Nurses Facilitate Change in Medical Practice: Unmasking Postpartum Depression
Article first published online: 14 JUN 2012
© 2012 AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses
Journal of Obstetric, Gynecologic, & Neonatal Nursing
Special Issue: 2012 Convention Proceedings
Volume 41, Issue s1, page S7, June 2012
How to Cite
Schaar, G. L. (2012), Nurses Facilitate Change in Medical Practice: Unmasking Postpartum Depression. Journal of Obstetric, Gynecologic, & Neonatal Nursing, 41: S7. doi: 10.1111/j.1552-6909.2012.01359_1.x
- Issue published online: 14 JUN 2012
- Article first published online: 14 JUN 2012
- Edinburgh Postnatal Depression Scale
Purpose for the Program
When one considers that every year in the United States approximately six million pregnancies occur and up to 20% of women develop postpartum depression, the far-reaching implications of this devastating illness are significant. Despite the many negative consequences associated with postpartum depression, the results from multiple studies that have addressed the screening practices of nurse practitioners, obstetricians, and family physicians suggest postpartum depression screening is not routine practice. The program's purpose was to increase postpartum depression awareness and identification.
In a metropolitan area, prior to starting the program, only one obstetrician in a private practice and two primary care facilities offered postpartum depression screening. The change involved implementing routine postpartum depression screening at the 4- to 6-week postpartum visit in outpatient obstetric practices. The screening instrument used was the Edinburgh Postnatal Depression Scale, a 10-item self-report scale. The training of the outpatient obstetric practices’ registered nurses and office staff also was completed. The educational training focus was comprehensive and emphasized the nurse's role in patient education, screening, and Edinburgh Postnatal Depression Scale scoring. Participating obstetricians agreed to initiate routine postpartum depression screening for 3 months and logging only the patients’ Edinburgh Postnatal Depression Scale score. The goal was that by agreeing to screen for 3 months, routine screening would be so woven into the fabric of postpartum care that the obstetric providers would formally adopt this screening strategy.
Implementation, Outcomes, and Evaluation
Twenty-two obstetricians (82%) implemented routine postpartum depression screening using the Edinburgh Postnatal Depression Scale for 3 months. The percentage of women screened in each practice ranged from 39% to 100%. Five of the nine obstetric practices screened 100% of their postpartum patients. The other four fell below the targeted 90%. Over a 7-month period, a total of 415 women were screened. Of the 415 women screened, 38 (9.2%) had Edinburgh Postnatal Depression Scale scores greater than 13, suggesting postpartum depression. The highest documented Edinburgh Postnatal Depression Scale score was 26 and the lowest was 0. Twenty-one of the 22 obstetricians returned an evaluation letter and 71.4% indicated they planned to continue using the Edinburgh Postnatal Depression Scale as part of their routine postpartum care.
Implications for Nursing Practice
Nurse leaders caring for mothers and newborns should passionately advocate for care that is evidence-based and patient-centered. This project can serve as a model in which nurses can facilitate replication regionally, statewide, and nationally.