3. Abstract
This presentation examines nursing interventions that labor-and-delivery and maternity
nurses perform to decrease Post-Partum Depression (PPD). It explores how nurses can
assess, educate, intervene and provide support to a mother early in the labor progress.
The need for change from the current practice was noted after an average 10-15% of
mothers are diagnosed with PPD. With the numbers so high, it is a must for early
intervention to occur while the mother is in the hospital and all resources are available.
The purpose of this research is for labor and delivery and maternity nurses to identify
risk factors and symptoms of PPD in all mothers during their hospital stay versus
awaiting mothers to present with PPD at their six week post-partum doctor appointment.
Furthermore, the Social Cognitive Theory framework is used to guide the PPD study as it
relates to behavioral patterns that can be used to understand PPD. In conclusion, it is
hoped that nurses are able to provide interventions at early stage to decrease the high
PPD rates.
4. About me
I decided to received my MSN in education ever
since I began nursing school three years ago. I
know that teaching is where I belong. I
currently work in labor and delivery and my
dream position is to stay in my department and
become the educator. My preceptor has been
the current educator on the labor and delivery
unit. I had a wonderful privilege to set up post-
partum hemorrhage in-service and
competencies. I was able to teach nurses and
nursing students. Furthermore, I was able to
assist my preceptor with a new hire intern
program in which power-points and lectures
were conduced. Overall, my experience I love puzzles, sudoku, home decor, hiking, traveling and space.
throughout the past weeks has been fantastic
and I’m looking forward to becoming an
educator soon.
5. Defining PPD
Depression that is suffered by a mother
after childbirth.
Typically mothers are presented to their
six week post-partum doctor visit with
symptoms of PPD.
6. Background
PPD depression was identified as the key problem because by many obstetricians
at Cedars Sinai Medical Center have brought up a concern.
More obstetricians are recognizing that mothers are experiencing PPD when
showing up to their six week post-partum visit
PPD can happen for multiple reasons
Bonding:
The emotional bond formed between mother and baby allows the promotion
of cognitive, socio-emotional, self-regulatory and moral development, and
promotes an optimal development in childhood and adolescence (Thompson
& Fox, 2010, p. 249).
For this to happen, maternal and infant needs must be met at an early post-
partum period
7. Problem and Purpose
The purpose of this research is for labor
and delivery and maternity nurses to
identify risk factors and symptoms of
PPD in all mothers during their hospital
stay versus awaiting mothers to present
with PPD at their six week post-partum
doctor appointment.
The focus of the problem refers to
mothers who are at risk for developing
post-partum depression.
8. Goals & Aims
1) Nurse should identify risk factors that can lead the mother away or towards the possibility of
experiencing PPD.
2) Nurse should identify symptoms the mother may possess that can lead towards PPD.
3) Nurse should provide nursing interventions to mothers who have been identified as a candidate for
PPD.
9. Clinical Importance/Significant
Results were inconclusive
It is unsure if nursing interventions for prevention of PPD started during mothers
hospital stay will decrease PPD rates
More research needs to performed
10. Literature Review
Various models have been proposed to explain PPD,
1) Article entitled “Post Partum Depression and Thyroid Function”
Is there a relationship between PPD and thyroid dysfunction?
results were not significant and in conclusion there was no correlation
2) Article entitled “Post-partum depression: a comprehensive approach to
evaluate and treatment”
What are some treatment interventions for PPD?
Mother-infant psychodynamic psychotherapy (PPT), Watch, Wait, Wonder
(WWW) and toddler-parent psychotherapy (TPP)
11. Literature Review Summary
Overall, articles didn’t possess any research if nursing interventions for
prevention of PPD should be started while the mother is in the hospital during
labor and post birth.
Does this mean that nurses should stop identifying risk factors and symptoms for
PPD?
13. Steps to Solve Problem
1) Questionnaire given to mothers as they are admitted to the hospital
2) The Edinburgh Postnatal Depression Scale
3) Nurses must assist all mothers with bonding
4) If PPD is high and the mother expresses symptoms of baby blues or PPD, the
nurse must notify the doctor right away and make sure a social worker is ordered
14. Evaluation
Are obstetricians noticing a decrease in PPD when their patients show up for
their six-week post partum appointment?
Where all preventative interventions performed during mother’s stay in the
hospital?
15. Professional Role
An advanced nurse is an RN who has gone through “expanded clinical practice” by gaining a master degree
in certain areas. This can include nurse practitioner, nurse specialist, nurse anesthetists, nurse midwife, and
nurse educator.
This course has prepared me for the nursing role of an educator through the many skills that were taught.
Researching evidence-based practice
Setting up a course outline
Educating nursing students and staff nurses
16. References
Bandar, A. (1997). Self-efficacy: The Exercise of control. New York: Freeman.
Cedars-Sinai. (2012). Advanced practice nursing. Retrieved from http://www.cedars-sinai.edu/Medical-
Professionals/Resources-for-Nurses/Advanced-Practice-Nursing/
MayoClinic. (2012). Postpartum depression. Retrieved from http://www.mayoclinic.com/health/ postpartum-
depression/DS00546/DSECTION=symptoms
Sears, William. (2012). Bonding with Your Newborn. Retrieved from http://
www.attachmentparenting.org/support/articles/artbonding.php
Thompson, K. S., & Fox, J. E. (2010). Post-partum depression: A comprehensive approach to evaluate and
treatment. Mental Health in Family Medicine, 7, 249-257.
17. Thanks, Future Plans
Thank you to the wonderful, knowledgable nursing mentors and educators at
Kaplan University.
Thank you to my preceptor, Pam, who has taken me under her wing.
In the future, I hope to teach with the skills that I have learned and be at least as
half good as my educators.
Editor's Notes
(Thompson & Fox, 2010)
Reasons for PPD: rape victim, previous depressive or psychotic disorders, or a traumatic event will make bonding more difficult or even non-existent. Bonding occurs between a mother and her newborn. Bonding is referred to a sensitive period of time that occurs right after birth has taken place because both mother and newborn are “naturally programmed to be in contact with each other and do good things to each other” (Sears, 2012).
1) This will be performed with a mandatory questionnaire administered to all mothers before delivery. By identify risk factors before birth, the preparation can occur early. Questions include history of depression or anxiety during pregnancy, socio-economic, stressful recent life events, poor social support, childcare stress, low self-esteem, maternal neuroticism and difficult infant temperament. Other risk factors include single marital status, poor relationship with partners, and lower socioeconomic status including income (Steward, & et al, 2008). 2) Symptoms that suggest PPD include loss of appetite, insomnia, intense irritability, overwhelming fatigue, lack of joy in life, severe mood swings, withdrawal from family and friend, and thoughts of harming oneself or the baby (MayoClinic, 2012). 3) This includes nursing education, encourage breastfeeding, encourage skin-to-skin with mother, and spend more time with the patient to make sure the mother is bonding with her infant.
1) A research group of forty eight mothers and a control group of sixty five mothers were entered into the study. An Edinburgh Postnatal Depression Scale was used to screen for PPD. 2) Both the WWW and TTP influence attachment between mother and infant. This causes an increase of positive involvement, communication, and bonding between mother and infant.
(Bandar, 1997)
1) Questions will include things such as financial assistance, spousal or family support, living situations 2) A total of ten questions with a score of 13 or above is a high predicament for PPD. (Cox, Holden, & Sagovsky, 1987). 3) This includes helping with breastfeeding and/or bottle-feeding (depending on mother preference). Education on how to change diapers, assist baby with position changes, what to do if baby is crying, and other resources that the mother requires.
Evaluation will be based on what physicians are observing when mothers come back for their post partum appointment. Since it is difficult to see if interventions during hospital stay prevented PPD, a certain time must pass before the mother expresses symptoms of PPD.
