Abstract
Postpartum depression is an abnormality occurring in women who had successful deliveries, but due to hormone readjustments find it difficult to cope emotionally. Its onset is insidious. However, it is characterized by feelings of unexplained sadness, grief, worthlessness, failure and some suicidal inclinations. In the majority of cases mothers can be talked out of these moods once there are supportive family members to take them through the process.
In situations when pregnancy and childbirth are complicated by neglect from spouse, parents and significant others and sensations of remorse are filtered to the mother the situation may persist leading into puerperal psychosis. So far, medical science has not discovered a definite cause neither cure for postpartum depression except for explanations of after delivery hormonal changes. There may be socio -cultural factors involved. Therapeutically, every attempt is made to prevent the dysfunction from progressing to the other level of puerperal psychosis.
Purpose of Research
To validate that nursing care measures are effective.
Identification of the practice based problem or issue selected.
Statement of the problem
The practice based problem identified for this research exposition is postpartum depression. Subsequently, the statement of this problem consists of a series of assumptions and prepositions suggestive of the theoretical perspective that nursing care measures are effective in the treatment of this dysfunction.
A major assumption posited by researchers is that ‘social support’ is a key determinant in the prevention of post partum depression. (Ugarrazia, Brown, & Chang- Martinez, 2007). Theretofore, providing mothers with a prophylactic alternative during pregnancy can greatly reduce incidences of the illness even in the absence of scientific evidence regarding its etiology.
The proposition then is that if during pregnancy mothers’ emotional health is evaluated through appropriate screening and corrective therapy is instituted prior to delivery the incidence would be greatly reduced.
It is also assumed that pregnancy and childbirth bring their distinct trauma to the body. Physiological, psychological and anatomical changes in themselves predispose to decompensation. Consequently, if maternal and child health clinics adopt strategies to help mothers cope during this delicate period of adjustment the condition can be arrested at the onset.
Since social support is the major element in prevention and treatment of postpartum depression the scope for family centered nursing intervention has been defined and broadened.
Summary of the Literature
A Review of Literature
Exploring the” Postpartum Questionnaire as a Predicator for Postpartum Depression” clear conclusions were drawn indicating its effectiveness in diagnosis. In utilizing the instrument as a prophylactic measure 40% of women were identified as being at risk.
The limitations were that even though it is a valid measurement generalizations were compromised due to cost. Administering questionnaires to a larger sampling population would have created more profound conclusions. (Davis, Cross, & Lind, 2008).
Subsequently, in the article “A Community- Based Screening Initiative to identify Mothers at Risk of Postpartum Depression “it was explained that the instrument is very successful in its purpose of identifying PPD in mothers.
It was highly supportive of other studies, which proved that screening through application of testing tools was useful in the treatment of PPD. There were supportive findings regarding selected risk factors prevalence and validation of the instrument for follow up evaluations. (Horowitz, Murphy, Gregory, & Wojcik, 2010)
While” Evidence-Based Recommendations for Depressive Symptoms” in Postpartum Women is still being researched it has been revealed that confirmation of risk factors, prevention of the condition and treatment are the three major objectives for intervention is Postpartum Depression.
Consequently, the “Registered Nurses Association of Ontario” (RNAO) has devised strategies for implementing measures to treat symptoms once the condition is confirmed. This emerged as an outcome of evidence- based research. (McQueen, Momgomery, Lappan-Gracon, Evans, & Hunter, 2007).
A study conducted on “20 Anglo- American Mothers in relation to the prevention of Postpartum Depression” is supportive of the “Ontario Nurses’ Association” research in assessing depression prevention activities with the aim of providing suitable intervention.
The recommended evidence –based intervention in this case study is ‘social support.’ These researchers confirmed that socio-cultural; socio- economic and psycho- social factors all contribute to postpartum blues. They feel that it must be addressed even though on an average only 13% of women do suffer from the illness. (Ugarrazia et al., 2007).
In examining the two preceding researches indications are that more practitioners are needed for intervention in the treatment of postpartum depression. It is true that there are no specialists in this area except for obstetric nurses and obstetricians.
But a recent study involving Postpartum Screening by Family Nurse Practitioners confirmed the inadequacy of skilful intervention in the implementation of evidence based practice. Importantly, it was discovered that screening for postpartum depression is not universal even though 80% of mothers are seen by a health care professional prior to delivery. Recommendations are that postpartum screening measures should be implemented in routine prenatal care. (Goldsmith.2006)
Likewise studies conducted in Rural Southeastern California on White, African- American and Hispanic Low income mothers support the theory that mood swings during pregnancy is highly indicative of PPD. Therefore, an adequate screening measure is a step forward in controlling its occurrence. (Hutto, Kim Goodwin, Pollard, & Kemppainen, 2011)
Summary of Approaches
The approaches were scientific investigative methodologies. Instruments administered to mothers were pretested to determine external and internal validity. They included application of measurements such as Center of Epidemiologic Studies Scales; SSP data sets; Ethnographs; Edinburgh Postnatal Depression scale and the Postpartum Adjustment Questionnaire.
Except for limitations considered with regard to sample size infringements emerging from the instrumentation itself and cost of administration, the approaches taken were valuable to the research.
A great advantage was the pretested instruments which avoided biases and unnecessary questioning, whereas the limitation of being able to generalize findings to similar populations was the major weakness of all these studies.
Sample sizes were either too small or did not assess alternative socio- economic groups. The assumption that low income women were the most affected created some imbalance in the methodology.
Evidence- Based Practice
Identification of Action
Clearly, from evidence provided through review of literature the guidelines pertinent to improved nursing intervention in the treatment of postpartum depression center around efficiency of screening at the appropriate time; identification of realistic high risk factors; developing a registry for postpartum depression clients and training of health care professionals to screen and diagnose the predisposition during the prenatal period.
As such, the objective of implementing evidence- based practice must be to provide postpartum screening as part of mothers’ prenatal care and allow for identifiable risk factors to be treated immediately through therapeutic intervention. Social support mechanism should be devised to help mothers through their peculiar crisis.
It would mean that an awareness regarding postpartum depression must be aroused among healthcare professionals who directly interact with mothers during this time of adjustment.
From the literature review education and reorientation are the first steps towards comprehensive Evidence –Based practice. Only then could it be confirmed that research validates the effectiveness of nursing care measures in treatment of postpartum depression internationally.
References
Davis, S., Cross, J., & Lind, B. (2008). Exploring the Postpartum Adjustment Questionnaire as a predictor of postpartum depression. JOGNN: Journal of Obstetric, Gynecologic & Neonatal Nursing, 37(6), 622-630.
Goldsmith, M. (2007). Postpartum depression screening by family nurse practitioners. Journal of the American Academy of Nurse Practitioners, 19(6), 321-327.
Horowitz, J., Murphy, C., Gregory, K., & Wojcik, J. (2011). A community-based screening initiative to identify mothers at risk for postpartum depression. JOGNN: Journal of Obstetric, Gynecologic & Neonatal Nursing, 40(1), 52-61. Web.
Hutto, H., Kim-Godwin, Y., Pollard, D., & Kemppainen, J. (2011). Postpartum depression among white, african american, and hispanic low-income mothers in rural southeastern north carolina. Journal of Community Health Nursing, 28(1), 41-53. Web.
Ugarriza, D., Brown, S., & Chang-Martinez, C. (2007). Anglo-American mothers and the prevention of postpartum depression. Issues in Mental Health Nursing, 28(7), 781-798. Web.