The Nurse's Role in Providing Mental Health Care for Mothers - Essay Example

Postpartum Depression: The Nurses Role Jennifer Runnels National Postpartum Depression: The Nurses Role Post-partum depression is fastbecoming one of the most common mental health disorders in health care. Figures released by the Centers for Disease Control and Prevention or the CDC (2008) reveal that postpartum depression (PPD) is seen in about “10-15% of mothers within the first year after giving birth”. The CDC goes on to discuss that mothers who were also stressed with their home lives and who were being abused by their partners were more likely to develop PPD (2008). The CDC’s assessment later revealed that in 17 US states, there were 11.7% (Maine) to 20.4% (New Mexico) self-reported cases of PPD (2008). Moreover, younger women who had lower educational attainment and those under welfare were also more likely to develop PPD (CDC, 2008). The CDC (2008) also reports that aside from partner-related stress and partner abuse, the following factors present during the pregnancy made the new mothers vulnerable to PPD; these factors include: use of tobacco in the last 3 months of pregnancy, traumatic stress during pregnancy, financial stress during pregnancy, delivering a low birth weight infant, and other forms of emotional stress experienced during pregnancy. The figures above present an alarming picture of postpartum depression. It is important to note that medical health professionals, especially nurses, who spend time with the new mothers more than any other health professional, play an important role in safeguarding and in improving the mental health of mothers. Hence, this paper shall now discuss (a) the general role of the nurse in the new mother’s life; (b) the specific interventions the nurse can implement in order to prevent post partum depression; and (c) the health programs available for mothers with PPD. Discussion Murray and Cooper (1997) cite Cox, et.al., when they define postpartum depression as “a nonpsychotic depressive episode that begins and extends into the postpartum period” (p. 5). Murray and Cooper (1997) further describe PPD as a depressive episode with the newly delivered mother in a dysphoric mood while also experiencing symptoms like anorexia, fatigue, and in some extreme cases, suicidal thoughts which may sometimes lead to suicide. Excessive guilt and psychomotor disturbance may also be seen in PPD mothers and when combined with other symptoms, PPD can cause significant impairment in the women’s daily functions (Murray & Cooper, 1997). The Mayo Clinic (2008) explains that women should not be afraid or ashamed to seek help for this disorder because with proper management and medication, PPD can be successfully resolved and treated. Medical health professionals can play various roles in preventing and managing PPD. The Mayo Clinic (2008) also explains that since nurses spend more time with mothers as compared to the other health professionals, their role in the management of PPD is more extensive. As the new mother has limited mobility, it is the nurse’s responsibility to assist the new mother in emptying her bladder in the first few hours after delivery. “The client should be assisted to the bathroom the first two to three times to protect against falls; the nurse must monitor her for orthostatic hypotension and faintness” (Littleton & Engebretson, 2009, p. 631). The nurse also has to note for symptoms of postpartum depression by assessing the mother using the symptoms of the disorder as mentioned previously. The nurse should notify the physician in case any of the symptoms for postpartum depression manifest in her patient. In a paper by Davies, Howells, and Jenkins (2003), they sought to establish the effects of applying early detection and treatment measures for PPD. The study utilized the Edinburgh Postnatal Depression Scale (EPDS) in order to assess the possibility of a pregnant woman later developing PPD. Based on this test, the higher the score of the woman in the EPDS, the higher the likelihood that she would be developing PPD after her pregnancy (Davies, Howells, & Jenkins, 2003). Those who registered with higher scores were the ones who were assessed for the application of preventive measures for PPD. After the implementation of early detection and preventive measures for PPD, the researchers then interviewed mothers who were at risk for PPD. The study was able to establish that these women were “happy to complete the EPDS and many expressed the view that they were pleased that their emotional needs were recognized by the health visitors” (Davies, Howells, & Jenkins, 2003, p. 251). With this assessment, and with the efforts taken by the nurses involved in this project, the rate of PPD was reduced to about 20% during the course of the study. The researchers continued their study for three years and after three years they were able to successfully enhance the early detection of postnatal depression (Davies, Howells, & Jenkins, 2003, p. 248). With early detection, the patients’ emotional problems or triggers for PPD were addressed. And as the nurse becomes more engaged in the life of the patient, there is a greater chance of preventing the initial onset of PPD and later to minimize its effects on the patient. In a position statement by Beck (2008) he points out that it is important for nurses to first differentiate between postpartum depression and other mental illnesses which may afflict the newly-delivered mother. Beck (2008) further claims that knowledge about postpartum depression and anxiety disorders can help the nurse make an appropriate and quick diagnosis of the mother’s condition. In some cases, undiagnosed or misdiagnosed PPD can lead to the usual risks seen in depressed patients, such as suicide and self-harm. “Postpartum psychosis represents a psychiatric emergency that requires immediate intervention because of the risk of infanticide and suicide” (Wisner, Parry, & Piontek, 2002). For the nurse, the challenge in caring for PPD mothers is to let these mothers know that they can share their feelings and emotions and, more importantly, that they are not “going crazy” (Caruso, n.d). A paper by Lintner (2006) sought to assess postpartum depression and the possible interventions which may be applied by nurses for this disorder. In her paper, she explained that early detection of PPD symptoms can help the nurse and the parent evaluate possible interventions and remedies on how to deal with stress during and after the pregnancy (Lintner, 2006). When the patient knows how to properly deal with stress, she can deal better with the possible onset of the disorder. While helping the patient deal with stress, the nurse can also provide printed materials which can help educate the families about PPD and allow for the early detection and treatment of the disorder (Lintner, 2006). General health education can also achieve more than the expected benefits for many PPD patients. In this regard, the nurse can include “education about self-care activities such as maintaining a healthful diet, improvement of physical activity, increased rest, development of a support network and maintaining realistic parenting expectations” (Linter, 2006, p. 56). These simple activities can prevent not just PPD, but also other diseases in general. And as part of a health care team, the nurse can also help resolve a patient’s PPD by making the necessary referrals to the other members of the health care team, especially those who can provide counseling and the necessary pharmacological remedies. Immediate referral can help in the early treatment of patients and help prevent the worsening of the patient’s symptoms (Lintner, 2006). Logsdon, Wisner, Billings and Shanahan (2006) also note that it is important for nurses to raise awareness about PPD. In order to do so, education of primary care givers about the disease is required. And this would entail the participation of the National Institute of Health and by the Joint Commission on Accreditation of Hospitals (Logsdon, Wisner, Billings, & Shanahan, 2006). There are different programs available for the treatment and management of PPD. One of these programs includes the NURSE program, developed by Sichel and Driscoll (as cited by Driscoll, 2006). This program is an acronym which refers to areas of care that the PPD patient may need assistance in. “N” is for nutrition and needs; this includes the patient’s daily nutritional, medication, and fluid intake, including her vitamin status (Driscoll, 2006). “U” would refer to understanding, which includes the self-awareness process. The “R” would refer to rest and relaxation including the assessment and management of sleep patterns (Driscoll, 2006). “S” stands for spirituality, which basically covers a person’s beliefs and faith in higher powers; and finally “E” refers to exercise (Driscoll, 2006). Through exercise, the patient’s mood can be enhanced. This program can be applied by the nurse in collaboration with the other members of the health care team in order to allow a holistic treatment of the patient. Conclusion Postpartum depression in the United States has a prevalence rate of 11% to 20%. It is a nonpsychotic depressive disorder which manifests in the mother during the postpartum period with symptoms which include impaired sleep and appetite. The nurse plays a supportive and assistive role in the postpartum mother’s life. Her role is also to observe the patient for possible manifestations of PPD because early detection of possible PPD mothers can signal the nurse and the members of the health care team on patients needing or stress management techniques. Other interventions include health education processes which can help further the patient’s and the family’s identification and understanding of the disorder. The NURSE program can also be implemented for PPD mothers with the assistance of the nurse and the members of the health care team. By applying the principles of health education, healthy living, prevention, early detection, and health collaboration, it is possible to reduce the incidence of PPD, to prevent its more drastic consequences, and to allow the mother to enjoy her role as a mother. References Beck, C. (June 2008) The role of the nurse in postpartum mood and anxiety disorders. AWHONN Symposium: Postpartum Mood and Anxiety Disorders: Case Studies, Research and Nursing Care, Washington, D.C. Retrieved January 18, 2010, from http://docs.google.com/viewer?a=v&q=cache:pZGgxMQvEiwJ:www.awhonn.org/awhonn/binary.content.do%3Bjsessionid%3D895C146F2B73CCC4733786DE36F17B4A%3Fname%3DResources/Documents/pdf/5_PMAD.pdf+The+Role+of+the+Nurse+in+Postpartum+Mood+and+Anxiety+Disorders&hl=en&gl=ph&sig=AHIEtbSiTBO-Nppy2demDSBRsrbpeIBvLg Caruso, K. (n.d) Postpartum Depression and Suicide. Suicide.org. Retrieved January 18, 2010, from http://www.suicide.org/postpartum-depression-and-suicide.html Centers for Disease Control and Prevention. (2008, April 11). Prevalence of Self-Reported Postpartum Depressive Symptoms --- 17 States, 2004--2005. Retrieved January 18, 2010, from http://www.cdc.gov/mmwR/preview/mmwrhtml/mm5714a1.htm Davies, B., Howells, S. & Jenkins, M. (2003). Early Detection and treatment of postnatal depression in primary care. Journal of Advanced Nursing, 44(3), 248-255. Retrieved 18 January from the PubMed.gov database Driscoll, J.W. (2006). Postpartum Depression: How nurses can identify and care for women grappling with this disorder. AWHONN Lifelines, 10 (5), 402-409. Lintner, N.C. (2006). Childbearing and Depression: What Nurses Need to Know. AWHONN Lifelines, 10 (1), 51-57. Retrieved 18 January from the PubMed.gov database Littleton, L, & Engebretson, J. (2009). Maternity nursing care. New York: Delmar pub. Logsdon, M.C, Wisner, K, Billings, D.M, & Shanahan, B. (2006). Raising the awareness of primary care providers about postpartum depression. Issues in Mental Health Nursing, 27, 59-73. Retrieved January 18, 2010, from Cinahl Plus database. Mayo Clinic. (n.d). Postpartum Depression: Retrieved January 18, 2010, from http://www.mayoclinic.com/health/postpartum-depression/DS00546 Murray, L, & Cooper, P. (1997). Postpartum Depression and Child Development. New York: Guilford Press, 201-220. Wisner, K, Parry, B, & Piontek, C. (2002). Postpartum Depression. New England Journal of Medicine, 347(3), 194-199. Read More