POSTPARTUM DEPRESSION THEORY ~Cheryl Tatano Beck~ (1949-present)I. Background of the Theorist She graduated from the Western Connecticut State University with a baccalaureate in nursing in 1970.
After graduation, Beck worked as a registered nurse at the Yale New Haven Hospital on the postpartum and normal newborn nursery unit. In 1972, Beck graduated from Yale University with a master’s degree in maternal-newborn nursing and a certificate in nurse midwifery.
In 1982, she received a doctorate in nursing science from Boston University. She has served as consultant on numerous research projects for universities and state agencies in the northeastern United States. She has given more than 30 awards, including Distinguished Researcher of the Year by the Eastern Nursing Research Society in 1999.
She has authored more than 100 journal articles and given scores of research presentations locally, nationally, and internationally. Served on the executive board for the Marce Society, an international society for the understanding, prevention, and treatment of mental illness associated with childbirth and on the advisory
committee of the Donaghue Medical ResearchFoundation in Connecticut. Fittingly, she began her research career with women in labor, examining their cognitive and emotional responses to fetal monitoring. Beck’s research wound its ways through the labor and birth process and became firmly
planted in the postpartum period, with aspecific focus on postpartum mood disorders. This body of work resulted in a substantive theory of postpartum depression and the development of Postpartum Depression Screening Scale (PDSS) and Postpartum Depression Predictors Inventory (PDPI).
A. Major Concepts and Definitions1. Postpartum Mood Disorders Postpartum depression- a nonpsychotic major depressive disorder with distinguishing diagnostic criteria, postpartum depression often begins as early as 4 weeks after birth. Maternity 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 behaviour Postpartum obsessive-compulsive disorder- symptoms include repetitive intrusive thoughts of harming the baby, a fear of being left alone with the infant and hyper vigilant in protecting the infant.
2. Loss of Control- it was identified as thebasic psychosocial problem in the 1993substantive theory development phase ofBeck’s work. Loss of control was an aspectwomen experience in all aspects of their lives.The process of loss of control left women“teetering on the edge” and consisted of thefollowing four stages:
Encountering terror- consisted of horrifying attack, enveloping fogginess, and relentless obsessive thinking. Dying of self- consisted of alarming unrealness, 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.3. Prenatal Depression- was found to be thestrongest predictor of postpartum depression.It occurs of any or all of the trimesters ofpregnancy.
4. Child Care Stress- is stressful events relatedto child care involve factors such as infanthealth problems and difficulty in infant carepertaining to feeding and sleeping.5. Life Stress- is an index of stressful lifeevents during the pregnancy and postpartum.Stressful life events could either be positive ornegative and can include experiences such asthe following:
Marital changes- divorce, remarriage Occupational changes- job change Crises- accidents, burglaries, financial crisis and illness requiring hospitalization6. Social Support- consists of receiving bothinstrumental support (eg. Baby-sitting, helpwith household chores) and emotional support.
Structural features of a woman’s socialnetwork (husband or mate, family, and friends)include proximity of its member, frequency ofcontacts and number of confidants with whomthe mother can share personal matters.7. Prenatal Anxiety- it can occur during anytrimester or throughout the pregnancy.Anxiety refers to feeling of uneasiness orapprehension concerning a vague, non-specificthreat.
8. Marital Satisfaction- the degree ofsatisfaction with a marital relationship isassessed and includes how happy or satisfiedthe woman is with certain aspects of hermarriage, such as communication, affection,similarity of values (eg. Finances, child care),mutual activity and decision making, global well-being.
9. History of Depression- any report by amother of having had a bout of depressionbefore this pregnancy must be noted.10. Infant Temperament- refers to the infant’sdisposition and personality. Difficulttemperament describes an infant who isirritable, fussy, unpredictable and difficult toconsole.
11. Maternity Blues- was defined as non-pathological condition found in many womenafter birth. Prolong episodes of maternity blues(lasting more than 10 days) can be predictive ofpostpartum depression.12. Self-esteem- refers to a woman’s globalfeelings of self-worth and self-acceptance. It isher confidence and satisfaction in herself.
13. Socioeconomic Status- is a person’s rank orstatus in the society, involving a combinationof social and economic factor such as income,education, and occupation.14.Marital Status- this demographiccharacteristic focuses on a woman’s standing
in regard to marriage. The ranking denoteswhether a woman is single, married orcohabiting, divorce, widowed, separated, orpartnered.15. Unplanned or Unwanted Pregnancy- thisrefers to a pregnancy that was not planned orwanted by the woman.
16. Sleeping and Eating Disturbances- thisdisturbances consist of an inability to sleepeven the baby is asleep, tossing and turningbefore actually falling asleep, waking in themiddle of the night with difficulty going backto sleep, loss of appetite, consciously beingaware of the need to eat but still unable toeat.
17. Anxiety and Insecurity- manifest inhyperattention to relatively minor issues,feeling as if one is jumping out of her skin andfeeling the need to keep moving or pacing.18. Emotional Lability- refers to a woman’ssense that her emotions are unstable and outof her control, commonly characterized ascrying for no particular reason, irritability,explosive anger, and fear that she may never behappy again.
19. Mental Confusion- is a marked inability toconcentrate, focus upon a singular task, ormake decisions.21. Loss of Self- women sense that thoseaspects of self that reflected their personalidentity have changed since birth, so thatwomen cannot identify who they really are andbecome fearful that they might never be ableto become their real selves again.
21. Guilt and Shame- feeling of guilt and shameare related to a woman’s perception that she isperforming poorly as a mother and has negativethoughts regarding her infant. It results in aninability to be open with others about how shefeels and contributes to delay in diagnosis andintervention.
22. Suicidal Thoughts- concern women’sfrequent thoughts of harming themselves orending their own lives to escape the livingnightmare of postpartum depress.
B. Major Assumptions1. Nursing is a caring profession with caringobligations to persons we care for, studentsand each other. Interpersonal interactionbetween nurses and those for whom we careare the primary ways nursing accomplishesgoals of health and wholeness.
2. Persons are described in terms ofwholeness. Persons have biological,sociological and psychological components.3. Health is the consequence of women’sresponses to the context of their livesphysically and to the context of theirenvironments. All context of health are vitalto understanding any singular issue of health.
4. Environment in broad terms might includeindividual factors, but also includes the worldoutside of each person. The outsideenvironment includes event, situation, culture,physicality, ecosystems, and socio-politicalsystems.
A.Empirical EvidenceIn 1993, after 4 major studies regardingpostpartum period, Beck developed asubstantive theory of postpartum depressionusing grounded theory methodology. Thistheory developed was entitled “teetering onthe edge” with the basic psychosocial problemsidentified as loss of control. Also during thisperiod, meta-analyses were
conducted on predictors of postpartumdepression, the relationship betweenpostpartum depression and infanttemperament, and the effects of postpartumdepression on mother-infant interaction. Inaddition, two qualitative metasyntheses wereconducted on postpartum depression andmothering multiples.
America’s one of the foremost nursing theorists was born in Baltimore, Maryland, in 1914. She began her nursing career at Providence Hospital School of Nursing in Washington, D.C.
In 1939, she later received a BS in nursing education from the Catholic University of America (COA) and in 1946, she received an MS in nursing education from the same university. From 1940-1949, Orem held the directorship of both the nursing school and the department of nursing at Providence Hospital, Detroit.
In 1957, she worked as a curriculum consultant at the office of education US department of Health, Education and Welfare. She became an assistant professor of nursing education at CUA. Subsequently became acting dean of the school of nursing.
In 1971, her first published book was Nursing: Concepts of Practice. In 1972, she was the editor for the Nursing Development Conference Group (NDCG) as they prepared and later revised Concept Formalization in Nursing: Process and Product. In 1976, Georgetown University conferred
on Orem the Honorary Degree of Doctor ofScience. She was awarded the Doctor of Nursing Honoris Causea from the University of Missouri in 1998. Subsequent editions of Nursing: Concepts of Practice were published in 1980, 1985, 1991, 1995, 2001.
She retired in 1984 and continued working alone and with colleagues on the development of Self Care Deficit Nursing Theory (SCDNT).
A. Major Concepts and Definitions1. Self-Care---comprises the practice of activities that maturing and mature persons initiate and perform, within time frames, on their own behalf in the interest of maintaining life, healthful functioning, continuing personal development, and well- being through meeting known requisites for functional and developmental regulation.
2. Self-Care Requisites---a formulated andexpressed insight about actions to beperformed that are known or hypothesized tobe necessary in the regulation of an aspect ofhuman functioning and development,continuously or under specified conditions andcircumstances.
3. Universal Self-Care Requisites---universallyrequired goals are to be met through self-careor dependent care and have their origins inwhat is known and what is validated or what isin the process of being validated about humanstructural and functional integrity at variousstages of the life cycle. The following eightself-care requisites common to men, women,and children are suggested:
The maintenance of a sufficient intake of food The maintenance of a sufficient intake of water The maintenance of a sufficient intake of air The provision of care associated with elimination processes and excrements The maintenance of balance between activity and rest The maintenance of balance between solitude and social interaction
The prevention of hazards to human life, human functioning and human well-being The promotion of human functioning and development within social groups in accordance with human potential, known human limitations, and the human desire to be normal.
4. Developmental Self-Care Requisites3 sets of DSCR: Provision of conditions that promote development Engagement in self-development Prevention of or overcoming effects of human conditions and life situations that can adversely affect human development
5. Health Deviation Self-Care Requisites---theseexist for person who are ill or injured, who havespecific forms of pathological conditions ordisorders, including defects and disabilities, andwho are under medical diagnosis and treatment.6. Therapeutic Self-Care Demand---consists ofthe summation of care measures necessary atspecific times or over a duration of time formeeting all of an individual’s known self-carerequisites particularized for existent conditionand circumstances
7. Self-Care Agency---is a complex acquiredability of mature and maturing persons to knowand meet their continuing requirements fordeliberate, purposive action to regulate theirown human functioning and development.8. Agent- it engages in a course of action orhas the power to do so.
9. Dependent-Care Agent---a maturingadolescent or adult, accepts and fulfills theresponsibility to know and meet thetherapeutic self-care demand of relevantothers who are socially dependent on them orto regulate the development or exercise ofthese persons’ self-care agency.10. Self-Care Deficit---is a relation between thepersons’ therapeutic self-care demands and
their powers of self-care agency in whichconstituent developed self-care capabilitieswithin self-care agency are not operable or notadequate for knowing and meeting some or allcomponents of the existent or projectedtherapeutic self-care demand.11. Nursing Agency- comprises developedcapabilities of persons educated as nursesthat empower them to represent themselves as
nurses within the frame of a legitimateinterpersonal relationship to act, to know, andto help persons in such relationships to meettheir therapeutic self-care demands and toregulate the development or exercise of theirself-care agency.12. Nursing Design- a professional functionperformed both before and after nursingdiagnosis and prescription, allows nurses on the
basis of reflective practical judgements aboutexistent conditions, to synthesize concretesituational elements into orderly relations tostructure operational units.13. Nursing Systems- are series and sequencesof deliberate practical actions of nursesperformed at times in coordination withactions of their patients to know and meetcomponents of their patient’s therapeutic self-care demands and to protect and regulate the
care demands and to protect and regulate theexercise or development of patient’s self-careagency.14. Helping Methods- helping method from anursing perspective is a sequential series ofactions which, if performed, will overcome orcompensate for the health-associatedlimitations of persons to engage in actions toregulate their own functioning anddevelopment or that of their dependents.
Nursing care and their health-associatedaction limitations are as follows: Acting for or doing for another Guiding and protecting Providing physical or pathological support Providing and maintaining an environment that support personal development Teaching
B. Major Assumption1. Human beings require continuous, deliberate inputs to themselves and their environments to remain alive and function in accordance with natural human endowments.2. Human agency, the power to act deliberately,is exercised in the form of care for self andothers in identifying needs and making neededinputs.
3. Mature human beings experiences privationsin the form of limitations for action in care forself and others involving and making of life-sustaining and function-regulating inputs.4. Human agency is exercised in discovering,developing and transmitting ways and means toidentify needs and make inputs to self andothers.5. Groups of human beings with structuredrelationships cluster tasks and allocateresponsibilities for providing care to group
members who experience privations for makingrequired, deliberate input to self and others.C. Empirical EvidenceOrem formulated her concept of nursing inrelation to self-care as part of a study on theorganization and administrations of hospitals,which she conducted at the Indiana StateDepartment of Health. This work enabled herto formulate and express her concept ofnursing. Her knowledge on the features ofnursing practice situations was acquired overmany years.
Orem used philosophical and scientificmethods in developing her insights andvalidating her conclusions. Since the SCDNTwas first published, extensive empiricalevidence was contributed to the developmentof theoretical knowledge. Much of this iscontributed to the theory; however, the basicsof the theory remain unchanged.
I. Comparison of the 2 theories (Analysis) POSTPARTUM SELF-CARE DEPRESSION THEORY DEFICIT THEORY SIMPLICITY The development The development of follows a simple and the theory using the 8 logical progression. entities (SCDTN) is Postpartum parsimonious. The depression is a relationship between complex experience and among these and theory to entities can be research. It makes presented in a simple sense, simply and diagram. The depth of useful. the concepts’ development gives the theory the complexity necessary to describe
POSTPARTUM SELF-CARE DEFICIT DEPRESSION THEORY THEORY and understand a human practice discipline.CLARITY Beck’s purpose was to The term Orem uses explain her theory in a are defined precisely. clearly understanding The language of the manner. theory is consistent with the language used Theory is clearly in action theory and defined and easily philosophy. The understood with clear terminology of the ideas, definitions, and theory is congruent language for all to throughout. understand.
POSTPARTUM SELF-CARE DEFICIT DEPRESSION THEORY THEORYGENERALITY Specific as it focused Orem has commented on a very narrow on the generality of the subject area. General theory: in that within the “The self-care deficit narrow spectrum it theory of nursing is not affects different cultures and contexts. an explanation of the individuality of a particular concrete nursing practice situation, but rather the expression of a singular combination of conceptualized properties or features
POSTPARTUM SELF-CARE DEFICIT DEPRESSION THEORY THEORY It serves nurses engaged in nursing practice, in development, and validation of nursing knowledge and in teaching and learning nursing.APPLICABILITY or Beck and Gable (2000) Orem’s theory has been EMPERICAL examined psychometric used for research using properties of the scale both qualitative and PRECISION with regard to quantitative reliability of the methodologies. The measure within the theoretical entities are
POSTPARTUM SELF-CARE DEFICITDEPRESSION THEORY THEORYdevelopmental and are well defined d lenddiagnostic samples. themselves toValidity analyses were measurement; however,conducted with the instrument have nottwo samples, as where been developed for allprocedures used to entities. Empiricalestablish cut-off precision is dependentscores for clinical on the operationalinterpretations. These definitionsstudies indicated that constructed by thethe PDSS is a reliable researcher for theand valid screening population to beinstrument for studied.detection ofpostpartum depression.
POSTPARTUM SELF-CARE DEFICIT DEPRESSION THEORY THEORY DERIVABLE The value of Beck’s is It is useful inCONSEQUENCES of growing importance developing and guiding within nursing and practice in research. It within other gives direction to disciplines. The nursing specific Importance of SCDNT outcomes related to evident in every aspect knowing and meeting of the nursing the therapeutic self- discipline clearly care demands, defined nursing and regulating the built upon basic development and concepts to develop an exercise of self-care all-encompassing agency, and framework all nursing establishing self-care disciplines and areas of and self-management
POSTPARTUM SELF-CARE DEFICITDEPRESSION THEORY THEORYof specialty can be systems.practiced within this It is useful in designingframework. curricula for pre- service, graduate, and continuing nursing education.
Case Study: Sheela’S Story Sheela was a 30 year-old mother of four childrenwho had been married for eight years. She lived withher husband and in-laws in a small village. She hadgiven birth to her fourth child three monthspreviously. Her pregnancy and labor had beenuneventful, and an untrained traditional midwifehelped conduct the home delivery. Becausepregnancy was viewed in her village as a normaloccurrence that did not require any medical attention,
Sheela did not received any antenatal or postnatalcare. For a month after the birth, Sheela felt normal,but then she began to exhibit unusual behavior. Shebecame reclusive and stopped speaking to anyone athome, losing interest in her daily activities andceasing to care for her children. The rest of thepeople in her family, however, were busy with theirown lives and seemed indifferent to her condition.One day, she decided to visit her friend and shareeverything about her condition. And she was advisedto have a consultation to a doctor.
Sheela was convinced by her friend to undergoconsultation. After several assessment, the doctorfound out that she have postpartum depression. Shewas advised to take some anti-depressant drugs andto undergo therapy. The family were also informedabout Sheela’s condition and they were able torealize that she needs care and assistance. Afterseveral months, Sheela was able to manage hercondition.*Being educated and aware of this condition is thebest way to be more accepting, accessible, andaccommodating to those with postpartum depression.