Risk factors for postpartum depression: the role of the Postpartum Depression Predictors Inventory-Revised (PDPI-R). Results from the Perinatal Depression-Research & Screening Unit (PNDReScU) study.

The aims of this study were to identify the frequency of the risk factors for postpartum depression (PPD) listed in the Postpartum Depression Predictors Inventory-Revised (PDPI-R) during pregnancy and 1 month after delivery and to determine the predictive validity of the PDPI-R. The study used a prospective cohort design. Women completed the PDPI-R at the 3rd and the 8th months of pregnancy and at the 1st month after childbirth. Women were prospectively followed across three different time points during the postpartum using Structured Clinical Interview for DSM-IV Disorders to determine the presence of major or minor depression. The prenatal version of the PDPI-R administered at two different time points during pregnancy predicted accurately 72.6% and 78.2% of PPD and the full version administered at the 1st month after delivery predicted 83.4% of PPD. The cutoffs identified were 3.5 for the prenatal version and 5.5 for the full version. The PDPI-R is a useful and a valid screening tool for PPD.

Meta-analysis: overview and application to clinical nursing practice.

If nursing practice is to benefit from the abundance of nursing research being conducted, a technique is needed to synthesize and integrate the results of individual studies. Meta-analysis, a quantitative approach to literature review, is such a technique. This article provides an overview of meta-analysis. Examples of published meta-analysis studies in obstetric and neonatal nursing are discussed to illustrate the clinical significance of this technique.

The research critique. General criteria for evaluating a research report.

General criteria for evaluating a research report are addressed. This outline of criteria can be used as a guide for nurses in critiquing research studies. A sample research report is summarized followed by a critique of the study. Readers have an opportunity to practice critiquing by doing their own analyses before reading the critique presented in the article.

Fundamentals of obstetric, gynecologic, and neonatal nursing research: Part II.

This is part two of a three-part series on the basics of obstetric, gynecologic, and neonatal nursing research. Research designs and data collection methods are the main focus. Examples of published maternal-newborn nursing research illustrate both of these steps of the research process.

Fundamentals of obstetric, gynecologic, and neonatal nursing research: Part I.

The basics of obstetric, gynecologic, and neonatal nursing research are discussed in a three-part article series. In Part I, the first six steps of the research process, including the research problem, literature review, theoretical framework, variables, hypotheses, and sampling, are explained. Parts II and III will appear in the July/August and September/October 1989 issues respectively. Highlighting each step of the research process are examples from published nursing research in the areas of obstetric, gynecologic, and neonatal nursing.

Screening methods for postpartum depression.

Nine to fifteen percent of women who have recently given birth experience postpartum depression; however, only a small portion of these women are identified as depressed by health professionals. To improve this poor detection rate, a new screening tool, the Postpartum Depression Checklist (PDC), was constructed, based on the findings of two qualitative studies. The PDC is a simple, practical device for use by health professionals that provides an opportunity to engage a woman actively in a dialogue about her experiences with the 11 symptoms included on the checklist. Its use by health professionals during the 1st year postpartum may help to ensure that mothers who experience postpartum depression receive treatment.

Perceptions of nurses' caring by mothers experiencing postpartum depression.

OBJECTIVE: To explore the meaning of nurses' caring for mothers experiencing postpartum depression. DESIGN: Phenomenological research design; in depth, unstructured interviews were conducted. SETTING: The interviews were conducted in the mothers' homes. PARTICIPANTS: A purposive sample of 10 mothers who had experienced postpartum depression. RESULTS: Using Colaizzi's (1978) phenomenological method, the transcriptions of these interviews were analyzed. Seven themes emerged that illustrated nurses' caring for mothers experiencing postpartum depression: having sufficient knowledge about postpartum depression; using astute observation and intuition to make quick, correct diagnoses; providing hope that the mothers' living nightmares will come to an end; readily sharing their time; making appropriate referrals for the right path to recovery; providing continuity of care; and understanding what the mothers were experiencing. CONCLUSIONS: The exhaustive description of caring that emerged from this phenomenological study will help sensitize nurses to issues to consider in caring for mothers experiencing postpartum depression.

A checklist to identify women at risk for developing postpartum depression.

This article describes the Postpartum Depression Predictors Inventory, a checklist to identify women at risk for developing this devastating illness. Postpartum depression wreaks havoc not only on mothers, but also on their entire families. Researchers have reported that postpartum depression has a moderate to large adverse effect on mother-infant interaction. Children older than 1 year whose mothers had postpartum depression have been reported to display more behavioral problems and cognitive deficits than children of mothers who were not depressed. It is crucial to identify and treat women with postpartum depression as early as possible. This problem often continues due to lack of identification. Identifying women at risk and providing early treatment interventions are the first steps in dealing with this problem.

Fundamentals of obstetric, gynecologic, and neonatal nursing research: Part III.

Data analysis, interpretation of data, and communication of research findings are the foci of this third part in a series on the basics of obstetric, gynecologic, and neonatal nursing research. Examples of published maternal-newborn research are included.

Maternity blues and postpartum depression.

OBJECTIVE: To investigate the relationship between maternity blues and postpartum depression in mothers discharged early from the hospital and those discharged after the customary length of hospital stay. DESIGN: A descriptive correlation design. SETTING: 550-bed community and teaching hospital in the midwestern United States. PARTICIPANTS: 49 privately paying, primiparous, American-born women, 18 years of age or older, with uncomplicated pregnancies and vaginal deliveries of healthy neonates weighing 2,600-4,000 g. MEASURES: Stein Maternity Blues Scale and Beck Depression Inventory were used to collect data. RESULTS: No significant differences found between the two groups of mothers; significant relationships found between maternity blues at 1 week after delivery and postpartum depression at 6 and 12 weeks after delivery. CONCLUSIONS: Early discharge appears to pose no threat to psychologic well-being. Primiparas experiencing more severe maternity blues are at increased risk for postpartum depression.

Reliability and validity issues in phenomenological research.

Reliability and validity are two areas where the criteria of logical empiricism appear to be imposed upon phenomenology as a research method. Cross-paradigmatic communication can result in difficulties because the same words may have different meanings. It cannot be assumed that reliability and validity have the same meaning in logical empiricism and phenomenology. Even among the three most frequently used phenomenological methods in nursing research, lack of consensus exists regarding the issues of reliability and validity. In order to help clarify reliability and validity from the phenomenological perspective, Colaizzi, Giorgi, and VanKaam's methodologies are compared and contrasted regarding their stance on these issues. Lincoln and Guba's four major criteria for rigor in qualitative inquiry, truth value, applicability, consistency, and neutrality may offer phenomenologists an appropriate alternative to logical positivists' terminology.

Qualitative research: the evaluation of its credibility, fittingness, and auditability.

The three criteria of credibility, fittingness, and auditability have been focused on in the hope of facilitating the critique of qualitative research. Once criteria that are appropriate to qualitative methodologies are developed, the scientific merit of these research studies can truly be appreciated. If traditional scientific criteria relevant to quantitative studies are used to critique qualitative methods, the development and acceptance of this paradigm-transcending research will be hindered.

Humor in nursing practice: a phenomenological study.

Humor is an important but underutilized resource in nurse-patient interaction. The multidimensional value of humor in providing nursing care has recently begun to receive attention. The purpose of this phenomenological study was to describe the meaning of nurses' use of humor in their nursing practice. Twenty-one registered nurses enrolled in a graduate nursing program described in detail an experience they had using humor in providing nursing care. The 21 written descriptions were analyzed using Colaizzi's phenomenological method. Five themes emerged in which humor was found to (a) help nurses deal effectively with difficult situations and difficult patients, (b) create a sense of cohesiveness between nurses and their patients and also among the nurses themselves, (c) be an effective therapeutic communication technique that helped to decrease patients' anxiety, depression, and embarrassment, (d) be planned and routine or be unexpected and spontaneous, and (e) create lasting effects beyond the immediate moment for both nurses and patients.

Women's temporal experiences during the delivery process: a phenomenological study.

The purpose of this phenomenological study was to discover the meaning of women's temporal experiences during the delivery process. Seven mothers were interviewed on their second day postpartum and asked to describe in depth all their thoughts and feelings related to their lived experiences of time passing during labor and delivery. Colaizzi's phenomenological method was used to analyze the data. The paradoxical and fluctuating nature of women's temporal experiences during the delivery process emerged. Implications for nursing practice are addressed.

Nursing students' initial clinical experience: a phenomenological study.

Nursing students have revealed that one of the most anxiety-producing aspects of their clinical experience is the initial clinical experience. In order to help students through their initial clinical experience, faculty must first understand more fully the meaning of this experience for nursing students. A phenomenological study was conducted to explore the lived experience of nursing students' first clinical experience. Eighteen undergraduate nursing students described in writing an experience they had during their first day of clinical. Data were analyzed using Colaizzi's phenomenological method. Six theme clusters emerged: pervading anxiety, feeling abandoned, encountering reality shock, envisioning self as incompetent, doubting choices, and uplifting consequences. Implications for nurse educators are addressed.

Phenomenology: its use in nursing research.

As nurses begin to recognize the incongruities between their philosophy of nursing and their research methods, growing acceptance of phenomenology as an alternative research method is occurring. This trend is evidenced by the increase in publications of phenomenological research studies in nursing literature. The purpose of this article is to review (a) some philosophical and methodological issues of phenomenology and (b) the use of phenomenology in nursing research. The studies reviewed in this article illustrate the breadth of applicability of this qualitative method for nursing. Phenomenological research has been conducted with persons ranging from adolescents to the oldest old. Diverse clinical specialties of nursing have already proven fertile areas for phenomenological research such as medical-surgical, maternal-child, gerontological, and emergency room nursing.

Grounded theory: overview and application in pediatric nursing.

The grounded theory approach is a valuable research method in pediatric nursing for understanding and explaining human experience. In the first part of this article the steps involved in the grounded theory method are described, with illustrations from published grounded theory in pediatric nursing. The application of grounded theory in pediatric nursing is the focus of the second section of this article. The results of a CD-ROM data base search of the Cumulative Index to Nursing and Allied Health Literature (CINAHL) from 1983 to 1995 are summarized to identify grounded theory research in pediatric nursing conducted during those years.

Qualitative research: methodologies and use in pediatric nursing.

With the increasing number of qualitative research studies being published in nursing journals, pediatric nurses need to understand the different qualitative research methodologies in order to adequately critique these studies and utilize the findings in their clinical practice. Three of the most prominent methodologies in qualitative research are discussed: phenomenology, ethnography, and grounded theory. Examples of published qualitative research in pediatric nursing are described to illustrate each of the three methodologies.

Statistical power analysis in pediatric nursing research.

Pediatric nurse researchers take a serious risk when they design an intervention study with insufficient power. In an underpowered study, the researcher may be testing a genuinely effective treatment but fail to recognize its efficacy. In the first part of this article, the concept of power analysis and how to perform a statistical power analysis are addressed. The second half of this article includes a review of published nursing research studies for the past 5 years in three nursing research journals. Specific examples of pediatric nursing research are highlighted. This review revealed a neglect of power analysis. Nurse researchers need to pay greater attention to statistical power analysis. It is an essential procedure for researchers to use before conducting a study.

Nursing students' experiences caring for dying patients.

Since the 1960s nurse educators have been searching for the most effective approach to prepare nursing students for care of the dying. Studies investigating the effectiveness of death education programs for nursing students have reported inconsistent findings. A phenomenological study was conducted to explore the meaning of 26 undergraduate nursing students' experiences in caring for dying patients. The nursing students' written descriptions of their experiences were analyzed using Colaizzi's (1978) phenomenological method. Six themes emerged from this analysis. While caring for dying patients, nursing students experienced a gamut of emotions such as fear, sadness, frustration, and anxiety. Contemplation of the patient's life and death occurred as the students cared for their patients. In addition to providing physical, emotional, and spiritual support for dying patients, an integral part of nursing students' care involved supporting the patients' families. Helplessness was experienced by the students regarding their role as patient advocates. While caring for dying patients, nursing students' learning fluorished. Educational strategies for preparing nursing students to care for the dying are addressed based on the findings of this qualitative study.