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Biomedical subjects

D Creedy

Publications and source records attributed to D Creedy.

10 recordsLinked to original sources
PubMed2004

Psychosocial and psychological interventions for preventing postpartum depression.

BACKGROUND: The cause of postpartum depression remains unclear, with extensive research suggesting a multi-factorial aetiology. However, epidemiological studies and meta-analyses of predictive studies have consistently demonstrated the importance of psychosocial and psychological variables. While interventions based on these variables may be effective treatment strategies, theoretically they may also be used in pregnancy and the early postpartum period to prevent postpartum depression. OBJECTIVES: Primary: to assess the effect of diverse psychosocial and psychological interventions compared with usual antepartum, intrapartum, or postpartum care to reduce the risk of developing postpartum depression. Secondary: to examine (1) the effectiveness of specific types of psychosocial and psychological interventions, (2) the effectiveness of individual versus group-based interventions, (3) the effects of intervention onset and duration, and (4) whether interventions are more effective in women selected with specific risk factors. SEARCH STRATEGY: We searched the Cochrane Pregnancy and Childbirth Group trials register (January 27 2004), the Cochrane Depression, Anxiety and Neurosis Group trials register (October 2003), the Cochrane Central Register of Controlled Trials (October 2003), MEDLINE (1966 to 2004), EMBASE (1980 to 2004) and CINAHL (1982 to 2004). We scanned secondary references and contacted experts in the field. SELECTION CRITERIA: All published and unpublished randomised controlled trials of acceptable quality comparing a psychosocial or psychological intervention with usual antenatal, intrapartum, or postpartum care. DATA COLLECTION AND ANALYSIS: Both reviewers participated in the evaluation of methodological quality and data extraction. Additional information was sought from several trial researchers. Results are presented using relative risk for categorical data and weighted mean difference for continuous data. MAIN RESULTS: Fifteen trials, involving over 7600 women, were included. Overall, women who received a psychosocial intervention were equally likely to develop postpartum depression as those receiving standard care (relative risk (RR) 0.81, 95% confidence interval (CI) 0.65 to 1.02). One promising intervention appears to be the provision of intensive postpartum support provided by public health nurses or midwives (RR 0.68, 95% CI 0.55 to 0.84). Identifying mothers 'at-risk' assisted the prevention of postpartum depression (RR 0.67, 95% CI 0.51 to 0.89). Interventions with only a postnatal component appeared to be more beneficial (RR 0.76, 95% CI 0.58 to 0.98) than interventions that also incorporated an antenatal component. While individually-based interventions may be more effective (RR 0.76, 95% CI 0.59 to 1.00) than those that are group-based, women who received multiple-contact intervention were just as likely to experience postpartum depression as those who received a single-contact intervention. REVIEWERS' CONCLUSIONS: Overall psychosocial interventions do not reduce the numbers of women who develop postpartum depression. However, a promising intervention is the provision of intensive, professionally-based postpartum support.

Depression, Postpartum↗
PubMed2001

What mothers want: a postnatal survey.

Mothers in the public health care system undergo mandatory early discharge after childbirth. The challenges associated with the decreasing length of hospital stay have rarely been investigated from a service consumer perspective. The aim of this study was to identify mothers' needs in the immediate postpartum period. An inpatient survey of 500 postnatal mothers undertaking the Early Discharge Program. Survey questions aimed to elicit the needs of mothers in the immediate postnatal period; perceived barriers to optimal care; and suggestions as to how these barriers could be addressed. Forms were distributed to all women on admission to a postnatal ward over a two month period and completed prior to discharge. Of 500 eligible mothers, 151 (30.2%) responded to the anonymous open ended survey. A thematic analysis of comments revealed that women wanted specific information about mothering, the creation of a restful environment, adequate pain relief, practical assistance, education, and set visiting times. For new mothers, early discharge made the need for rest and information a high priority. Constraints within the public health care system and midwifery practice need to be examined to better serve mothers' needs. Midwifery practice within the context of early postpartum discharge should seek to better serve new mothers by giving high priority for rest and information requirements.

Female↗
PubMed1998

A framework for practice with women survivors of childhood sexual abuse.

Women who are victims of prolonged childhood sexual abuse involving penetration, and physical and emotional abuse are more likely to develop major psychiatric distress. These survivors may use defence mechanisms to block out the past, and their distress may only come to the attention of health professionals at times of crisis. However, health practitioners do not routinely assess for a history of sexual abuse. This state of affairs is compounded by limited research on survivors of childhood sexual abuse and a readiness to label them with adult psychopathology. Such labels result from a failure to listen and from a willingness to blame, processes replicated from the dominant culture.

Adult↗
PubMed1997

Reducing perineal trauma: implications of flexion and extension of the fetal head during birth.

In this paper a critical analysis of two popular perineal management techniques used during birth, flexing the baby's head and the Ritgen manoeuvre, are presented. Each technique claims to reduce perineal trauma by reducing the presenting diameter of the fetal skull through the woman's vaginal opening. These two techniques are, however, contradictory and act against the normal mechanisms of labour. In normal labour, the smallest diameter of the fetal skull, the suboccipito-bregmatic, presents through the woman's vaginal opening. In order to negotiate the 90 degrees curve in the birth canal, the baby must change from an attitude of flexion to an attitude of extension during birth. The Ritgen manoeuvre encourages early extension of the fetal head which causes a larger fetal head diameter, the occipito-frontal diameter, to present. Flexing the fetal head cannot cause a smaller diameter to present, and the pressure the birth attendant applies to flex the head serves only to retard the emergence of the baby and unnaturally force the emerging fetal head down toward the stretched perineum. The discussion outlines the implications of this analysis for practice.

Female↗
PubMed1996

Caring for women suffering depression in the postnatal period.

The research and theoretical perspectives that underpin knowledge of depression in the postnatal period have tended to rely on standardized measures and 'objective' data which combine to disempower women's individual experiences. From a feminist perspective, contradictions exist between women's accounts of the early days and months following childbirth and the diagnosis of postnatal depression made by some health professionals. A framework for nursing care that uses the strengths of feminist and cognitive therapies is suggested. From this feminist-cognitive perspective, mental health nursing care will provide opportunities for women suffering depression to debrief the experience of birth and pregnancy, manage conflicts about identity, gain a sense of survival, and develop a new perspective.

Cognitive Behavioral Therapy↗
PubMed1996

Establishing a therapeutic milieu with adolescents.

Adolescents with acute psychiatric illness need an environment that emphasizes containment, structure, support, involvement and validation. Within such an environment therapeutic relations based on collaboration can be developed. However, these relations require nursing actions that facilitate adolescents' acceptance of containment, their ability to form attachments and development of achievement. The proposed collaborative approach for nursing care positions the adolescent as an active participant in the treatment process. The collaborative approach encourages a sense of responsibility for self and enhances the adolescent's skills to cope with situations and relations that pose difficulties through the development of self-awareness and problem-solving abilities.

Adolescent↗
PubMed1994

The implementation of problem-based learning: changing pedagogy in nurse education.

Problem-based learning (PBL) employs approaches to teaching and learning in nurse education that develop meaningful links between theory and practice. The adoption of such approaches, however, may require changes in pedagogical beliefs and practices which reflect a student-centred approach to teaching and learning. This paper focuses on a group of volunteer nurse educators (n = 14) who attended a 7-month professional development programme centred on introducing pedagogical changes when adopting PBL. From this group, three nurse educators participated in an in-depth study which aimed to examine the processes of conceptual change associated with adopting PBL as part of alternative teaching strategies. These three participants held common concerns about the changes required to their current teaching practices when moving to a new pedagogical approach. On completion of the programme, varying degrees of change in existing instructional practices were evident. This change was found to result from engaging educators in reflection about practice, providing opportunities to implement the new approaches on a trial basis, and providing feedback and support throughout the change process.

Education, Nursing↗
PubMed1992

Problem-based learning in nurse education: an Australian view.

This paper addresses the need to adopt teaching-learning approaches in nursing education that develop links between theory and clinical practice in a meaningful way. Problem-based learning (PBL) is such an approach and is gaining popularity in tertiary nursing programmes in Australia. PBL, as an example of the constructivist philosophy, focuses on students' existing knowledge as a starting point for conceptual change teaching. The implications for the nurse educator's role when using PBL are discussed in terms of assumptions about the nature of teaching and learning; conceptual change teaching; ability to focus; the role of negotiation; and the ability to analyse student learning. These factors are seen to be critical components of the pedagogy necessary for nurse educators to utilize PBL approaches effectively.

Australia↗
PubMedDate not supplied

Women's experience of early miscarriage: a phenomenological study.

This paper describes the experience of three women who had experienced early miscarriage within the previous 12 months. Three major themes of loss emerged: the loss of a baby, the loss of the role of motherhood and the loss of the hopes and dreams the women possessed for their baby. These losses were complicated by the women's negative thoughts about the care they received while in hospital, their perceptions of health professional's negative attitudes, the lack of information given to them, and the lack of understanding shown by family and friends about their situation. The authors recommend a number of changes to practice including the need for an increased sensitivity towards women following early miscarriage.

Abortion, Spontaneous↗