How to Interact with Postnatal Depression Patient - Case Study Example

Name University Course Tutor Date Postnatal Depression Table of Contents Opening statement 1 1. Clinical Observations 2 a. Signs and symptoms that Kathy is presented with 2 2. How to interact with Kathy in the first instance and beyond as a nurse 3 a."Therapeutic use of self" skills to use when talking with Kathy 3 b.How to ensure that the therapeutic approaches helps Kathy’s active participation in assessing, planning, and managing her care 4 3.Steps to take to ensure Kathy’s personal safety 5 a.Risk identification and management 5 i.Care plan, outcome and intervention for anxiety 6 ii. Care plan, outcome and intervention for sleeplessness 7 c. How to use referral pathways to assist Kathy and why these referral agencies are chosen 8 List of References: 10 Postnatal Depression: Case Opening statement Depression is a major public health concern and is more common in women than men, especially during the childbearing period (Stewart et al. 2003). Some women experience a considerable impact of natal and postnatal depression (Battle et al., 2006). Depression during the pregnancy and postnatal period can compromise a woman’s parental ability and affect self-care during the pregnancy (Cohn et al., 1990). It also causes sensitive parenting in the postnatal period. The following documentation belongs to Kathy, a 27 year old gravid 2 para 1 mother who seems to be experiencing episodes of postnatal depression. The woman reported to the wellness clinic accompanied by her mother, husband, and baby. The documentation identifies the signs and symptoms reported, the risks identified and their management, the duty of care owed, and the referral pathways. Updates should be made of progress and any new reports. 1. Clinical Observations Kathy is an expecting 27 year old woman brought to the child’s wellness care centre, along with her infant baby Molly, mother, Sally and Husband Bob. Kathy seems sad and depressed despite the fact that she has a baby and expecting another one. She seems to undergo emotional and physical turmoil as indicated by her physical appearance and reactions, as well as reports from her family. a. Signs and symptoms that Kathy is presented with -Kathy has problems sleeping as reported by her husband Bob. She sleeps even less than a breast-feeding woman with a colic-prone infant. -Kathy cries while standing besides Molly’s crib most of the nights -Kathy seems obsessed about caring for Molly and she believes that Molly would be much better off without her -Guilt, that she is not taking good care of Molly -Sadness as noticed from her fretful and weepy reaction during the interview -Overwhelmed as evidenced from her lack of focus and obsessed concern about Molly’s safety and health -Social withdrawal and inability to be comforted as evidenced by her irate and withdrawal attitude despite the fact that she has remarkable support from family and friends. -Easily frustrated, and spells of anger as evidenced by her restless limbs during the interview. -Hopelessness as evidenced by Kathy’s remark that she doesn’t feel she can do anything well. -Kathy shows increased anxiety and feels inadequate in taking care of Molly. 2. How to interact with Kathy in the first instance and beyond as a nurse As a nurse, it is important that I assist the client-Kathy-to understand what she is going through. First, it is important to provide the necessary education to help Kathy, her husband, and mother to recognize Kathy’s signs and symptoms in a more in-depth manner. This will enhance the ease of the woman getting proper screening, diagnosis, and screening procedures (Beck 2006). Moreover, educating the couple about the signs and symptoms will enable the couple to be aware when the signs and symptoms experienced occur again (Leahy-Warren et al. 2011). Next, I will assist Kathy to increase her understanding of how to meet her self’s needs. The objective is to help Kathy to improve her overall state of mental wellness and possibly reduce or cease the experiences showcased in her signs and symptoms. Moreover, it will help Kathy to shun away feelings of isolation and enable her to seek help from the necessary resources of her care (Day 2007). a. "Therapeutic use of self" skills to use when talking with Kathy As a nurse, the first direction to take is to provide an individualized flexible postpartum care for Kathy, and this will be based on her depressive symptoms and maternal preferences. I will also offer Kathy with the Edinburgh Postnatal Depression Scale (EPDS) as a tool for self-report and confirmation of the depressive symptoms. Kathy will be encouraged to complete the EPDS by herself in privacy after being shown how to conduct the assessment. Kathy needs to take of herself in day to day duties such as cooking and eating nutritious foods, getting enough rest through sleeping, or relaxing, and allowing other people to help her take care of the child. b. How to ensure that the therapeutic approaches helps Kathy’s active participation in assessing, planning, and managing her care The best way to help Kathy is by ensuring that there is a continual interaction and assessment of her progress (Day 2007). This will be done by:- Arranging and providing at least a weekly interaction for supportive care and ongoing assessment. Helping her understand that it is not her fault of the way she is feeling and she has nothing to be guilty about. Facilitate opportunities for the provision of peer support for her case (Simkin 2001). Facilitate the involvement of the spouse and family members in the provision of care as appropriate (Simkin 2001). Consult the appropriate resources for the current and most accurate information in the process of educating Kathy on her condition (Simkin 2001). 3. Steps to take to ensure Kathy’s personal safety a. Risk identification and management Kathy has a risk to self harm-or even suicide. Even though she denies of any suicidal attempts, she believes that she is better off dead through her statement “...Molly would be better off without me”. Kathy seems to have moderate to high risk of depression as evidenced by her anxiety, high levels of child care stress, low self-esteem and hopelessness, and a previous history of panic attacks (Sheehan 1998). I will ask Kathy to utilize self-skills in any way possible. These begin with simple things like to focus on one issue at a time other than being overwhelmed by several issues at ago. I will urge Kathy to prepare and eat food as well as accept offers from her mother and friends to assist in taking care of the baby. Lack of food and nutrition is a risk factor to depression and anxiety (Bennet & Indman 2003).This is because it malnutrition can lead to conditions such as anaemia which cause fatigue and tiredness and make it hard for the mother to relate to her baby (Bennett & Indman 2003). Another area of risk concerns sleep, concentration and anxiety. Kathy’s sleeplessness, lack of focus, and anxiety makes her vulnerable to accidents (Day 2007) and hence I will urge her to avoid driving or using machinery for a while. In this case, she needs someone to help her carry or watch over the baby. Moreover, Kathy should try to get some sleep during the night and let her husband or mother feed the baby at some turns (Mauthner 1999). Another way is to move the baby’s crib next to hers so that she can be less worried about how far the baby is, and also experience less disruption in walking a far distance to feed the baby. I will also urge her to sleep when the baby sleeps, or ensure that she gets plentiful of rest during the day. Other skills to adopt include relaxation techniques which can be achieved through hobbies and sufficient rest (Beck 2002). b. The Nurse’ duty of care regarding Kathy's presentation I owe Kathy a duty of care as a nurse because she is my client and I have the skills to deal with her situation. i. Care plan, outcome and intervention for anxiety Kathy suffers from anxiety; related to perceived threat to the self concept that she is in unable to take care of her baby. The anxiety is evidenced by insomnia, nervousness, and inability to concentrate. My care plan is that:- Kathy will demonstrate a decrease in anxiety by: -Reducing the presentation of cognitive and emotional manifestation of anxiety -Verbalizing the relief of anxiety The nurse will discuss and demonstrate effective coping mechanisms for dealing with anxiety. The interventions include:- Assisting the patient to reduce the present anxiety level by: -Providing comfort and reassurance (Beck & Driscoll 2006) -Stay with or recommend company for her -Not making demands or requesting any decisions -Speaking to her calmly and slowly (Day 2007) -Give clear and concise explanations concerning the impeding procedures -Identify and reinforce coping strategies that Kathy has used in the past to overcome anxiety -Discussing the pros and cons of the existing coping methods -Discuss alternative strategies for coping with anxiety -Establish limits on irrational demands -Assist to establish short term goals that can be met -Initiate health teaching and referrals -Placing focus on the present situation (Beck & Driscoll 2006). ii. Care plan, outcome and intervention for sleeplessness Kathy’s sleeplessness is related to life-style disruptions (postpartum mother) and response to anxiety. The week sleep pattern is evidenced by her difficulty in falling and remaining asleep throughout the night, agitation and low mood. My plan and outcome is as follows:- -Kathy will demonstrate an optimal balance of rest and activity with at least 5 hours of uninterrupted sleep at night. The interventions include: -Exploring with the patient the potential contributing factors to her sleeplessness (Declercq et al. 2006). -Urge the patient to maintain bedtime routine as per her preference;-that’s the time she prefers to go to bed at night, quite or some music, darkness or some night light. -Take sleeping pill as ordered by the physician at the designated time -Provide comfort measures to induce sleep. These include a back rub, herbal tea for relaxation, warm milk, pillows for neck support, and bed time snack if appropriate, among others (Simkin 2001). -Coordinate treatment medication to limit interruptions during the sleep period (Declercq et al. 2006). -Increase daytime activity to encourage sleeping at night c. How to use referral pathways to assist Kathy and why these referral agencies are chosen It is important for Kathy to have a referral network if she screens positive for post partum depression. These referrals will be documented and a follow up will be done to ensure that Kathy receives the needed assistance. Many different resources are established and available to postpartum women, and this includes the Postpartum Support International (Zauderer 2009). Other organizations include The Association for Post Natal Illness, British Association for Counselling and Psychotherapy, Perinatal Illnesses UK, and the National Childbirth Trust, among others. The first step is to know the referral sources in Kathy’s locale and especially those that accept her kind of medical insurance, utilize a sliding fee, and will develop a payment plan with the client, as well as offer free counselling. The referral agencies are chosen not only to provide the best available care that the patient needs but also enhance her ease of access to the care (Mauthner 1999). The referral agencies are also to ensure that long-term care is provided and that the patient benefits from the treatment. The referral agencies focus on helping women through education, support and further referrals in the event of difficulties. They also offer support group information, recommended reading lists, conferences, and the list of mental health providers in every geographic location in the region (Zauderer 2009). An agency like the Postpartum Support International has a Web site that has put information about postnatal depression and offers self-help suggestions. Such sites are good for the couple because they can help to access information at their own time and recognize the symptoms, and also help them to feel that they are not alone in their situation (Edhborg et al. 2005). Closing statement Women experience varying experiences, feelings, and attitudes during pregnancy and the postpartum period. In some cases, this is quite normal but in others, the signs and symptoms are strong enough to cause a diagnostic condition. The above evaluation has assessed Kathy’s situation in dealing with anxiety as a gravid 2 para 1 mother. Postnatal depression has been shown in many cases not only to negatively affect the mother to child relationship but also subjects the mother to many harmful risks. It is expected that the care plan and interventions will assist her to overcome the negative feelings and help her cope better in the situation. List of References: Battle, C., Zlotnick, C, Miller, I., Pearlstein, T.,& Howard, M. 2006. ‘Clinical characteristics of perinatal psychiatric patients: A chart review study’ The Journal of Nervous and Mental Disease, 194(5):369–377 Beck, C.,T. 2002. ‘Theoretical perspectives of postpartum depression and their treatment implications, MCN’, The American Journal of Maternal Child Nursing, 27(5):282–287 Beck, C.,T. 2006. ‘Postpartum depression: It isn't just the blues’, The American Journal of Nursing,106(5):40–50. Beck, C. T., & Driscoll, W. 2006. Postpartum mood and anxiety disorders: A clinician's guide. Sudbury, MA: Jones and Bartlett Publishers. Bennett, S., & Indman, P. 2003. Beyond the blues. Prenatal and postpartum depression. San Jose, California: Moodswings Press. Day, E.,H. 2007. ‘Applying the Listening to Mothers II results in Lamaze class. The Journal of Perinatal Education,16(4),52–54 Declercq, E.,R., Sakala C., Corry, M.,P., & Applebaum, S. 2006. Listening to mothers II: Report of the second national U.S. survey of women's childbearing experiences. New York: Childbirth Connection. Cohn, J., Campbell, S., Matias, R., & Hopkins, J. 1990. ‘Face-to-face interactions of postpartum depressed and nondepressed mother infant pairs at 2 months’, Developmental Psychology, 26(1), 15-23 Edhborg, M., Friberg, M., Lundh, W., Widstrom, A.,M. 2005. “Struggling with life”: Narratives from women with signs of postpartum depression, Scandinavian Journal of Public Health, 33(4):261–267 Leahy-Warren, P., McCarthy, G., & Corcoran, P. 2011. ‘First-time mothers: Social support, maternal parental self-efficacy and postnatal depression’, Journal of Clinical Nursing, 1365-2702. Mauthner, N.,S. 1999. ‘Feeling low and feeling really bad about feeling low: Women's experiences of motherhood and postpartum depression, Canadian Psychology, 40(2):143–161. Sheehan, D.V., Lecrubier, Y., Harnett-Sheehan, K., Amorim, P., Janvas, J., Hergueta, T., Baker, R. & Dunbar, G. 1998. ‘The Mini International Neuropsychiatric Interview (M.I.N.I.): The development and validation of a structured diagnostic interview’. Journal of Clinical Psychiatry, 59(20), 22-33 Simkin, P. 2001. The birth partner: Everything you need to know to help a woman through childbrith. 2nd ed. Boston: Harvard Common Press; 2001. Stewart, D., Robertson, E., Dennis, C., Grace, S.,& Wallington, T. 2003. Postpartum depression: Literature review of risk factors and interventions. Toronto: University Health Network Women’s Health Program. Zauderer, C. 2009. Postpartum depression: How childbirth educators can help break the silence’ Journal of Perinatal Education, 18(2), 23-31 Read More