Introduction Postpartum depression is a moderately common experience among mothers either during

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Introduction Postpartum depression is a moderately common experience among mothers either during pregnancy or following delivery. Signs and symptoms are often present, but few women actually accept referrals to mental health care providers. Many women feel uncomfortable, feel they can find ways to manages, fear implementation of medication, or simply feel resources were not presented efficiently. In addition to women being affected, male counterparts or partners in the relationship can also be affected by postpartum depression. Untreated postpartum depression can result in detrimental effects to the mother, child, and spouse relationships. Therefore, this qualitative study aims to focus on care preference of both mother and their partner, which little to no investigation has been done prior (Feeley et al., 2015). Since mental health remains a serious, yet often overseen or even taboo topic; the results of this study are vital to nursing practice to better implement education to patients and really focus on their preferences to possibly see greater acceptance rates of care in future cases of postpartum depression. The research article was written by a group of five well accredited women which include: Nancy Feeley, RN PhD, Linda Bell RN PhD, Barbara Hayton, MD, Phyllis Zelkowitz, EdD, and Marie-Eve Carrier. The women come from different specialties which include professors of nursing, health sciences and, psychiatry, a nursing researcher, and a director of perinatal mental health services. The specialties allow insight and knowledge to form a cohesive understanding of the research information. In addition, the primary researcher is an RN PhD and focusses change in nursing implications and nursing care for patients. To find this article I used the CINAHL database. Initially my searches were focused around PTSD, but one article about PTSD and postpartum depression in mothers who had traumatic labor experiences caught my attention. Unfortunately, the article was unfit for evaluation, but allowed me to adjust my search topic. My search consisted of “postpartum depression AND qualitative study or research”. The initial search brought up 264 articles. I then filtered my search in order to reduce the number of articles. The filters I included consisted of; English language, full text, and publication range 2009-2019. This narrowed the search to 61 articles. I wanted to make this a slightly more manageable number, so I adjusted the publication range to 2015-2019 which brought the search results to 28. Lastly, I looked into articles that interested me and assured that the appropriate criteria were met for article evaluation. Study Design (10 points) The type of qualitative research that was similar to a grounded theory approach but lacked the systematic aspect. The researchers state in the article that no prior studies have investigated both partners care preferences, therefore making an indication of grounded theory. However, the phenomlogical approach seems to the best fit for this study. The researchers primary focus is on patient and partner preferences of care for postpartum depression and focusses heavily on both partners lived experience to uncover and understand their choice of care. Extensive interviews with women and their partners were performed until data saturation was met to ensure that themes of the phenomenon were accurate and complete. I personally believe there are great strengths from using the phenomological approach although their specific research had little to no prior information. One strength I found that was particularly vital to nursing, was simply listening to their preferences and feelings about aspects of care they received, and feel should be implemented. Another strength of a phenomological study is the fact that it is based off the lived experience. There are studies about women with postpartum and their day-to-day struggles, but few focus on the partners lived experience of dealing with and even developing co-occurring symptoms of depression. Although this approach is very beneficial, there are some negative aspects. One that particularly stood out was the previously mentioned statement that no other studies have investigated the preference of both partners. Due to this, a grounded theory could have been a great approach if the research were more systematic. This would allow for replication, and possibly further information to be uncovered in the future. Sampling Strategy (10 points) Participants in the study included women who were less than twelve months postpartum, showed symptoms of depression, and their partner. Participants were divided into two groups, those who accepted, and those who declined referral for mental health assessment. All participants were recruited from hospitals which were approved by the research ethics committee. Both hospitals were located in Canada where the study took place; one was in a more urbanized area where couples were recruited from obstetrical clinics and from perinatal mental health clinics, while the other was a smaller center and couples were recruited just from obstetrical clinics. One requirement for the women was to have an EPDS (depression questionnaire) score of 12+, and offered mental health assessments. Verbal agreement was initial obtained from the patient, and the partner was later contacted for agreement. Once the couple agreed an interview was conducted and official consent was signed. Postpartum women were the primary target of the study, but one aspect that could have affected information was the fact that only from the large urban area participants were recruited within a perinatal mental health clinic. This indicates that the women are interested and actively seeking mental health clinic and have access to the tailored care. This may affect information, as women from the smaller are may not have the access, nor information about recourses and could be more timid in seeking help. One aspect that could have affected the number of participants was that mental health is somewhat of an intimidating topic, where many could feel scared or too vulnerable to seek help. This limits the number of opinions heard that could be vital. Bias was limited as requirements were not too specific, and recruitment areas existed in two types of areas with a focus in OB care. Data Collection (10 points) To obtain data, the researchers conducted interviews that lasted 45-90 minuets. The setting of the interview took place in the participants home. This enriches the data collection as the interviewer can observe the environment of the participant and obtain clues as to what holds value in their life. I feel the use of a naturalistic setting particularly in a study about depression is vital because participants may not feel motivated to leave home, or their home could be a great reflection of the mental state which would be important to observe. Using the participants home also enriches the data due to the fact that it is a safe, comfortable, familiar place for the participant, which could help them express more about their lived experience of postpartum depression without intimidation. In addition, the couples were interviewed separately in separate space of the home by someone of the same sex. This ensure that each partners full experience and individual experience and personal preferences are stated without pressures that may be added by their partner. The implementation of the interviewer being the same sex can also allow a level of comfort for the participant. Open ended questions were used to investigate each partners feelings and preferences of care for mental health. All interviews were transcribed and uploaded into a software for analysis. Each interview was read and analyzed several times during data collection and adjustments were made as needed. Lastly, recruitment occurred until data saturation was met, and each participant was rewarded with a $20 gift certificate for their time. Overall, I fell that the data collection process was conducted very well. The researches followed a professional approach and focused on details of the interview such as setting, and individual interviews to greatly enriches the data as the approaches make the participant feel comfortable and safe to express feelings. The use of open ended questions allows the interview to be guided primarily by the participant and will allow for maximum data. Using trained research staff helps limit the bias of the interview as they have experience with bracketing their personal beliefs to limit bias and will allow the participant to lead the path of the interview. Unfortunately, the questions used were not stated, so the productivity and strength of the open-ended questions is unknown. The research was professional and followed ethics and protocols, therefore if there were breach or an autonomy issue, the study would lose its credibility, make participants feel unsafe, and could be shut down. Credibility and Auditability (10 points) The authors utilized audio recordings and transcription in order to accurately and precisely portray participants quotes, which were located in the results section of the article. The results section focused heavily on the use of quotes, in order to understand each individual experience, and divided them amongst the common themes between participants. Professional and trained interviewers were utilized in order to limit bias through the implementation of bracketing and focus on a participant led interview. The article remains organized and data support for each of the most common patient and partner preferences are easily located, along with further response from the researchers. The researchers do not report any following meetings with participants to clarify meaning of results, which could possibly have left some responses open to interpretation of the researcher. The transcriptions were read over multiple times prior to grouping themes of the participants response. The researchers clearly laid out each of their processes throughout the research, in order to help future studies replicate. Although there was no follow up conducted with participants, I believe that the implementation of audio recordings and transcriptions is a trustworthy method because they are accurately capturing the words and preferences of the women and their partners during the interviews in addition to confirming the team’s consensus. Additionally, the researchers also cite several other sources throughout the article to further strengthen their responses. In the respect of auditability, I believe the researches effectively laid out the research process step by step. Each of the steps from recruitment, to requirements, data collection, and analyzing data was clearly stated to readers. Each decision made throughout the data collection process was discussed and paper trailed by the research team, and they continued the recruitment process until no new data emerged from participants, which was when data saturation was reached. There were four themes identified after analyzing the data collected which include: comprehensive health care, support, activities, and counseling and medication. To support these themes, the results were broken down in to sections of each theme where participant quotes were utilized to connect the evidence to the them. As for the findings, they were concisely stated at the top of the article but went into greater detail throughout the article. Collectively, the authors effectively made the article easy to follow, and eventually replicate the study. They clearly tied in evidence to the themes as well as support to their finding making the article successfully auditable.Fittingness (10 points)Interviews were conducted in the patient’s home with factors to maximize patients comfort in order to gain perspective on the day-to-day experience and each partners preferences of care in regard to postpartum depression. The findings were described in great detail with an abundant number of quotes from both groups whom accepted or declined mental health referrals. The article states that the preferences were similar, although those who chose to accept care showed to have a high want for support from physicians and a clinical setting, while those who declined preferred support from outside sources. The quotes and evidence provided by the researchers clearly identify how this key difference is made, along with each of the other preferences that were developed into themes. Their use of quotes, and evidence from outside sources allows readers to grasp the information and comprehend why each preference was made based on their experience with postpartum. In addition, the article includes a section on how nurses can implement these preferences found amongst the couples, or possibly other patients outside of the study. The primary recommendation is to provide knowledge about postpartum realities in an OB setting, strategies of care, and asses the couple preferences and individualize care and recommendations based upon those needs. Each of these recommendations that stemmed from the finding of the study can be implements among a vast majority of pregnant, postpartum, and even other types of patients. Conclusion (5 points total)The researches provided a great conclusion which focused on limitations and recommendations for future research. Potential research opportunities may utilize this information to provide even greater control of the study which may lead to new information, or simply further solidify the finding about care preferences from this study. The researches also included a section for implications for nursing practice which provides a guide to better care for postpartum women and their partners. It implies sensitivity to the subject, understanding of fears, better patient education primarily in OB setting, and high value on patient preferences. As a nursing student this information provides great insight that I can implement not only to postpartum patients, but many patients I may encounter in the future. As a person, this information also provided insight to postpartum itself, and I thought it was interesting to focus on the opinions of the partners. Often, they are overlooked, but they may experience co-occurring symptoms themselves, or simply lack understanding of how to support their partners due to limit knowledge transferred from physicians. The finding expressed by the partners, I would also implement into a nursing practice. I would focus on education of postpartum and possible options to both mothers and their partner. This would make patients and partners feel less intimidated and supported by physicians and nurses primarily in OB clinics or units. Although I gained a great deal of new knowledge pertaining to postpartum depression care, there are a few things I still would like to know. First, I would like to know difference patients and partners preferences had they received extensive information of postpartum depression and were supported by their doctors. Next, I would like further information on mental health assessments in OB clinic and how that changes views and preferences among patients and their partners. Overall, I feel that researchers conducted a well-planned and ethical study. They limited many biases and maintained control throughput the study which was stated through their detailed decryptions in the article. Interviews were bracketed, recorded and checked to reinforce the trustworthiness of the study. The findings were clear and many quotes from participants were utilized for support. The article laid out clearly as to how the finding of this study can be implemented in nursing care and transferred directly from the study into practice. I gained a better understanding as to why certain decisions are made by individuals and couples, and this will be a great tool that I will implement into my care as a student and eventually and RN.