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Sunday, September 26, 2010
Title: By Utilizing Susan Nolen-Hoeksema's Response Style to Negative Life Events Theory to Mitigate Depression, the “Wini, Wally, and Wanda” Program for the Hospitalized Antepartum Woman Finds a Solution
Discipline: Childbearing (CB), Advanced Practice (AP)
Learning Objectives:
Submission Description:- Describe the impact depression has on the hospitalized antepartum patient, (its impact, the ramifications of untreated depression, and side effects of different treatments for depression).
- Apply Susan Nolen-Hoeksema Reaction Style Theory to the treatment of depression. Identify the benefits of utilizing this theory (including the proven efficacy and side effects of distraction in relation to other treatments for depression).
- Explain how the “Wini, Walley, and Wanda” program provided meaningful distraction utilizing creativity and available community resources.
Long term bedrest is a recommended option for 700,000 women with high risk pregnancies. Since we work at a regional tertiary hospital, we frequently provide care for two or three of these long term patients at any one time.
Nursing diagnosis for these patients include possible fetal injury due to pregnancy complications, and possible skin and hematologic complications from prolonged inactivity. These patients are also far more susceptible to mood disorders. One investigator found that 44% of bedridden high risk antenatal patients have at least some depressive symptoms. Of these, 19% will screen positive for a major depressive disorder. (Brandon et al. 2008). Another study stated that while depressive symptoms decline significantly as pregnancy progresses (reflecting better gestational ages and better pregnancy outcomes), depressive symptoms still remained higher than controls, indicating concern “for the psychological state of women who are hospitalized for prolonged periods” (Maloni et al. 2005).
Several studies have recorded that pregnancy stress, antenatal depression and postnatal depression are interrelated. (Austin MP, Tully L, Parker G 2007; Sutter-Dallay et al. 2004; Leigh B, & Milgrom J 2008; Tuohy A & McVey C 2008).
Both antenatal and postnatal depression may have significant implications for the fetus or newborn. Depression may delay prenatal growth; and prematurity and low birth weight occur more often (Field, Diego & Hernandez-Reif, 2006). Women with depression are more likely to report suicidal ideation (Levey, Newport, & Stowe, 2004) to have inadequate weight gain, to underutilize prenatal care, and to abuse substances (Moses-Kolko et al., 2004; Frieder et al., 2008). Babies of depressed mothers have more sleep disturbances (Armitage et al., 2009) and are less responsive to faces (Field, Diego, Hernandez-Reif, 2009). Mothers with depression are less likely to sustain breastfeeding (Dennis CL et al. 2009).
Interventions for depression must be evaluated in light of their risk. Medications in particular carry a risk of fetal harm as well as maternal benefit (A.C.O.G., 2008).
One treatment modality for prenatal depression is distraction. In a large review of self-help interventions for depressive disorders and symptoms, distraction was noted to have one of the best evidences of efficacy (Morgan & Jorm, 2008).
The response style theory of reaction to negative life events (Noel-Hoeksema, 1991) predicts that those who “ruminate” on their depressed mood will amplify depressed feelings. Those who use distraction in response to their depressed mood will attenuate these feelings.
Our goal is to assist our patients to avoid a ruminative reaction to their problem pregnancy and to provide them with meaningful distraction tools. We have designed a three-prong approach. “Wini” provides internet access; “Wally” is a cart designed to play downloadable audible library books (the local library has over 2000 titles); and “Wanda” is a wandering cart loaded with books, movies, and crafts.
Nursing diagnosis for these patients include possible fetal injury due to pregnancy complications, and possible skin and hematologic complications from prolonged inactivity. These patients are also far more susceptible to mood disorders. One investigator found that 44% of bedridden high risk antenatal patients have at least some depressive symptoms. Of these, 19% will screen positive for a major depressive disorder. (Brandon et al. 2008). Another study stated that while depressive symptoms decline significantly as pregnancy progresses (reflecting better gestational ages and better pregnancy outcomes), depressive symptoms still remained higher than controls, indicating concern “for the psychological state of women who are hospitalized for prolonged periods” (Maloni et al. 2005).
Several studies have recorded that pregnancy stress, antenatal depression and postnatal depression are interrelated. (Austin MP, Tully L, Parker G 2007; Sutter-Dallay et al. 2004; Leigh B, & Milgrom J 2008; Tuohy A & McVey C 2008).
Both antenatal and postnatal depression may have significant implications for the fetus or newborn. Depression may delay prenatal growth; and prematurity and low birth weight occur more often (Field, Diego & Hernandez-Reif, 2006). Women with depression are more likely to report suicidal ideation (Levey, Newport, & Stowe, 2004) to have inadequate weight gain, to underutilize prenatal care, and to abuse substances (Moses-Kolko et al., 2004; Frieder et al., 2008). Babies of depressed mothers have more sleep disturbances (Armitage et al., 2009) and are less responsive to faces (Field, Diego, Hernandez-Reif, 2009). Mothers with depression are less likely to sustain breastfeeding (Dennis CL et al. 2009).
Interventions for depression must be evaluated in light of their risk. Medications in particular carry a risk of fetal harm as well as maternal benefit (A.C.O.G., 2008).
One treatment modality for prenatal depression is distraction. In a large review of self-help interventions for depressive disorders and symptoms, distraction was noted to have one of the best evidences of efficacy (Morgan & Jorm, 2008).
The response style theory of reaction to negative life events (Noel-Hoeksema, 1991) predicts that those who “ruminate” on their depressed mood will amplify depressed feelings. Those who use distraction in response to their depressed mood will attenuate these feelings.
Our goal is to assist our patients to avoid a ruminative reaction to their problem pregnancy and to provide them with meaningful distraction tools. We have designed a three-prong approach. “Wini” provides internet access; “Wally” is a cart designed to play downloadable audible library books (the local library has over 2000 titles); and “Wanda” is a wandering cart loaded with books, movies, and crafts.
We plan to evaluate our program in two ways: by our Intelligent Survey scores; and by evaluating our patients’ response to questionnaires specifically designed for this purpose.
