Theses and Dissertations at Montana State University (MSU)
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Item Quality improvement project: implementing a standardized postpartum depression screening protocol in an outpatient pediatric setting(Montana State University - Bozeman, College of Nursing, 2024) Leaphart, Kassie Marie; Chairperson, Graduate Committee: Benjamin J. Miller; This is a manuscript style paper that includes co-authored chapters.Background: Postpartum depression (PPD) continues to be a common condition following childbirth affecting 1 in 5 birthing parents during the postpartum period. The American Academy of Pediatrics (AAP) recommends screening birthing parents for PPD at well-child visits within the first 6 months of the infant's life. The Edinburgh Postpartum Depression scale is a well validated tool used to identify postpartum depression in the birthing parent. Local Problem: A site assessment at an outpatient pediatric clinic identified practice differences among the pediatric providers once a EPDS screen was completed. The provider group expressed interest in standardizing their approach with results of EPDS screens. Methods: To increase screening and referral rates by standardizing care when screening birthing parents for PPD with the utilization of a screening protocol tool. Interventions: A screening protocol was adapted and created with targeted interventions depending on the EPDS score and symptoms expressed by the birthing parent. The protocol utilized for this project was adapted by a stepwise approach protocol created by Olin et al., (2017) called "PPD Stepped Care". Additionally, an educational pamphlet with associated resources was created to aid the providers in creating dialogue about PPD during well-child visits. Results: Surveys revealed most staff and providers within the clinic found screening for PPD to be important for pediatric health and well-being. Screening rates and referral practices improved from baseline data after the implementation of the standardized screening tool. The provider group determined continued use of the standardized screening protocol tool in practice beyond the implementation period for this DNP project. Conclusion: This project provided an outpatient pediatric clinic an improved screening process for PPD and standardized a referral process for birthing parents who have been determined positive using the EPDS tool.Item Postpartum depression: standardization of the referral and screening process(Montana State University - Bozeman, College of Nursing, 2024) Liedtka-Holmquist, Diana; Chairperson, Graduate Committee: Lindsay Benes; This is a manuscript style paper that includes co-authored chapters.Approximately 6.5% to 20% of women will experience postpartum depression (PPD), which can have lasting negative effects on both mother and newborn. Universal screening of women for PPD is recommended; however, less than 20% of women undergo guidelines- consistent screening during pregnancy or postpartum. Early identification of PPD through consistent screening, follow-up, and referral can improve maternal outcomes. This project aimed to standardize each part of the process to improve PPD outcomes in a women's health and newborns unit in Western Montana providing comprehensive obstetrics/gynecology, maternal- fetal medicine focusing on high-risk pregnancy and births. The standardized process required RNs to screen all patients with the EPDS (Edinburgh Postnatal Depression Scale), with scores 13 or greater generating an automatic referral to social work. After receiving the referral, social workers follow up with the patient, addressing concerns, providing education to the patient, and referring to additional resources. Following the implementation of the standardized process, the unit saw an increase in EPDS screening rates from 78% to 92%. Seventy-one percent of patients (5 out of 7) who screened positive on the EPDS received a follow-up by the social worker. Postpartum awareness and education materials identifying signs and symptoms of PPD were provided for all patients and families. Having a plan in place for a positive EPDS screen facilitates effective referral and follow-up treatment for women suffering from postpartum depression allowing for the appropriate intervention.Item Screening for perinatal mood and anxiety disorders during well-child appointments: a quality improvement project(Montana State University - Bozeman, College of Nursing, 2023) Buscher, Jennifer; Chairperson, Graduate Committee: Christina BorstPerinatal mood and anxiety disorders (PMADs) are prevalent among birthing individuals. Conversely, PMAD screening rates are insufficient to support assessment, making PMADs the most underdiagnosed obstetrical complication in the United States. This quality improvement project aimed to improve PMAD screening and referral rates within one pediatric clinic. Prior to implementation, the pediatric clinic was screening with the PHQ-2 at 2-month well child checks. The purpose of this initiative was to update the clinic's screening process to align with current clinical practice guidelines as outlined by the American Academy of Pediatrics. The Edinburgh Postnatal Depression Scale (EPDS) was provided to birthing individuals at each 2-week, 2- month, 4-month, and 6-month well-child check appointment. Individuals who screened positive were provided with follow-up support. Over six weeks 152 birthing individuals were present for 2-week, 2-mo, 4-mo, and 6-mo well-child check appointments. Among these women, 129 (85%) were screened with the EPDS. Among those individuals, 14 (11%) had a positive score. Among the positive scores, 8 (57%) were addressed for follow-up recommendations. When following clinical practice guidelines, more birthing individuals were screened for PMADs and referred for follow-up support as compared to the previous screening intervention used by the pediatric clinic which was misaligned with clinical practice guidelines. This quality improvement project effectively increased PMAD screening rates and amplified awareness of the topic. Additional PDSA cycles are recommended to bolster adequate follow-up among individuals scoring positive.Item Improving sleep opportunities in hospitalized postpartum mothers(Montana State University - Bozeman, College of Nursing, 2022) Cantwell, Lindsay Rose; Chairperson, Graduate Committee: Christina BorstSleep deprivation and the fatigue experienced by new mothers remain well-accepted facts of life after the birth of a newborn. In the past, most new mothers utilized hospital nurseries to aid them in caring for their infants after birth; but recent paradigm practice changes in hospitals emphasize rooming-in, breastfeeding, and strongly discourage separation of the mother/newborn couplet. In Baby-Friendly accredited hospitals, postpartum mothers are encouraged to prioritize their infant's needs often above their own, contributing to significant maternal sleep deprivation and fatigue. This quality-improvement project aimed to increase sleep/rest opportunities for mothers through the implementation of coordinated quiet times on a postpartum unit in a Baby-Friendly hospital in the northwestern area of the United States. The Knowledge to Action framework guided this project. Staff received education about the importance of postpartum sleep and the quiet-time practice change. The implementation took place over 4 weeks. Chart reviews were completed, and the mothers who received quiet times were tracked. Practice outcomes included 51% of postpartum moms having a quiet time during week 1; week 2, 64%; week 3, 57%; and week 4, 62%. The quality-improvement project successfully increased sleep/rest opportunities for mothers through quiet times. Prior to the project, there was no standardized effort on the unit to promote maternal sleep or rest. An increase of over 50% during all practice weeks was accomplished. Additionally, there was no significant increase in infants utilizing the nursery, making this intervention viable in the Baby-Friendly hospital setting.Item A pilot implementation of postpartum depression screening guidelines in the pediatric primary care setting(Montana State University - Bozeman, College of Nursing, 2019) Popa, Ryann Christine; Chairperson, Graduate Committee: Susan LuparellStatement of the problem. Postpartum depression (PPD) is a common postpartum complication. This condition can have a negative effect on family wellness and can impact the development of the infant. Unfortunately, it is estimated that only half of PPD cases are ever recognized and diagnosed by providers. Although evidence supports incorporating PPD screening guidelines into well-child visits, the pediatric providers at the project site do not routinely include this screening process in their practice. As a result, opportunities to identify mothers with PPD and provide them with education and resources were being missed. Methods. The project took place at an outpatient pediatric clinic in Montana. Four pediatric providers incorporated PPD screening guidelines utilizing the Edinburgh Postnatal Depression Screening tool into routine well-child checks for children ages 1 to 12 months. Using a data collection tool, providers recording data related to the screening process including the age of the child, whether or not the mother was screened, the EPDS score, and how the situation was addressed if the results of the EPDS were positive. The perspectives and beliefs of the providers were captured using a pre-implementation and post-implementation survey as well as a verbal debriefing at the end of the project. Results. Data were collected on 88 encounters where screening was indicated. Fifty-three of the 88 mothers were screened. Eight screenings were positive which suggested possible depression symptoms. Although providers were in favor of this practice change overall both before and after implementation of the PPD guidelines, some significant barriers and challenges emerged during the process. Discussion. Barriers to incorporating PPD screening guidelines into well-child visits include time constraints, cooperation and willingness of the mother to participate, remembering to administer the screening tool, and repetition of unnecessary screening in mothers who have already been diagnosed with depression. Changes could be made to the design of this project to reduce limitations and improve the implementation process. Overall, this project found that PPD screening at well-child visits has the potential to be feasible and valuable to the practice of this organization.Item Prevention of postpartum depression at an OB/GYN clinic: a translational research project using group interpersonal psychotherapy(Montana State University - Bozeman, College of Nursing, 2018) Donofry, Susana Joy; Chairperson, Graduate Committee: Sandra KuntzBetween one in eight to ten mothers in the United States experience frequent postpartum depressive symptoms. Postpartum depression has a wide range of negative effects on a woman's psychological and social functioning, as well as her family's. Sufficient evidence indicates that an interpersonal psychotherapy group therapy intervention may help prevent postpartum depression in childbearing women. Unfortunately, many obstetrician and gynecologist clinics are not utilizing collaborative-care models that address such mental health needs. The purpose of this project was to (a) translate current best evidence into practice, (b) design and implement an interpersonal psychotherapy group intervention at one Colorado obstetrician and gynecologist clinic, and (c) evaluate the impact of the intervention based on the Edinburgh Postnatal Depression Scale scores at the beginning of the project and at six weeks postpartum. An evidence table was created to evaluate the current best evidence for preventing postpartum depression. A Colorado clinic was selected for its convenient location and sufficient patient population. An intervention was created based on the description of interventions utilized in the randomized-controlled trials that were included in the evidence table. Four women were recruited for the group intervention and only one woman completed the intervention and post-assessment tools. This woman had a clinically significant improvement in her depression scale from pre-intervention to post-intervention. An unanticipated difficulty was the low attendance rate or follow through with the intervention. This project highlights the need for more comprehensive services to prevent and treat postpartum depression. Psychiatric nurse practitioners are optimally placed to coordinate and/or deliver the services in coordination with obstetrician and gynecologist clinics.Item Postpartum depression screening and treatment in a rural setting : an evidence based policy(Montana State University - Bozeman, College of Nursing, 2014) Truesdell, Melinda Marie; Chairperson, Graduate Committee: Kathleen SchachmanDespite years of research and discussion surrounding the impact of postpartum depression, it continues to be under diagnosed and under treated. Many women believe they are failing to handle the stress of motherhood and are embarrassed to seek help. Women living in rural communities have the added pressure of limited access to services and embarrassment related to a lack of anonymity that accompanies living in a small town. Equally important to successfully addressing this pervasive mental health issue is education and engagement of clinicians who provide the bulk of care for expectant mothers and their families. The purpose of this project is to develop a policy utilizing evidence-based screening and interventions which can be initiated during prenatal office and subsequent follow up visits during the first year postpartum.Item Barriers to care for women with postpartum depression : an integrative review of the qualitative literature(Montana State University - Bozeman, College of Nursing, 2013) Tranmer, Ashton Shalene; Chairperson, Graduate Committee: Kathleen SchachmanThe purpose of this qualitative literature review is to examine barriers to care for women with postpartum depression in order to provide a better understanding of ways that healthcare providers can help patients overcome these barriers. Postpartum depression has been identified as the "most common complication of childbearing" (Teng, Blackmore, & Stewart, 2007, pg. 93). It is estimated that between 10% and 20% of all childbearing women will be affected by postpartum depression (PPD) (McCarthy & McMahon, 2008). This disorder not only affects the well-being of the mother, but of the infant as well. As many as 50% of all cases may go unrecognized and untreated. Barriers to care that have been identified include stigma, lack of child care, finances, poor past experiences with healthcare providers, language barriers, failure to recognize own symptoms as PPD, and providers' lack of understanding of the condition (McCarthy & McMahon, 2008). Increasing awareness of these common barriers among primary care providers may enable them to assist patients in a way that will improve health outcomes for both the mother and the infant.Item Interventions for decreasing postpartum depression among adolescent mothers : an integrative literature review(Montana State University - Bozeman, College of Nursing, 2013) Mistretta, Katherine Diane; Chairperson, Graduate Committee: Kathleen SchachmanIt is suggested that adolescent mothers experience postpartum depression (PPD) at a higher rate than compared to adult mothers (Deal & Holt, 1998). With early detection and proper treatment the effects that PPD has on both maternal and child wellbeing can be reduced (Lanzi et al., 2009). However, at this time the most effective intervention for treating or preventing PPD among adolescent mothers is unknown (Yozwiak, 2010). This integrative literature review was conducted in the hopes of determining an effective intervention used to either prevent or treat PPD among adolescent mothers. The literature search included a total of three strategies: electronic database, hand search, and networking, in which nine articles met inclusion criteria and were utilized in the final review. Only articles that met all of the inclusion criteria and that were from scholarly journals were chosen to be included in the review process. After reviewing the included literature, no clear themes emerged indicating the most effective interventions for reducing or treating depressive symptoms in adolescent mothers. Reviewing the findings from these studies did not produce a clear understanding of one particular intervention that can help prevent or treat PPD in adolescent mothers. However, the four studies that showed a decrease in CES-D scores all utilized a type of intervention that offered the adolescents more contact (either direct or indirect) with trained personnel. There is a lack of literature on this topic, and much more research is needed to determine the best intervention for treating and preventing PPD among these young mothers.Item Postpartum depression : a comparison of military and civilian populations(Montana State University - Bozeman, College of Nursing, 2010) Coburn, Brittany Jean; Chairperson, Graduate Committee: Kathleen SchachmanAfter careful review of the literature, a gap exists regarding the prevalence of postpartum depression in the military population compared with the civilian population. It is currently estimated that postpartum depression affects 13% of the childbearing population and over 50% of cases go unnoticed. The purpose of this study was to determine if a higher prevalence of postpartum depression exists in women married to active duty military members compared with women married to members of the general population in rural northwestern Montana. A sample population of 27 women from rural northwestern Montana completed the Postpartum Depression Screening Scale (PDSS) and their results were compared with those from a comparative population of 54 women married to active duty military members from southern Georgia. The PDSS short form was used and consists of seven questions with a Likert type scoring. The possible scores ranged from seven to 35 and a score of greater than 14 indicated that the woman had symptoms of depression. Data were analyzed and the average score and the prevalence rate were determined for each population. The average score for the civilian population was 16.85 with a prevalence rate of 62.96% compared with the military population's average score of 13.7 and prevalence rate of 50%. Demographic data was also collected and analyzed. The prevalence rate for the civilian population from rural northwestern Montana was greater than for the population of women married to active duty military members. Both populations had a greater than average prevalence rate. Possible limitations to the study include a small sample size, the data were collected from different time periods and different geographic areas, economic instability was increasing for the sampling of rural women, rural women were screened in the winter months, and there is limited research regarding the rural woman and postpartum depression.