IntroductionThe groundwork of nursing and the building blocks on which it is

IntroductionThe groundwork of nursing and the building blocks on which it is assembled is the concept of theory (Marsh, 2013). Nurses have the knowledge and capability to apply theories along with conceptual frameworks to utilize within their practice (Marsh, 2013). The result is an effective multidisciplinary approach to patient care research along with implementing evidence based practice within the clinical setting (Marsh, 2013). Cheryl Tatano Beck created a middle range theory on postpartum depression that can be implemented by all providers and caregivers involved in perinatal and postpartum care (Marsh, 2013). Her theory was created after the recognition of a limitation on research on the topic of postpartum depression (Marsh, 2013). The theory consists of four different phases which occur during the postpartum phase that relates to the concept of losing control (Marsh, 2013). She ensured through proper implementation of her middle range theory the entire female population would be represented by the research she conducted (Marsh, 2013). The principle of this paper is to utilize a set of concepts that can be implemented as a screening tool prior to a diagnosis of postpartum depression. In order to obtain this goal, patients must be educated before giving birth to their child, additionally, assistance in identifying resources must be obtained as soon as possible. Twenty percent of the female population suffer from postpartum depression (Marsh, 2013). Postpartum depression occurs after giving birth to a child (CDC, 2017). The intensity of feelings, along with the duration and how deeply they are felt vary from woman to woman (CDC, 2017). Common hallmark signs and symptoms used to diagnosis postpartum depression include: crying on a regular basis, frustration, isolation, not creating a bond with your baby, fears of hurting your baby, and feeling incapable of caring for your baby (CDC, 2017). Postpartum depression has a stigma related to diagnosis within society (Ruybal and Siegel, 2018). Patients blame themselves for this devastating diagnosis along with facing feelings of inadequacy and not being a joyful new mother (Ruybal and Siegel, 2018). Diagnostic tools exist in order to clinically diagnose a patient with postpartum depression although, a screening tool would be beneficial to utilize with all patients. The purpose of this paper is to develop an innovative screening tool in order to guide early diagnosis along with education and prevention of postpartum depression. This tool will be based on Beck’s postpartum depression theory as its guide. The widespread epidemic of this diagnosis impacts patients across the world. The screening tool would allow providers in the healthcare field to identify high risk populations along with patients who are at increased risk to develop postpartum depression while fostering a dialogue between patients and providers on a currently taboo topic. Overview of the Program The sole purpose of this screening tool is to allow patients to recognize and identify early signs and symptoms of postpartum depression. This will also assist providers recognizing the patients at risk and referring patients to seek additional medical assistance. The tool can be executed by any provider. Examples include, but are not limited to, a nurse practitioner, a primary medical physician or an OBGYN. The population the tool can be demonstrated on includes all females who are in the postpartum phase, or after delivery of their infant. It should be stressed this is only a screening tool and should not be used to diagnose a patient but to guide or assist providers on the possible development of postpartum depression as well as the increased area of the population at risk of diagnosis. The screening tool is a questionnaire that includes a series of questions pertaining to risk factors of postpartum depression. Answers are given a value whether yes or no after the questions are asked. Patients are identified according to low, intermediate. or high risk based off of the number of questions that are answered with a yes by the patient. The tool can be used while that patient is still in the hospital after delivery of their infant. Although it is proven that postpartum depression symptoms do not develop until approximately two weeks postpartum (Bass and Bauer, 2018). This screening tool can acknowledge if the patient is at an increased likelihood to develop postpartum depression in the coming weeks after being discharged home. At approximately twenty four hours after delivery the provider can check on the patient and ask for permission to review the screening tool. Written consent must be obtained by the patient in order to utilize the tool. Prior to asking questions from the screening tool the provider must ensure the patient has no questions or concerns. Questions and concerns should be addressed prior to the screening tool. This confirms the provider and the patient have all of their attention on the questions and answers to them. The questions are as follows: Have you ever been diagnosed with depression, anxiety, or bipolar disorder? Has anyone in your family been diagnosed or suffered from postpartum depression? If applicable, did you suffer from postpartum depression or from what you believe could be postpartum depression with your other children/child? Have you ever suffered from physical or verbal abuse in the past? Are you a single mother? Would you be able to acknowledge if you were not properly bonding with your newborn? A previous diagnosis of depression is the single most critical risk factor in the development of postpartum depression (Bass and Bauer, 2018). Risk factors associated with the development of postpartum depression include: does a genetic history already exist with the patient, or has a family member already been diagnosed or suffered from postpartum depression (Bass and Bauer, 2018). Having more than one child can also be associated with development along with facing any form of abuse (Bass and Bauer, 2018). The lack of a support system or being a single mother can contribute to being diagnosed due to the feeling of isolation and loneliness (Bass and Bauer, 2018). Inadequate bonding with their newborn can be a sign or symptom of postpartum depression that the patient should be able to recognize if that exists (Habel et al., 2015). The identification of the patient rated as low, intermediate, or high risk depends on the amount of questions the patient answers yes to, if the patient states no to all questions she is at low risk for postpartum depression. If she answers yes to two or more questions, then she is an intermediate risk for being diagnosed with postpartum depression. If she answers yes to three or more of the six question she is at high risk for developing postpartum depression. The next step of the screening process should be to discuss the results with the patient. The screening tool consist of six questions which is minimal therefore, easy to score immediately and allow ample time to discuss results and educate the patient. Education is pivotal during the next step of discussing results of the screening tool, since the full attention of the woman is on the provider discussing her results. The definition of low, intermediate, and high risk should be revealed. If low risk, it does not necessarily rule out the patient from developing postpartum depression per the screening tool. All of the risk factors for development are not immediately present. Intermediate and high risk results reveal several risk factors are present therefore, the patient is at an increased likelihood for postpartum depression to progress over time. Providers should educate patients on the signs and symptoms of postpartum depression, along with notifying community resources to identify for help and assistance if those symptoms are experienced. Patients should be able to verbalize some common signs and symptoms including: excessive tearfulness, anxiety, feelings of guilt, exhaustion, and desperation (Habel et al., 2015). The education will be reaffirmed with confirmation of verbalizing signs and symptoms and to notify a provider for assistance if symptoms are experienced. Overview of Theory Cheryl Tatano Beck, creator of the middle range theory on postpartum depression concentrated her research for twenty years on the concepts of anxiety along with postpartum disorder (Marsh, 2013). In the year of 1993, she was able to publish her theory which she named, Teetering on the Edge (Marsh, 2013). In order to further explore postpartum depression Beck conducted a study to analyze the psychological and social aspects of postpartum depression (Marsh, 2013). She met with a group of women for a year and a half to discuss the ladies and their individual involvements they faced with postpartum depression (Marsh, 2013). The group consensus revealed a feeling of the inability of control whether pertaining to oneself, feelings, beliefs and or actions (Beck, 1993). She was able to reveal that patients travel through four different stages relating to the loss of control (Beck, 1993). The first step is the feeling of being unable to escape or feeling as though they are stagnant and enclosed within their mind (Beck, 1993). Women are unable to sleep and suffer from panic attacks and begin to think in a compulsive manner, as if they are unable to shut their minds off (Beck, 1993). The second step is the loss of one’s true self or identity (Beck, 1993). Separation from others can occur as a loss for the things the patient enjoys including hobbies, family. and friends (Beck, 1993). The result of stage two can be thoughts of death or harming themselves or their baby (Beck, 1993). The third stage consist of a constant overexertion by the patient (Beck, 1993). A constant struggle occurs and it becomes difficult to complete activities of daily living (Beck, 1993). Feelings occur of irritation, rage, and sadness partially due to a lack of support from those surrounding them. A support group is key at this stage (Beck, 1993). The final stage is where control can be re-claimed by the woman although mixed emotions are still present (Beck, 1993). There are fears of depression and its cycles occurring again along with the sense that time has slipped away in addition to a loss of precious time with their infant (Beck, 1993). In addition to these four stages Beck, has completed other research that consists of tools and a depression inventory system (Marsh, 2013). She reveals up to twenty-two different aspects including factors that are commonly seen in patients along with projections, signs, and symptoms (Marsh, 2013).Use of the Theory to Guide Program DevelopmentThe postpartum depression theory can be utilized with the screening tool implemented to prevent the further development of postpartum depression. The tool is a screening process to identify the population at risk and the common risk factors identified throughout women, increasing the likelihood of postpartum depression. The stages of Beck’s theory that exacerbate the concept of losing control increase in severity as every stage advances, producing further symptoms that can lead a woman into a mental breakdown (Beck, 1993). Women during the peak of postpartum depression feel as though their sanity is being lost along with their identity which in turn can lead to harm of the infant or themselves (Beck, 1993). The simplicity of a proactive screening tool with six questions can allow providers to shed light on those patients that may require further assistance or guidance while caring for their newborn infants. While the postpartum phase progresses mothers facing postpartum depression fail to form an attachment or bond with their infant (Silveira, Ertel, Dole, and Taber, 2015). This can result in devastating effects. The mother can face bouts of further depression along with neglect in caring for the infant (Silveira et al., 2015). Due to continued neglect over time and if help is unable to be received or refused the infant may face neurological developmental delays along with a stunt in growth due to isolation from his/her mother (Silveira et al., 2015). Barriers to assistance for postpartum depression may be the result of stigma within society (Deren, Benn, Balbierz and Howell, 2017). Stigma can also result from the patients including a personal feeling of embarrassment, worry or concern at the idea of requesting help for a mental health issue (Deren et al., 2017). The screening tool questionnaire being utilized promptly at the beginning of the postpartum stage will be key to prevent females from facing all of the stages of Beck’s postpartum depression theory. The tool will allow early identification of risk factors and utilization of resources and education. The key to preventing stigma whether internal or societal is to create an open dialogue of communication. This dialogue will allow providers and patients to openly speak about postpartum depression and the severity of its effects. Patients over time will develop comfort and a willingness to discuss any possible signs and symptoms that may be exhibited as well as allow the provider to navigate a diagnosis with them. If the screening tool identifies an intermediate to high risk not only should education about postpartum depression signs and symptoms be discussed, but resource utilization should be addressed as well. The patient should be left with contact information for support groups, providers specializing in postpartum depression, along with the provider contact information. An abundance of resources gives the patient options to utilize for help if she begins to exhibit symptoms. As a provider the screening tool along with the information being provided to the patient yields protection for herself and her infant.Conclusion Giving birth to a child is one of the many miracles that occur daily within the world. Although feelings of joy and happiness occur, there is an increased vulnerability to emotions of varying degrees (Abdollahi, Lye, and Zarghami, 2016). Postpartum depression has the capacity to set in several weeks after birth and can reach its peak four months after delivery of an infant (Bass and Bauer, 2018). The devasting effects of postpartum depression can not only impact the mother of an infant, but effects may ultimately reach the infant due to neglect and detachment (Silveira et al., 2015). Beck’s theory on postpartum depression sheds light on the four stages of losing and gaining control that are experienced by women during postpartum depression (Beck, 1993). The neurological and emotional roller coaster that ensues with the struggles that are postpartum depression are unique and tragic to a mother and an entire family unit. In order to prevent the severity of postpartum depression, prevention and early diagnosis are critical. An original, unique screening tool was created consisting of six questions focusing on the mother and her risk factors for postpartum depression. This questionnaire demonstrated by providers after delivery of an infant can be the key to identifying women at risk for developing postpartum depression. The assessment of risk factors along with early education on the symptoms of postpartum depression can have beneficial effects on the population as a whole. This can result in significant identification of postpartum depression along with primary interventions and preventing the mother from undergoing all four stages of Beck’s postpartum depression theory. An open communication between patients and providers on the topic of postpartum depression can eliminate stigmas along with any societal taboos. Immediate identification along with medical interventions and community resources can be the key to preventing an increase in the number of women facing postpartum depression in the world today.

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