Nursing Interventions For Postpartum Depression

DOMAIN

Result

1. Overactive, aggressive, disruptive behaviour.

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2. Non – accidental self- injury.

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3. Substance use and misuse.

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4. Cognitive problems

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5. Physical illness or disability problems

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6. Hallucinations or delusions.

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7. Depression mood

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8. other mental health issues

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9. Relationship

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10. Activities of daily living.

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11.Problem with living conditions

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12.Problem with occupations and activities

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Consumer priority

Identified goals/issues

The consumer’s strengths to address these issues.

Consumer and Nursing Interventions

Person/s Responsible

Timeframe for next Review

Consumer Priority# 4

Rachelle, a married 21-year-old woman experiencing symptoms of depression- peripartum onset.

-These symptoms were noticed after 10-weeks of giving birth to her baby.

-The presenting complaint of the mother are—

“not coping at all with the baby”

“sad and upset all the time”

“I’m a bad mother”

-Rachelle has poor thought content demonstrated by feeling of hopelessness, worthlessness, helplessness, guilt, and sense of being a failure

– Rachelle showed symptoms of anhedonia, withdrawn behavior, and impaired functioning, decreased appetite, Loss of weight,  

-Rachelle engages in bouts of crying  and has wish for death

-Rachelle does  not attend Church

social groups

HONOS Score: 4

Issue- Rachelle experiencing depressed mood and disturbance after the birth of the 10-weekold

daughter, Claire.

Goal-

Rachelle to overcome depression for her and Claire’s well being and safety

Patient has insight of illness,

intact judgment,

Recent memory is intact,

Goal directed thinking,

Very family oriented,

God husband’s support as 9 years marriage was stated as good,

Satisfactory work life as office manager,

High educational attainment,

She has friends in school and community  

-Encourage Rachelle and her husband to participate in crisis counselling when feeling depressed, helpless or sad (Townsend & Morgan, 2017).

-Encourage group talk to express feelings of sadness, anger, sad to gain sense of control using alternate ways to overcome feelings  

(Herdman & Kamitsuru,2014).

-Advocate Rachelle to take medicines on time to overcome depression (Comtois et al., 2015).

-Engagement of patient in self help groups and network of resources to feel socially engaged. Maximise the clients contacts to prevent suicide ideation followed by engagement in self help groups. (Currier et al., 2015).

Group therapy with other mother  to minimise the feelings of isolation,

(Gartlehner et al., 2015). 

-Refer Rachelle to nutritionist for well balanced nutrition and inform client on healthy eating to minimise weight loss and dehydration.

To reduce disturb sleep pattern, encourage relaxation measures such as listening soft music, provide rest periods from baby care (Werner et al., 2015).

-Speak to client in simple concrete words and allow the clients to slowly frame the responses

(DiClemente et al., 2016).

Case manager, maternal health nurse and nurse

-Patient shows willingness to attend the counselling sessions when feeling overwhelmed

-Rachelle involves in communication with her husband and case manger to express/verbalise irrational thoughts, reframe responses, encounter negative thoughts,

-Rachelle shows interest in taking care of her daughter and improve relationship with her husband

 -Rachelle demonstrates compliance with medication and  communicate with nurse/ physician regrading any complications with medication

-Rachelle identifies at least two to three people other than her husband for support at the time of crisis/ suicide ideation,  and get emotional guidance

-Rachelle engages in healthy eating and cooks food recommended by nutritionist

Weekly review of Rachelle using the “Postpartum Depression Screening Scale”.

It is the self-report instrument,  35-item Likert-type designed for new mothers. This questionnaire will be used for the patients after every visit.

This questionnaire will help Rachelle and her health care professional to determine feelings.

The mothers respond through five point scale that contains options from “strongly disagree” to “strongly agree”.

The scores falls in three categories-

normal adjustment (≤ 59),

Positive screen of major depression (≥ 80) and potential depression symptoms (60 – 79).

Initially only seven questions were asked to fill and if the score is greater than 14, then the remaining questions will be asked to fill

(Zhao et al., 2015).

In case of Rachelle with each visit a positive results may be observed showing improvement in score

A decrease in depression may occur as Rachelle engages in her treatment and therapy. It will improve her mood and help her enjoy her motherhood. Rachelle can better reconnect with her husband and daughter

(Herdman & Kamitsuru, 2014)

Consumer Priority # 4

Problem with  Activities of daily living

-Rachelle finds difficult to perform activities of daily living,

Evident by difficult concentration and impaired parenting

She was unable to do do

Serial 7’s

She could do digit span of 4 forward, and none backward  

Rachelle demonstrated  impaired functioning

 After birth of her daughter 10 weeks  ago

Rachelle is unable to care for her daughter after depression

Rachelle is inappropriately dressed, has unkempt appearance and does not cook healthy food for herself, weight loss  

-Her motor behaviour demonstrates rigid posture, few spontaneous movements,  slumped slightly forward   

HONOS Score: 4

Issues

Rachelle is poorly performing her daily living activities, not taking care for her new born or herself.

Goals

-Rachelle has intact memory and judgment skills

-Rachelle is aware of her illness and s seeking intervention

Husband Martin is encouraging,

-Her orientation to place, person and time  is good

Marriage is a supporting factor and for positive change

Always was motivated to work well in office and  was successful in becoming office manager

Supportive network from  friends in community,

High educational attainment,

Very family oriented

-Allow client to work with sufficient time on activities of daily living to decrease anxiety.

-Encourage client’s husband to uptake more responsibility to reduce

pressure on Rachelle

(Dennis, Brown & Morrell, 2016).

-Educate Rachelle with theory of self care 

(Revello & Fields, 2015).

-Help the family in designing predictable routines that is easier to follow and remember (Dennis, Brown, & Morrell, 2016).

-Rachelle. Routine must involve rest periods to avoid stress and appropriate time for  daily activities, sleep, eating, reading and exercise   

-Martin to motivate Rachelle to attend weekly mass, occasional confession, attend Church

social groups

-Engagement in mindfulness activities such as mediation, yoga or mild exercise o strengthen muscle and increase concentration in work

(Dennis, Brown, & Morrell, 2016).

-Encourage Rachelle in cooking independently  and assist in making healthy meal plan

-Maintain journal to record thoughts, barriers in performing activities and list of achievements 

-Martin must praise and give positive feedback to Rachelle to increase interest in daily living activities

Encourage the client to brush, use soap, washcloths, make up, hygiene etc too increase self esteem

Nurse, Rachelle’s husband, case manger, friends in community

Rachelle may consult her friends in community who are already a mother to learn ways to handle new born.

Rachelle may work with her husband on household chores   

Initially Rachelle may be monitored every alternate day and then on weekly basis.

Ability to perform activities living Martin, will improve with motivation, and support from husband and guidance from the case manger (Moorhead et al., 2014). 

Consumer Priority # 4

Rachelle expresses her feeling of hopelessness and worthlessness with her motherhood after birth of her daughter Clarie, which is sign of low self esteem. These are unrealistic expression of self

Issue:

HONO’s Score  # 4

Issue:

Self esteem disturbance makes Rachelle perceive herself as bad mother and demonstrate self negative verbalisations

Goal  

Increase self esteem of Rachelle and address the feeling of guilt

Spiritual belief,

support from husband,

intact judgment and memory

Past work achievements 

-Help Rachelle learn infant cues and its meaning.

-Engage in community group programs or personal counselling

(Franck et al., 2016).

-Teach visualisation techniques to have positive thoughts and more realistic self image. It will also prevent suicide ideation (Comtois et al., 2015).

Group therapy minimise the feelings of isolation,

-Involvement in activities of problem solving to eliminate the feelings of low self esteem.

-Help Rachelle  set realistic goals to overcome unrealistic expectations  

-Identify cognitive distortions that promote negative self appraisal such as discounting positive attributes (Franck et al., 2016).

-Martin to consider relocating with Rachelle to community with more friends. Having strong network of friends may boost self-confidence

(Gartlehner et al., 2015).

Arrange referral services for Rachelle. It may include-

·PANDA foundation

·Gidget foundation

·Pregnancy birth and baby help line

·Beyond blue

·Local community mental health services     

(Cesphn.org.au. 2018).

Nurse, case manger, mental health professionals  and Martin

Rachelle may consult nurse for setting realistic life goals.

Rochelle may take support of her husband Martin to know the areas of improvement and know personal strength

Review daily for first few weeks and then monthly.

Client needs can be evaluated using “assertiveness training tools” to identify the clients wants/needs in life and assess problem solving skills

(Townsend, & Morgan 2017).