A hospital has reported on implementation of a new policy to guide hospital-based perinatal nurses in caring for women at risk of postpartum depression.
M. Cynthia Logsdon, APRN, PhD, FAAN, professor at the University of Louisville School of Nursing and associate chief of nursing research at the University of Louisville Hospital and the James Graham Brown Cancer Center, led a team that created evidence-based practice guidelines to help the approximately 13% of new mothers who experience PPD in the first year after childbirth.
One issue is that many women who experience PPD may not recognize the symptoms or discuss their feelings with a healthcare provider.
“The hospital policies and procedures are designed to provide perinatal nurses the tools they need to prepare new mothers so they are able to self-monitor for symptoms of depression and know what steps to take if they experience symptoms,” Logsdon said in a news release.
According to Logsdon, most hospitals lack comprehensive perinatal patient PPD assessment, education and referral policies. The new recommendations go beyond previously published guidelines, she said, by focusing on the first few days following childbirth and on nursing care while the new mother is hospitalized.
Logsdon and her team — Diane Eckert, RN, BSN, clinical manager of the mother-baby unit at ULH, and Roselyn Tomasulo, RN, MSN, perinatal educator — collaborated with internationally-known researchers in the field to draft the article. A task force of clinical nurses was consulted to determine how to improve nursing practice at ULH. Implementation included identifying at-risk patients and referral sources, along with physician and staff education.
“When many nurses enter the profession, they dont fully understand their critical role as patient educators,” Tomasulo said. “We are helping our perinatal nurses feel more competent in their roles by offering interhospital online education and staff training.”
Identifying those at risk
During the obstetric patient admission process, ULH perinatal nurses assess new mothers for PPD and suicide risk factors: low-income status, lack of social support and previous history of depression. At-risk patients are reported to the obstetrical physician.
The evening before hospital discharge, all new mothers fill out a questionnaire that utilizes the Edinburgh Postnatal Depression Scale. Mothers are asked questions such as whether they feel anxious or worried for no particular reason and whether they feel sad or miserable. The higher the score, the greater the risk for PPD.
The physician, social services worker and oncoming shift nurse are then informed. The nurse who administered the EPDS reviews the results of the depression screening with the patient and her support person. Patients also are informed about depression symptoms and what to do if they begin to feel hopeless.
New mothers go home with a list of community resources and physician referrals, meaning names and numbers are immediately accessible if they need to seek help. They are asked to retake the EPDS questionnaire about a week after leaving the hospital to determine whether PPD symptoms are present.
“We hope our work will be seen as a model of good policy and can be considered by other hospitals and professional organizations,” Logsdon said.
The article, “Identification of Mothers at Risk for Postpartum Depression by Hospital Based Perinatal Nurses,” is scheduled for publication in the American Journal of Maternal/Child Nursing. To read the abstract and download a PDF of the study, visit http://bit.ly/KqsN6t.