Theory of Unpleasant Symptoms Practice specialty perspective Personal clinical focus areas Women and Childrens Services Currently working with LampD Postpartum and Newborn to implement practices to support breastfeeding ID: 433655
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Slide1
Karen Fugate BSN RNC-NIC, CPHQ
Theory of Unpleasant Symptoms
Practice specialty perspectiveSlide2
Personal clinical focus areas:
Women and Children’s Services
Currently working with L&D, Postpartum and Newborn to implement practices to support breastfeeding Main focus Neonatal ICUPerspective for this presentationPostpartum
Clinical focus areaSlide3
Major focus areas
Postpartum depression
Postpartum fatigueDuration of breastfeeding
Current Application of TOUS to postpartum practiceSlide4
Pugh & Milligan (1998) – yes, this is the same Pugh who authored the TOUS
Targeted interventions resulted in decreased fatigue at 14 days postpartum and sustained breastfeeding
avg of 6wks longer than control group
Use of theory in practice #1
Physiologic factors (Interventions) Sleep rest
diet exerciseSituational factors (Interventions)
Warm compressesBreastfeeding positionUse of social support
Psychologic
factors (Interventions)
Build self-esteem
Symptoms
Level of fatigue
Breast discomfort
Performance
Duration of breastfeedingSlide5
Relentless postpartum fatigue on PP day 14
significantly correlated to
significant postpartum depression on PP day 28 (Corwin, Brownstead
, Barton, Heckard & Morin, 2005)
Intervention: Fatigue checklist at PP day 14 could identify women at high risk for PPDUse of theory in practice #2
Symptoms
Post partum depression
Situational factors
Partner in home
Other children in home
Family support
rurality
Physiologic factors
Age
Postpartum status
Level of fatigue
Psychologic
factors
Past h/o depression
Family h/o depression
stress
Performance
Not specifically mentioned although could be PPDSlide6
Depression, anxiety, maternal sleep, surgical delivery, breastfeeding, infant mood all
correlated with fatigue
in active duty, postpartum military women; anxiety was strongest predictor
of fatigue; higher levels of fatigue were correlated with decreased functional status at 6 wks
PP (Rychnovsky, 2007). Intervention: assessment and treatment of anxiety may reduce fatigue and increase functional statusUse of theory in practice #3
Physiologic factors
Type of deliverylactogenesis
Psychologic
factors
Depression
anxiety
Situational factors
Maternal sleep
Infant mood
Symptoms
Level of fatigue
Performance
Functional statusSlide7
Unpleasant symptoms – post-op C-section pain
Possible factors
Physiological – duration of labor, scheduled or unscheduled C-section, primary or repeat C-section, type of pain medication, ageSituational – sleep, infant feeding method, family support, ethnicityPsychological – anxiety, depression, past pain experience
Possible performance outcome – functional status - physical activity
Unpleasant symptoms – faintness/dizzy in the immediate PP periodPossible factorsPhysiological – hydration, duration of labor, PP day, age, type of delivery, type of pain medicationSituational – time of day, staffingPsychological – level of knowledge regarding physiologyPossible performance outcome – falls in immediate PP period
Future research possibilitiesSlide8
Corwin, E., Brownstead
, J., Barton, N.,
Heckard, S., & Morin, K. (2005). The impact of fatigue on the development of postpartum depression. JOGNN: Journal Of Obstetric, Gynecologic & Neonatal Nursing, 34(5), 577-586. doi:10.1177/0884217505279997
Pugh, L.C. & Milligan, R.A. (1998). Nursing intervention to increase the duration of breastfeeding. Applied Nursing Research, 11(4), 190-194.
Smith, M.J. & Liehr, P.R. (2013). Middle range theory for nursing, 3rd ed. New York: Springer Publishing Company.Rychnovsky, J. (2007). Postpartum fatigue in the active-duty military woman. JOGNN: Journal Of Obstetric, Gynecologic & Neonatal Nursing, 36(1), 38-46. doi:10.1111/j.1552-6909.2006.00112.x
references