The Relationship between Barriers to Entry and Economic Performance - Essay Example

Critically evaluate peer support groups for women in postnatal depression (PND) in primary healthcare setting Introduction/ background Public healthcare is a crucial part of government healthcare initiatives. In the fast advancing technology and rapid globalization, public healthcare imperatives have become key factors for department of health (DOH, 2009; NHS, 2002). The wide scope of public healthcare has brought the nursing perspective to forefront of the public healthcare who is taking especial care to disseminate information (NMC, 2006; Pander et al., 2006). Briddon (2009) asserts that around 15% expectant mothers experience postnatal depression. The postnatal depression amongst women has become a serious concern and needs to be studied at primary healthcare setting, using wider platform of service initiatives (O’Hara et al., 1984; Whitton, Warner & Appleby, 1996). The study would be making efforts to identify the needs of the mothers and critically evaluate the support and proactive participation of peer support groups for women with PND in St. Albans. I am a student healthcare visitors and the student would greatly facilitate in exploring the various facets of timely interventions to reduce pnd. 2. Literature search strategy Literature Search Strategy Table Data Bases Searched 1. Postnatal depression amongst women in UK 2. Pre and postnatal depression amongst women in UK 3. Cause and effect of postnatal depression on family 4. Cause and effect of postnatal depression on mother, child and partner 5. Peer group support for women with postnatal depression 6. Nursing advocate for women with postnatal depression Key words / terms / phrases Postnatal depression Pre and postnatal depression Peer group Nursing advocate Boolean operators, wildcard, truncation commands OR: while searching for postnatal depression OR post-natal depression OR post natal depression Inclusion Criteria Exclusion Criteria 1. Databases for UK only 2. postnatal depression 1. database outside UK was excluded 3. Literature rationale/ review There is considerable evidence to show that PND has a substantial impact on the mother, her partner and baby (Linnet et al, 2003; Brown, Bacigalupo, 2006; Hall & Elliman, 2008). Evidence suggests that mothers’ psychosocial and mental health can have a significant effect on the mother and baby relationship and that PND can result in both emotional and cognitive disorders in the infant (Bee & Boyd, 2008; Stein et al.,1991; Murray & Cooper, 1991). All of which have significant health impacts on individuals and society, signifying a major public health issue (Hearn et al., 1998; Briscoe, 1986). Motherhood is one of the most important and challenging role of women. It becomes a lifelong learning process and is hugely facilitated by emotional support of the family (Scrandis, 2005). But often, the changing role of single women into mother is accompanied by socio psychological adjustments which are hugely facilitated by the husband, support family and peer groups (Rodrigues et al., 2000; Oats et al., 2004). The social expectations become highly stressful because of the various factors like lack of knowledge, conflicting views and differences about childcare between the expectant mothers and peer group. Very often this adversely impacts the self confidence and promotes doubts about one’s competency level of being a good mother thereby creating stress and pnd amongst the women (Dressel & Clark, 1990; Beck, 2002). Thus, encouraging family support becomes highly desirable. Professor emeritus, Ramona, Mercer (2004) has asserted that for women, maternal role attainment is a process that has four well defined developmental phases: anticipation; formal; informal; and personal development. Each phase help prepares the future mother to accept the changes and acquire new skills for rewarding motherhood (ibid). Indeed, the expectations of the would-be and new mothers primarily focus on the predefined societal norms which need to be explained and understood in the wider welfare of child and mother context (ibid). Thus, consensual and informal learning becomes the most effective way of reducing unnecessary stress (ibid). Scholars have asserted that women need counselling and share their experiences with others to develop better understanding of being a good mother and handle crisis (Ross & Dennis, 2009; Lipman et al., 2000). The epidemiological, sociological and demographical determinants of healthcare needs are critical factors of postnatal depression (Carr, Unwin & Mulloli, 2007). Bradshaw’s taxonomy of needs (1972) primarily focuses on four types of needs where normative need is observed to be intrinsically linked to PND. The various government initiatives like ‘Every child matter’, ‘Healthy child program’ and ‘National service framework’ can contribute positively towards the cause with the help of support groups (DOH, 2009; NSF, 2004). 4. The Service initiative plan The service initiative plan encompasses goals and research activities that would be able to identify the needs and develop activities plans which can be implemented in the desired target group of women with postnatal depression. The major objectives of initiative plans are to give moral and emotional support to the parents with a new born child and help avert PND in mothers who may be socially isolated. The initiatives are designed to reduce the PND through peer support and create wider understanding of mother and child welfare imperatives. The area selected for research is St Albans which is located in southern Hertfordshire 22 miles north of central London (requires no REF as the area of study is selected by YOU). The people have made a lifestyle choice to reside in the periphery of central London but acknowledge that the migration of family members to city has made it difficult for them to establish social networking after the arrival of the newborn (St. Albans, internet). The framework of initiative plans are focused towards SMART goals (specific, measurable, achievable, realistic and timely), means and evaluation methods that facilitate reduction in pnd in new mothers. The healthcare advocate and visitors are primarily motivated by the objectives and evaluation of the study rather than the ideology or values. Naidoo and Wills (2005) have affirmed that there is no certainty of anticipated outcome of health promotion. Thus, evaluation of health programs becomes vital to ensure their viability and survival. The initiative plans take into considerations the holistic model of health with wider aspects or dimensions that have significant impact on the overall health of a person. They are: physical; emotional; spiritual; social; sexual; and psychological health (Aggletons & Homans, 1987; Ewles and Simnets, 1999). The wide scope of the initiative plans would promote peer support group as major intervention measure to reduce PND in new mothers. 4.1 Goals The major goals of the study are to identify the extent to which the peer support group is able to influence the expectant and new mothers in reducing pnd. The As per the rationale of the literature reviewed, it is expected that the peer group and community support would hugely facilitate in meeting the needs and requirements of the women in postnatal depression. Hence, four months of activities vis-à-vis formation of peer groups, nursing advocates and community support groups would take up regular activities with the expectant and new mothers could be affected by postnatal depression. The peer support group would help expectant mothers from one month prior to their delivery till after three months of post delivery period. The time schedule is chosen so that impact of the interaction with peer support group could be studied at various stages. 4.2 Activities The activities would be important part of implementing the concepts of literature and so as to evaluate their impact on the learning outcome on the women with pre and postnatal depression. Each activity would be accompanied by short interviews with the participants who would also be required to fill in the questionnaires. 4.2.1 Group discussion There would be bi-weekly consensual and informal group discussion of expectant and new mothers with pre and postnatal depression with the various community members. 4.2.2 Nursing advocacy Advocacy is a vital concept in nursing perspective and can be defined as supporting the just cause and working towards it (Polit & Beck, 2003). The proactive involvement of nurses as advocates or the facilitators, in the issues and patient-nurse relationships have direct impact on the welfare of the people, has become crucial in the rapidly changing values of the fast evolving society (ibid). Thus they make it easy for people, the volunteers and those who are facing such problems, to be more informed and thus better equipped to handle the issue. It is assumed that nurse advocates as health visitors would greatly promote the objectives of the study and facilitate easy interventional techniques of effectively using peer support group to reduce PND in new mothers. 4.2.3 . Peer group interaction The support of peer group is vital element of inculcating confidence amongst women with pre and postnatal depression (Ziersch et al., 2000). The social expectations unless explained, often cause stress and promote low confidence in their competencies to cope with motherhood (Dennis, 2003; moore et al., 2007). The guidance of the peer group facilitates understanding and encourages mothers to develop better mother. Dr Mercer’s phases are important paradigms of maternal role attainment which play important role in understanding the psyche of expectant mothers and their transition into different role (Mercer, 2004). The weekly interaction with peer group is expected to boost the confidence level of the expectant and new mothers. 4.3 Resources The major tools of the study would comprise of questionnaires and interview schedules that would be used periodically to evaluate the impact of activities, intervention of peer support group with expectant mothers. The other resources that would be sought are the cooperation from the government and non government agencies which are involved into healthcare. The support of community and peer group would also be a major resource to implement the service initiative plans. 4.4 Evaluation Plan for service initiatives The service users would be involved in the critical evaluation of the initiative plans. The study would primarily be analyzing the various inter-related issues and factors that are hindering or promoting the quality and affordability of the healthcare services. The study would use the PDSA model of NHS as evaluation tool to measure the outcome (NHShealthy). The PDSA model incorporates four stages: plan; do it; study; and act on it. The SMART goals would serve as anticipated outcome within predetermined time schedule. The initiative plans would be formulated and implemented. Their impact would then be studied for the outcomes and subsequently needs to be acted on those plans for long term positive results. It would also make efforts to measure and analyze the criteria for efficient, quality and affordable healthcare for the vulnerable expectant and new mothers who may be vulnerable to postnatal depression. It would focus on the peer group support as major intervention tool to reduce PND in new and expectant mothers, especially those who are socially isolated. 4.4.1 Methods The proposed research study would be qualitative in nature and would involve comprehensive literature review. Qualitative research is a very important tool for evaluating trends and behavioural pattern of the people who are in a position to influence a set of defined parameters or vice versa (Denzin, 2000). The qualitative research is based on ‘grounded theory’ where the qualitative analysis of the data is used for generating theories that reflect the realities of life. Social scientists are therefore more inclined to use this type of research so that social changes and real life situations could be predicted with relative accuracy at unpredictable and unexpected circumstances. Since the study is carried under the assumption that peer support group would greatly help women with PND, the qualitative research would help to identify the factors of change in their behaviour. It would facilitate in studying behavioural pattern of the women with postnatal depression and study the impact of peer support group on them. Indeed, the transforming roles of women are decisive factors for postnatal depression and the study would greatly facilitate in identifying the factors and needs that promote PND.(Hall, 2006) The study would be taking into account the conceptual model as well as the theoretical model. Secondary information sources such as libraries, commercial bibliographic databases for peer review, internet resources and e journals would be used for literature review. The wider conceptual model of the research would be used to analyze the data. The evaluation comprises of the plan to study the changes in behaviour of new and expectant mothers vis-à-vis their close family members and peer group like husband, in-laws, acquaintances and other community members. The research questions are designed so that it can reveal changes in the behaviour of new mothers who show signs postnatal depression and help identify the factors that influence those changes. 4.4.1.1 Research question 1. Does the changing role of women as expectant mother or new mother inculcate anxiety and low confidence? 2. Do the social expectations have significant impact on the psyche of expectant mothers and promote pre and postnatal depression? 3. Can the support of peer groups and nursing advocacy help mitigate the PND? 4.4.1.2 Data collection and Sample Since qualitative research methodology was adopted focusing on literature reviews, the sampling primarily comprised of reading works of wide ranging authors on the topic concerned who had compared different approaches to the same issue but with different perspectives and small group of new mothers selected randomly from the community. Sampling is highly crucial part of qualitative research mainly because the research is time consuming and relies primarily on interactive sessions and therefore sample needs to be small but the target group or the sample must encompass the essential factors and features to fulfil the basic criteria of the research. Small sample size of 10-15 expectant and new mothers would be selected randomly from the community. Through well designed questionnaires and interview schedules, they would be evaluated against the changes in their behaviour during the pre-defined period. Informal interview creates an atmosphere of trust and mutual respect that establishes the rapport which in turn prompts the subject to freely express his views and thoughts facilitating better understanding of the attitudes and behaviour of the subject. Active listener is another important aspect of the researcher. An informal chat can be followed by a focussed and structured interview that could give specific reaction of the subject on identified areas. This is critical element of the study as the mothers with PND might be wary of exposing themselves to the strangers. 4.4.1.3 Data Analysis The ‘typology method’ of data analysis would be adopted. ‘it is a classification system, taken from patterns, themes or other kind of group data’ (Patton, p393, 398; Lofland & Lofland, 1995). In this case, the literature contents would be segmented according to pre-defined criteria of theme, pattern and issues to develop and predict pattern that best reflect the sentiments of the people. This set would then be compared with the new patterns and theme that would merge from the analysis of qualitative data taken periodically from the selected sample of 10-15 new mothers. 4.4.2 Ethical consideration The rapid globalization has brought in an era of pluralistic society and increasingly large segment of population comprise of people from different race, colour, culture and nationality (Pope, 2000; Marshall, 2003). The participants must reflect the diversity and the researchers must exhibit understanding of cross cultural values. Ethical considerations are important ingredients of research and must ensure the trust and confidentiality of the participants. The covert and overt dimension of the research where the subjects’ right to privacy and the public’s right to know, clash over the ethical issues. The delicate line between the two is often contentious and it is important that the researcher does not transgress his ethical boundary to commit any serious offence that might lead to criminal proceedings. The researcher must at all times, remember that confidence building and mutual trust are foundation for the generation of an authentic and socially relevant theory that must stand the test of time. As Dean says that ‘a person becomes accepted as a participant observer more because of the kind of person he turns out to be in the eyes of the field contacts than because of what the research represents to them. Field contacts want to be reassured that the research worker is a good guy and can be trusted not to do them dirt with what he finds out’. (1954, p. 233). Hence, the informed consent of the people involved in the research becomes essential ethical aspect and must be incorporated within the research criteria. 4.4.3 Dissemination of findings Public health and general well being of the masses has become pivotal to the development of a nation (this is My general conclusion and therefore cannot be REFS). The findings of the research would greatly help to improve and improvise the overall health of the expectant mothers. According to McKenzie, Nigel and Thackeray (2009), the ‘health education is a profession of educating people about health’. It is therefore assumed that health promotion activities would empower people to actively participate in activities that are designed to improve their general health condition and well being. The data of the study would be made available to the libraries and universities for the future research paradigms so as to enhance the scope of the research in future. 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