Compassionate Care: Listening Visits Provided by Neonatal Intensive Care Unit Nurses.

PURPOSE: Although mothers of infants hospitalized in a neonatal intensive care unit (NICU) often experience clinically significant levels of depression symptoms, accessing mental-health treatment may be difficult. NICU mothers need emotional support that is conveniently delivered at the infant's point-of-care by a trusted professional who is knowledgeable about the medical and nursing care in the NICU. Listening Visits are an effective and accessible, nurse-delivered depression intervention, yet little is known about what mothers discuss during these sessions. This analysis of sessions recorded during the randomized controlled trial evaluation of Listening Visits in the NICU provides a glimpse into NICU mothers' concerns and experiences. STUDY DESIGN AND METHODS: This is a secondary, qualitative case analysis of the recorded Listening Visits sessions of four depressed NICU mothers as indicated by a score of 12 or above on the Edinburgh Postnatal Depression Scale. The mothers, who were all White, varied in their economic resources, educational level, availability of support, and infant illness severity. RESULTS: Mothers discussed similar concerns and experiences, often at analogous temporal points in the six Listening Visit sessions, as well as one common concern they voiced throughout: family and friends do not understand what it is like to have an infant in the NICU. CLINICAL IMPLICATIONS: For mildly to moderately depressed mothers of infants hospitalized in the NICU, Listening Visits provide a way for bedside nurses to deliver compassionate care by listening to mothers' concerns and experiences.

Postpartum Depression Screening Scale: Its Availability for Use.

OBJECTIVE: A silent health crisis in the United States is the underdiagnosed and undertreated mental health of women related to childbirth. This discussion paper describes the Postpartum Depression Screening Scale (PDSS) with its scoring and interpretation along with its psychometric testing and translations. METHOD: In addition to the studies conducted by the instrument developers, databases were searched for studies where other researchers used the PDSS to assess postpartum depressive symptoms. Studies were included that measured the psychometrics of the scale and studies that reported the translation of the PDSS into other languages. RESULTS: Evidence is presented that the PDSS is a reliable and valid screening scale for use by psychiatric mental health nurses and other health care providers. The scale also has been translated into 14 languages, so it is available to screen non-English speaking mothers. CONCLUSION: Childbirth is one of the most powerful triggers of psychiatric illness in a woman's life. Postpartum depression is a treatable mental health condition, but first, women need to be screened so they can be identified and referrals made. Screening for this devastating mood disorder in new mothers is an essential role of psychiatric mental health nurses and other clinicians so that treatment can be started as early as possible to avoid harmful consequences.

Survivors' Experiences of Hyperemesis Gravidarum.

Hyperemesis gravidarum can result in life-threatening physical and psychological maternal morbidity, including severe dehydration, weight loss, electrolyte imbalance, depression, and suicidal ideation. The reported prevalence of hyperemesis gravidarum ranges from 0.3% to 3.6%. The purpose of this qualitative study was to investigate what blogs can tell us about women's experiences of hyperemesis gravidarum. Thirty-three blogs written by hyperemesis gravidarum survivors posted on Hyperemesis Australia's website were analyzed using Krippendorff's qualitative content analysis method. Clustering was used and yielded 6 themes: (1) debilitating physical and mental health problems: digging deep to persevere, (2) heartbreaking choices, (3) lack of understanding and dismissed, (4) so much guilt surrounding their unborn infant, (5) it takes a village to support women with hyperemesis gravidarum, and (6) warriors and survivors: giving back. Infusion nurses are in a perfect position to provide support and compassionate care for women who are repeatedly coming to the hospital for rehydration treatment. Infusion nurses can validate women's physical and emotional struggles with hyperemesis gravidarum and help to no longer make women feel stigmatized.

The Value of Secondary Analysis for Qualitative Inquiry.

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Posttraumatic Growth after Postpartum Psychosis.

PURPOSE: To explore positive changes in women's beliefs, emotions, and behaviors following their struggles with postpartum psychosis. STUDY DESIGN AND METHODS: This is a descriptive qualitative study of women who experienced posttraumatic growth after postpartum psychosis. We recruited participants from postings on three Facebook groups. Participants sent their stories of posttraumatic growth after postpartum psychosis via email attachment. We used the following five domains from Tedeschi and Calhoun's (2004) posttraumatic growth model to guide our deductive content analysis: Relating to Others, Personal Strength, Appreciation of Life, New Possibilities, and Spiritual and Existential Change . RESULTS: Thirteen women participated. Relating to Others was the posttraumatic growth domain most often described by the participants followed in order of frequency by Personal Strength, Appreciation of Life, New Possibilities , and Spiritual and Existential Change . Partners and family members' support was instrumental in recovery from postpartum psychosis. CLINICAL IMPLICATIONS: When considering the total sample, participants experienced all five domains of posttraumatic growth after postpartum psychosis though not every individual experienced growth in all five domains. Interventions can be tailored to meet the needs of women depending on which phase of recovery from postpartum psychosis women are in, acute, early recovery, or advanced recovery. Advanced recovery is the most appropriate phase to discuss the possibility of posttraumatic growth with women. Such discussion should be done with caution and sensitivity as not all women experience positive growth, and it can be harmful to frame this in a way that indicates or encourages expectation.

Postpartum Preeclampsia: What Can Stories Posted on the Internet Tell Us?

Postpartum preeclampsia has not received the needed attention that preeclampsia has. It is the lesser-known hypertensive disorder but can be just as life-threatening as eclampsia. Because of the scarcity of qualitative research on postpartum preeclampsia, the purpose of this study was to help fill this gap by exploring personal experiences of this dangerous complication as described in online blogs. Using Google search engine, 25 stories of postpartum preeclampsia were located. Krippendorff's content analysis for qualitative data was the research design used. Five themes were identified: (1) Not even on my radar as a new mom, (2) Bombarded with physical and emotional symptoms, (3) Life-threatening situation: Dismissed or misdiagnosed, (4) Heartbroken: Separation from my newborn, and (5) Trust your instincts and advocate for yourself. Advanced practice nurses and other health care providers need to be on alert for postpartum preeclampsia when a woman, who recently gave birth, presents at the emergency department.

Lexicon of Metaphors: An Innovative Approach to Detect the Aftermath of Traumatic Childbirth.

An innovative approach to help mental health providers identify individuals who may be struggling with the aftermath of birth trauma is to become vigilant in listening for metaphors women may use to describe how they have been feeling. Metaphors can provide a safe bridge for individuals to share and work through painful and challenging feelings. This lexicon of metaphors has four sections: impact birth trauma had on breastfeeding, impaired mother-infant interaction, anniversary of birth trauma, and subsequent childbirth. Examples of these metaphors include empty affair, head in a vise, short fuze, severed ties, great pretender, and mental baggage.

Teetering on the Edge: A Third Grounded Theory Modification of Postpartum Depression.

Reported prevalence rates of elevated postpartum depressive symptoms in immigrant and refugee women range from 24% to 82%. A third modification of Teetering on the Edge, a grounded theory of postpartum depression, was conducted to extend this midrange theory to address immigrant and refugee women. Data from 13 qualitative studies that specifically focused on this vulnerable population were included in this modification. Two categories were added to the third stage of Teetering on the Edge: Barriers to Sources of Support and Battling Self and Culture. These new categories shed light on the struggles of immigrant and refugee mothers.

Postpartum Mood and Anxiety Disorders: A Lexicon of Metaphors.

Undiagnosed and untreated postpartum mental health disorders represent a silent health crisis. The aim of this paper was to develop a lexicon of metaphors women use to describe their postpartum mood and anxiety disorders to assist holistic nurses in recognizing as early as possible these struggling mothers. Mothers may not know the medical terminology to articulate their mental health problems and may turn to using metaphors. The metaphors included in this lexicon were obtained from the author's earlier qualitative studies of metaphors women used to describe their experiences of postpartum depression, postpartum panic disorder, and posttraumatic stress disorder due to traumatic childbirth. In this lexicon these metaphors are organized by these three mental health disorders and includes a table of definitions of each metaphor along with examples of the context of the metaphors represented by quotes from the mothers. Metaphors can be keys that open and unlock doors that stand between holistic nurses and their patients. Being attentive to metaphorical language women use to describe how they are feeling after giving birth can be an innovative approach holistic nurses can use to identify these vulnerable women and provide an opportunity to nurture and empower new mothers.

Experiences of Postpartum Depression in Women of Color.

PURPOSE: To examine the experiences of postpartum depression among U.S.-born women of color via an integrative review. STUDY DESIGN AND METHOD: Databases searched were PubMed, CINAHL, Scopus, and PsycInfo. Sample inclusion criteria included qualitative research published in English that explored U.S.-born women of color's experiences of postpartum depression. There was no time limitation on when studies were published. Krippendorff's thematic content analysis method was used. RESULTS: In this integrative review, eight qualitative studies investigating Black and Hispanic women's postpartum depression experiences and eight blog postings were synthesized. Five themes were identified that described postpartum depression experiences of Black and Hispanic women: (1) Struggling with an Array of Distressing Symptoms , (2) Cultural Stigma as a Powerful Roadblock, (3) Complicating Barriers to Seeking Much-Needed Professional Help, (4) Support as a Lifeline or "Just Pulling Yourself up by Your Bootstraps," and (5) Preferences for Help with Postpartum Depression . CLINICAL IMPLICATIONS: Cultural stigma of mental illness plus lack of knowledge of postpartum depression were strong barriers to women of color seeking timely professional mental health care. Nurses can share information about perinatal mental illness with women in cultural communities to help decrease stigma and increase mental health literacy. All health care providers and policy makers need to focus attention on the impact that women of color's economic and social stressors have on their postpartum depression.

Exploring Jordanian emergency registered nurses' experiences of workplace violence: A phenomenological study.

BACKGROUND: Workplace violence against emergency nurses is an alarming hazard in Jordan, as it is globally. There is no prior research exploring the experiences of workplace violence against Jordanian emergency nurses. This study aimed to investigate Jordanian emergency registered nurses' lived experiences of workplace violence from their patients or relatives while working. METHOD: A descriptive phenomenological study was conducted using Colaizzi's data analysis method. Twelve emergency nurses participated in this study and were recruited via two Facebook groups using purposeful sampling. RESULTS: Four themes emerged from the analysis of violence in the emergency department revealed in this phenomenological study: (1) feeling overwhelmed that violence is so common, (2) ambivalent feelings toward patients and their families, (3) The feeling of inadequacy in handling violent situations, and (4) nurses' suffering. DISCUSSION: The findings of this study have practical implications for in-service workplace training programs and may be used to inform potential changes to policies and legislation designed to establish a safer emergency department environment for nurses, patients and their relatives/visitors. CONCLUSION: The findings can help policymakers, healthcare leaders, and managers better understand the consequences of workplace violence to advocate for and establish workplace violence prevention programs and strategies to support nursing staff who have experienced these events.

Avoiding Potential Pitfalls in Qualitative Research Methods.

The Associate Editor provides strategies for authors to use when they prepare reports of qualitative studies.

Narrating Perinatal Obsessive-Compulsive Disorder Through Blogs.

PURPOSE: To describe women's experiences of perinatal obsessive-compulsive disorder (OCD) as written in their blogs. STUDY DESIGN AND METHOD: This qualitative descriptive study examined perinatal OCD blogs identified using Google search engine. Krippendorff's thematic content analysis method for qualitative data was used. The unit of analysis included segments of the bloggers' descriptions of their perinatal OCD. Clustering and dendrograms were used to group the data into themes. RESULTS: Forty-three different posts from women in the United Kingdom, United States, Australia, and South Africa were analyzed. Five themes were identified that described women's experiences of perinatal OCD as told in their blogs: (1) Starting to tighten its grip during pregnancy, (2) Keeping horrific secrets all to themselves, (3) Tortured with terrifying images and thoughts, (4) Driven to compulsive behaviors to protect their infants, and (5) Long difficult road to recovery but so worth it. CLINICAL IMPLICATIONS: Perinatal OCD is a hidden problem that can have negative consequences for mothers and for their infants and families if not diagnosed or if misdiagnosed. There are effective treatments for OCD, but first nurses and other health care providers need to identify the women who are struggling with this anxiety disorder. During the perinatal period nurses can screen women for OCD. Developing a trusting relationship with pregnant and postpartum women is critical for nurses so that their patients can feel safe enough to share their horrific secret thoughts.

Secondary Traumatic Stress and Moral Injury in Maternity Care Providers: A Narrative and Exploratory Review.

Introduction: A significant percentage of maternity providers have experienced secondary traumatic stress following a traumatic birth. Previous studies identified it as an issue, but this literature review is 5-9 years old. In addition, the construct of moral injury has significantly increased our understanding of secondary trauma for military veterans. In the wake of COVID-19, this construct also applies to healthcare providers. Objectives: The present article updates these reviews and compares findings for three groups: labor and delivery nurses, midwives, and obstetricians. The second portion of this review re-examines previously published qualitative research to determine whether moral injury might more accurately describe the experiences of maternity personnel. Methods: A comprehensive review of PubMed, Scopus, Web of Science, PsychINFO, and CINAHL was conducted in June 2021 using search terms such as compassion fatigue, secondary trauma, moral injury, labor and delivery, nurses, midwives, and obstetricians. Forty articles were identified, but only 16 focused on secondary trauma or moral injury. Results: Secondary trauma is a significant concern affecting at least 25% of maternity staff. However, some countries have very low rates, which correspond to low rates in childbirth-related trauma in mothers. Secondary trauma can lead to several symptoms, including re-experiencing, avoidance, negative changes in mood and cognitions, and hyperarousal, which can cause significant impairment. As a result, many providers decide to leave the field in the wake of a traumatic birth. The incidence of moral injury is unknown, but a re-examination of previously published qualitative data suggests that this construct, generally used to describe combat veterans, does describe some of what providers have reported. Acts of omission, i.e., failure to stop the harmful acts of others had long-term negative effects on labor and delivery nurses, consistent with data from military samples. Two possible mediators were proposed: hierarchical and gendered relationships in hospitals and agency of care. Conclusion: The effects of traumatic birth on providers can be severe, including possible psychological sequelae, impaired job performance, and leaving the field. Moral injury expands upon the construct of secondary traumatic stress. This construct better describes the experiences of maternity staff in non-primary roles who witness traumatic births and are often haunted by events that they could not prevent, but often question whether they should have.

Secondary Qualitative Analysis of Moral Injury in Obstetric and Neonatal Nurses.

OBJECTIVE: To investigate the presence of symptoms of moral injury in obstetric and neonatal nurses. DESIGN: A secondary qualitative analysis using an analytic expansion of three primary studies. SETTING: Postal mail and electronic surveys. PARTICIPANTS: I used three primary studies: participants in the first consisted of 78 labor and delivery nurses, participants in the second consisted of 75 nurse-midwives, and participants in the third consisted of 22 NICU nurses. METHODS: I used Krippendorff's content analysis method for qualitative data to reanalyze the three primary data sets. The categories I used in this analysis were the 10 symptoms of moral injury that are assessed by the Moral Injury Symptoms Scale-Health Professionals Version. RESULTS: When combining the three types of obstetric and neonatal participants, the top three most frequently cited symptoms of moral injury were moral concern, guilt, and self-condemnation. For participants in labor and delivery units and NICUs, moral concern was the most often described symptom, whereas for participants in midwifery it was guilt. None of the participants reported loss of meaning in their lives, loss of faith, or religious struggle. Participants who worked in NICUs did not describe any symptoms of shame or difficulty forgiving. CONCLUSION: In addition to the primary symptoms of moral injury, reported secondary consequences of moral injury can include depression, anxiety, anger, self-harm, and social problems. Interventions such as acceptance and commitment therapy are needed to help nurses address the potential for moral injury and repair its effects. Since the COVID-19 pandemic, now more than ever, moral injury needs to be recognized in obstetric and neonatal nurses and not just in the military population.

Postpartum Depression: A Metaphorical Analysis.

BACKGROUND: The reported incidence of postpartum depression in healthy women without a history of depression was 12%, and the prevalence was 17%. A silent health crisis in America is the undiagnosed and untreated mental health of women related to childbirth. Unfamiliar with medical terminology, persons may communicate more effectively by means of metaphors to describe what they are experiencing. AIMS: To examine the language women used to describe their experiences of postpartum depression with metaphors that can provide a valuable source of insight for psychiatric nurses and other clinicians. METHODS: Secondary qualitative data analysis of three primary datasets of postpartum depression was conducted. Metaphor identification procedure was the approach used to analyze the texts for metaphorical expressions. RESULTS: Eleven metaphors were identified that women used to help explain their postpartum depression: being hit by a ton of bricks, being a tightrope walker, living in a nightmare, feeling trapped, being in the middle of the sea, feeling like an alien, being a loner, being a basket case, having cobwebs in the brain, feeling like garbage, and hitting rock bottom. CONCLUSIONS: These 11 metaphors provide a new voice for women's experiences of postpartum depression. As a result, they provide rich insights for psychiatric nurses and other clinicians to help identify women struggling with postpartum depression.

Postpartum Depressive Symptoms and Experiences During COVID-19.

PURPOSE: To identify postpartum depression risk and describe experiences of women in the first 6 weeks after giving birth during the COVID-19 pandemic. STUDY DESIGN AND METHODS: Using a convergent mixed-methods approach, we recruited a convenience sample of women living in the United States who gave birth March 1, 2020 or later from social media Web sites. Participants completed the Postpartum Depression Screening Scale-Short Form and provided written answers to open-ended questions regarding their experiences at home with their new infant. RESULTS: Our 262 participants were on average 32.6 years of age, the majority were White (82%), married or partnered (91.9%), and college educated (87.4%). Mean postpartum depression score was 17.7 (SD = 5.9) with 75% scoring ≥14, indicating significant postpartum depressive symptoms. Qualitative content analysis revealed five themes: Isolation and seclusion continue; Fear, anxiety, and stress filled the days; Grieving the loss of normal: It's just so sad; Complicated by postpartum depression: A dark time; and There is a silver lining. Quantitative and qualitative findings provided a holistic view of women's depressive symptoms and experiences at home with their infants during the COVID-19 pandemic. CLINICAL IMPLICATIONS: Although policies that reduce risk of COVID-19 exposure and infection for patients and the health care team must continue to be implemented, the adverse effects of depressive symptoms on maternal-infant wellbeing within the context of increased isolation due to the pandemic need to be kept at the forefront. Nurses need to be aware of the consequences of women sheltering in place and social distancing on maternal-infant outcomes, particularly on depression and likelihood of breastfeeding.

When Fear Surrounding Childbirth Leads Women to Request a Planned Cesarean Birth.

Fear surrounding childbirth requires a more in-depth understanding from women's perspectives, especially those who request a planned cesarean due to that fear. Therefore, we explored primiparous and multiparous women's lived experiences of fear surrounding childbirth in relation to their decision to request a planned cesarean birth. We used Colaizzi's (1978) phenomenological method to interview 16 women from 4 provinces and to analyze the data. Women expressed numerous fears and most experienced more than one fear. Most feared their baby/babies being injured or dying during childbirth or developing complications themselves. Others feared experiencing a traumatic birth. Women described numerous emotional and physical manifestations of fear, and all believed that a planned cesarean birth would provide more control over the birth process. For some, the birth of their healthy baby/babies began a healing process, whereas others noted that their fear subsided or resolved upon confirmation that they would have a planned cesarean.

The experience of the nurse during the COVID-19 pandemic: A global meta-synthesis in the year of the nurse.

PURPOSE: From its beginnings in China in December of 2019, the novel coronavirus COVID-19 spread and quickly became the center of nursing care and conversation across the globe (WHO, 2020). This meta-ethnographic study was conducted in order to provide the profession of nursing interpretative explanations of a common experience during the care of patients with COVID-19. DESIGN AND METHOD: A literature review focused on the experience of the nurse during the COVID-19 pandemic revealed a total of 13 qualitative studies conducted in China, Spain, Turkey, Iran, Brazil, and the United States. A meta-ethnographic review of these qualitative works, using the method of Noblit and Hare, was then conducted which revealed the experience of the nurse across the globe during the COVID-19 pandemic. FINDINGS: The review revealed strong similarities between the experiences of the nurse across the 13 studies. Given this reciprocal relationship, translations were constructed and synthesized until four new themes emerged outlining the global experience of the nurse during the COVID-19 pandemic. CONCLUSIONS: Despite the differences between the structures of healthcare and government of the six countries represented in this meta-ethnography, the experience of the nurse emerged into a narrative shared by those represented in this study. As the profession of nursing continues to work through ongoing waves of COVID-19, these results will help guide the resources and training provided to nurses on the frontline of care. CLINICAL RELEVANCE: Despite great personal risk, nurses across the globe stepped up to the challenge of upholding and improving the health of the world's people during the COVID-19 pandemic. As health policy, education, and system leaders, we must listen to the common experience revealed in this meta-synthesis and respond by providing the resources needed to improve nursing practice and care.

Postpartum onset of panic disorder: A metaphor analysis.

Prevalence rates of postpartum panic disorder range from 0.5% to 2.9%. New mothers may not know the medical terminology to describe what they are experiencing. Metaphors can provide women with a different voice to help provide a basis for shared understanding with clinicians. The purpose of this secondary qualitative data analysis was to examine the metaphors used by women to describe their panic disorder after birth. Metaphor Identification Procedure was used to analyze the primary dataset. The process revealed the following eight metaphors: caged animal, Coke in my veins, bone-tired, imposter, escape artist, magnifying glass, detective, and hermit.