Eleanor Bradley

Women's views of antidepressants in the treatment of postnatal depression

Little research has been carried out on the treatment of postnatal depression and clinicians must currently rely on general recommendations for the use of antidepressants. Antidepressant medication as the main treatment for depression in general practice has been shown to be effective when used as prescribed. However, research has shown that depressed patients consistently receive either no medication or consistently low doses of medication. This study will investigate womens experiences of taking antidepressant medication for postnatal depression. Thirty-five women with a clinical diagnosis of postnatal depression who had been prescribed antidepressant medication completed a questionnaire detailing their experiences of taking medication. Four open-ended questions and responses were discussed with the women. Of the 35 women who were prescribed medication, 4 chose not to take it because they were breast-feeding. Twenty of the women described finding medication helpful. Although only 4 women directly reported not taking antidepressants as prescribed, the comments made by a further 9 women suggest that compliance may have been poor. This study suggests a need to improve information about medication for postnatal depression. If this information is not provided, women are likely to continue to self-manage medication at a dosage that may be clinically ineffective.

The prevention of postnatal depression: A narrative systematic review

This systematic review assessed the success of randomized controlled trials of preventative interventions for postnatal depression (PND). Outcomes examined were estimates of PND prevalence. Methodological quality was determined through the examination of key components individually with independent data extraction by all three authors. Data sources included Medline, PsycINFO, Sociofile, CINAHL, COPAC, EMBASE, Cochrane library; hand searches and a newsletter requests for unpublished trials to the Marcé Society and Postpartum Support International. Twenty-one RCTs were included in this review. Nine of these trials demonstrated short-term preventative success (seven psychological and supportive interventions, one unpublished antidepressant trial and a calcium carbonate trial) but none provided any evidence of long-term success. Furthermore, the results of three of the psychological intervention trials should be viewed with caution due to a lack of methodological rigour. There is a need for future research into the prevention of PND to be tightly designed and maybe include an exploration of the experience of postnatal depression for multiparous women.

Evidence-based practice: implications and concerns.

AIMS The aim of this paper was to undertake a brief critical appraisal of evidence-based practice (EBP) as it is currently perceived in health care settings. BACKGROUND The past two decades have seen EBP become increasingly important in health care planning, clinical thinking, and choice of treatments. It is based on scientific rationalism and adherents claim that decisions based on EBP are superior to those based on other approaches to care. Concerns are now being expressed that positivistic approaches to health care fail to take into account peoples preferences, their internal resources and their personal understandings of health and wellbeing. It has been argued that there may be multiple types of evidence, all of which have a part to play in the formulation and execution of health care. METHODS After a literature search, this paper argues that whereas EBP may be useful in treating conditions that have a biological cause, it may be less helpful in understanding and treating conditions that have their origins in the social, psychological or spiritual domains. RESULTS The nature, strengths and limitations of evidence-based practice is discussed in this paper. Nurses are encouraged to develop the critical skills of evaluating EBP in the lives and experiences of the people they care for. CONCLUSIONS Evidence-based practice has a part to play in improving the treatment provided for patients. Nonetheless, nurses should be aware of other kinds of evidence, and appreciate that any single approach to determining care, no matter how popular, is likely to lead to a service that does not truly meet the complex individual needs of patients. Implications for nursing management In order for evidence-based practice to be safe, the nursing workforce must be able to evaluate the strength and relevance of research findings, and be able to understand that there are different kinds of evidence which should be called upon in order to respond sensitively and appropriately to the preferences of patients. A responsive workforce embraces multiple ways of thinking, respects different paradigms of care, and is able to respond to and respect the forms of care people value and seek.

Nurse prescribing in mental health: national survey

Mental health nurses can now train to become independent prescribers as well as supplementary prescribers. Independent nurse prescribing can potentially help to reorganize mental health services, increase access to medicines and improve service user information, satisfaction and concordance. However, mental health nursing has been slow to undertake prescribing roles, and there has been little work conducted to look at where nurse prescribing is proving successful, and those areas where it is less so. This survey was designed to collect information from directors of nursing in mental health trusts about the numbers of mental health prescribers in England, gather views about prescribing in practice, and elicit intentions with regards to the development of nurse prescribing. In some Trusts, the number of mental health nurse prescribers has increased to the point where wider impacts on workforce, the configuration of teams and services are inevitable. Currently, the way that prescribing is used within different organizations, services and teams varies and it is unclear which setting is most appropriate for the different modes of prescribing. Future work should focus on the impact of mental health nurse prescribing on service delivery, as well as on service users, colleagues and nurses themselves.

Survey of psychiatrists' views of nurse prescribing.

For mental health nurses and service users to realize the benefits of non-medical prescribing, psychiatrists need to understand the remit of this role and be actively involved in influencing it. Although healthcare policy in the UK supports the expansion of non-medical prescribing, it requires much more for the successful implementation of such initiatives in practice. The aim of this survey was to explore the attitudes of all grades of psychiatrist working in two mental health trusts in the West Midlands to nurse prescribing. A specifically designed questionnaire was sent out to two groups of psychiatrists to assess their attitudes towards non-medical prescribing. Psychiatrists (n = 147) completed and returned a specifically designed questionnaire of their views. The more senior doctors appeared less concerned about nurse prescribing. Junior doctors expressed equivocation towards the role, suggesting that nurse prescribers be consistently supervised and have limited access to mental health drugs. The findings from this study have considerable implications for teams if junior doctors hold different views to their senior colleagues. Without the assistance of trusts in facilitating role change, the introduction of new roles could potentially heighten conflict between professions.

Illness Identity and the Self-regulatory Model in Recovery from Early Stage Gynaecological Cancer

Women in recovery from early stage gynaecological cancer have extremely good survival and low recurrence rates. Despite this, women continue to feel vulnerable to cancer recurrence for years after treatment. Semi-structured interviews were utilized to explore the factors involved in recovery from gynaecological cancer. This article argues that the illness identity of gynaecological cancer perpetuates a vulnerability to cancer recurrence. The absence of self-diagnosis prior to medical diagnosis is important in the formation of gynaecological cancer illness identity. A lack of self-diagnosis may be due to the ‘normalization’ of initial symptomatology. It is suggested that illness identity is responsible for maintaining fears of symptom-free cancer recurrence. The self-regulatory model is employed to explore this process, looking in particular at the reinforcement of reassurance needs.

Nurse prescribing and the enhancement of mental health services

Abstract Mental health nurses are relative latecomers to nurse prescribing. This is primarily because nurse prescribing has been seen as more appropriate for general nurses, particularly those working in the community or primary care. Pharmacists and psychiatrists were concerned about the complexity of prescribing for clients with mental health problems and felt that the training of mental health nurses and their clinical experience did not fit them to take on a prescribing role. These, and other impressions, may have influenced which groups of nurses were first selected to become nurse prescribers. However, recent studies have indicated that mental health nurses add considerably to the effectiveness of assessments and care plans, and that they are in an ideal position to integrate drug treatments with a wide range of non-pharmacological therapies knowledgeably, safely, effectively and in a manner that is acceptable to the patient. They have also been found to have an important role to play in monitoring the side effects of drugs and in providing education about medication, and in maintaining a therapeutic alliance with clients on long-term drug treatment. Whatever the limitations, mental health nurses as prescribers may still be deemed to have by some professional groups, and even by themselves, at this stage in the evolution of nurse prescribing, it is now inevitable that they will play a significant part in the overall improvement of mental health services during this decade. They are likely to challenge the existing prescribing practices and help in identifying the conditions under which medication is most therapeutic.

Users' views of two alternative approaches to the treatment of postnatal depression

Postnatal depression (PND) is a major public health concern, yet services are lacking. Most women with PND receive routine primary care from general practitioners, health visitors, and in a few cases community psychiatric nurses. A Parent and Baby Day Unit (PBDU) has been developed in Stoke-on-Trent and attendance at this Unit has a greater therapeutic impact on PND than routine primary care (RPC). This small pilot study elicits user views to understand the role of specialist and routine care in PND treatment and pinpoints which aspects of specialist care are important to women. Thirty women with PND attending the PBDU and 30 receiving RPC completed a questionnaire on their views of the service they received. Written comments were analysed thematically using content analytic techniques. The majority of women attending the PBDU were satisfied with this service, whereas women receiving RPC were dissatisfied with their treatment and a perceived absence of information. The main value of the PBDU seems to be one of social support. Effective communication from primary care professionals is important for women with PND and a perceived lack of information is a major cause of dissatisfaction. Availability of peer and professional support is perceived as valuable, but is insufficient within primary care.

Meeting the challenges of teenage mothers with postpartum depression: overcoming stigma through support

Objective: This study aimed to elicit and explore the experiences of teenage mothers with postpartum depression focussing on their experiences of being a teenage mother; support needs and the potential for support and education to be delivered by healthcare workers, or peers. Background: Teenage mothers are three times more likely to get postnatal depression than older mothers and are at increased risk of poorer mental health for up to three years postpartum. Method: Fifteen first-time mothers aged 16–19, living in Stoke on Trent, UK, with an infant aged under one year and suffering from postpartum depression were interviewed. Qualitative data were analysed using thematic framework analysis to identify emergent patterns and themes. Results: Four key themes emerged: stigma and perceptions of being judged; social and professional support; knowledge and information; and barriers to utilising support. Conclusion: The results highlighted the stigma, both real and perceived, that teenage mothers experienced as well as the lack of informal support networks for many and the unavailability of relevant and appropriate information targeted at teenage mothers. Some mothers highlighted the positive relationships they had with their health visitor which was essential to them in building a trusting relationship. However, not all had such good experiences, with some reporting that they did not know who their health visitor was. The need for tailored services and innovative methods of delivery are highlighted.

Heart Failure and Chronic Obstructive Pulmonary Disease Multimorbidity at Hospital Discharge Transition: a Study of Patient and Carer Experience

Care for patients with multimorbidity represents a major challenge not only for patients and carers but to health‐care systems. Hospital discharge transition is a critical point at which challenges for multimorbidity may amplify.