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Postpartum depression diognosis and nurses proficiency in diognosis of PPD

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    A profound analysis on neonatal nurse’s knowledge about postpartum depression and a survey on the level of proficiency in nurse’s ability to treat and diagnose PPD in the general society

    Postpartum depression

    What is postpartum depression?

       This is a condition that applies on a woman’s physical and emotional well being after giving birth. The condition is in-form of 3 different categories, baby blues, postpartum depression PPD and postpartum psychosis. The condition makes a woman to develop mood swings right after giving birth. The mother gets very good moods and subsequently feels very morose. She cries for nor logical reason, develops irritability and anxiety. She also develops emotive conditions like restlessness, loneliness and sadness. This condition once diagnosed might last between several hours or 1-2 weeks after the successful childbirth. This diagnosis is exemplifies baby blues

      Postpartum psychosis is a condition which is truly very disturbing. It is a mental illness that affects the new mother often within the initial months of bearing a child. The new mothers develop a mental condition wherein clinically she is mentally ill. This means she hears things that are not true, loose touch with reality hallucinate, develop insomnia and related madness characters.

    Postpartum depression is the third aspect of PPD. It happens just after or months after delivery. The feelings resemble those of the baby blues syndrome; the difference is only within the physical aspects of well being. The woman is much stronger physically and her emotions are less aggressive in terms of levels in comparison to the baby blues. The subsequent effects of PPD are incapacitating the woman. She is not able to do her works and most essential things.

    What are the causes of PPDS?

        The causes of PPD are not well established clinically but most medical experts relate the PPD to hormonal changes in the woman. The theory explains that oestrogen and progesterone levels in the woman go up during pregnancy but drastically do down after child delivery. This drastic drop in level is attributed to the postpartum depression. Experts also point out the connection between the thyroid level drop and the PPD. The commonplace effect of low thyroid levels is depression and emotional response and feelings in a human, all which resemble the PPD characteristics.

      This context is the onset of minimum knowledge-ability on treatment and diagnoses of PPD in NICU. Neonatal intensive care nurses have minimal background knowledge on PPD cases making them lass affable to handle and diagnose cases. Though a percentage of them have sufficient knowledge based on the training and academic background, a number still have minimal knowledge. This has led to a decline in arrest of cases and poor referrals where necessary leading to a demand for training in diagnoses, and treatment so as to manage the PPD, Beck, C. (1992)

    Symptoms of PPD

    These are the symptoms a nurse or a midwife who is taking care or attending to a new mother should watch out for in the physical of the patient. These symptoms signify the onset of postpartum depression.

     Crying a lot, depression and sadness

     General body weakness

    Insomnia

    Overeating

    Over-worried about the baby

    A feeling of worthlessness’ and guilt

    Not interested in pleasure activities

    Restlessness and irritability Having headaches, chest pains, heart palpitations (the heart being fast and feeling like it is skipping beats), numbness, or hyperventilation (fast and shallow breathing).

    Neonatal nurses and their proficiency in postpartum depression PPD

      Nurses and midwifes need education about how effectively they can nurse, advice and manage postpartum depression. The need to establish the consistency of knowledge in nurses has become important due to prevalence rate of postpartum depression. About 10-25% 0f nurses lack enough skills and background knowledge on diagnosing postpartum depression in the new mothers. This requires more educative approach so as to educate the nurses on how to diagnose and help the women suffering from the PPD.

      This approach will help the nurses develop the relevant skills and also acquire knowledge about postpartum depression. They learn how to recognize postpartum depression symptoms and the risk factors. Learning also facilitates the development of skill and protocols to screen and assess postpartum depression. It is also integral since it is the basis of improving proficiency in treating and referring women with postpartum depression for treatment and follow up.

    Fig 2a shows the proficiency of three clusters of nurses, certified midwifes, certified community nurses and qualified neonatal intensive care nurses. Each of the cluster has variations in the level of education and experience in practice

                                              Neonatal             Certified             Certified

                                              Intensive care     community          midwife

                                              Nurse                  nurse

    The education and knowledge level is high with NICN due to the sensitivity of their occupation as well as their education background. This trickles down to the last cluster of midwifes whose knowledge is very minimal.

    Survey on Neonatal nurse Proficiency in PPD diagnosis and knowledge

      Nurse’s proficiency in diagnosis and treatment of postpartum depression is not very consistent within a vast percentage. This is based on facts and respondent response to a survey on their ability to understand and diagnose postpartum depression in new mothers.

       The general level of postpartum depression cases in the general society is rated at 16-20%. This is quite a profoundly disturbing figure. About 25% of nursing practitioners don’t have enough knowledge to diagnose postpartum depression.

      Though this is a significant figure, the other 75% is minimally equipped and their screening and comprehensive diagnoses proficiency needs more training. This splits this percentage to 39% as the NICU nurse who are proficient with the rest being efficient but not fully conversant with severe cases of postpartum depression.

      Survey on nurse knowledge on the level of postpartum cases in the general population show that nurses put the level of PPD occurrence in the general population is at 16-20%. The clinical assessment might have a dissenting figure meaning, the level is not diagnosed properly due to socio-economic aspects of the society and availability of clinical knowledge to address the problem. This was proved by the survey, wherein, a question to ascertain the level of undetected cases in the general society. Nurses were asked to give their overall view on how many cases of postpartum depression go undetected by health care professionals yearly. The respondents of this question put the overall number of cases that go undetected at approximately at 10% which is a very high number. It shows the decline of professionals approach to social health and an increasing level in lack of healthcare availability and affordability.

    Overview on neonatal nurse’s perceptions on treatment and their abilities in handling postpartum depression (a clinical and paediatric physician argument)

      Research on nurse’s abilities in postpartum depression is varied. Clinical assertions, facts and treatment preferences about postpartum depression define PPD as a problem with diverse levels of effect, and that its symptoms and are varied. The severities of symptoms define the severity of the postpartum depression. The PPD is, within clinical arguments a crippling emotional problem. The nurse’s perception about the disorder is that, though there are major milestones in diagnoses and screening of the disorder, the PPD remains still un-researched and under-diagnosed.

      Nurses respond to resent surveys assessing paediatric and family physicians efforts with more complex approach to treatment and diagnoses of PPD. Paediatric physicians approach is not on the maximum in terms of input, practitioners and nurses see the that family and paediatric physicians approach to PPD  is not a confident one. The overall view upon the research is that the practitioners believe the postpartum depression disorder is serious but they feel not apt in diagnosing it in a timely manner. The Research draws out the scepticism of ability and consistency of screening. Screening which is the integral part of diagnosis has basic elements of making it through. Tools used to screen patients and the background knowledge and relevant experience is seen within this context to be in question in terms of ability to use them.

      This research determines and comprehensively shows the nurses knowledge and proficiency in postpartum depression is not consistent. The nurses and mid wife’s knowledge and screening abilities among certified midwifes and certified community nurses is deemed not apt and able to diagnose the 10% that goes un-diagnosed annually.

    Survey and method

       A group neonatal nurses, certified community nurses and certified midwifes responded to a questionnaire that asked about their proficiency, knowledge, experience and overview on postpartum depression. The survey targeted the nurses and midwifes who screen for postpartum depression. Their knowledge level, overview on clinical positions and paediatric physician abilities on PPD was the determinant of the samples factualness and conclusion.

    Sample data collected

    Level of PPD in population 16-20%

    Undetected cases of PPD in the society 10%

    Baby blues detection is hard to diagnose

    Low confidence in PPD diagnosis ability

    Very negligible familiarity with PPD screening

    Mothers don’t speak of PPD

    PPD affected women do not know their PPD status

    PPD is a serious problem requiring screening

    It is in order to use a brief self administered tool to screen for PPD unit

    Conclusion

      The majority of respondents view availability of clinical services to treat PPD are not adequate. They view the syndrome as a serious problem. Their education and training background on postpartum depression is formal and have little proficiency in making out competent conclusions from screening methods. The confidence in recognizing and successfully diagnosing postpartum depression is a mere 30% of the respondents.

      Their view is that the screening practices are not consistent in their own practice. They are informed of new screening methodologies though many are not. There is need to have more paediatric and physician approach to clinical resolves for postpartum depression.

    Neonatal intensive care unit nurse and treatment of postpartum depression

      According to the nurses, the clinical and paediatric position on postpartum depression is that PPD is treatable. Treatment differs with the severity of the condition. Use of medication especially antidepressants is the major treatment and the commonplace methodology. Psychotherapy comes second and involves referrals to therapy classes and advisory sessions. Use of drugs to manage the PPD is becoming more known within the NICU. This means the level of awareness and better training about PPD is on the rise.

    Literature review

      The knowledge and awareness in the general public on the dangers posed by postpartum depression has significantly improved. The issue is the level of knowledge in the nurses about how to diagnose and help treat patients suffering from postpartum depression. According Patricia A., (2000) postpartum depression is an emotional problem that causes problems in early motherhood. It diminishes the love a mother should have for her newborn.

      In this research neonatal intensive care unit nurse sampled believe that postpartum depression is adverse and dangerous. They all agree it is a common problem. The sample also proves reasonably that nurses competency level in diagnoses and treatment of postpartum depression should involve them through more active participation in diagnoses and the treatment (Graham Russell 1999). On the consistent and aptness of methodologies of screening, nurses sampled believe screening practices are not consistent and that these methodologies do not really detect the postpartum depression condition. Nurses agree that they don’t understand screening procedures and tools. As such the conclusion is that active participation; training and clinical advice on screening PPD should include nurses to help in improving the level of detection of cases.

     According to Beck, C. (1996) the effects of postpartum depression vary with patients, but the overall paediatric physician view is that the problem is serious and has far reaching effects on mothers. The maternal interaction between the child and the mother are severed by the condition. Also there are very negligible good signs of proper growth and positive expressions in the infant character. These effects extend to the child’s future lifestyle and show in a pattern. Their emotions, attentiveness, social interaction patterns and intelligence quotient are at a diminished level in a child whose mother suffered from postpartum depression.

        The level of postpartum depression cases according to the professional nurses is high at 10-20% and they believe almost 50% of these cases go undetected and reported. The nurses assert that regular use of postpartum depression screening procedures has increased the efficiency of detection of PPD nowadays. However the need for an aggressive, concise and convincing screening methodology is required to assess PPD. About 70% of the sample show this view is shared by nurses and about 29% don’t feel confident on their ability to detect and use screening kits to assess and diagnose PPD. 40% of the interviewed nurses feel that early detection of PPD would help treat the condition. They all agree that there is a likely hood of PPD to be detected during pregnancy and through therapy is treated.

      Highly trained nurses and midwifes point out that depression during pregnancy and any pressure on the mother during the pregnancy triggers stress levels which, clinically are seen to correlate with postpartum depression.

    Sample research 2 on nurse’s methodologies in screening PPD (A clinical approach)

    A self administered questionnaire to avail the awareness and relevant knowledge on postpartum depression and screening methodologies is passed to respondents congenially to examine their knowledge and in preference resubmit the questionnaire fully answered in principal. This determines the proficiency in NICU nurses ability to arrest incidence of postpartum depressive symptomatology

    PPD symptoms and severity spreads to a time frame of 2 weeks after child birth. The nurses responding to this questionnaire estimate prevalence is high and detection is minimal. The nurse level of knowledge and learning background needs to be established.  This study is conducted to ascertain and determine the knowledge and screening practice of postpartum depression among neonatal intensive care nurses. A check on beliefs ang recognized theories on PPD were analyzed.

    Respondent response (outcomes)

     Neonatal intensive care nurses belief that the postpartum depression needs more screening and a more thorough clinical and paediatric research and attention. The nurses strongly believe they can help in screening when involved with experts and that they would be more efficient if the often were involved in screening and diagnoses of PPD.

      NICN believe they can diagnose postpartum depression while about 48% say they encounter the PPD cases often enough to become knowledgeable about the symptoms. About 25% believe the general public has sufficient ability to arrest postpartum depression cases.

      On experience levels practitioners with modern education and more experience have developed more diagnostic skills and are able to detect PPD consistently while those who have not gained modern education but practiced for long have not gained competency in PPD diagnoses. (p=x, r=y). This means the older the nurse and the less her education she is not likely to detect PPD while the younger the nurse and with modern nursing degree the more proficient she is in PPD diagnosis.

      Lack of proper facilities, no modern education and training on postpartum depression diagnoses training has led to the decline in the older nursing practitioner proficiency in arresting a postpartum depression case Beck, C. (1992. Lack of relevant resources and cooperation within practitioners as well as ineffective referrals cause escalation of cases. Cost of diagnoses tools especially the screening kit and poor referral response result to diminishing of treatment and knowledge background of diagnoses and treatment of PPD.

      The neonatal intensive care nurses agree that education and awareness should encompass the general nursing practitioner including certified midwives and registered community nurses. There should be aggressive training and a more clinical approach to awareness and training so as to reduce the gap in low knowledge in nurses. The approach to the depression seen in cases of postpartum depression is more aggressive due to late diagnoses, however on a very lower level of research is this find prevalent. According to James A, H, & Patricia N H, (1992), diagnoses have been made by psychological testing and standardized interviews of all of the obstetrical patients in the defined population.

      This will tone own the paediatric and family physician low abilities to detect and treat postpartum depression while give the healthcare providers a more stable stead to treat the condition with a participatory and comprehensive help by the nurses.

    Fig 2b

    Red:  modern trained Neonatal nurses

    Green: Certified community nurses

    Blue grey: Registered midwifes

    Conclusion

    The age of a nurse in all clusters shows deterioration on ability to diagnose postpartum depression.

    Newly trained nurses have more proficiency in diagnosis of postpartum depression but a low ability to treat and advice on treatment.

    Neonatal nurses have a large number of knowledgeable practitioners who understand the cases and diagnose it professionally.

    Screening abilities in all clusters are poor though slightly higher within the neonatal intensive care nurses.

    Education background in neonatal intensive care nurses in much advanced and more apt to detect PPD.

    Midwifes have minimum relevant knowledge on detecting, treating and diagnosing postpartum depression.

    The older the nurse the poorer she is in PPD knowledge

      This basically drives the case of low knowledge ability as one part education has focused on. NICU nurses need to be informed on how to administer treatment. Administering antidepressants during breast feeding and therapy also is integral aspects of their knowledge Beck, C. (1995). In that regard, physicians have now been taught about medications that can be used to treat postpartum depression while the woman is still breastfeeding. Tricyclic antidepressants such as imapramine have a long history of safe use, and there is growing evidence for the safe use of low doses of serotonin uptake inhibitors such as fluoxetine and sertraline
    (Kuller, Katz, McMahon, Wells, & Bashford, 1996; Wisner, Perer, & Findling,
    1996).

    Treatment and therapeutic knowledge level in nurses (a general clinical/ nursing overview)

       The support, counselling, understanding, and explanation given to women by midwives in the postnatal period provide benefits to psychological well-being. Maternity units have a responsibility to develop a service that offers all women the option of attending a session to discuss their labour (Tina Lavender & Stephen A. 1998)

    New mothers should not work until they heal and should avoid stress levels and pressure on themselves

    Communicate and seek husband, relatives and friends support so s to avoid stress and straining

    Express feelings and make your condition and emotions known.

    New mothers should have a lot of rest. Sleep always when the baby sleeps.

    Talk to a physician and make sure all your emotions and conditions are well diagnosed by the physician

    Discuss and share with other mothers, learn their views and abilities and learn about their experiences.

    Sources

    Beck, C. (1996). Postpartum depressed mothers’ experiences interacting with
    their children. Nursing Research, 45, 98-104. Ovid Full Text TDNet Bibliographic
    Links

    Kuller, J., Katz, V., McMahon, M., Wells, S., & Bashford R. (1996). Pharmacologic
    treatment of psychiatric disease in pregnancy and lactation: Fetal and neonatal
    effects. Obstetrics and Gynecology, 87, 789-794

    Beck, C. (1995a), Screening methods for postpartum depression. Journal of
    Obstetric, Gynaecologic, and Neonatal Nursing, 24, 308-312

    Beck, C. (1992). The lived experience of postpartum depression: A phenomenological
    study. Nursing Research, 41, 166-171. TDNet Buy Now Bibliographic Links

    Deepika l , Susan O  , Jayne C (2007): Immigrant asian Indian women and postpartum depression. http://lib.bioinfo.pl/pmid:16466357

    Graham Russell 1999: Essential psychology for nurses and other health professionals: Routledge London, p 177

    Tina Lavender & Stephen A. 1998: Can Midwives Reduce Postpartum Psychological Morbidity? http://www.blackwell-synergy.com/doi/abs/10.1046/j.1523-536X.1998.00215.x

    James A, H,. & Patricia N H,.(1992): Postpartum psychiatric illness: A picture puzzle, University of Pennsylvania Press, Philadelphia. Chapter 19 p *1

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