Kathleen C. Spadaro

Screening for Depression in the Postpartum Period: A Comparison of Three Instruments

OBJECTIVES Postpartum depression, the most prevalent complication of childbirth, is often unrecognized. Our objective was to compare the effectiveness of three screening instruments--Edinburgh Postnatal Depression Scale (EPDS), Patient Health Questionnaire (PHQ-9), and the 7-item screen of the Postpartum Depression Screening Scale (PDSS)--for identifying women with postpartum depression in the first 6 months after delivery. METHODS We administered the three instruments via telephone to women who were > or =18 years and had delivered infants 6-8 weeks earlier. We arranged home interviews to confirm DSM-IV criteria current major depressive disorder (MDD) in women who had an above-threshold score on any of the instruments. For women who screened negative on the 6-8 week call, we repeated the screening at 3 months and 6 months to identify emergent symptoms. The primary outcome measures were the screening scores and DSM-IV diagnoses. RESULTS Of 135 women reached, 123 (91%) were screened, 29 (24%) had home visits, and 13 (11%) had an MDD within 6 months of delivery. Analyses of the scores at 6-8 weeks postpartum and the DSM-IV diagnoses indicated the EPDS at a cutoff point of > or =10 identified 8 (62%) of cases, the PHQ-9 at a cutoff point of > or =10 identified 4 (31%), and the PDSS 7-item Short Form (PDSS_SF) at a cutoff point of > or =14 identified 12 (92%). However, 15 of 16 (94%) women without current MDD screened positive on the PDSS_SF. The EPDS was significantly more accurate (p = 0.01) than the PDSS_SF and PHQ-9 with the cutoff points used. After correcting for verification bias, we found the EPDS and the PDSS_SF were significantly more accurate than the PHQ-9 (p < 0.03). CONCLUSIONS Administering the EPDS by phone at 6-8 weeks postpartum is an efficient and accurate way to identify women at high risk for postpartum depression within the first 6 months after delivery.

Exploring The effects Of An online asynchronous mindfulness meditation intervention with nursing students On Stress, mood, And Cognition: A descriptive study

BACKGROUND Nurses returning to school while working, raising families, and maintaining other roles, can experience stress, mood changes and cognition disturbance that negatively impact their academic success. OBJECTIVES To explore the effect of an online mindfulness meditation intervention with distance nursing students on stress, mood and cognition. DESIGN A 24 week descriptive study. SETTINGS An 8 week online intervention was offered to all undergraduate and graduate nursing students, of three nursing programs of a middle-sized university in mid-Atlantic US. PARTICIPANTS A total of 26 nursing students completed the study. METHODS An 8 week online, asynchronous mindfulness intervention was provided through the learning management system with a 16 week follow-up. OUTCOMES MEASURES Perceived Stress Scale (PSS), Hospital Anxiety and Depression Scale (HADS), and Attention Network Test (ANT). RESULTS Stress was significantly reduced (F(2,24)=4.163, p=.019). A decreasing trend for anxiety was noted with significant difference between time points (F(1,23)=6.889, p=.015) when practice frequency was weekly to daily. Cognition: ability to shift attention, attention selection, concentration, and accuracy improved. CONCLUSION Findings from this study may illuminate the usefulness of a mindfulness based stress reduction program offered to distance nursing students. Further studies are needed to better demonstrate the effectiveness of the intervention.

Developing Executive Nurse Leaders: Exemplar for Using Information Technology to Bolster Professional Role Development of BSN-DNP Students

Background: Universities are offering a Bachelor of Science in Nursing (BSN) to Doctor of Nursing Practice (DNP) track to meet the demands of complex health systems by preparing nurses to lead change. Curriculums developed for the adult learner may benefit from adding supplemental resources to prepare nurses with limited leadership experience for their future roles. Objective: Support the development of executive leadership skills of BSN-DNP students. Methods: Faculty at a Western Pennsylvania university used the existing learning management system (LMS) to create a nursing leadership site. Practice competencies described by professional organizations were used as the framework for identifying best practice resources. Results: A supplemental site serving as a repository of information for students was successfully developed. Students were encouraged to access the site to augment their learning on professional competencies. Conclusions: Developing an online support site via the university LMS was a creative solution for providing supplemental professional development content to best prepare future nurse executive leaders. Implications for Nursing: Faculty teaching in streamlined academic programs can provide additional content based on professional standards to students using innovative and interactive methods. Promoting further development of executive leadership skills may bolster program strength and influence future nurse leaders.

Effect of mindfulness meditation on short-term weight loss and eating behaviors in overweight and obese adults: A randomized controlled trial

Abstract Background There is a significant health crisis with rates of obesity continuing to increase despite research and clinical standard behavioral weight loss programs (SBWP). Mindfulness meditation (MM), with demonstrated benefits on physical, psychological health, and self-regulation behaviors was explored with SBWP. Methods Forty-six adults (BMI=32.5±3.7 kg/m2; age=45.2±8.2 years, 87 % female, 21.7 % African American) were randomly assigned to a 6-month SBWP only (n=24) or SBWP+MM (n=22) at a university-based physical activity and weight management research center in a northeastern US city. Participants were instructed to decrease intake (1200–1500 kcal/day), increase physical activity (300 min/wk), and attend weekly SBWP or SBWP+MM sessions. SBWP+MM had the same SBWP lessons with addition of focused MM training. Outcome measures collected at 0, 3, and 6 months included: weight, Block Food Frequency Questionnaire, Eating Behavior Inventory, Eating Inventory and Paffenbarger Physical Activity Questionnaire. Data were analyzed using linear mixed modeling for efficacy analysis of weight (primary) and eating, exercise and mindfulness (secondary outcomes). Results Retention rate was 76.1 % (n=35). A significant group by time interaction (p=0.03) was found for weight, with weight loss favoring SBWP+MM (−6.9 kg+2.9) over SBWP (−4.1 kg+2.8). Eating behaviors (p=0.02) and dietary restraint (p=0.02) improved significantly in SBWP+MM, compared to SBWP. MM enhanced weight loss by 2.8 kg potentially through greater improvements in eating behaviors and dietary restraint. Conclusions These findings support further study into the use of MM strategies with overweight and obese adults. The use of this low-cost, portable strategy with standard behavioral interventions could improve weight management outcomes.

Incivility in the Online Classroom: A Guide for Policy Development

The growth of online education has created a learning environment that permits nontraditional students the opportunity for degree completion without the burden of relocation. Given the shortage of nurses at all educational levels, many institutions of higher learning have created online programs to meet the needs of both the student and the profession as a whole. Although convenient for the student and beneficial for the nursing profession, the online learning environment can present numerous challenges. Among these challenges are acts of student incivility-creating a difficult work environment for faculty and, at times, negatively affecting other students. Therefore, the purpose of this article is to review problems associated with student incivility and share the experience in creating as well as implementing a professionalism policy that addresses student incivility. Recommendations for policy creation are summarized.

Uncovering the Golden Veil: Applying the Evidence for Telephone Screening to Detect Early Postpartum Depression.

ABSTRACT Postpartum depression (PPD) is often detected later than symptom onset, or even undetected, because of lack of prompt or adequate screening. An evidence-based PPD screening protocol using a telephone-based format within a primary care practice was developed to identify symptoms and initiate treatment between 2 and 3 weeks postpartum. The Edinburgh Postnatal Depression Scale was used, with positive screens referred for provider and support services, and then tracked for follow-through. Fifty-two percent of women screened positive. Sixty-four percent accepted both provider and support referrals, with 89% follow-through with provider referrals and 78% follow-through with support referrals. Outcomes support early screening for PPD using a telephone-based format to effectively identify symptoms and acceptance of referrals by participants.

Nursing Honor Societies: Past, Present, and Future

Honor societies have been a valued tradition among academia dating back to 1776. Traditionally, honor societies have evolved as a means of recognizing academic excellence, leadership, service and scholarship. As a result, various disciplines including nursing have inducted students into respective honor societies over the past several hundred years. The proliferation of online education programs have raised issues related to the continuance of recognizing academic excellence in similar ways as traditional brick and mortar institutions. As a result, this article explored past, present and future trends for Honor Societies as educational programs and delivery formats continue to evolve.