro-
priate quotations was done.

RESULTS

Socio-Demographic Characteristics

There were 8 males and 14 females who participated in the study di-
vided up as three males and seven females in the in-depth interviews
and five males and seven females in the focus group discussions. In
terms of the relationship of the participants to the patients, 5 were
spouses, 9 siblings, 6 parents (mothers) and 2 children. Their mean
age was 38 years with range from 21 to 68 years. For the in-depth inter-
views 7 of the participants had income generating activities while 3 did
not have. After data analysis, the following themes came up, experience
of chronic sorrow, trigger factors, coping mechanisms, helpful/not help-
ful situations and caretakers’ suggestions.

The Experience of Chronic Sorrow

In-Depth Interviews
The presence or absence of chronic sorrow was determined from the

participants’ responses on the Burke/Eakes chronic sorrow question-
naire (Burke/NCRS). Nine of the 10 (90%) participants in the in-depth
interviews had experienced chronic sorrow. They described a range of
grief-related feelings associated with the initial knowledge of their rel-
ative being diagnosed with schizophrenia. These participants recounted
numerous situations and circumstances over time where those feelings
were re-experienced. Caregivers who experienced chronic sorrow re-
ported grief-related feelings to be on and off over a prolonged period
of time. Five of the nine participants who evidenced chronic sorrow
cried during the in-depth interview exhibiting an expression of the
overwhelming emotion which they had. A 26 year old daughter
whose mother had been diagnosed with schizophrenia 18 years previ-
ously vividly stated:

I feel very sad, I feel pain, and I feel like crying (cries). This sadness
comes and goes, but it can never go away unless when God decides
and I know that she is gone; she is gone. If it’s not that, I will always feel
sad. (Daughter caretaker, in-depth interview)

Another example was expressed by a single mother who had a
mentally ill son. She said:

At times I would cry to God wondering how long these problems were
going to last. I would think it was better to die and leave this world than
watch my child in that state (Mother caretaker, in-depth interview)

When the participants were asked to recall the feelings they experi-
enced when they first realized that their relative was mentally ill, they
described a variety of feelings including sadness, shock, confusion, de-
spair, fear, devastation, pain, anger. An example of these feelings was
expressed by a 42 year old single mother who had a son who was diag-
nosed with schizophrenia 2 years previously. She said:

I felt so bad, so sad. I am a single mother and this child has been helping
me. I was so devastated. People said he was bewitched and others said
probably it was because of cannabis, I was in a state of confusion.
(Mother, caretaker, in-depth interview)

The most prevalent feelings expressed by the caregivers in
describing both their initial reactions to the relative’s mental illness
and the feelings experienced periodically over the course of their
relative’s illness were those of “sadness, feeling bad, devastation and
frustration”. A 29 year old lady whose elder sister was diagnosed with
schizophrenia in 2005 said:

I felt really bad because it was something that had never been in our
family and we were wondering where it was coming from. I felt so
devastated (cries).” “What increases my sadness is her lack of acceptance.
I want to help her, be there for her but probably because I am younger she
doesn’t want help from me yet I know she needs help. That saddens me.
(Sister, caretaker, in-depth interview)

Focus Group Discussions

The feelings and emotions expressed in the FGDs were similar to
those expressed in the individual in-depth interviews. Among the 12
caregivers who participated in the FGDs, feelings of sadness were
cited most frequently followed by stress disturbances, anger and emo-
tional pain/anguish. Other reported grief-related feelings included feel-
ings of devastation, fear, worry, frustration, confusion and shock. For the
majority of the participants, the intensity of these grief-related feelings
was reported to be more intense at the beginning when they first learnt
of their relatives’ mental illness of schizophrenia. Eight out of the nine
who evidenced chronic sorrow experienced these more intense grief-
related feelings at the beginning with only one participant who experi-
enced them many years later. Some of the caregivers compared their
feelings to the feelings somebody would have if they lost a loved one.
However, after taking their relative to hospital and knowing that the
symptoms could be somewhat controlled with medication they had
some hope with time and with lessening of the intensity of feelings
even when there were triggers.

Trigger Factors

In-Depth Interviews
Caregivers reported grief-related feelings characteristic of chronic

sorrow triggered by many factors. These factors fell into the following
categories: unending care giving; patient’s change in behavior; manage-
ment of crises; society reaction to the mental illness; and missed com-
panionship. Unending care giving included frequent and lengthy
hospitalizations, recurring symptoms, excessive use of their energy
and/or time, financial constraints, overwhelming responsibility, and los-
ing their independence. The second category was ‘change in behavior’ of
the patient which included refusal to go to hospital, refusal to take med-
ications, and resentment. The third category of ‘society reaction to the
mental illness’ included beating or mistreating the mentally ill,
abandoning the mentally ill, and wrong perceptions/misconceptions
about mental illness resulting in stigma. Management of crises was re-
ported by many of the caregivers who said it was saddening to see
their relatives relapse or experiencing side effects from medication
which they had trusted would improve the illness with time.

Focus Group Discussions
During the FGDs, caregivers reported several factors causing them

distress when taking care of their mentally ill relatives. The most fre-
quent factors were in the category of unending care giving and society’s
reaction to mental illness. Under ‘unending care giving,’ participants
identified frequent relapses and unrelenting symptoms, lack of

46 C. Olwit et al. / Archives of Psychiatric Nursing 29 (2015) 43–48

resources and the impact on family members, the latter including fear
of the unknown, unpredictability, personal safety and thinking of the
future. Societal reaction to mental illness according to participants
involved abandoning the mentally ill which would result in them
wandering on streets, society’s perceptions misconceptions of mental
illness often resulting in stigma and putting additional pressure on the
caregivers. The seven caregivers pointed out general health workers as
the most stressing factor. This was well captured from one of the mem-
ber in the male FGD who stated that:

Health workers are the most painful thing for me. It’s true we have
patients who make us sad but health workers make us sadder.(Participant,
male FGD).

Among the most frequently reported distressing factors were
communications-related. The caretakers wanted healthcare workers
to show understanding and flexibility when dealing with their relatives
with schizophrenia. Poor communication involved long waiting
hours when the caregivers came with their patients for reviews, mis-
communication with appointments, no timely communication of any
problems/emergencies, poor means of communication, and miscom-
munication from students without supervision and poor customer
care. There were 15 citations related to communication issues from
seven members from FGDs and two in-depth interviews. Below is an ex-
ample of what one male FGD member stated:

…a nurse comes with files, speaks English then you request her to repeat
in Luganda (local language) so that you understand well but you then
see her in another mood, she becomes angry, quarrels. Then what
happens because you didn’t understand English, your patient’s file
comes and you don’t get to know. They read your name and you do
not hear, so other people come and leave you there… That thing makes
me feel sad, angry, I feel very bad! (Participant, male FGD)

Coping Mechanisms

Participants in FGDs were asked to state what they do to overcome
stressors in order to feel better. Their responses were categorized into
the following: interpersonal strategies, action oriented activities, cogni-
tive and emotional strategies.

Interpersonal strategies included talking to other people who
showed understanding, looking for support from surrounding people,
sharing with a friend in the same situation, listening to encouraging pro-
grams on radio, watching television (TV), reading encouraging words
(like from the Bible), going to church and praying (trusting and having
faith in God). Action oriented activities included watching movies, TV,
listening to the radio, doing chores, and sports. Many caregivers turned
to religion for answers. Almost all of them identified God as the solution
to their problems and worries. Many of them resorted to prayers,
trusting God and their faith. Emotional coping included crying, avoid-
ance (taking short breaks like moving away from home temporarily),
and keeping feelings to oneself. Crying was often observed during the
in-depth interviews and FGDs. Four of the nine caregivers who scored
positive for chronic sorrow on the Burke/NCRS questionnaire cried dur-
ing the interviews and one did during the female FGD. The cognitive
strategies included burden acceptance and positive thinking which
were used by two of the nine caregivers who scored positive for chronic
sorrow on the Burke/NCRS questionnaire.

Helpful/Not Helpful Situations

Most caregivers reported relatives and friends to be helpful during
tough and emotionally laden situations. The friends ranged from
neighbors, church members, age mates/peers and community leaders.
The relatives ranged from husbands, brothers, sisters, parents, aunts
and uncles. The caregivers reported they were helpful in terms of

offering sympathy, consoling and comforting as well as counseling,
giving company, advising and seeking alternative solutions including
divine healing in church. Health workers were reported to be helpful
in terms of providing medication to reduce on the symptoms and to
reduce hospitalization frequency especially with severe symptoms.
The most frequently reported useful help from health-workers was
providing medication. Two of the nine caregivers who scored positive
for chronic sorrow reported health-workers being friendly and
encouraging and one caregiver from the female FGD felt health-
workers were welcoming and willing to help. However the majority
of the caregivers reported healthcare workers as being a big source of
triggers of chronic sorrow.

Unhelpful factors were reported to be stigma, cracking negative
jokes about mental illness and laughing when the relative got sick.
The police were also identified as being unhelpful when they were
needed most especially when support was needed to bring the patients
to hospital or when they were potentially dangerous to the others. The
health system was seen as frustrating, hectic and many times not
user friendly and not understanding of the handicaps occasioned by
mental illness.

Caregivers’ Suggested Recommendations

Caregivers were asked what the health workers could do to help
them deal with the feelings, emotions and distresses brought on by feel-
ings of chronic sorrow. The caregivers responded with the following
themes; showing understanding, health education, and community
sensitization as well as communication, counseling, resources, accessi-
ble services and follow up visits. Showing understanding, counseling
and health education were the most frequently cited recommendations.
Under health education several topics were suggested with the most
common being increasing awareness by teaching about mental illness;
how to handle mentally ill patients; what to do in case of a mental
health emergency; and expectations while caring for the patients.
Community sensitization included educating the community about
mental illness, their expected responsibilities, and changing their nega-
tive perception regarding mental illness. Resources involved availability
of drugs, facilitation of health workers, and involvement of the police.
Lastly on the theme of communication, caregivers cited a variety of con-
cerns which needed improvement such as customer care, proper and
timely communication.

DISCUSSION

Our sample of 22 participants was small but representative of the
feelings of caretakers for the severely mentally ill attending the national
mental referral hospital. There were more females than males because
the females, in this country, generally take up the role of care-giving/
caretaking. It is the females who stay with the patients at home, take
them to hospital and stay with them in the hospital while the men go
looking for money which they provide to facilitate the care giving.
This is not unusual in African communities with patrilineal kinship sys-
tems, Uganda inclusive.

Nine out of ten participants (90%) scored positive for chronic
sorrow. This prevalence of chronic sorrow is similar to findings by
other researchers among people experiencing different types of losses.
For example among the studies that were carried out by Nursing
Consortium for Research on Chronic Sorrow (NCRCS), out of 98 persons,
87 (88%) evidenced chronic sorrow (Burke, Eakes, & Hainsworth, 1999).
Olwit and Jarlsberg (2014) had similar findings (88%) among the people
with facial disfigurement in Uganda experienced chronic sorrow. The
intense emotional experiences of chronic sorrow in this study are con-
sistent with findings in the Western world; consisting of confusion, sad-
ness, devastation, anger, fear and worry (Eakes, 1995). In another study,
Eakes et al. (1998) found that the intensity of these feelings varied from
person to person. This could be because of the mixture of the study

47C. Olwit et al. / Archives of Psychiatric Nursing 29 (2015) 43–48

sample, because grief-related feelings change with time, being more in-
tense at the beginning when caretakers experience disbelief, shock, con-
fusion and devastation but which later on abates with time. This,
therefore points out the importance of health workers taking time to
talk to the caregivers especially with newly diagnosed patients in hospi-
tal. This helps caretakers express their emotions/feelings and clear out
any misperceptions as health-workers provide them with health
education about mental illness and help them to develop positive
coping strategies.

Regarding triggers that produce feelings of chronic sorrow, the most
predominant were in the themes of unending care giving, change in be-
havior, societal reaction to mental illness and management of crises.
Similar to the findings of Burke et al. (1999), our findings are not sur-
prising because schizophrenia is a chronic mental condition, with pa-
tients often relapsing and, portraying odd behaviors and mannerisms
to the chagrin of the caregiver. Hospitalization triggered severe chronic
sorrow emotions in the caregivers, a finding similar to Roick, Heider,
Toumi, and Angermeyer (2006) where caregivers of patients diagnosed
with schizophrenia showed high levels of stress upon their relatives
being re-hospitalized again and again although in this study, hospitali-
zation was viewed as helpful as patients received treatment in hospital
and got better. Our caretakers experienced excessive use of energy and
time as well as financial strain, findings which were termed as objective
burdens by some researchers (Caqueo-Urízar et al., 2009; Idstad, Ask, &
Tambs, 2010). Societal reaction to the mental illness of schizophrenia
was negative and often suggesting stigma similar to findings by several
other researchers (Angermeyer & Matschinger, 2003; Buizza, Schulze,
Bertocchi, Rossi, & Pioli, 2007; Young et al. 2004).

Our caregivers’ coping strategies (interpersonal, action oriented,
emotional and cognitive) were similar to those reported by Hainsworth
(1996) and Eakes (1995). However, our caregivers used more internal
strategies than external ones contrasting with findings by Olwit and
Jarlsberg (2014) who found that facially disfigured people who experi-
enced chronic sorrow used more external coping strategies than inter-
nal. This could be because of the discrimination and stigma that
surrounds mental illness in the communities in Uganda. It is, therefore,
not surprising given Ugandan society’s negative perception of mental ill-
ness (Buizza et al. (2007). These findings imply that effort is needed to in-
crease awareness of mental health and curtail society’s perceptions and
misperceptions regarding mental illness in the communities.

Finally, healthcare workers were reported by caregivers to be helpful
during the whole experience, in terms of providing medication to re-
duce the symptoms although they were often reported to have poor
communication and the mental health systems’ similarly reported by
Eakes (1995). The police were also identified as being unhelpful as
they did not seem to know their role in the mental health system.

Limitations

This was a study confined to one SMI, schizophrenia. Moreover the
study took place in urban setting in Central Uganda. The findings in
the research may therefore not be representative of the all population
of caregivers of schizophrenic patients in Uganda.

CONCLUSION

This study showed that caregivers of patients diagnosed with schizo-
phrenia experienced chronic sorrow as defined by Eakes et al., 1998. The
common triggers that lead to feelings of chronic sorrow were related to
the themes of unending care giving, change in behavior, societal
reaction to mental illness and management of crises. Health workers
were reported by the caretakers to be unhelpful especially when it
came to communication. Caregivers in this study felt there were
wrong community perceptions about mental health and much stigma
in Ugandan society. The police were also reported as not be cooperative
when approached to help in containing aggressive patients. The

different coping strategies employed by the caregivers included, inter-
personal strategies e.g. sharing feelings with others, reading and
praying, action oriented activities e.g. sports, working, and watching
movies, emotional strategies e.g. crying, avoidance and cognitive strate-
gies e.g. burden acceptance and positive thinking.

There is a need for nurses to assess the coping mechanisms used by
the caregivers, and re-enforce positive strategies and offer time to the
family members of mentally ill patients to express their feelings and
finally provide health education to the public on mental health related
issues in effort to reduce stigma or and discrimination and creating
awareness of their role in mental health.

Lastly, ongoing research is needed regarding chronic sorrow in
different situations of loss in developing countries because it
helps health workers understand better what loss victims and family
members go through and it guides in the care given.

Acknowledgment

My sincere thanks to the sponsor, Norwegian government through
NOMA project for their financial support that enabled this research to
be carried out. Special thanks my family members and friends for
being understanding and supportive throughout this period. Thanks to
the almighty God for bringing us this far, without him this would not
have happened.

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• Chronic Sorrow: Lived Experiences of Caregivers of Patients Diagnosed
  With Schizophrenia in Butabika Mental Hospital, Kampala, Uganda

Methods
Data Collection and Procedure
Instruments and Study Variables
Data Analysis
Trustworthiness
Results
Socio-Demographic Characteristics
The Experience of Chronic Sorrow
In-Depth Interviews
Focus Group Discussions
Trigger Factors
In-Depth Interviews
Focus Group Discussions
Coping Mechanisms
Helpful/Not Helpful Situations
Caregivers’ Suggested Recommendations
Discussion
Limitations
Conclusion
Acknowledgment
References

NR320-326 Mental Health Nursing

NR320-326 RUA Scholarly Article Review V2 11/06/2018 CS/el

Required Uniform Assignment: Scholarly Article Review

PURPOSE
The student will review, summarize, and critique a scholarly article related to a mental health topic

.

COURSE OUTCOMES

This assignment enables the student to meet the following course outcomes.

• CO 4. Utilize critical thinking skills in clinical decision-making and implementation of the nursing process for psychiatric/mental health clients.

(PO 4)

• CO 5: Utilize available resources to meet self‐identified goals for personal, professional, and educational development appropriate to the mental

health setting. (PO 5)

• CO 7: Examine moral, ethical, legal, and professional standards and principles as a basis for clinical decision‐making. (PO 6)

• CO 9: Utilize research findings as a basis for the development of a group leadership experience. (PO 8)

DUE DATE

Refer to Course Calendar for details. The Late Assignment Policy applies to this assignment.

TOTAL POINTS POSSIBLE: 100 points

REQUIREMENTS

1. Select a scholarly nursing or research article (published within the last five years) related to mental health nursing, which includes content related

to evidence‐based practice.

*** You may need to evaluate several articles before you find one that is appropriate. ***

2. Ensure that no other member of your clinical group chooses the same article. Submit the article for approval.

3. Write a 2–3 page paper (excluding the title and reference pages) using the following criteria.

a. Write a brief introduction of the topic and explain why it is important to mental health nursing.

NR326 Mental Health Nursing

NR320-326 Mental Health Nursing

NR320-326 RUA Scholarly Article Review V2 11/06/2018 CS/el

b. Cite statistics to support the significance of the topic.

c. Summarize the article; include key points or findings of the article.

d. Discuss how you could use the information for your practice; give specific examples.

e. Identify strengths and weaknesses of the article.

f. Discuss whether you would recommend the article to other colleagues.

g. Write a conclusion.

4. Paper must follow APA format. Include a title page and a reference page; use 12‐point Times Roman font; and include in‐text citations (use citations

whenever paraphrasing, using statistics, or quoting from the article). Please refer to your APA Manual as a guide for in‐text citations and sample reference
pages.

5. Submit per faculty instructions by due date (see Course Calendar); please refer to your APA Manual as a guide for in‐text citations and sample

reference pages. Copies of articles from any Databases, whether PDF, MSWord, or any other electronic file format, cannot be sent via the Learning

Management System (Canvas) dropbox or through email, as this violates copyright law protections outlined in our subscription agreements. Refer to
the “Policy” page under the Resource tab in the shell for the directions for properly accessing and sending library articles electronically using permalinks.

NR320-326 Mental Health Nursing
NR320-326 RUA Scholarly Article Review V2 11/06/2018 CS/el

DIRECTIONS AND ASSIGNMENT CRITERIA

Assignment

Criteria

Points % Description

Introduction 10 10 • An effective introduction establishes the purpose of the paper.

• The introduction should capture the attention of the reader.

Article summary 30 30 Summary of article must include the following.

• Statistics to support the significance of the topic

• Key points and findings of the article

• Discussion of how information from the article could be used in your practice (give

specific examples)

Article critique 30 30 Article critique must include the following.

• Strengths and weaknesses of the article

• Discussion of whether you would recommend the article to a colleague

Conclusion 15 15 The conclusion statement should be well defined and clearly stated. An effective
conclusion provides analysis and/or synthesis of information, which relates to the main

idea/topic of the paper. The conclusion is supported by ideas presented throughout the

body of your report.

Article Selection &

Approval
5 5 • Article is relevant to mental health nursing practice and is current (within 5 years of

publication).

• No duplicate articles within the clinical group.

• Article submitted and approved as scholarly by instructor.

Grammar/Spelling/
Mechanics/APA

format

10 10 • Correct use of Standard English grammar and sentence structure

• No spelling or typographical errors

• Document includes title and reference pages

• Citations in the text and reference page

Total 100 100

NR320-326 RUA Scholarly Article Review V2 11/06/2018 CS/el

GRADING RUBRIC

Assignment
Criteria

Outstanding or Highest

Level of Performance

A (92–100%)

Very Good or High Level of

Performance

B (84–91%)

Competent or Satisfactory

Level of Performance

C (76–83%)

Poor, Failing or

Unsatisfactory Level of

Performance

F

(0–75%)

Introduction (10

points)
• Introduction is present and

distinctly establishes the
purpose of paper

• Introduction is appealing and
promptly captures the
attention of the reader

10 points

•

Introduction is present and
generally establishes the
purpose of paper

• Introduction has appeal and
generally captures the
attention of the reader

9 points

Introduction is present and
generally establishes the
purpose of paper

8 points

No introduction

0‐7 points

Article summary (30

points)
• Statistics presented strongly

support the significance of the
topic

• Key points and findings of the
article are clearly stated

• Thoroughly discusses how
information from the article
could be used in your practice
by giving two or more specific,
relevant examples

28‐30 points

• Statistics presented
moderately support the
significance of the topic

• Key points and findings of the
article are vaguely stated

• Adequately discusses how
information from the article
could be used in your practice
by giving two or more specific,
relevant examples

26‐27 points

• Statistics presented weakly
support the significance of the
topic

• Key points and findings of the
article are stated in a manner
that is confusing or difficult to
understand.

• Briefly discusses how
information from the article
could be used in your practice
by giving examples that are
not specific, yet are relevant

23‐2

5 points

• Statistics presented do not
support the significance of the
topic OR no statistics are
presented.

• Key points and findings of the
article are incorrectly
presented OR missing

• Briefly discusses how
information from the article
could be used in your practice
by giving examples that are
neither specific, nor relevant
OR implications to practice
not discussed

0‐22 points

NR320-326 RUA Scholarly Article Review V2 11/06/2018 CS/el

Article critique (30

points)
• The strengths and weaknesses

are

well‐defined and clearly
stated.

• Provides a thorough review of
whether or not they
recommend the article

28-30 points

• The strengths and weaknesses
are adequate and clearly
stated.

• Provides a general review of

whether or not they would

recommend the article

26-27 points

• The strengths and weaknesses
are brief and clearly stated.

• Provides a brief review of

whether or not they would

recommend the article.

23-25 points

• The strengths and weaknesses
are unclear or not stated.

• Provides an unclear or no
insight as to whether or not
they would recommend the
article.

0-22 points

.

Assignment
Criteria
Outstanding or Highest
Level of Performance

A (92–100%)
Very Good or High Level of
Performance

B (84–91%)
Competent or Satisfactory
Level of Performance

C (76–83%)
Poor, Failing or
Unsatisfactory Level of
Performance
F (0–75%)

Conclusion (15

points)
• The conclusion statement is

well‐defined and clearly
stated.

• Conclusion demonstrates
comprehensive analysis or
synthesis of information from
the article.

• The conclusion is strongly
supported by ideas presented
throughout the body of the
paper.

15 points

• The conclusion statement is
general and clearly stated.

• Conclusion demonstrates
comprehensive analysis or
synthesis of information from
the article.
• The conclusion is strongly
supported by ideas presented
throughout the body of the
paper.

13-1

4 points

• The conclusion statement is
general and clearly stated.

• Conclusion demonstrates
adequate analysis or synthesis
of information from the article.

• The conclusion is adequately
supported by ideas presented
throughout the body of the
paper.

12 points

• The conclusion statement is
vague or not stated.

• Conclusion demonstrates
inadequate analysis or
synthesis of information from
the article.

• The conclusion is inadequately
supported by ideas presented
throughout the body of the
paper.

0‐11 points

NR320-326 RUA Scholarly Article Review V2 11/06/2018 CS/el

Article Selection &
Approval
(5 points)

ALL Items MET

• Article is relevant to mental

health nursing practice and is
current (within 5 years of
publication).

• No duplicate articles within the
clinical group.

• Article submitted and
approved as scholarly by
instructor.

5 points

ONE item NOT MET

• Article is relevant to mental
health nursing practice and is
current (within 5 years of
publication).
• No duplicate articles within the
clinical group.
• Article submitted and
approved as scholarly by
instructor.
4 points

2 or more items NOT MET
• Article is relevant to mental

health nursing practice and is
current (within 5 years of
publication).
• No duplicate articles within the
clinical group.
• Article submitted and
approved as scholarly by
instructor.

0‐3 points

Assignment
Criteria
Outstanding or Highest
Level of Performance

A (92–100%)
Very Good or High Level of
Performance

B (84–91%)
Competent or Satisfactory
Level of Performance

C (76–83%)
Poor, Failing or
Unsatisfactory Level of

Performance F

(0–75%)

Grammar/Spelling/
Mechanics/APA
Format
(10 points)

• References are submitted
with assignment.

• Used appropriate APA format
and are free of errors.

• Includes title and reference

pages.

• Grammar and mechanics are
free of errors.

10 points
• References are submitted
with assignment.

• Used appropriate APA format
and has one type of error.

• Includes title and reference
pages.

• Grammar and mechanics have
one type of error.

9 points
• References are submitted
with assignment.

• Used appropriate APA format
and has two types of errors.

• Includes title and reference
pages.

• Grammar and mechanics have
two types of errors.

8 points

• No references submitted with
assignment.

• Attempts to use appropriate
APA format and has three or
more types of errors.

• Includes title and reference
pages.

• Grammar and mechanics have
three or more types of errors.

0‐7 points

NR320-326 RUA Scholarly Article Review V2 11/06/2018 CS/el

Total Points Possible = 100 points

COURSE OUTCOMES
DUE DATE
REQUIREMENTS
DIRECTIONS AND ASSIGNMENT CRITERIA
GRADING RUBRIC