The mental health continuum of care is a diverse system of services that are provided for individuals aimed at maintaining and restoring people's mental health and well-being (Austin & Boyd, 2014). The care continuum can include series provided by health professionals as well as resources outside of the formal health care system such as community support (p 42). The continuum of care focuses on health promotion, prevention, treatment, and recovery (Mehrotra & Swami, 2018). The continuum recognizes the complexity of mental illnesses and addresses the biological, social, psychological, and spiritual aspects of people’s lives (Austin & Boyd, 2014). Postpartum depression is a serious mental health disorder characterized by the onset of depressive symptoms up to twelve months after the delivery of a child (Horowitz, Murphy, Gregory, Wojcik, Pulcini & Solon, 2013). Nurses play a role along the entire continuum of care for clients experiencing postpartum depression. The registered nurse can help a client navigate this continuum by both providing direct care and directing clients to appropriate alternative resources. Within the context of nursing practice in Canada, nurses play a key role in providing culturally relevant care. The aim to reduce the barriers for Aboriginal women in seeking postpartum care is a priority in Canada to counter the implications of colonization on the mental health of Aboriginal Canadians (Richardson, L. & Murphy, T., 2018).
This paper will address the nurse’s role in relationally engaging with clients throughout the detection and treatment of postpartum depression as well as their responsibility to reduce the barriers for clients in seeking mental health care. It should be noted that there is growing research about the experience of postpartum depression within men (Wee, Pier, Richardson & Milgrom, 2010). For this paper, the focus will be on the mother. Following the birth of their child, many women will experience a period known as the postpartum blues. This is common, about 80 percent of women experience these symptoms (Stevens, 2009). Women may feel tired, irritable, tearful, anxious, and experience quick mood changes. This may contrast their expected mood of feeling happy and accomplished furthering their negative feelings. These feelings are normal and will generally go away after a few weeks. The nurse should validate these feelings for clients and ensure they feel comfortable. Without belittling these feelings, women should be assured these feelings will generally go away without intervention. Postpartum depression (PPD) however, is more serious and is different than the postpartum blues. It is less common, affecting approximately 10 percent of women (Stevens, 2009). Postpartum depression is a serious medical condition, which affects the bond between the mother and child, possibly affecting the attachment process and the healthy development of the child (Rush, 2012). A range of symptoms designates postpartum depression.
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Symptoms include feelings of inadequacy and failure, a sense of hopelessness, exhaustion, emptiness, anxiety or panic, decreased energy and motivation, and inability to cope with daily routines. The symptoms do not differ from major depression symptoms except for the timing. Mothers may also experience suicidal thoughts, thoughts of harming the baby as well as indifference towards the baby (Strass, 2002). Postpartum depression is diagnosed when the major onset of the depressive episode is up to 12 months after delivery. Various risk factors for postpartum depression make women more likely to experience postpartum depression. Family history of postpartum depression, depression, anxiety, and bipolar disorder make women particularly at risk for postpartum depression. Other factors may include stressful live events, financial stress, difficulty breastfeeding, social isolation, and adolescent or older mothers.
Early detection and intervention are vital for women experiencing PPD. Long-term health problems and interference with the mother-child relationship can occur without treatment (Strass, 2002) Further repercussions of this can include negative effects on the child’s cognitive and emotional development as well as a risk for neglect and abuse (Rush, 2012) (Strass, 2002). As symptoms of PPD are often overlapping with the more common, “baby blues”, PPD can often go undetected. Early identification of mothers who may be at risk is challenging. However, with proper screening, follow up and support, PPD is treatable (Strass, 2002). In a study on the maternity nurse’s role in postpartum treatment, Rush (2012) identified key interventions performed by the nurse. Four weeks postpartum, maternity nurses meet with the mother and review their mental well-being. They are asked questions to identify whether they have risk factors associated with PPD. For women deemed at risk for PPD, additional home visits, clinical visits, and telephone calls are encouraged. As home health nurses may have the most contact with the mother and exposure to their environment, they can often be the most aware of symptoms that suggest PPD. There are numerous treatment options available and will depend on the severity and the presenting symptoms. Support groups, counseling, and medications are all forms of treatment that are effective in treating PPD. Nurses must commit to a collaboration between client and nurse to reach the most positive outcomes. Client-centered care involves showing respect for the client’s autonomy and their right to participate in decision-making (Austin & Boyd, 2014).
Mothers suffering from post-partum depression should feel in control of their recovery as well as hopeful for their recovery – demonstrated through their desire to be part of their care plan. A client-centered approach is essential as the very definition of recovery within mental illness is defined by the client. Recovery is unique to each individual - designed to focus on the person's strengths, vulnerabilities, culture, and the resources available to that particular individual. A key part of recovery is the individual's realization of his or her potential. Without a client-centered approach, this would be impossible. A client must feel in control of their recovery and feel their input and opinions are valued to facilitate empowerment and feelings of hope. Self-care activities should be promoted as much as possible such as bathing, sleeping regularly, and eating properly. A new mother will be overwhelmed with the added care required to take care of her new baby but ideally will not neglect herself. Rush (2012) identified the role of rapport as a major theme specified by nurses working with women suffering from PPD. All nurses highlighted the importance of “rapport and continuity of care to be able to respond to women with suspected PPD” (Rush, 2012, p. ). Ensuring the women trusted them and would feel welcome to contact them at any time, improved their relationship and recovery success. Nurses described their role as identifying and referring, not diagnosing. They were often very aware of the risk factors and symptoms and would then refer the woman to see her doctor. Nurses pointed out that identifying symptoms of PPD can often emerge from relaxed and casual conversation. Women may feel nervous expressing their feelings in a clinical setting but may be more open if doing so in an informal way. This study highlights the importance of relational engagement, aimed to approach the situation in a way that makes women feel comfortable and accepted. Antidepressants are help in the treatment of PPD. Home health nurses who are involved in treating women with PPD will refer clients to a physician for medication therapy. Nurses play a role throughout the entire process of pharmacological medication therapy. Before medication therapy, nurses must gather a detailed history and baseline assessment.
Client-focused goals for drug therapy and attitudes about drug treatments should be discussed before treatment. Current medications should be documented as well as any other current symptoms that could later be confused with side effects (Austin & Boyd, 2014). Before a client starts medication therapy, nurses must also think about the potential barriers to compliance and work with the client to develop strategies that would enhance compliance. For example, the nurse should consider accessibility to a pharmacy, discussing with the client how they will get to a pharmacy. After medication therapy has started, the nurse is responsible for continual assessments and documentation of the client's response to medication, any side effects, or adverse reactions. This should also include a discussion with the client about their thoughts on how the treatment is working. The client should be educated on what adverse effects look like and when to seek help. When addressing side effects, the nurse should work with the client and the physician to consider a risk-benefit analysis and give the client alternatives if possible. The nurse may have the most contact with the client, so they also have a role in facilitating communication between the client and the physician should the client have concerns during their psychopharmacological treatment. Management of side effects is a priority for nurses as clients are taking medications. Undesired side effects can result in poor adherence to the medication regime. Concurrent therapies, that aid in the management of side effects are an important addition to treatment with medication. Therapeutic communication and use of self can go a long way in aiding psychopharmacological medication therapy and other therapies. Through both verbal and non-verbal communication, therapeutic use of self fosters a relationship based on trust. A client must believe that the healthcare providers have their best interest at heart through feelings of trust. If they trust the healthcare system, they are more likely to follow the psychopharmacological regime. They are also more likely to be open about their feelings about their therapies which can enhance their progress and recovery. Cognitive-behavioral therapies are useful in the treatment of
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