NUR702 Developing Evidence-based Practice Essay.

NUR702 Developing Evidence-based Practice Essay.

The student is to critically appraise the studies that are shared in the paper. In addition to identifying 3-5 strong studies that will serve as the evidence base for evidence based practice, the student will also share general study findings related to addressing the problem using alternative interventions.NUR702 Developing Evidence-based Practice Essay. Following your literature review, the student should be able to be knowledgeable about what the studies have found with regards to addressing a clinical problem and be able to ultimately identify the intervention they plan to use. This paper will briefly address the clinical problem, but mainly focus on studies found in the research literature that intervene upon the problem. This paper is NOT about the project you will design in NUR 704, but rather on the intervention you find in the research literature. This assignment will be used to support Chapter 2 in the final written capstone document.NUR702 Developing Evidence-based Practice Essay.

The basic outline for the integrative review of the literature is as follows. This scholarly written assignment is to be formatted following the APA (6th edition).
I. Introduction (5 points). This section should be a very succinct introduction of the clinical problem (Postpartum Depression: Providing Standardize Education to Patients and Families), the proposed intervention (which will be supported by this paper). You will need to share some background information to help the reader understand why the clinical issue must be addressed. The section should conclude with a statement that states “The purpose of this paper is to….” Total length of this section is no more than two paragraphs.NUR702 Developing Evidence-based Practice Essay.
*Note, this section is the first section of your paper which is preceded by a level one heading which is the same as the title of your paper. Do not use “Introduction” as a level one header.
II. Literature Search Methods (Total 10 points) – This section should discuss two major areas of content:
A. Sampling Strategies (5 points) – you used to conduct the search process, such as the databases accessed, year restrictions used, types of studies you focused on, and key terms (PICO elements) used in the search. You need to justify or help the reader understand why you used these strategies (ex. data bases and key terms). Utilize the search strategy matrix you have been using during your search to write this paragraph. Refer to this document in this section (“see Appendix A” or B…).NUR702 Developing Evidence-based Practice Essay.
B. Inclusion/Exclusion Criteria (5 points) – you need to discuss the criteria you used when evaluating and deciding to utilize a piece of literature. For example, article needed to be “published within the last 5 years” or only certain “levels of evidence” would be accepted.
My PICO
Problem: Postpartum depression (PPD) warning signs/symptoms,
Intervention: Providing standardize education to new mothers and their families on recognizing signs and symptoms of PPD,
Comparison: Education vs no education
Outcome: Recognizing early warning signs of PPD.NUR702 Developing Evidence-based Practice Essay.

III. Literature Review Findings (Total 25 points) – this section is composed of two parts:
A. General Findings –
This section generally highlights all possible interventions found in the literature, but should not focus on your chosen intervention. That goes in the next section. This is a broad list of possible interventions found in the literature supported by a brief description of a few of the studies. If there were a lot of interventions found, it is not expected that you describe all of them but a sampling of them. Remember, this is NOT where you are describing your chosen intervention. This should not include the intervention used in your PICO statement but others you have uncovered during your literature review. Be sure to carefully cite all the studies found. Briefly explain why you aren’t using any of these interventions. Add additional level headings as appropriate.NUR702 Developing Evidence-based Practice Essay.
B. Chosen Intervention-
Now introduce/present the 3 to 6 studies that support the exact practice change intervention you are considering (Scales for Educating Patients with Postpartum Depression). Each study should be presented sharing a clear, thorough description of the study including the setting, the sample, the methodology used including the intervention and the study’s outcomes (*Note you must share actual statistical data to reflect the positive outcomes achieved as a result of using the intervention). Utilize your Evidence Matrix you have been completing to write this section. Attach the Matrix in the Appendix. Add additional level headings as appropriate. Be sure to cite your studies. **Remember, there must be evidence to support a practice change initiative. The evidence table-matrix must be submitted with the final version of the assignment as an appendix. There must be at least 3 to 6 pieces of evidence that strongly support your chosen intervention/project.NUR702 Developing Evidence-based Practice Essay.

IV. Discussion – (Total 15 points) – This section discusses three parts:
A. Limitations-Identify limitations of the literature review process – some examples could be you only located literature that seems dated by our standards, there was a lack of published empirical studies on the topic (offer a rationale for using non-empirical studies), there was a lack of studies in nursing but did locate studies in another disciplines, etc. Explain why you needed to expand your search to other disciplines. You cannot say there wasn’t any support for your chosen intervention or else you cannot use it!!NUR702 Developing Evidence-based Practice Essay.
B. Conclusion of Findings- Briefly highlight your chosen intervention. How robust was the evidence? Why did you choose it?
C. Potential Practice Change- Considering the information you provided in section B above, describe a potential practice change you can design for your problem using this intervention –remember, this is just a lead off to what you will actually design in NUR 704

V. Conclusion (5 points) – a short summary of what was presented in the paper. Address “key take aways.” Do not introduce new information in the conclusion.
VI. References
VII. Appendix (Total 10 points)
A. Search Strategy Log- 5 points
B. Evidence Matrix- 5 points

VIII. Structure and Format of Scholarly Writing Assignment (Total 30 points)
A. Written in APA (6th edition) format (10 points)
B. Correct spelling, grammar, and punctuation (10 points)
C. Organization and presentation of content (10 points) – Be sure to use transitioning sentences when moving between sections of the paper. You need to help your reader follow your thinking.
D. This paper should be 12-15 pages (Not including cover page, references or appendix). Maximum pages: 15.NUR702 Developing Evidence-based Practice Essay.

Review of the Literature

Postpartum depression (PPD) is inarguably an incapacitating mental health disorder with a high prevalence of 10-60% globally (Tel, 2018). Post-partum depression manifests in the following ways: appetite changes, concerns about an infant, mood swings, sleep disorders, eating disorder, crying and sadness, difficulty paying attention, suicidal thoughts and lack of interest in routine activities (McCarter-Spaulding & Shea, 2016). In the most severe cases, being hopeless can become life-threatening and result in suicide; which has accounted for up to 20% of postpartum deaths (Zlotnick et al., 2016). NUR702 Developing Evidence-based Practice Essay.

Research suggests that prior education of mothers and their families about postpartum depression promotes early identification of PPD warning signs. This provides an avenue for healthcare providers to institute appropriate measures prompting timely intervention that ultimately influences good patient health outcomes (Ho et al., 2009). However, very little scientific evidence exists to support this finding. This paper purposes to find supporting literature on educating mothers about PPD to promote early identification of PPD warning signs and symptoms using a well-formatted PICOT question. A detailed description of the literature search methods, literature review findings, and limitations of the study will be provided.NUR702 Developing Evidence-based Practice Essay.

Literature Search Method

Sampling Strategy

An initial comprehensive search was conducted in several electronic databases. In the Cochrane database, the keywords postpartum depression, education, signs of postpartum depression were used. The use of Boolean search operators “and” and “or” ensured a more refined search outcome. The search yielded three articles, one that was withdrawn and another that was excluded since it focused on screening for PPD using the Edinburg PPD scale. A search in the PubMed database was also done using the keywords: postpartum depression, education, signs, and symptoms of PPD. This search involved an activation of the following filters: meta-analysis, systematic reviews and RCTs which were published within the last 10 years in the English language. This search yielded a total of 28 articles. When an additional search phrase using the ‘and’ and ‘or’ search operated was added, the number of articles was brought down to 10.NUR702 Developing Evidence-based Practice Essay.

All the reference lists of the articles that were included were searched for relevant articles. The same search strategy was used to obtain additional articles from weekly search updates on PubMed. This search focused more on articles with experimental and non-experimental designs with post-partum depression or psychosocial stability as outcome measures. Systematic reviews that were linked to early recognition of PPD signs and symptoms through education were also considered. All the articles obtained were assessed based on their relevance to the PICOT question.NUR702 Developing Evidence-based Practice Essay.

Inclusion/Exclusion Criteria

The search included peer-reviewed articles that were published in English. These articles were either experimental designs comprising of systematic reviews, meta-analysis and randomized controlled trials or non-experimental designs. The search also included articles whose interventions focused on providing education about PPD to mothers and families with early recognition of PPD signs and symptoms as the primary outcome measure. Therefore, the search excluded all articles that were published beyond the last 10 years, articles in languages other than English and those which included interventions other than providing standardized education to mothers and families. Studies that included other interventions of recognizing early warning signs and symptoms of PPD other than education to mothers and families were excluded resulting in 7 articles. Eight of 31 articles met the inclusion criterion. However, due to the specificity of the subject matter, most articles failed to address the criteria. The articles found were based on the following subjects: standardized education, the significance of support Edinburgh Postnatal Depression Scale (EPDS) use as the most appropriate PPD screening tool.NUR702 Developing Evidence-based Practice Essay.

Literature Review Findings

General Findings

Screening for PPD Using the EPDS

Hanusa et al. (2008) conducted a randomized control study whose purpose was to compare the effectiveness of three instruments used to screen mothers for PPD. The three instruments being tested were: PDSS, EPDS and the PHQ-9. Based on the findings of the study, 135 women were reached, 123 underwent screening, 29 had home visits ad 13 had a mild depressive disorder within 6 months following delivery (Hanusa et al., 2008). Scores were analyzed between 6-8 weeks post-partum.NUR702 Developing Evidence-based Practice Essay.

Diagnoses based on the DSM-IV revealed 8cases of PPD (EPDS), 4cases of PPD (PHQ-9) and 12 cases of PPD (PDSS). When compared with the cut-off points that were used, EDPS was notably the most accurate (p=0.01) in comparison to the PHQ-Q and PDSS tools (Hanusa et al., 2008). After making relevant corrections for verification bias, Hanusa et al. (2008) established that the PDSS and EDPS tools were the most accurate in comparison to the PHQ-9 in screening for PPD. The researchers, therefore, concluded that the administration of the EPDS at 6-8 weeks postpartum is an effective approach of identifying mothers with an increased risk of PPD 6 months postpartum.NUR702 Developing Evidence-based Practice Essay.

Social Support

Most articles discussed the essence of support in postpartum depression. Social support was highlighted as one of the most effective ways that decrease the risks of PPD diagnosis and the associated symptoms. Social support can be provided by close family members, a spouse, friends or even the religious community. A perfect example of how the religious community can provide much-needed support in reducing PPD symptoms before conception was provided by Kieffer et al. (2012) in a study that sought to establish the effect of healthy MOMS lifestyle interventions to reduce the symptoms of depression. This intervention was tailored to provide participants with the necessary social support to live healthily and ensure a reduction in symptoms among Latinos who were pregnant and post-partum. In this RCT, 275 mothers were randomized to either an intervention (Healthy MOMS Lifestyle Intervention) or a control group (Healthy Pregnancy Education). Since the study was culturally tailored, it intended to provide social support from community health workers and peers to promote healthy lifestyles of participants.NUR702 Developing Evidence-based Practice Essay.

How interventions that purpose to provide support which is culturally appropriate influence a reduction in depressive symptoms are also discussed. At baseline, the study participants were vulnerable to depression. However, six weeks later, the depressive symptoms of all the study participants in the intervention group had reduced. The decrease was attributed to the training and social support that was provided by the community workers. On the other hand, Kieffer et al. (2012) emphasized that the symptoms of PPD can increase when social support lacks, especially from immediate members of the family and friends. According to the findings of this study, most women who had conflicts and frequently argued with their spouses or family members experienced more severe symptoms of PPD. Kieffer et al. (2012) found that between the beginning of the study and 6 weeks postpartum, a significant decline in depressive symptoms was experienced although the decline was very marginal in the control group. These findings signify that a community-planned and healthy lifestyle intervention tailored based on culture helps to reduce depressive symptoms among pregnant Latinos.NUR702 Developing Evidence-based Practice Essay.

Addressing Information/Education Needs

Some of the studies demonstrated inadequate knowledge or a lack of education on PPD among new mothers. For instance, in a study that was conducted by Sword and Watt (2005) to establish the learning needs of post-partum women 4 weeks post-discharge, the researchers conducted a cross-sectional survey on the health outcomes, care costs and use of services of women 4 weeks after discharge from hospital. 17% of the participants had a low-socio-economic status. Most women had concerns/learning needs that were yet to be met on signs of illness among infants. Most of these women had a low socioeconomic status. Besides, most mothers in the study wanted more details on self-care upon discharge from the hospital after delivery yet nurses prioritized sharing information on how to care for the baby. According to Sword and Watt (2005), there is a huge difference between what mothers consider to be beneficial information following delivery and what is believed to be useful information by nurses.NUR702 Developing Evidence-based Practice Essay.

In another randomized control trial study was conducted by Ho et al., (2009) whose aim was to establish how effective a hospital discharge education program was in decreasing depression following delivery. This education included information on post-partum depression. The study included 200 mothers who were either allocated to intervention (PPD discharge education) or control group (general education). Ho et al., (2009) used the EPDS as the main outcome measure which was administered through questionnaires at 6 weeks and 3 months post-delivery respectively. It was found that women in the intervention group who received discharge education on PPD had a less likelihood of having high scores of depression in comparison to those who received general post-partum education at 6 weeks and 3 months.

Lower scores of depression among women who were educated about PPD were noted in a randomized control trial that purposed to establish how effective an education intervention to prevent or reduce PPD symptoms was (McCarter-Spaulding & Shea, 2016). The researchers conducted a quasi-experimental study involving 240 participants whereby, the first 120 was the control group receiving usual care and the other 120 was the intervention group receiving an education. Nurses educated mothers who were in the study’s intervention group on PPD post-discharge while those in the comparison group just received routine care and general education about the post-partum period (McCarter-Spaulding & Shea, 2016). Although the researchers found no significant difference in depression symptoms in both the control and intervention group based on the EPDS, it was concluded that a history of anxiety or depression during pregnancy and low socio-economic status are major predictors of PPD (McCarter-Spaulding & Shea, 2016).NUR702 Developing Evidence-based Practice Essay.

Managing PPD Using Interpersonal Psychotherapy

Interpersonal psychotherapy is described as a brief form of psychotherapy that focuses on attachment and aims at addressing interpersonal conflicts and the recovery of symptoms. As a form of treatment with empiric support, it follows an approach that is limited on time and structure and can be conducted for approximately twelve-fifteen weeks (Zlotnick et al., 2016). Interpersonal psychotherapy concentrates on the present as compared to past relationships, challenges, and changes experienced by women during the entire post-partum period. According to Zlotnick et al. (2016), interpersonal psychotherapy is the most effective and useful way of diagnosing women with PPD. The studies obtained did not have many non-pharmacological treatment approaches for PPD. Occasionally, cognitive behavioral therapy (CBT) was mentioned but the researchers centered more on PPD. The study by Zlotnick et al. (2016), sought to establish the effectiveness and efficiency of interpersonal psychotherapy among women who had PPD. Most women who received interpersonal psychotherapy as an intervention turned out to have lesser symptoms of depression in comparison to those who did not receive interpersonal psychotherapy. In the same study, most women preferred interpersonal psychotherapy in case they needed PPD therapy irrespective of whether or not they received medication.NUR702 Developing Evidence-based Practice Essay.

Chosen Intervention- Providing Standardized Education on PPD

Based on the findings of the literature search, several studies demonstrated that inadequate knowledge or lack of education on PPD among new mothers was associated with low socioeconomic status and an increased likelihood of PPD. A perfect example is a study that was conducted by Howell et al., (2012) which purposed to decrease the symptoms of postpartum depression among Latina and black mothers. The researchers conducted a randomized controlled trial on the health outcomes of 540 Hispanic/Latino and African American women using behavioral education intervention approach that was applied in two steps. Majority of the participants generally had a poor socio-economic status. Most women were at risk of postpartum depression as identified by the following factors (lack of social support, lack of knowledge and access to resources, low self-esteem and efficacy).NUR702 Developing Evidence-based Practice Essay. Due to lack of access to resources on postpartum depression, others had unmet learning needs on PPD. Therefore, the researchers randomized the participants to either an intervention (education on PPD) or control group. Education was provided in the form of pamphlets and trained bilingual social workers were present to assist. After 6 months, all patients were assessed using the EPND for PPD. It was found that mothers in the intervention group (education on PPD) had a less likelihood to screen positive for PPD in comparison to mothers in the control group (usual care post-delivery).NUR702 Developing Evidence-based Practice Essay.

In another randomized control trial study was conducted by Hayes, Muller & Bradley (2001) whose aim was to establish the effectiveness of antenatal education in preventing PPD among primi-paras, the researchers’ randomized 206 women the prospective RCT in different settings in Australia. These participants were either allocated to intervention (PPD discharge education) or control group (general education). Hayes, Muller & Bradley (2001) used the profile of mood states questionnaire to assess the participants’ mood state as the primary outcome measure. This questionnaire was administered once during the antenatal period and twice in the post-natal period. The researchers also collected demographic and social support data. Hayes, Muller & Bradley (2001) found that women in the intervention group who received discharge education on PPD had a less likelihood of having high scores of depression in comparison to those who received general education.NUR702 Developing Evidence-based Practice Essay.

Lower scores of depression among women who were educated about PPD were noted in a randomized control trial that purposed to establish how effective an education intervention to prevent PPD (Moshki, Baloochi Beydokhti & Cheravi, 2014). The researchers conducted a RCT study involving 230 volunteer participants who were randomly assigned to an experimental (115 participants) or control group (115 participants). Nurses educated mothers who were in the study’s experimental group on PPD post-discharge while those in the comparison group just received routine care and general education about the post-partum period (Moshki, Baloochi Beydokhti & Cheravi, 2014). The researchers found a significant difference in both groups based on the EPDS. It was concluded that educating mothers on PPD increased their awareness, empowered them and enhanced their ability to internalize common beliefs that control health. This resulted to an overall improvement in psychological well-being and prevented PPD. (Moshki, Baloochi Beydokhti & Cheravi, 2014). NUR702 Developing Evidence-based Practice Essay.

The selected studies highlight that since three out of ten women are more likely to experience PPD and one may go undiagnosed, education is vital. Failure to educate mothers on PPD before delivery increases the likelihood of missed and wrong diagnoses such that depressive symptoms are likely to be confused for baby blues or chronic fatigue and can be left untreated for quite a long time (Howell et al., 2012). Being unable to identify PPD signs and failure to obtain the necessary treatment can result in more serious consequences. Untreated PPD makes one more vulnerable to recurrent psychiatric disorders, creates tension between married couples and can even lead to death. Moshki, Baloochi Beydokhti & Cheravi (2014) emphasizes how educators of childbirth can play a vital role in preventing PPD through education about PPD early signs and symptoms. By educating women and their families on PPD before childbirth, it will be easier to identify the signs and seek timely medical assistance rather than to wallow in feelings of shame and discrimination.NUR702 Developing Evidence-based Practice Essay.

Even though depression can be diagnosed during pregnancy, there are no pretests that can be done to determine whether or not a mother is likely to suffer from PPD after delivery. This explains the significance of educating mothers and their families about PPD before childbirth. As highlighted by Howell et al. (2012), lack of knowledge can prompt even close family members to mistake PPD signs for another illness or something less serious. Social workers who are licensed can positively impact postpartum mothers at risk of PPD and those already diagnosed with PPD through education and referral for care. Moshki, Baloochi Beydokhti & Cheravi (2014) emphasize on the need for increased knowledge on the comprehensive biological, psychological and social issues which distress mothers with PPD among social worker. They further highlights that social workers who cannot be in contact with mothers two weeks post-delivery should ensure that, the mothers and their respective families are educated on PPD and service access.

Educating women on PPD promotes their ability to have control over their lives, to be more decisive, better planning for life, increases self-esteem and to obtain support from family, friends or the religious community. Besides, women who are informed about PPD can adopt what they have learned and apply in real-life scenarios (Moshki, Baloochi Beydokhti & Cheravi, 2014). The findings on the impact of educating mothers on PPD seem to vary from study to study. Whereas some studies seemed to show no differences between educated and non-educated mothers, an essential aspect that should also be given consideration is the education timing and the content of the education provided (Hayes, Muller & Bradley, 2001).NUR702 Developing Evidence-based Practice Essay.

For instance, during discharge training, patient acuity, welcoming visitors, physical recovery and taking care of an infant can potentially distract both the mother and the nurse. While some mothers can feel that they received high-quality and adequate education on PPD, the information shared may exceed what the mother may recall during the initial days following delivery. To add on, since fatigue is also associated with PPD, spending too much time on discharge education can impact the mother negatively. Therefore, it is highly recommended that education on PPD should start during the prenatal period, addressed briefly during admission and further reinforced post-discharge for it to be more effective (Hayes, Muller & Bradley, 2001) NUR702 Developing Evidence-based Practice Essay.

DISCUSSION

Findings from the literature review indicate that social support from close family members, the community or even friends significantly reduces the likelihood of PPD. among those already diagnosed with PPD, social support from the community members, family or friends decreases the period of treatment. The findings also revealed limited studies on the approaches used to educate new mothers on PPD and what they should probably expect when leaving the hospital with an infant. There is also a limited amount of information on PPD treatment strategies which are non-medication based.NUR702 Developing Evidence-based Practice Essay.

Limitations

One of the major limitations of this literature review is that the majority of the articles had a small sample size. and were done in regional areas. This limits the reliability and applicability of the results to wide/general population settings. The studies used were generally free of potential biases and provided details on what is essential in the early detection and management of PPD. Regarding the methodology used in this research, not all the articles that were selected adequately addressed the topic of study. This increased difficulty in finding more specific articles based on the study topic. NUR702 Developing Evidence-based Practice Essay.

Conclusion of Findings

This study sought to determine if educating women about PPD before and after delivery can help to prevent PPD during the post-partum period. PPD was noted as a common childbirth complication. The articles supported the education and anticipatory guidance of women about PPD to reduce the likelihood of being diagnosed with PPD during the post-partum period. It was also discovered that the differed opinions of nurses and new mothers were essential to learning in preparation for the post-partum period. Therefore, nurses should have an effective educational intervention plan that also purposes to inform mothers and families on PPD to reduce the likelihood of its diagnosis post-delivery. Other essential findings were ensuring social support from close friends, family, and religious community and using the EPDS for the early detection and screening of PPD.NUR702 Developing Evidence-based Practice Essay.

Potential Practice Change

The available limited sources of information on the topic of study support the education of women on PPD. If women and their families fail to receive the appropriate information on PPD, most cases can go undetected or undiagnosed hence failure to receive the necessary treatment. Lack of PPD knowledge does not only affect a mother but also the infant, other siblings, and the entire family. Besides, the lack of knowledge to differentiate between depressive symptoms and extreme fatigue can worsen the effects. The fact that there are limited studies on PPD education necessary to inform and educate women and their families on PPD.NUR702 Developing Evidence-based Practice Essay.

Educating mothers is not only a nursing role. Instead, social workers in hospital and community settings can actively be involved in educating mothers and their families on PPD. Within the 1^st six weeks following delivery, all mothers should also be screened. This research has recommended EPDS use for screening and detection of PPD.

CONCLUSION

Post-partum depression has been associated with a weak attachment to an infant, fear of causing harm to an infant and attempts of infant suicide. It also results in high incidences of infectious illnesses, diarrhea diseases, admission to hospital and missed immunization opportunities. In worse case scenarios, children’s cognitive, behavioral, physical and emotional development of infants with reduced child survival. Since basic research suggests that prior education of mothers and their families about post-partum depression promotes early identification of PPD warning signs and an avenue for healthcare providers to institute appropriate measures prompting timely intervention that ultimately influences good patient health outcomes.NUR702 Developing Evidence-based Practice Essay.

The findings of this study emphasize the significance of ensuring that mothers are educated on PPD before discharge from hospital as it reduces the risks of being diagnosed with PPD, ensures social support and is linked to low depression scores. Furthermore, it is recommended that future studies ought to focus more on some of the most effective education strategies of educating mothers and families on PPD and its usefulness in mothers’ self-identification of PPD symptoms. An additional recommendation for further research on social workers’ role in PPD prevention, screening, and treatment in hospital and community settings is warranted.NUR702 Developing Evidence-based Practice Essay.

Students will complete a review of the research literature specific to the problem of interest(Postpartum Depression: Providing Standardize Education to Patients and Families)in order to uncover possible interventions that can be utilized in evidence-based practice. The submitted paper will include relevant research findings that are offered as an intervention to address the clinical problem identified in the first assignment. The student is to critically appraise the studies that are shared in the paper. In addition to identifying 3-5 strong studies that will serve as the evidence base for evidence based practice, the student will also share general study findings related to addressing the problem using alternative interventions. Following your literature review, the student should be able to be knowledgeable about what the studies have found with regards to addressing a clinical problem and be able to ultimately identify the intervention they plan to use. This paper will briefly address the clinical problem, but mainly focus on studies found in the research literature that intervene upon the problem. This paper is NOT about the project you will design in NUR 704, but rather on the intervention you find in the research literature. This assignment will be used to support Chapter 2 in the final written capstone document.NUR702 Developing Evidence-based Practice Essay.

The basic outline for the integrative review of the literature is as follows. This scholarly written assignment is to be formatted following the APA (6^th edition).

Introduction(5 points). This section should be a very succinct introduction of the clinical problem (Postpartum Depression: Providing Standardize Education to Patients and Families), the proposed intervention (which will be supported by this paper). You will need to share some background information to help the reader understand why the clinical issue must be addressed. The section should conclude with a statement that states “The purpose of this paper is to….” Total length of this section is no more than two paragraphs.NUR702 Developing Evidence-based Practice Essay.

*Note, this section is the first section of your paper which is preceded by a level one heading which is the same as the title of your paper. Do not use “Introduction” as a level one header.

Literature Search Methods (Total 10 points)- This section should discuss two major areas of content:
1. Sampling Strategies(5 points) – you used to conduct the search process, such as the databases accessed, year restrictions used, types of studies you focused on, and key terms (PICO elements) used in the search. You need to justify or help the reader understand why you used these strategies (ex. data bases and key terms). Utilize the search strategy matrix you have been using during your search to write this paragraph. Refer to thisdocument in this section (“see Appendix A” or B…).
2. Inclusion/Exclusion Criteria(5 points) – you need to discuss the criteria you used when evaluating and deciding to utilize a piece of literature. For example, article needed to be “published within the last 5 years” or only certain “levels of evidence” would be accepted.NUR702 Developing Evidence-based Practice Essay.

My PICO

Problem: Postpartum depression (PPD) warning signs/symptoms,

Intervention: Providing standardize education to new mothers and their families on recognizing signs and symptoms of PPD,

Comparison: Education vs no education

Outcome: Recognizing early warning signs of PPD.

Literature Review Findings(Total 25 points) – this section is composed of two parts:
1. General Findings –

This section generally highlights all possible interventions found in the literature, but should not focus on your chosen intervention. That goes in the next section.This is a broad list of possible interventions found in the literature supported by a brief description of a few of the studies. If there were a lot of interventions found, it is not expected that you describe all of them but a sampling of them. Remember, this is NOT where you are describing your chosen intervention. This should not include the intervention used in your PICO statement but others you have uncovered during your literature review. Be sure to carefully cite all the studies found. Briefly explain why you aren’t using any of these interventions.Add additional level headings as appropriate.NUR702 Developing Evidence-based Practice Essay.

Chosen Intervention–

Now introduce/present the 3 to 6 studies that support the exact practice change intervention you are considering (Scales for Educating Patients with Postpartum Depression). Each study should be presented sharing a clear, thorough description of the study including the setting, the sample, the methodology used including the intervention and the study’s outcomes (*Note you must share actual statistical data to reflect the positive outcomes achieved as a result of using the intervention). Utilize your Evidence Matrix you have been completing to write this section. Attach the Matrix in the Appendix.Add additional level headings as appropriate. Be sure to cite your studies. **Remember, there must be evidence to support a practice change initiative. The evidence table-matrix must be submitted with the final version of the assignment as an appendix. There must be at least 3 to 6 pieces of evidence that strongly support your chosen intervention/project.NUR702 Developing Evidence-based Practice Essay.

Discussion-(Total 15 points) – This section discusses three parts:
1. Limitations-Identify limitations of the literature review process – some examples could be you only located literature that seems dated by our standards, there was a lack of published empirical studies on the topic (offer a rationale for using non-empirical studies), there was a lack of studies in nursing but did locate studies in another disciplines, etc. Explain why you needed to expand your search to other disciplines.You cannot say there wasn’t any support for your chosen intervention or else you cannot use it!!
2. Conclusion of Findings– Briefly highlight your chosen intervention. How robust was the evidence?Why did you choose it?NUR702 Developing Evidence-based Practice Essay.
3. Potential Practice Change– Considering the information you provided in section B above, describe a potential practice change you can design for your problem using this intervention –remember, this is just a lead off to what you will actually design in NUR 704

Conclusion(5 points) – a short summary of what was presented in the paper.Address “key take aways.” Do not introduce new information in the conclusion.NUR702 Developing Evidence-based Practice Essay.
References

Appendix (Total 10 points)
1. Search Strategy Log– 5 points
2. Evidence Matrix– 5 points

Structure and Format of Scholarly Writing Assignment (Total 30 points)
1. Written in APA (6^th edition) format (10 points)
2. Correct spelling, grammar, and punctuation (10 points)
3. Organization and presentation of content(10 points) – Be sure to use transitioning sentences when moving between sections of the paper. You need to help your reader follow your thinking.
4. This paper should be 12-15 pages (Not including cover page, references or appendix). Maximum pages: NUR702 Developing Evidence-based Practice Essay.

Total Possible Points=100Points (40% of final grade)

Grading Criteria	Possible Points	Student Score
Introduction	5
Methods = 10 total – Sampling Strategies = 5 – Criteria used = 5	10
Findings = 25 total – General findings – Chosen intervention	25
Discussion = 15 total – Limitations – General conclusions – Potential project	15
Conclusion	5
Appendix	10
Written in APA format	10
Correct spelling, grammar, punctuation	10
Organization and presentation	10
Total = 100points	100

Important Tips for Successful Writing

(not just for this paper but for all formal writing assignments):

Please plan to pay close attention to: grammar, spelling, sentence structure, paragraph development, format, word usage, and style of writing. NUR702 Developing Evidence-based Practice Essay.

Mechanics:

*Your paper should have a title page and a reference page.

*You should also have page numbers and subject level headings. (use the level headings provided to you in this guideline!)

*All citations and the reference page should follow the APA Manual (6^th edition) guidelines.

*The text should be 12 font, Times New Roman.

*Your paper should be double-spaced.

*There should beone inch margins.

Writing:

*Refer to yourself at the Project Implementer or Project Manager.

Whatever you use, plan to use this through all 8 chapters of your final capstone.

*Do NOT write any formal paper in this program in first person (I, me, my, our, we) unless specifically asked for as a personal reflection. This paper is not a personal reflection and should be written very formally.

*A paragraph should have at least three sentences. A paragraph leads off with a single idea (first sentence) and then the rest of the sentences in that paragraph support the main idea. A single paragraph should not contain multiple topics.NUR702 Developing Evidence-based Practice Essay.

*New information (cited information) should not be introduced in the summary/conclusion. This is a summary of the entire paper/section/chapter.

*There should be a brief paragraph (at least three sentences) under each level heading introducing the section.

*Try to avoidwriting “Results showed…. or do not show……”, but “Results indicate, suggest, demonstrate, report, etc.

*Never state “Investigators or studies conclude….” for there is always some bias in results (except in the strictest of lab environments). Investigators or studies may suggest, indicate or demonstrate.

BACKGROUND INFORMATION

Introduction

Post-partum depression (PPD) is inarguably an incapacitating mental health disorder with a high prevalence of 10-60% globally (Tel, 2018). The pain of feeling helpless among directly affected mothers is intense to an extent that some mothers see life as a death trap whereas those who are not depressed consider the birth of their babies as one of the happiest moments in life. Post-partum depression manifests in the following ways: appetite changes, concerns about an infant, mood swings, sleep disorders, eating disorder, crying and sadness, difficulty paying attention, suicidal thoughts and lack of interest in routine activities (McCarter-Spaulding & Shea, 2016). In the most severe cases, being hopeless can become life-threatening and result in suicide. This has accounted for up to 20% of post-partum deaths.NUR702 Developing Evidence-based Practice Essay.

There have also been reports linking PPD with a weak attachment to an infant, fear of causing harm to an infant and in most extreme cases, attempts of infant suicide. This explains the significance of identifying those at high risk before delivery to institute appropriate measures of care. In the United States, a substantial body of evidence reveals that the prevalence of postpartum depression ranges between 10-15 % (Zlotnick et al. (2016). The prevalence is much higher among minority ethnic groups and underserved populations. Post-partum depression has been linked to high incidences of infectious illnesses, diarrheal diseases, admission to hospital and missed immunization opportunities. In worse case scenarios, children’s cognitive, behavioral, physical and emotional development of infants with reduced child survival (Tel, 2018).NUR702 Developing Evidence-based Practice Essay.

Research suggests that prior education of mothers and their families about post-partum depression promotes early identification of PPD warning signs. This provides an avenue for healthcare providers to institute appropriate measures prompting timely intervention that ultimately influences good patient health outcomes (Ho et al., 2009). However, very little scientific evidence exists to support this finding. This research paper purposes to find supporting literature on educating mothers about PPD to promote early identification of PPD warning signs using a well-formatted PICOT question. A detailed description of the literature search methods, literature review findings, and limitations of the study will be provided.NUR702 Developing Evidence-based Practice Essay.

Problem Background

According to Zlotnick et al. (2016), PPD is an issue of public health significance which occurs in 10-15% of mothers who have recently delivered. The rates are even higher among financially disadvantaged women or those with a low socioeconomic status. Since the post-partum period can be a time for increased depression risks which can negatively impact the infant, the mother and child outcomes in future, effective and timely interventions to reduce its risks are critical.NUR702 Developing Evidence-based Practice Essay.

Most women who suffer from PPD often go undiagnosed thus, they do not receive treatment. This is partly due to the stigma associated with PPD and partly due to limited access to appropriate treatments. Timely education with routine screening and follow-up is the best avenue to reduce the incidences of PPD and associated risks since pharmacological treatment approaches are usually met with a lot of hesitancy especially from newly breastfeeding mothers (Tel, 2018). The exact causes of PPD based on current literature are equivocal. However, several risk factors can be used to predict its likelihood such as lack of social support, lack/inadequate knowledge on its signs and symptoms, depression during the prenatal period among others. Inadequate/lack of knowledge on PPD and social support are modifiable factors that can be the major emphasis of preventive interventions.NUR702 Developing Evidence-based Practice Essay.

LITERATURE SEARCH METHODS
Sampling/Search Strategy

An initial comprehensive search was conducted in several electronic databases. In the Cochrane database, the keywords postpartum depression, education, signs post-partum depression were used. The use of Boolean search operators “and” and “or” ensured a more refined search outcome. The search yielded three articles, one that was withdrawn and another that was excluded since it focused on screening for PPD using the Edinburg PPD scale. A search in the PubMed database was also done using the keywords: postpartum depression, education, signs, and symptoms of PPD. This search involved an activation of the following filters: meta-analysis, systematic reviews and RCTs which were published within the last 20 years in the English language. This search yielded a total of 28 articles. When an additional search phrase using the ‘and’ and ‘or’ search operated was added, the number of articles was brought down to 10.NUR702 Developing Evidence-based Practice Essay.

Studies that included other interventions of recognizing early warning signs and symptoms of PPD other than education to mothers and families were excluded resulting in 7 articles. Similarly, all the reference lists of the articles that were included were searched for relevant articles. The same search strategy was used to obtain additional articles from weekly search updates on PubMed. This search focused more on articles with experimental and non-experimental designs with post-partum depression or psychosocial stability as outcome measures. Systematic reviews that were linked to early recognition of PPD signs and symptoms through education were also considered. All the articles obtained were assessed based on their relevance to the PICOT question. A detailed list of the articles obtained in each database is illustrated in Appendix A. NUR702 Developing Evidence-based Practice Essay.
B. Inclusion/Exclusion Criteria

The search included articles published within the past 20 years in English. These articles were either experimental designs comprising of systematic reviews, meta-analysis and randomized controlled trials or non-experimental designs. The search also included articles whose interventions focused on providing education about PPD to mothers and families with early recognition of PPD signs and symptoms as the primary outcome measure. Therefore, the search excluded all articles that were published beyond the last 10 years, articles in languages other than English and those which included interventions other than providing standardized education to mothers and families.
PICO Question: Among new others and their families (P), does provide standardized education on PPD (I) compared to not providing standardized education(C) help to recognize early warning signs of PPD(O)?NUR702 Developing Evidence-based Practice Essay.

Population	New mothers and their families
Intervention	Providing standardized education on PPD
Comparison	Not providing standardized education
Outcome	Recognize early warning signs of PPD

III. LITERATURE REVIEW FINDINGS

General Findings –
Eight of 31 articles met the inclusion criterion. However, due to the specificity of the subject matter, most articles failed to address the criteria. The articles found were based on the following subjects: standardized education, the significance of support EPDS use as the most appropriate PPD screening tool. NUR702 Developing Evidence-based Practice Essay.

Screening For PPD Using the EPDS

Postpartum depression is detected in various ways. However, the EPDS is the most favorite and recommended scales in clinical settings (Hanusa et al., 2008). In the articles, the EPDS was the most used scale to detect PPD. In a randomized control trial that purposed to test various PPD screening tools, the EPDS was found to be more effectual and reliable in the detection of both minor and major symptoms of depression.NUR702 Developing Evidence-based Practice Essay.

Social Support

The ways in which interventions that purpose to provide support which is culturally-appropriate influence a reduction in depressive symptoms are also discussed. At baseline, the study participants were vulnerable to depression However, six weeks later, the depressive symptoms of all the study participants in the intervention group had reduced. The decrease was attributed to the training and social support that was provided by the community workers. On the other hand, Kieffer et al. (2012) emphasized that the symptoms of PPD can increase when social support lacks, especially from immediate members of the family and friends. According to the findings of this study, most women who had conflicts and frequently argued with their spouses or family members experienced more severe symptoms of PPD.NUR702 Developing Evidence-based Practice Essay.

Addressing Information/Education Needs

Some of the studies demonstrated that inadequate knowledge or lack of education on PPD among new mothers. For instance, irrespective of the socio-economic status, most women felt that they were not prepared for the post-partum period in the study by Sword and Watt (2005). Therefore, based on the researcher’s findings, several learning needs that were not met according to the participants in the study were identified. According to McCarter-Spaulding & Shea (2016), there is a huge difference between what mothers consider to be beneficial information following delivery and what is believed to be useful information by nurses. Whereas mothers in the study wanted more details on self-care upon discharge from the hospital after delivery, nurses instead prioritized sharing information on how to care for the baby.NUR702 Developing Evidence-based Practice Essay.

Lower scores of depression among women who were educated about PPD were noted in a randomized control trial that purposed to establish how effective hospital discharge education was on PPD (Ho et al., (2009). Nurses educated mothers who were in the study’s intervention group on PPD post-discharge while those in the comparison group were just given general education about the post-partum period. As noted by Ho et al., (2009), participants who received comprehensive PPD education in had significantly reduced risks of depression with fewer depression scores in comparison to those who were in the comparison group. The researchers, therefore, recommended that general practice should incorporate education on PPD in post-partum discharge.NUR702 Developing Evidence-based Practice Essay.

Managing PPD Using Interpersonal Psychotherapy

Interpersonal psychotherapy is described as a brief form of psychotherapy that focuses on attachment and aims at addressing interpersonal conflicts and the recovery of symptoms. As a form of treatment with empiric support, it follows an approach that is limited on time and structure and can be conducted for approximately twelve-fifteen weeks (Zlotnick et al., 2016). Interpersonal psychotherapy concentrates on present as compared to past relationships, challenges and changes experienced by women during the entire post-partum period. According to Zlotnick et al. (2016), interpersonal psychotherapy is the most effective and useful way of diagnosing women with PPD. The studies obtained did not have many non-pharmacological treatment approaches for PPD. Occasionally, CBT was mentioned but the researchers centered more on PPD. The study by Zlotnick et al. (2016) sought to establish the effectiveness and efficiency of interpersonal psychotherapy among women who had PPD. Most women who received interpersonal psychotherapy as an intervention turned out to have lesser symptoms of depression in comparison to those who did not receive interpersonal psychotherapy. In the same study, most women preferred interpersonal psychotherapy in case they needed PPD therapy irrespective of whether or not they received medication.NUR702 Developing Evidence-based Practice Essay.

Chosen Intervention

The selected studies highlight that since three out of ten women are more likely to experience PPD and one may go undiagnosed, education is vital. Failure to educate mothers on PPD before delivery increases the likelihood of missed and wrong diagnoses such that depressive symptoms are likely to be confused for baby blues or chronic fatigue and can be left untreated for quite a long time. Being unable to identify PPD signs and failure to obtain the necessary treatment can result in more serious consequences (Ho et al., 2009). Untreated PPD makes one more vulnerable to recurrent psychiatric disorders, creates tension between married couples and can even lead to death. McCarter-Spaulding & Shea (2016) emphasizes that educators of childbirth can play a vital role in preventing PPD through education about PPD early signs and symptoms. By educating women and their families on PPD before childbirth, it will be easier to identify the signs and seek timely medical assistance rather than to wallow in feelings of shame and discrimination.NUR702 Developing Evidence-based Practice Essay.

Even though depression can be diagnosed during pregnancy, there are no pretests that can be done to determine whether or not a mother is likely to suffer from PPD after delivery. This explains the significance of educating mothers and their families about PPD before childbirth. Lack of knowledge can prompt even close family members to mistake PPD signs for another illness or something less serious (Ho et al., 2009). Social workers who are licensed can positively impact post-partum mothers at risk of PPD and those already diagnosed with PPD through education and referral for care. The NAPSW emphasizes (National Association of Perinatal Social Workers) the need for increased knowledge on the comprehensive biological, psychological and social issues which distress mothers with PPD among social workers (Lara, Navarro & Navarrete, 2010). The association emphasizes that social workers who cannot be in contact with mothers two weeks post-delivery should ensure that, the mothers and their respective families are educated on PPD and service access.NUR702 Developing Evidence-based Practice Essay.

Educating women on PPD promotes their ability to have control over their lives, to be more decisive, better planning for life, increases self-esteem and to obtain support from family, friends or the religious community. Besides, women who are informed about PPD can adopt what they have learned and apply in real-life scenarios (Lara, Navarro & Navarrete, 2010). The findings on the impact of educating mothers on PPD seem to vary from study to study. Whereas some studies seemed to show no differences between educated and non-educated mothers, an essential aspect that should also be given consideration is the education timing and the content of the education provided (McCarter-Spaulding & Shea, 2016).NUR702 Developing Evidence-based Practice Essay.

DISCUSSION

Findings from the literature review indicate that social support from close family members, the community or even friends significantly reduces the likelihood of PPD. Besides, among those already diagnosed with PPD, social support from the community member, family or friends decreases the period of treatment. The findings also revealed limited studies on the approaches used to educate new mothers on PPD and what they should probably expect when leaving the hospital with an infant. There is also a limited amount of information on PPD treatment strategies which are non-medication based.NUR702 Developing Evidence-based Practice Essay.

Limitations

One of the major limitations of this literature review is that majority of the articles had a sample size that was smaller and were done in regional areas. This limits the reliability and applicability of the results to wide/general population settings. The studies used were generally free of potential biases and provided details on what is essential in the early detection and management of PPD. In regards to the methodology used in this research, not all the articles that were selected adequately addressed the topic of study. This increased difficulty finding more specific articles based on the study topic.NUR702 Developing Evidence-based Practice Essay.

B. Conclusion of Findings

This study sought to determine if educating women about PPD before delivery can help to prevent PPD during the post-partum period. PPD was noted as a common childbirth complication. The articles supported the education and anticipatory guidance of women about PPD to reduce the likelihood of being diagnosed with PPD during the post-partum period. It was also discovered that, the opinions of nurses and new mothers what was essential to learn in preparation for the post-partum period differed. Therefore, nurses should have an effective educational intervention plan that also purposes to inform mothers and families on PPD to reduce the likelihood of its diagnosis post-delivery. Other essential findings were ensuring social support from close friends, family, and religious community and using the EPDS for the early detection and screening of PPD.NUR702 Developing Evidence-based Practice Essay.

Potential Practice Change

CONCLUSION

Post-partum depression has been associated with a weak attachment to an infant, fear of causing harm to an infant and attempts of infant suicide. It also results in high incidences of infectious illnesses, diarrheal diseases, admission to hospital and missed immunization opportunities. In worse case scenarios, children’s cognitive, behavioral, physical and emotional development of infants with reduced child survival. Since basic research suggests that prior education of mothers and their families about post-partum depression promotes early identification of PPD warning signs and an avenue for healthcare providers to institute appropriate measures prompting timely intervention that ultimately influences good patient health outcomes, This research paper purposed to find supporting literature on educating mothers about PPD to promote early identification of PPD warning signs using a well-formatted PICOT question.NUR702 Developing Evidence-based Practice Essay.

The findings of this study emphasize the significance of ensuring that mothers are educated on PPD before discharge from hospital as it reduces the risks of being diagnosed with PPD, ensures social support and is linked to low depression scores. However, it is recommended that future studies ought to focus more on some of the most effective education strategies of educating mothers and families on PPD and its usefulness in mothers’ self-identification of PPD symptoms. An additional recommendation for further research is social workers role in PPD prevention, screening and treatment in hospital and community settings.NUR702 Developing Evidence-based Practice Essay.

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