Racial Cultural Perceptions Associated with PPD - Research Proposal Example

Racial Cultural perceptions associated with PPD Introduction: Some levels of depression are common in all women just after a baby is born; this is referred to as “baby blues”, which occurs because new mothers feel exhausted after giving birth and tend to worry about themselves and their babies. In about 15% of the cases however, the levels of anxiety, fatigue and restlessness may escalate to alarming proportions and is termed as post partum depression (Joy, 2010). While the primary cause for post partum depression is hormonal imbalance, the kind of care received during this period could have a significant impact upon well being and health outcomes. Since social factors also impact upon the health outcomes, nurses who are caring for post partum patients will also have to take into account, the cultural aspects of care. This study proposes to examine the perspective of nurses’ duties in post partum depression and how they can promote health outcomes through the application of the Leininger’s culture theory. Literature review: The birth of a child is associated with dramatic hormonal shifts. During the term of a pregnancy, the levels of endogenous glucocorticoids and estrogens in the body increase; however after the delivery of the child, the level of these hormones suddenly plummets, which causes a temporary hypoactivation in the hypothalamic-pituitary axis, which lasts for several weeks. As Cizza et al (1997) have demonstrated, this suppression of the hypothalamic-pituitary axis tends to be much more severe and lasts for a much longer period in women who are suffering from post partum depression. While the extent of the hormonal impact does contribute to post partum depression, Several studies have shown that a correlation exists between post partum depression and the lack of social support. According to Hagen (2001), new mothers may tend to suffer from post partum depression when they feel that they do not have adequate levels of social support; they may adapt by experiencing post partum depression where they feel emotionally or financially disinvested in their infants. Some of the ante-natal risk factors which have been seen to be conducive towards the development of post partum depression include experiencing depression or anxiety during pregnancy, a previous history of stress, lack of social support, low levels of self esteem, low socio-economic status, single marital status or a poor relationship with one’s partner.(Stewart et al, 2004). Post partum depression could have a potentially detrimental effect on infants, because the children of such mothers tend to have a higher level of cognitive, emotional and behavioural problems, as compared to the children of normal mothers. It is difficult to screen effectively for potential post partum depression in the antenatal stage, because of the multitude of causal factors that could contribute to the problem. Hence, health care practitioners and nurses need to have a greater awareness about the problem and the potential available in local areas which might be available to treat the problem. Leninger’s theory of culture playing a role in post partum depression developed on the basis of clinical experiences which suggested that nursing knowledge and practice in the area of post partum depression might be lacking in that it neglected to take into account, i.e., the role played by culture, which is a holistic concept, in contributing to the clinical condition. Early in her experiences of clinical care, she realized that “care”, especially as perceived by the patients, was a central concept in nursing. As George (2002) has pointed out, Leininger was shocked as she realized that some of the recurrent patterns in the behaviour of children was actually rooted in the culture they belonged to; as a result she deduced that a lack of understanding and knowledge in nurses about cultural elements in the provision of care could well be the missing link in a nurse’s understanding of the different variations required in order to ensure an outcome of well being and health. Leininger derived a new approach to care, which she referred to as transcultural care and described as a branch of nursing focusing on “comparative cultural care, values beliefs and practices” of individuals or groups belonging to similar or different cultures with the nursing objective of providing “culture specific and universal” nursing care practices that would contribute towards the health and well being of the patient, and help them to “face unfavourable human conditions, illness, or death in culturally meaningful ways.” (Leininger, 1995:58). Leininger thus highlighted an important aspect of nursing, i.e., the cultural elements that must be taken into account in nursing practice and the extent to which they influence nursing outcomes, especially as they are reflected in the nurse and patient interactions. Leininger’s theory is notable in that it combines the concept of culture which is derived from anthropology as well as care which is derived from nursing and thus presents a new angle to nursing, i.e., culture care. The premise of this theory, a spout forward by the author, is that of providing a culturally congruent standard of care, i.e., that health care practitioners should fully discover the meanings, patterns and processes of care within the content of the cultural background of the patient, because this would not only help to explain what kind of care would be the best to promote the health of the patient but would also be the best predictor of health of the person (Leininger, 1998). This approach addresses the cultural dynamics of a nurse-patient relationship and allows for a broader application of nursing practice because it provides a holistic approach to care. Applying Leininger’s approach, the nurse provides the patient with culturally congruent care and Leininger set out how this would refine the nurse patient relationship as follows (Leininger, 1981): (a) The nurse and patient work together in a creative manner to design a new or a different care lifestyle for the patient, which will use professional as well as broad based generic knowledge (b) The knowledge of care and the attendant skills will be re-patterned in a manner such that they can conform o the best interests of the clients Thus, the important aspect of this approach is that the nurse and the patients work together in order to identify and plan the relevant caring modes to ensure that the care provided is culturally congruent and then these caring modes are implemented and evaluated for their efficacy. Methodology: The research method used in this study is necessarily qualitative, because the objective is to examine subjective feelings and experiences of the patients who are the participants in this study. The detailed phenomenological approach which has been set out by Colazzi will be used to guide the inquiry in this study and arrive at an assessment of the subjective attitudes of the participants. Colazzi has put forth a seven step approach, which was successfully used in a study specifically targeted at adolescent mothers who are often the victims of post partum depression (Clemmens, 2002). In this study, each of the participants spoke into an audio tape and described their experiences of pregnancy and the attendant feelings they were experiencing. The first step was to collect these transcriptions on audio tapes and listen to them. This allowed the researchers to gain a preliminary idea, which was supplemented through the preparation of a written transcript of the audio tapes; a reading of these transcripts provided the researchers with a feeling for them. The third stage was formulating meanings from the text that reflected the significant statements and phrases contained in them. The fourth stage involved gathering these formulated meanings into themes of clusters. The fifth stage involved the reviewing of the themes and a comparison to the meanings formulated earlier, in order to ensure that they truly reflected the content that was described. The results arising out of this data analysis process were then integrated into an exhaustive and detailed description of the post partum depression that was being studied. The seventh and final stage of the process was the validation of the meaning of the data by taking it back to the original participants and reviewing it with them and gathering any additional comments or input that was proffered. This study proposes to utilize a similar procedure in carrying out an exhaustive validation of each step of the seven stage process Colazzi suggests for collection and analysis of data. This study will however, be carried out from the perspective of the nurses rather than the patients themselves. While a quantitative approach would tend to view reality as objective and singular, reality is subjective and multiple under the qualitative approach (Hussey and Hussey, 1997:48). It is based upon constructivism and multiple truths are assumed under this approach (Sale et al, 2002). Reality could assume various shapes and forms, because reality is viewed as being socially constructed rather than one objective reality. In this method of data analysis, the researcher and the object of study are linked with each other, and reality is derived from both researcher and participants. The methods used in such research studies are in-depth focus interviews using small sample sizes, because participants are not necessarily representative of a larger group but because they are able to provide important information (Sale et al, 2002:45). This will be a purposeful study, using a small group of 10 nurses specifically working in North east Ohio, who deal with post partum patients. Qualitative data is primarily concerned with the collection of individual opinions and the preferred method that is often selected for use with this kind of research is structured or semi structured interviews (Trochim, 2001). The structured or semi structured interview is a favoured research tool in qualitative analysis, because it allows for the collection of detailed and exhaustive information from participants, which can help to provide insight into the research problem (Wilkinson and Birmingham, 2003). Semi structured face to face interviews will be conducted in this study with the ten nurses who are the participants. This questionnaire will include open ended questions, in order to facilitate discussion and elicit as much information as possible from the nurses on their experiences of providing care to patients of post partum depression. They will also be questioned on the extent to which they have incorporated a sensitivity to and understanding of culture in administering treatment to their patients. Qualitative research is “endlessly creative and interpretative”, and a researcher needs to construct a “qualitative interpretation” through methods such as indexing and moving to a research text, which consists of notes and interpretations which are based on the field text.(Denzin and Lincoln, 2000: 37). In this study, the proposal is to interview the patients and collect notes on the experiences that the nurses have experienced with the post partum patients. Since the semi structured interview consists of open ended questions, it is likely that the nurses will be free and informative in expressing their experiences and indicating what procedures or processes they have found to be useful in their nursing experience. These responses will be analysed both orally and through their written transcripts, and then grouped into clusters, to identify the prevalent themes and arrive at an assessment of the extent to which cultural sensitivity has been incorporated into the treatment approaches. Conclusions: Existing treatments for post partum depression have mostly been framed around the hormonal bases of the condition and medication has been devised accordingly. It appears likely however that this study will reveal some limitation in the understanding of these patients about the impact of cultural issues on ensuring the success of health outcomes. As Leinginger’s cultural approach reveals, when nurses are endowed with an understanding of the cultural backgrounds of the patients they treat, they are better able to interact with them and ensure that the underlying causes of the depression are addressed. The results obtained from this study will be analyzed in order to determine (a) the extent to which nurses understand the importance of cultural sensitivity in administration of care (b) the extent to which they apply that cultural understanding and (c) any limitations that exist. Applying the Colazzi’s seven step method will provide a wealth of information that will enrich the process of analysis of the data that is collected from the nurses. Based upon the findings above, the study will be able to arrive at an assessment of how nurses in north east Ohio are tackling the issues of cultural sensitivity and their attitudes towards their patients who are from different cultural backgrounds than their own and how they have treated such patients in the past. Based upon the results that are derived from the qualitative analysis and the clustering process that will identify the most important themes that are to be addressed, it would be possible to arrive at recommendations on how to improve the existing training practices for the nurses in Ohio who are the subjects of this study. The results of this study could add to the pool of knowledge already available on post partum depression, so that the nurses would become aware of how they can provide a holistic system of care that not only includes medicines, but also includes the background care that the patients would be able to understand and appreciate because it conform to the backgrounds that they come from. In the United States in particular, which is a multicultural nation containing individuals from different cultural backgrounds, the dynamics of the interaction between nurses and patients is likely to be considerably improved through the application of Leininger’s integrated cultural care approach, because it would enable the provision of a holistic system of care that addresses not merely the clinical causes of the problem, i.e., the hormonal imbalances, but also addresses the social aspects of the problem. Since the anxiety and depression associated with post partum depression is closely linked to the patient’s emotional state which may be strongly influenced by the social interactions of the individual with the surrounding environment, it may be beneficial in promoting a higher level of positive outcomes in health and well being of the patients of post partum depression. References: Cizza G, Gold PW, Chrousos GP, 1997. “High-dose transdermal estrogen, corticotropin-releasing hormone, and postnatal depression”, Journal of Clinical Endocrinal Metabolism, 82: 704. Clemmens, Donna A, 2002. “Adolescent mother’s depression after the birth of their babies: weathering the storm”, Adolescence, Fall 2002. Denzin, Norman K and Lincoln, Yvonna S, 2000. “Collecting and interpreting qualitative materials”, Sage. Hagen, Edward, H, 1999. “The functions of post partum depression”, Evolution and Human Behaviour, 20:325-359. Hussey, J.I. and Hussey, Roger, 1997. “Paradigms: analyzing qualitative data”, London: Macmillan Press Joy, Saju, 2010. “Post partum depression”, Retrieved June 25, 2010 from: http://emedicine.medscape.com/article/271662-overview Leininger, Madeleine M, 1998. “Leininger’s Theory of Nursing: Cultural care diversity and universality”, Nursing Science Quarterly, 1:152-160 Leininger, M. M, 1995. “Transcultural nursing: Concepts, theories, research, and practice”, (2nd ed.). New York: McGraw-Hill. Leininger, M. M. (1981). Transcultural nursing: Its progress and its future. 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