Nutrition-Related Experiences of Women With Perinatal Depression During the COVID-19 Pandemic: A Qualitative Study.

Women with perinatal depression are at a high risk for unhealthy dietary behaviors but whether the coronavirus disease 2019 (COVID-19) pandemic has exacerbated this risk is unknown. Here we report the findings of a qualitative study exploring the impact of the COVID-19 pandemic on nutrition-related experiences of women with perinatal depression. Using a qualitative descriptive approach, in-depth interviews were conducted with 18 women with a history of perinatal depression and 10 healthcare providers. A semistructured format elicited how food and nutrition-related behaviors of women with perinatal depression were affected by the COVID-19 pandemic. Thematic analysis identified 4 themes related to the COVID-19 pandemic: (1) Adaptations in shopping and cooking behaviors; (2) increases in stress and declines in respite; (3) declines in support and increases in isolation; and (4) low levels of breastfeeding guidance. Our findings confirm the importance of resilience among women with perinatal depression and future research is needed to elucidate the mechanisms connecting resilience and dietary behaviors.

Supporting optimal dietary behaviors in women with perinatal depression: A qualitative exploration of experiences, practices, and challenges.

BACKGROUND: Women with perinatal depression (PD) are at high risk for unhealthy dietary behaviors and suboptimal child feeding practices. Despite evidence supporting the importance of healthful nutrition-related behaviors during and after pregnancy, few behavioral nutrition interventions for women with PD have been developed. The objectives of this study were to identify nutrition-related challenges and needs among women with PD and to elucidate the role that feeding plays in mother-infant interaction, to inform the development of nutrition interventions. METHODS: Using a qualitative study design, in-depth interviews were conducted with 18 mothers with a history of PD and 10 interdisciplinary healthcare providers with expertise in PD. Data were thematically analyzed using a hybrid inductive and deductive coding approach. RESULTS: Mean age of mothers was 31 ± 6 years, 56% identified as non-Hispanic White, and 33% identified as Black/African American. Eighty percent of healthcare providers practiced for more than five years. Six themes were identified: (a) Time scarcity mindset; (b) Importance of social support; (c) Unrealistic expectations of motherhood; (d) Mom as the last priority; (e) Postpartum body changes and shape ideals; and (f) Contentment associated with infant and young child feeding. CONCLUSION: Women with PD have several needs pertaining to their nutrition and that of their children. The findings from this study illustrate key considerations and recommendations for addressing these needs.

Intensive Perinatal Mental Health Programs in the United States: A Call to Action.

Despite the growth of intensive perinatal mental health programs in the United States, too few programs serve women with perinatal mood and anxiety disorders (PMADs). Furthermore, little is known about program operations, services, the women served, and the methods of collecting outcome data. With this Open Forum, the authors aimed to share their investigation of intensive perinatal mental health programs in the United States and offer recommendations to improve services for women with PMADs. The authors recommend forming a national consortium that can foster collaboration to expand existing services and establish a national database to inform program development, evaluation, policies, and funding.

A Stepped Care Model of Patient Navigation to Enhance Engagement with Perinatal Mental Health Care.

During the perinatal period, women are at increased risk for developing perinatal mood and anxiety disorders (PMADs). As perinatal mental health screening efforts increase, significantly more women will be identified who require mental health services. Evidence-based treatments exist, yet many women do not receive adequate care. Patient navigation (PN) offers a promising patient-centered approach to improve treatment attendance and engagement. The purpose of this study is to describe the development of a stepped care PN service at an intensive outpatient program for women with PMADs. Our experience incorporating this model of PN revealed significant features that may guide other treatment care facilities to adopt this service to increase identification and connection to care.

Introducing mother-baby interaction therapy for mothers with postpartum depression and their infants.

Postpartum depression (PPD) and other perinatal mental health disorders have profound adverse effects on maternal-infant interaction and child health. However, standard psychiatric treatment does not necessarily improve the quality of mother-infant interaction. The purpose of this article is to describe the evidence-based CARE intervention and its translation to practice as Mother-Baby Interaction (MBI) Therapy to promote infant outcomes by supporting mothers' sensitive, responsive, and contingent interactions with their infants. Two vignettes illustrate MBI. We advocate that MBI needs to be a requisite adjunct treatment for PPD, and other perinatal mental health disorders, to promote maternal functioning, and positive long-term infant health outcomes.

Introducing Mother Baby Connections: a model of intensive perinatal mental health outpatient programming.

Perinatal mental health problems, experienced by 15-20% of women, are a significant public health issue associated with adverse effects among childbearing women; yet only 20-25% receive adequate treatment. There has been a recent proliferation of intensive perinatal day treatment programs in the United States. To meet this need in the greater Philadelphia area, we introduce Mother Baby Connections (MBC), an innovative interdisciplinary, attachment-focused, intensive, outpatient perinatal mental health program recently launched at Drexel University. The purpose of this paper is to (1) present an overview of MBC, its theoretical framework for services, and its evidence-based components, highlighting the unique factors that differentiate this program from traditional outpatient treatment, and (2) present clinical outcome data utilizing scores from reliable and valid scales, including enrollment to discharge outcomes from 20 months of MBC operation. In sum, outcomes for 20 predominantly minority women with complete measures showed significant improvements in maternal depression symptom severity, maternal functioning, birth trauma symptoms, perceived stress, parenting stress, and emotional regulation. Effect sizes were medium to large (i.e., 0.42-2.00). We conclude that MBC is a viable model for tailored intensive outpatient treatment to foster maternal mental health and functioning during the perinatal period.

The Impact of Kangaroo Care on Premature Infant Weight Gain.

BACKGROUND: Preterm births occur among 11.4% of all live infant births. Without steady weight gain, premature infants may experience lengthy hospitalizations, neurodevelopmental deficits and hospital readmissions, which can increase the financial burden on the health care system and their families. The total U.S. health-related costs linked to preterm infant deliveries are estimated at $4.33 billion. Kangaroo care is a feasible practice that can improve preterm infant weight gain. However, this intervention is utilized less often throughout the U.S. due to numerous barriers including a lack of consistent protocols, inadequate knowledge, and decreased level of confidence in demonstrating the proper kangarooing technique. An integrative review was conducted to evaluate the impact of kangaroo care on premature infant weight gain in order to educate nurses about its efficacy among preterm infants. DATA SOURCES: A literature search was conducted using CINAHL, PubMed, Cochrane Reviews, ClinicalKey and Google Scholar. Large volume searches were restricted using appropriate filters and limiters. CONCLUSIONS: Most of the evaluated studies determined that weight gain was greater among the kangarooing premature infants. Kangaroo care is a low-tech low-cost modality that can facilitate improved preterm infant weight gain even in low-resource settings. Despite its current efficacy, kangaroo care is not widely utilized due to several barriers including an absence of standardized protocols and a lack of knowledge about its benefits. Kangaroo care can become a widespread formalized practice after nurses and parents learn about the technique and its numerous benefits for premature infants, including its association with improved weight gain.

Exercise Interventions to Reduce Cancer-Related Fatigue and Improve Health-Related Quality of Life in Cancer Patients.

Cancer-related fatigue (CRF) is the most common and debilitating side effect of patients receiving treatment of cancer. It is reported that 60% to 100% of patients will develop CRF as a result of the treatment or the cancer itself. The effects last for years posttreatment and lower overall quality of life. The purpose of this integrative review was to determine whether exercise interventions could reduce CRF and improve overall health-related quality of life (HRQOL) among selected cancer patients. Clinical Key, ProQuest Nursing and Allied Health Source, Cochrane Library, Mosby's Nursing Consult, and MEDLINE (Ovid) were the databases searched. Key terms searched were fatigue, exercise, cancer fatigue, holistic, spiritual, quality of life, and prevention. Findings from most studies suggest that exercise can decrease the effects of CRF among cancer patients, leading to an overall improved HRQOL. No negative results on the effects of exercise on CRF were reported. Nurses can be instrumental in developing holistic multidisciplinary exercise programs to assist in the management of CRF and improve HRQOL among cancer patients during and after cancer treatment. Recommendations for future research include the need for larger study sample sizes, a universal definition of fatigue, determination of the best exercise regimens, more consistent fatigue measures to facilitate better comparison across studies, and specifically assess patient improvements in overall mental and spiritual well-being within a holistic framework.

Telephone-Administered Interpersonal Psychotherapy by Nurse-Midwives for Postpartum Depression.

INTRODUCTION: Postpartum depression (PPD) affects 7% to 13% of childbearing women. Access to care may be limited by maternal time constraints and fears of being judged, labeled as mentally ill, and having their infants taken away. The study's objective was to test the feasibility, effectiveness, and acceptability of certified nurse-midwife telephone-administered interpersonal psychotherapy (CNM-IPT) as a treatment for PPD. METHODS: A prospective cohort study was conducted from 2010 to 2014. A sample of women meeting Diagnostic and Statistical Manual of Mental Disorders, Version 4, Text Revision (DSM-IV-TR) criteria for depression was recruited from 8 obstetric practices employing CNMs in the United States. Forty-one women in the treatment group received up to eight 50-minute CNM-IPT sessions, and 20 in the control group were referred to mental health professionals. The main outcome measure was the Hamilton Rating Scale for Depression. Secondary outcomes included maternal and marital functioning, mother-infant bonding, social support, and client satisfaction. RESULTS: The Hamilton Rating Scale for Depression at 8 and 12 weeks was significantly lower among women in the treatment group compared to the control group (Week 8, P = .047; Week 12, P = .029). Client satisfaction was high in both groups. While only 5 out of 8 CNM-IPT counselors continued the intervention until the study's conclusion, CNM-IPT counselor protocol adherence was high. DISCUSSION: CNM-IPT is effective and acceptable as a method of reducing the severity of PPD symptoms. Careful assessment of CNM availability is critical to intervention feasibility. Future research is needed to evaluate translation of this intervention into practice.

A narratology of postpartum psychosis in an Orthodox Jewish woman.

PURPOSE: The purpose of this study was to understand the experience of postpartum psychosis in an Orthodox Jewish woman. DESIGN AND METHODS: A case-based narratology using an unstructured interview was conducted to facilitate the telling of her story. FINDINGS: While the nurses were unable to recognize her symptoms in the hospital, her family members were also unable to recognize escalating symptoms once she returned home, until she became a danger to herself. PRACTICE IMPLICATIONS: Better recognition of symptoms, empathetic connections, cultural appreciation of faith-based rituals and their effect on patient isolation, and education of families and nursing staff may be vital components to successful recovery from postpartum psychosis.

Women's decision-making regarding medication use in pregnancy for anxiety and/or depression.

AIM: To increase understanding of women's decision-making process concerning the medication use for anxiety and/or depression while pregnant. BACKGROUND: Anxiety and depression affects many pregnant women, yet the decision to take psychotropic medication is complex and possibly subject to social oppression. DESIGN: Cross-sectional descriptive survey design. METHODS: A web-based survey was used to collect data from a convenience sample of 143 pregnant women over 3 months beginning in early 2011. An independent t-test was conducted to determine differences in satisfaction between women with high and low levels of emancipated decision-making (EDM). A multiple regression analysis was conducted to determine which subscales of the emancipation scale best predict level of satisfaction with the decision. FINDINGS: The majority of respondents were White, between 25-34 years of age. The group with lower levels of emancipation reported lower mean satisfaction scores compared with those with higher levels of emancipation. Regression analysis showed that the three subscale emancipation model was a statistically significant predictor of satisfaction with the decision and accounted for 54% of the variance in satisfaction. The subconcept of personal knowledge was most predictive of satisfaction with decision. CONCLUSIONS: Women may be able to overcome oppressive forces by using an EDM process. EDM allows them to make a decision that feels right for them and to feel satisfied with the decision.

Learning from business: incorporating the Toyota Production System into nursing curricula.

The faculty at Drexel University decided to investigate a new model to transform nursing education, aiming to produce a new skill set that would serve to improve the transition of nursing graduates from academic settings to practice, to better serve the needs of patients and reduce medical error. Faculty looked to the Toyota Production System (TPS), which has established credibility in industry and health care settings. TPS has demonstrated increased efficiency and effectiveness, reduced cost, and enhanced achievement of stated goals. Drexel University is the first academic institution to incorporate the principles of the TPS into nursing education.

Promoting quality and safety in women's health through the use of transdisciplinary clinical simulation educational modules: methodology and a pilot trial.

This manuscript presents the methodology used to assess the impact of a clinical simulation module used for training providers specializing in women's health. The methodology presented here will be used for a quantitative study in the future.

Transdisciplinary teamwork simulation in obstetrics-gynecology health care education.

This program evaluation was designed to assess whether a transdisciplinary teamwork simulation experience improves collaborative attitudes among women's health students toward the goals of reducing medical errors and improving patient outcomes. This program evaluation used a pretest-posttest comparative design to measure changes in collaborative attitudes among 35 multidisciplinary women's health students before and after a transdisciplinary simulation experience. Collaborative attitudes were measured by the Team Attitudes Questionnaire. Data analysis consisted of descriptive analysis, paired t tests, and post hoc item analysis. Findings suggest significant increases in collaborative attitudes for mutual support and communication but no significant increases in attitudes for structure, situation monitoring, or leadership from pretest to posttest. Trans-disciplinary simulation experiences among women's health students may enhance mutual support and communication and promote better patient outcomes. Future research should focus on mechanisms to facilitate improvements in structure, situation monitoring, and leadership.

The medicinal qualities of Moringa oleifera.

Moringa oleifera is an ancient tree that is historically known to possess numerous medicinal qualities. The purpose of this article is to familiarize nurses with the use of Moringa oleifera in traditional medicine, present the findings of evidence-based studies, and provide implications for clinical practice and further research.

Social energy exchange theory for postpartum depression.

Postpartum depression (PPD), a significant health problem affecting about 19.4% of postpartum women worldwide, may result in long-term cognitive and behavior problems in children, spousal depression, widespread family dysfunction, and chronic and increasingly severe maternal depression. Although current theoretical frameworks provide a rich context for studying PPD,none provides a framework that specifically addresses the dynamic relationship of the inner personal experience with the social and cultural context of PPD. The authors propose the social energy exchange theory for postpartum depression to understand how PPD impedes this dynamic relationship and suggest it as a theoretical framework for the study of interventions that would target intra- and interpersonal disturbance within the social and cultural context.

The role of midwives in facilitating recovery in postpartum psychosis.

Postpartum psychosis, an emergency psychiatric condition affecting one to two women per 1000 after childbirth, can result in a significant increased risk for suicide and infanticide. Symptoms of postpartum psychosis, such as mood lability, delusional beliefs, hallucinations, and disorganized thinking, can be frightening for the women who are affected and for families and obstetric care providers of those women. Women experiencing postpartum psychosis are often thrust into a mental health system that does not capitalize on the close relational bond that forms between midwives and the women they care for over the course of prenatal care. The purpose of this article is to propose using the Recovery Advisory Group Model of mental illness as a theoretical framework for care of women with postpartum psychosis, to assist midwives in recognizing symptoms, define the role of the midwife in treatment, and learn the importance of becoming part of the psychiatric mental health care team in order to facilitate optimum recovery for women with postpartum psychosis.