Emotional is an important aspect of life. We experience joy, anger, and sadness in everyday life. When we do not tend to our emotion needs, psychological complications may occur (Burger & Goddard, 2010). According to health Canada (2009), 16% of women in Canada will experience major depression in the course of their lives. Women experience increased risk for psychological disorders in postpartum period (Raines, Campbell, &Hall, 2010).
The most common psychological disorders are postpartum blues, postpartum depression (PPD), and postpartum psychosis (Raines, Campbell, &Hall, 2010). 75% of women experience postpartum blues, but the symptom is usually mild and can usually improve without professional help (Raines, Campbell, &Hall, 2010). A more serious condition is called postpartum depression. Postpartum depression is a medical condition that affects about 10% of mothers (Raines, Campbell, &Hall, 2010). In this article, I will examine the postpartum depression in relation to the healthy emotional transition.
This topic is important because the postpartum depression is more serious and can usually last for months (Raines, Campbell, &Hall, 2010), and because postpartum depression can usually be detected and prevented (Donaldson-Myles, 2011) (Wojcicki & Heyman 2011) (Garabedian et al. , 2011). The purpose of this paper is to provide the knowledge to prevent PPD. In order to meet the purpose of this paper, I will examine 3 articles that I have chosen from CINAHL and write critical review and relate the information from the article to my own nursing experience. Synthesis These articles offer great in-depth on how to prevent PPD.
Wojcicki and Heyman (2011) have reviewed 10 articles and made conclusion that although more studies are needed, high dosage of omega-3 fatty acid can reduce the risk of PPD. Donaldson-Myles (2011) reviewed on the evidence of breastfeeding and PPD and has found a strong inverse link between the two. Garabedian et al. (2011) has found that women who are victim of violence in adulthood are more likely to suffer from PPD. These 3 articles have contributed to additional information on PPD to what is learned from the textbook. They provide insight on when PPD will likely happen and how to reduce the likelihood.
Based on the information on these articles, prevention of PPD would be the top priority in my nursing practice. For example, although it is known from the class that 10% of women will suffer from PPD (Raines, Campbell, &Hall, 2010), it is further explained that women suffer multiple abuses should be expected to have higher risk of PPD (Garabedian et al. , 2011). In the future nursing practice, I will check for signs of injury and the mental state of the client as well as those of her partner’s to make sure that the client does not suffer from violence.
I will include breastfeeding and high dosage of omega-3 fatty acid daily as part of my health teaching to reduce the risk of PPD (Donaldson-Myles, 2011) (Wojcicki & Heyman 2011). The questions that have emerged from this assignment are many. One question is that even though there are ways to reduce the risks of PPD, what is the sure way of preventing it? Another question is that Wojcicki & Heyman (2011) has found that high dosage of omega-3 fatty acid can reduce the risk of PPD, does taking too much omega-3 have any side effects? Thirdly, what should I do to reduce PPD if the client refuses to breastfeed?
The first 4 weeks of this course has provided me with foundation of caring for postpartum mothers. I learned the basic cares and assessments for postpartum mothers. Those 3 literatures provide me with further knowledge of psychological aspect postpartum mother and made me look for signs of trouble. For example, Garabedian et al. (2011) has found that single mothers, smokers, and women of young age are more likely to experience violence, hence more likelihood of PPD. During my first week of practicum, the first mother that I examined was recently single, had to go out to smoke during my visit and was 26 years old.
At that time, she looked perfectly fine and well composed and was reading her self-help book. I thought that she was going to be fine with her postpartum life. If I possessed this piece of knowledge back then, I would recognize her has high-risk for postpartum depression and offer her additional information on how to deal with psychological changes. During the week of my health teaching, I had the privilege of witnessing childbirth and caring for the mother and the child for the day. I used Watson’s caritas process 3, which is “developing and sustaining a helping trusting authentic caring relationship” (Jesse, 2010).
From the moment I walked into the delivery room, I kept reminding myself that helping the patient was my first priority, and that anything that I could learn was just a bonus and should not interfere with the woman’s needs. Therefore, after I introduced myself, I used the technique of using silence and avoid looking at the woman’s exposed body parts because I thought it would create more tension for the woman (Burger & Goddard, 2010). I kept quiet till the family finally thought that I was trustworthy.
During the teaching, I used Watson’s caritas process 7, which is “Engaging in genuine teaching-learning experience that attends to unity of being and meaning, attempting to stay within others’ frame of reference” (Jesse, 2010). Since the family looked very educated, I shared my observation on their knowledge to help communicate (Burger & Goddard, 2010). I used terms such as “you might already know this” to make myself less lecturing. My patient was very willing to listen to what I had to say because I was very helpful in their delivery and they knew that my teaching was an assignment for school.
They asked me a few questions regarding to how to deal with postpartum blues and appeared genuinely interested in my presences. I thought my teaching was effective because firstly I was very nice and humble towards them. Secondly, I received feedback from them in term of questions (Burger & Goddard, 2010). Effective communication involves dialogues in both directions (Burger & Goddard, 2010). Conclusion Postpartum period is a difficult time for a woman (Evans, 2010). The body has to undergo physiological and psychological changes (Evans, 2010).
Several factors influence the psychological changes. From my reading of the articles, it is learned that breastfeeding and high intake of omega-3 fatty acid reduces the risk of PPD (Donaldson-Myles, 2011) (Wojcicki & Heyman 2011), and that violence victim have higher risk of PPD (Garabedian et al. , 2011). As a nurse, one has to stay vigilant on client’s behavior, diet, and environment and reduce the likelihood of PPD by informing the patient the benefit of breastfeeding, the benefit of omega-3 fatty acid, and by assessing the patient’s living environment.
Reviews The key points of this article is that women who breastfeed are less likely to suffer from postpartum depression notwithstanding the old researches proving otherwise and that breastfeeding provides protection that lasts up to 3 month (Donaldson-Myles, 2011).. The intended audiences of this article are midwives (Donaldson-Myles, 2011). The limitations of this study is the defining the postpartum depression and defining breastfeeding. In some of the study, some people are “mixed” feeding, which can confuse the result (Donaldson-Myles, 2011).
There is also no clear, universally defined method on how to breastfeed in all the studies (Donaldson-Myles, 2011). The definition of postpartum depression is also unclear (Donaldson-Myles, 2011). Although most studies use the Edinburgh depression scale, some of the depression symptom may be just due to lack of sleep or religious factors (Donaldson-Myles, 2011). The cut-off point for depression is also not the same across all the studies, with some using the cut-off point of 13 for depression and some using 12 as cut-off point (Donaldson-Myles, 2011).
This research is done in Britain (Donaldson-Myles, 2011). It applies to Canadian nursing because both countries share the same culture and customs. The implication of this article for nursing practice is that as nurses, we need to advocate on breastfeeding in our patient care. Since breastfeeding can offer protection from postpartum depression up to 3 month (Donaldson-Myles,2011), we need to make sure that the clients know the benefit of breastfeeding and make sure that they can breastfeed properly.
The key points of this article are that taking high dose omega-3 fatty acid supplement reduce the risk for postpartum depression (Wojcicki & Heyman 2011) and that moderate amount shows no effect (Wojcicki & Heyman 2011) . The intended audience of the article is for the researchers who intend to do more research on the correlation omega-3 and postpartum health (Wojcicki & Heyman 2011). The limitation of this research is that it is a review of other journals. Thus the author does not have raw data from the research (Wojcicki & Heyman 2011).
This research is done department of pediatrics, university of California, San Francisco, California, USA (Wojcicki & Heyman 2011). This research applies to Canadian content because of the proximity of two countries. One limitation of this research is that it is a review of other articles (Wojcicki & Heyman 2011). The author does not have the primary data from all the studies. Another limitation of this research is that the dosage of omega-3 fatty acid is not the same in all the studies. Some studies take 100mg daily, others take 500 mg daily and there are also recommendations for 2g/day (Wojcicki & Heyman 2011).
The key points of this article is that women who are the victim of violence are more likely to self-report postpartum depression (Garabedian, Lain, Hansen, Garcia, Williams, & Crofford, 2011) and that the more types of violence experience, the more likelihood of self-reported postpartum depression (Garabedian, Lain, Hansen, Garcia, Williams, & Crofford, 2011), and that the likelihood of postpartum depression strongly correlates to the race, marital status, education, and the usage of drugs (Garabedian, Lain, Hansen, Garcia, Williams, & Crofford, 2011).
The intended audiences of the article are for the medical professionals who are screening depression for postpartum women. The limitation of this study is that this is composed of mostly online questionnaires (Garabedian, Lain, Hansen, Garcia, Williams, & Crofford, 2011); therefore, false data can appear in the data collection. For example, postpartum blue can be mistaken as postpartum depression (Garabedian, Lain, Hansen, Garcia, Williams, & Crofford, 2011).
Secondly, this is survey has a difficult time distinguishing disciplinary action and child abuse (Garabedian, Lain, Hansen, Garcia, Williams, & Crofford, 2011). For example, any hit from the guardian could be considered as child abuse in this survey (Garabedian, Lain, Hansen, Garcia, Williams, & Crofford, 2011). This research is done in Kentucky, USA (Garabedian, Lain, Hansen, Garcia, Williams, & Crofford, 2011). It applies to Canadian nursing practice because 5%-50% of women experience abuse in their lifetime (Garabedian, Lain, Hansen, Garcia, Williams, & Crofford, 2011). The implication of this article for nursing practice is that as nurses, we need to check for evidence of abuse as part of nursing assessment. For example, suspicious bruises should be reported. Since violence is strongly correlated to postpartum depression, we need to make sure that the clients with history of abuse can get help in the postpartum period (Garabedian, Lain, Hansen, Garcia, Williams, & Crofford, 2011) .