Karen J. Foli

Paternal Postpartum Depression: What Health Care Providers Should Know

Paternal postpartum depression (PPD) is a clinically significant problem for families that is currently underscreened, underdiagnosed, and undertreated. Maternal PPD is a well-known condition and has been extensively researched. In comparison, PPD in fathers and its potential effects on the family are not widely recognized. Studies have shown the importance of optimal mental health in fathers during the postpartum period. Negative effects of paternal PPD affect marital/partner relationships, infant bonding, and child development. To promote optimal health for parents and children, pediatric nurse practitioners must stay up to date on this topic. This article discusses the relationship of paternal PPD to maternal PPD; the consequences, signs, and symptoms; and the pediatric nurse practitioners role in assessing and managing paternal PPD.

Depression in Adoptive Parents: A Model of Understanding Through Grounded Theory

A limited number of studies have explored parental depression in the postadoption time periods and these studies frequently lack a social context of the adoptive parent experience. The objective of this study is to form a midrange theoretical interpretation of parental postadoption depression as shared by adoptive parents and experts through a grounded theory approach. Semistructured interviews of adoptive parents, who acknowledge being depressed after the child is placed in the home, and adoption experts are audiotaped, transcribed, and coded to reveal themes. In total, 30 interviews are conducted. Researchers are also participant-observers during an adoptive parent support group meeting. Data reveal recurrent themes in relation to postadoption depression. These themes take into account the various contexts of adoption (international and domestic, public and private, etc.). Parents express unfulfilled and unrealistic expectations in the domains of self, child, family or friends, and society or others. A theoretical model is presented to facilitate the understanding of depression reported by adoptive parents.

Development of Leadership Behaviors in Undergraduate Nursing Students: A Service-Learning Approach

AIM The purpose of this study was to determine leadership behaviors developed by nursing students and peers before and after a service‐learning experience. BACKGROUND Nurses have been called to fill growing needs in the health care setting, rendering care to vulnerable and diverse populations in a wide range of organizations. Leadership behaviors are therefore essential. METHOD Baccalaureate students (N = 65) completed the Student Leadership Practices Inventory‐Self at the beginning and end of the semester. The students also rated peers using the Leadership Practices Inventory‐Observer and answered six questions about service‐learning. RESULTS Repeated measures of analysis of variance for pre‐ and posttests revealed that leadership behaviors improved (p < .0001). A significant correlation was found (p = .02) between the overall posttest scores for both instruments. CONCLUSION Integrating service‐learning into a leadership course is an effective approach to the development of leadership behaviors.

Rates and predictors of depression in adoptive mothers: moving toward theory.

There are approximately 1.8 million adopted children living in the United States. Adoptive parents may experience depressive symptoms and put their children at risk for negative outcomes. The results of this study describe the rates of depression in 300 adoptive mothers and associations with hypothesized explanatory variables, which predict approximately half of the variance in maternal depressive symptoms: expectations of themselves as mothers, the child, and family and friends; feeling of rest; past and present psychiatric difficulties (self-esteem, history of depression); and interpersonal variables (bonding, marital satisfaction, perceived support). These findings are useful in planning effective interventions to mitigate depressive symptoms.

Survivor in the cancer context: a concept analysis

AIM The aim of this analysis was to define survivor in the cancer context. BACKGROUND Cancer survivor has been used in the cancer lexicon, but may not represent the individuals it defines. DESIGN This concept analysis was completed according to Walker and Avants method. DATA SOURCES PubMed, PsychInfo, CINAHL, JSTOR, Google and medical and public health websites. REVIEW METHODS Thirty sources from multiple disciplines, published between 1987-2013, were analysed for recurrent themes and conceptual meaning. Critical attributes, antecedents and consequences were extrapolated. Model, related and contrary cases were developed based on an amalgamation of clinical observations. Illegitimate, borderline and invented cases were excluded for this reason. RESULTS Survivor in the cancer context is an individual with a history of malignancy, who has lived through a personalized challenge and has ongoing positive and negative consequences. Not all cancer survivors would identify themselves using the term survivor. CONCLUSIONS This contributes to the paradigm shift of cancer as a chronic disease as it establishes the unique nature of the cancer experience while highlighting the long-term concerns related to this set of diseases. The Theory of Uncertainty in Illness provides a framework to understand the individualized nature of being a cancer survivor. Nursing research and practice should address the personal experiences of cancer survivors while still focusing on general survivorship needs.

Maternal Postadoption Depression, Unmet Expectations, and Personality Traits

Background: There are approximately 2 million adoptive parents in the United States and some struggle with depressive symptoms postplacement. We know little about personality traits that may be associated with depression in adoptive parents. Objectives: This study describes the relationships between personality traits, unmet expectations, and maternal postadoption depression. Design: Adoptive mothers (N = 136) were surveyed for depressive symptoms using the Center for Epidemiologic Studies–Depression Scale (CES-D) and the Edinburgh Postnatal Depression Scale (EPDS). Analyses included correlations and a regression analysis between depressive symptoms and unmet expectations with the Five-Factor Model personality traits (extraversion, agreeableness, conscientiousness, emotional stability, openness to experience) as measured by the Ten-Item Personality Inventory. Results: Both the CES-D and EPDS were significantly, negatively correlated with all five personality dimensions. Mothers whose expectations of themselves as parents matched pre- and postplacement were more likely to be emotionally stable and extraverted. Approximately 36% of the variance in depressive symptoms was explained by personality traits (emotional stability: p < .0001). Conclusions: The postadoption period is a crucial time of transition for mothers and their children. Maternal emotional stability, depressive symptoms, and unmet expectations may affect this period. Mothers who are lower in emotional stability may be at risk for postadoptive depressive symptoms. In planning and providing innovative care that promotes positive mother–child relationships, nurses should assess adoptive mothers for depressive symptoms, emotional stability, and unmet expectations.

Maternal postadoption depression: theory refinement through qualitative content analysis

Background: Some adoptive parents struggle with depressive symptoms post-placement. Foli’s Mid-Range Theory of Postadoption Depression provided the theoretical context for the analysis. Research Aim: To explicate connections between adoptive mothers’ unmet/unrealistic expectations and experiences with postadoption depression in the first 24 months of parenting their child(ren). Methods: Data were collected as part of a web-based study that examined predictors of maternal postadoption depression. A qualitative content analysis of approximately 332 responses, ranging from two words to two pages of text, was conducted using a deductive, unrestrained matrix approach. Major Findings: Support and refinement of major maternal expectations were attained and new concepts were revealed. Parents reported experiencing depression; they expressed unmet expectations as parents and of their children; they reported wishing they had received more medical and behavioural information about their child; and they reported mixed reactions and support from family and friends. Mothers described trans-racial family characteristics and being an adoptive family as factors in being accepted by society. Finally, the passage of time was described as a contributor to bonding and re-establishing family equilibrium. Conclusions: The findings refine and expand Foli’s Mid-Range Theory. Nurses render care to adoptive parents and their children in a number of practice settings, and these findings provide evidence to guide nursing care.

Familism and Health Care Provision to Hispanic Older Adults.

The Hispanic older adult populations rapid growth calls for an awareness of values that can affect the rendering and receipt of care. Familism, or familismo, a traditional Hispanic value, places importance of family over the self and can potentially affect health care perceptions and practices for Hispanic older adults. The current article discusses familism, which is upheld by some Hispanic older adults, and the potential for underuse of health care services. The traditional feminine role, marianismo, and masculine role, machismo, are considered, as well as implications for how decision making may be made by family members rather than the patient. Clinical implications for the provision of health care to Hispanic older adults are provided, along with the importance of considering acculturation and ethnic heterogeneity. Health care management strategies that reflect recognition and respect of familism, yet emphasize optimization of adherence and self-care, are described.

Post-adoption depression: Parental classes of depressive symptoms across time

BACKGROUND Approximately 10-15% of birth mothers and fathers experience postpartum depression, but reports of depressive symptoms in adoptive parents are more variable. Findings from investigators range from 10% to 32%, which may mask the experiences of distinct groups of adoptive parents from pre-to post-placement of a child. METHODS We performed latent class growth analysis using the Center for Epidemiologic Studies-Depression scores of 129 primarily heterosexual, adoptive parents (50% females) for three time points: 4-6 weeks pre-placement of the child, 4-6 weeks post-placement, and 5-6 months post-placement. Mixed effects models by parent depressive trajectories were also conducted for three types of variables: interpersonal, psychological symptoms, and life orientation. RESULTS Five classes of depressive symptom trajectories were found. The majority of parents (71%) belonged to a class with low levels of depressive symptoms across time. However, two classes of parents were above the threshold for depressive symptoms at placement, and three classes of parents were above the threshold at 6 months post-placement. The majority of interpersonal, psychological symptom, and life orientation variables were significant across classes and by time. LIMITATIONS The homogeneity of the sample calls for replication of study findings. CONCLUSIONS An explanation for inconsistencies in the range of adoptive parent depressive symptoms may be explained by different subgroups of parents who vary by their trajectory of depressive symptoms before and after placement of the child. Adoption and mental health professionals should be aware that select adoptive parents may struggle pre-and post-placement of a child.

Great expectations of adoptive parents: theory extension through structural equation modeling.

Background:Most of the 2 million adoptive parents in the United States make the transition to parenting successfully. Adoptive parents who do not make the transition easily may put their children at risk for negative outcomes. Objectives:The aim of this study was to further refine Foli’s midrange theory of postadoption depression, which postulates that fulfillment of expectations is a principal contributor to parental emotional health status, aggravation, and bonding. Methods:The linked dataset (National Survey of Children’s Health and National Survey of Adoptive Parents) was used for structural equation modeling. The sample consisted of 1,426 parents with adopted children who had been placed in the home more than 2 years before survey completion. Results:Special services and child’s behaviors were direct determinants of parental expectations, and parental expectations were direct determinants of parental aggravation and parentalbonding. As anticipated, parental expectations served as a mediator between child-related variables and parental outcomes. A path was also found between child’s behaviors and special services and parental emotional health status. Child’s past trauma was also associated with parental bonding. Discussion:Parental expectations showed direct relationships with the latent variables of parental aggravation and bonding. Future research should examine factors associated with early transition when children have been in the adoptive home less than 2 years and include specific expectations held by parents.