According to the CDC, about one in nine women
experience postpartum depression. Oftentimes, nurses may be able to recognize
this in their patients and assist them in getting help. First, though, you have
to know what you’re looking for.
Susan Altman, DNP, CNM, FACNM, a clinical assistant professor and midwifery program director at the NYU Rory Meyers College of Nursing, has been a midwife for more than 20 years. She took some time to answer our questions on recognizing postpartum depression in new moms.
What are the main symptoms of postpartum depression in new moms? How can nurses learn to recognize what are the signs of PPD as opposed to something else?
Many women who give birth experience changes in mood due to significant changes in hormone levels after the birth. These changes do not cause depression in all women. The most common of perinatal mood changes in the postpartum period is postpartum blues or “baby blues,” which manifests itself with such symptoms as sadness, crying, and mood swings. Most often these signs begin 5-7 days after the birth, lasting just several weeks.
PPD, a major depressive disorder, can also begin in
the days following birth, and may be mistaken for baby blues at
first. But the symptoms are more commonly noticed several weeks
or months after the birth, and their duration is usually much longer. Symptoms
are more severe in PPD than they are in postpartum blues. Those diagnosed with
PPD often have symptoms with severe features such as feeling sad and hopeless,
crying for no apparent reason, being worried or overly anxious, oversleeping,
having difficulty concentrating or remembering things, losing interest in
activities that were once enjoyed, being angry, withdrawing from family and
friends, not feeling emotionally attaching to baby, and thinking about harming
themselves.
Nurses and midwives are experts in assessment and
should carefully investigate and look more closely at the postpartum person who
is frequently crying, having trouble sleeping, reports low energy or appetite
changes or loss of enjoyment of activities that were once enjoyed.
It is important to be mindful that increased anxiety is often associated with perinatal depression, so assess for signs of this as well. A thorough, comprehensive review of the person’s prenatal history in order to flag certain risk factors for PPD is important to help clinicians distinguish between diagnoses. Risk factors include prior history of any depression or mental illness, stressful life events during pregnancy, and little or no social support, just to name a few.
Most importantly, providers must listen to
what the person is saying about what they are feeling or experiencing. Most patients
know that something is not right. They know themselves the best.
If
a nurse recognizes some of the signs in a new mom, what should s/he do?
Approach the mom? What should s/he say? Please explain.
Nurses and midwives who suspect postpartum mood
disorders in anyone they take care of must intervene. PPD should not be ignored.
In approaching a mom, nurses and midwives need to
let the person know what symptoms they are observing and why they are concerned.
The person must be educated that postpartum depression is common and that they
are not alone. Explaining that PPD is simply a complication of birth can be
helpful. Always acknowledge that the person has done nothing wrong. Include
that although PPD may be difficult to deal with, it is possible that with the right
individual treatment and emotional support, management of symptoms and recovery
is very likely.
Suppose
the mom denies it. What should the nurse do then?
From my experience, when someone is approached, they
rarely deny it. They often already know that something is not right in how they
are feeling, and they are often relieved that someone has reached out to them
to help. Again, telling them that they are not alone and that there is care
that they can get which can make them feel better is helpful.
If the person really does deny it and does not see the need for help, this is where family members and friends should be recruited to help. Family and friends may actually have already recognized the symptoms of PPD in this person and are often very willing to get involved. They can help reinforce what the nurse has explained and encourage the person to meet with a mental health care provider. They can also offer ongoing emotional support, assist with transportation to appointments, and care for the baby or help with household chores—freeing up the person to go for care. Again, underscore that the person is not alone in this recovery process.
What
if the nurse recognizes the symptoms after the mom has left the hospital—like
in a home health visit? What should s/he do?
Because, in most cases, PPD does not manifest
itself until weeks or months after birth, it is quite common that the nurse who
works at the bedside immediately postpartum will not be the one to recognize
the signs and symptoms of postpartum depression.
Our standard system of postpartum care for birthing individuals is generally only a postpartum visit at six weeks after birth with little or no communication until that visit. Many suffer with signs of PPD during this six-week window, not knowing that what they are feeling is not normal and may require professional help. More often than not, recognition of signs and symptoms of PPD can come from nurses other than those working in the postpartum unit. For instance, nurses making home visits, taking office phone calls, or perhaps taking care of the baby in the pediatrician’s office are sometimes the ones who bring the symptoms to the postpartum person’s attention.
Any nurse who recognizes PPD has the responsibility to educate and then provide resources and referral to providers skilled in caring for those with symptoms noted. In this way, nurses can be instrumental in helping women get the care they need in a timelier manner.
“An
investment in knowledge pays the best interest.”
Benjamin Franklin had the right idea when he talked about using the knowledge you’ve earned and putting it to good use. As nurses, we have a desire for continual learning, especially with the ever-changing new practices and research in the health care profession. If you’re new to nursing and have been working for only a year or two, you may be wondering, “What path should I be taking?” or “How can I broaden my knowledge and skills?”
There are many ways you can develop your career as a new nurse with opportunities that are often within your area of employment.
1. Obtain a certification.
For as many different nursing specialties that exist, there are virtually as many certifications for each and every one of them. Many hospitals offer additional compensation for nurses who are “board-certified,” meaning you are recognized by a specialty association of nursing as an expert in that specific area of nursing. There are other specific roles within your field of nursing that you may choose to be certified in such as becoming a Certified Diabetes Educator or a Certified Childbirth Educator.
2. Join a committee.
Many hospitals have committees for nurses called Shared Governance. Shared Governance is a group of nurses working together to implement best practices on a hospital unit. These practices can range from work-related issues such as scheduling to practice-related issues such as updating a policy on the best way to monitor patients’ blood sugar. These unit-based councils may also collaborate with other hospital units within a specific department to address how to best work together and keep patients safe.
3. Find a nurse-residency program.
This is particularly for brand new nurses who are looking for their first job after nursing school. Many teaching hospitals offer a residency program for nurses to participate in for one year after the beginning of their employment. These programs meet monthly and are a way for new nurses to discuss struggles they may be having or learning issues they might be facing. Often there is a research project nurse residents complete specific to their area of practice. These programs are a great way to meet other new nurses and can often help ease the transition from being in school into working in nursing practice.
4. Participate in continuing education.
Many states require a certain number of CEU or continuing education unit hours to re-register as a licensed nurse. There are many local and national conferences nurses can go to for the latest topics in the nursing profession and within different specialty areas. Most hospitals, upon employment, allot nurses with a certain number of education hours they may use at their discretion and may reimburse for class or conference costs.
5. Go back to school.
Making the choice to go back to school is a huge decision. While some nurses may already know, specifically, what area they want to focus on during their time in nursing school, others may need a few working years under their belt to get a feel for different kinds of nursing practice. Masters programs range from specializing as a nurse practitioner or nurse educator to forensic nursing or public health. Getting an advanced degree may broaden your career options and opportunities. Many nurses continue to work full-time while getting their degree with the great advantage of tuition reimbursement from their employer.
Advancing your existing nursing knowledge is a great way to become an expert in your nursing specialty or to explore other paths in nursing you may want to take. It’s well known that nursing is one of the most trusted professions and patients appreciate the knowledge and skills you bring to their care. Take the time to find out what career opportunities exist within your place of employment and in your community.
Nurses are incredibly resilient. Each day, they wake up, throw on a set of scrubs, and head into work to perform a demanding 12-hour shift—all while striving to provide the best possible care to their patients. Then, they get home and fall asleep, only to begin the process all over again.
But as a nurse, you know that this barely touches the reality of the situation. In the United States, most hospitals and clinics are woefully understaffed, which often forces nurses to work longer shifts and manage far more patients than they can actually handle. The unfortunate result is nursing fatigue, a common condition which can make you feel both mentally and physically exhausted for days, weeks, or even months.
Almost all nurses have experienced nursing fatigue at some point in their careers, so don’t feel guilty over it. Instead, you can try these seven strategies to combat the effects of nursing fatigue.
1. Leave work at the door.
When you
clock out from work, it’s important for you to clock out mentally as well.
Leaving your work at the door is essential for avoiding compassion fatigue, a
condition which results from repeated exposure to patient suffering while
working in a high-stress environment.
In a 2017 study published in the European Journal of Oncology Nursing, researchers found that nurses were more likely to experience compassion fatigue when they were more self-judgmental. If you come home from work and feel guilty about all the things you could have done to make your patient’s life easier, you won’t give yourself time to recharge for the next shift.
2. Practice different forms of self-care.
Nurses go from patient-to-patient, checking their vital signs, administering medicine, and assisting them with daily activities. As a result, it’s easy to get so caught up in caring for patients that you forget to take care of yourself.
To be on top of your game each day, it’s critical that you do things for yourself on a regular basis. Some self-care practices you can try include: going for a walk in nature, starting your day with meditation, or signing up for a healthy subscription meal service.
If you tend to feel guilty about treating yourself, make your forms of self-care double as a bonus for work. For example, do arm work every other day to help lift your patients or invest in the new pair of nursing shoes that you’ve been eyeing for months.
3. Use your vacation days.
You have
vacation days, so remember to use them. Taking time off work is key to
preventing burnout and will help you return to work feeling refreshed and rejuvenated.
If your nursing unit schedules vacations at the start of each year, be sure to
get your days in the books—even if you don’t have anywhere in particular to go.
In fact, planning a “staycation” for yourself may be the perfect getaway. You can recharge your batteries by relaxing at home, catching up on things you’ve been neglecting, and spending quality time with the family.
4. Unload your brain after each day.
After a
particularly tiring shift, sometimes you just need to declutter your mind and
get all your thoughts out of your head. One way to do this is by writing them
down on paper or typing them into a Google doc.
Untangling your mind and getting the thoughts out of your head can lower your mental brain fog and allow you to relax after a shift. The process is simple: Just set a timer for 15 minutes and unload your thoughts. Once the time is up, delete your document or click out of it. Reading it over again will only put the words back into your head.
5. Change your work environment.
While it’s no secret that most hospitals and clinics stretch their nurses far too thin, some take it to another level by creating an environment that is downright dangerous. If your health care institution has a poor nurse-to-patient ratio and no system in place to provide help for nurses, it may be worth it to begin searching for a new job.
Though nursing is an in-demand field, finding the right fit can be trickier than it sounds. Don’t be afraid to explore different health care settings to find your ideal work environment. While you might take a pay cut in some instances, the change could be the key to preventing nurse fatigue.
6. Find a specialty you love.
It’s much
easier to prevent nursing fatigue when you truly love what you do. If being a
registered nurse just isn’t working for you, consider switching to a nursing
specialty that makes you happy to stroll into work each day.
While you could always take a nursing specialty quiz to help you nail down your career, one of the best ways to get a feel for a particular specialty is hands-on experience. Are you interested in a position as an emergency room nurse? Talk with the ER manager and let them know you’re ready to help. There are hundreds of nursing specialties, so be sure to explore all your options to find a job that truly ignites your passion.
7. Explore new hobbies.
Every nurse
needs a hobby that allows them to decompress and wind down from work. Finding
joy in a new hobby can combat nursing fatigue by giving you something to look
forward to after a shift.
Some of the best hobbies for nurses often double as stress-relieving activities, such as painting, knitting, woodworking, and jewelry-making. Be sure to explore hobbies that get your heartrate up. Getting involved in a pickup soccer game, going ziplining with friends, and enrolling in a martial arts class can help keep your mind off work while improving your mood.
Long shifts combined with understaffed nursing units are the perfect storm for nursing fatigue. While some health care facilities are working to address the problem, it’s important for you to be proactive about your health and happiness. With the help of these strategies, you can fight back against nursing fatigue and prevent it from affecting your personal and professional life.
According to the Anxiety and Depression Association of America, anxiety disorders are the most common mental complications in the United States affecting more than 40 million adults in the U.S. or at least 18% of the population every year. Although anxiety disorders are highly treatable, only about 36% of anxiety patients receive treatment.
Several factors can lead to anxiety. Some of
these factors include brain chemistry, genetics, personality, and drastic life
changes. We are all, therefore, prone to anxiety.
Anxiety affects us differently. Some people
might feel unprepared, unsure, or nervous when trying something new or before
giving a speech. These feelings may manifest in physical symptoms such as
headaches, shortness of breath, or clammy hands.
Anxiety is actually an adaptive response that
can help us cope with challenges or day to day threats. These responses can
help identify and avert potential threats, encourage us to work harder, etc.
However, when we don’t respond well to these triggers, they can become
maladaptive leading to clinical anxiety disorders.
There exist many medications to deal with this
condition. Some of the common drugs include tranquilizers like Valium and Xanax
and selective serotonin reuptake inhibitors like Zoloft and Prozac. While some
of these drugs may work, some people may not respond well. There have been
cases where patients fail to see any changes or are unable to tolerate the side
effects. Also, drugs such as Xanax and Valium can be highly addictive.
For this reason, more and more people are
looking for natural alternatives that can help them cope with anxiety
disorders. This is where CBD comes in. But the question is, can it work?
FIRST THINGS FIRST:
WHAT IS CBD?
CBD (Cannabidiol) comes from the cannabis
plant. It is one of the 120+ chemical compounds (cannabinoids) that are
naturally produced by the plant. Unlike THC (tetrahydrocannabinol), another
popular compound in the cannabis plant, CBD is not psychoactive. This means
that you won’t get the ‘high’ that is usually associated with cannabis
consumption.
CAN CBD HELP WITH
ANXIETY?
Cannabidiol has been touted for its many health benefits, including remedying chronic pain, depression, cancer symptoms, and now anxiety.
HOW DOES CBD WORK?
Before we delve deeper into this subject, it
is worth noting that most studies describing how CBD works for anxiety are
preclinical and based on animal models. This means that more research is still
needed to ascertain the effectiveness of CBD as a natural remedy for anxiety.
That said, Cannabidiol exerts several actions
on the brain that may help explain why it may be an effective treatment for
anxiety disorders.
5-HT1A AGONIST
5-HT1A is a subtype of the serotonin receptor.
According to experts, anxiety can be treated using medications or drugs that
target the serotonin system.
Findings indicate that CBD could represent a novel fast antidepressant drug.
Selective serotonin reuptake inhibitors (SSRI)
such as Zoloft and Prozac treat anxiety by inhibiting the re-absorption of
serotonin in the brain. This ensures that serotonin is available in the
synaptic space, which helps the brain cells to transmit more serotonin signals.
It is believed that this can help boost moods and reduce anxiety. (Of course,
the actual biological process is more complicated than this)
Just like selective serotonin reuptake
inhibitors, Cannabidiol may boost serotonin transmission.
According to a study conducted by Spanish researchers,
CBD can enhance 5-HT1A transmission and can actually affect serotonin faster
than standard selective serotonin reuptake inhibitors.
HIPPOCAMPAL
NEUROGENESIS
The hippocampal is a vital brain area
responsible for critical roles such as cognition and brain formation. Scans on
patients suffering from anxiety or depression have often shown a smaller
hippocampus. Depression and anxiety medications, therefore, aim at triggering
neurogenesis (birth of new neurons)
In a study involving mice, it was discovered
that repeated application of Cannabidiol may help boost neurogenesis. A
growing body of research suggests a link between CBD, SSRIs,
neurogenesis and anxiety and depression.
Based on these findings, researchers are
bringing forward data suggesting that CBD may help improve the common
anxiety-disorders in humans.
HUMAN STUDIES
SUGGESTING CBD MAY HELP TREAT ANXIETY
A study carried out in 2010 found out that CBD
could help remedy symptoms in social anxiety disorder (SAD)
patients. Follow up brain scans on the group revealed altered blood flow to the
brain parts concerned with anxiety and mood regulation. In this study, CBD was
not only found to be effective in making people feel better but also altered
the way their brains responded to stress and anxiety.
In 2011, another study was conducted to find out
whether CBD could remedy social anxiety disorder. In a public speaking test
that followed, people who received 600mg CBD experienced less anxiety, had less
cognitive impairment, were more relaxed and comfortable than their counterparts
who received a placebo.
CBD inhibits the fear of speaking in public, a symptom of social anxiety disorder.
A 2015 analysis of existing studies concluded
that Cannabidiol has great potential as a natural remedy for different forms of
anxiety including panic disorder, social anxiety disorder, post-traumatic stress disorder, generalized
anxiety disorder, and obsessive-compulsive disorder.
In 2017, researchers from Sao Paulo University
in Brazil found out that CBD helped reduce anxiety in patients with social phobia.
WRAPPING UP
It is clear that more studies on human are
still needed to ascertain the link between anxiety and CBD. However,
preliminary findings validating CBD’s efficacy as a natural remedy for anxiety
are promising.
It is important that all stakeholders in the
health sector come together and see if there is a way to improve this natural
compound to produce even better results. This should be treated as a matter of
urgency, given the huge economic and social cost that anxiety impacts not only
in the US but across the globe.
Most people in the medical profession agree that a nursing career can often be stressful; it comes with the territory of caring for those who are ill and injured. And on an average day, well-trained nurses are more than capable of managing the day to day stressors that their profession brings. But there are also those occasional shifts that bring nurses to their knees, putting them in need of restorative tactics. Here are some solutions for bringing a nurse back from the brink after a rough shift.
After a rough shift, it helps to debrief with colleagues who have also had a tough day. Reviewing what didn’t go well and determining how events could have been better managed can be educational or reinforce that the decisions made were the best possible options. And the opportunity to share the days’ struggles can be a great bonding experience for the team.
Break up the routine. Take a different or longer route home.
Taking the long way home can provide valuable time to clear the mind and break
up the “autopilot” to which we tend to default on our commutes.
Play soothing or instrumental music on the radio,
or leave it off altogether. Patient care can be extremely noisy, especially in
acute and long-term care facilities. After a long shift of constant noise, a
little oasis of quiet can be very soothing. After you get home, continue to
limit external stimuli for a while. Keep that Zen mode going a little longer if
you’re able.
Are you a pet owner or lover? It’s a wonderful thing after a long day to be greeted at the door by a faithful companion, but take it a bit further. A long walk with your dog or some snuggle time with your cat, ferret, or another small animal can help you detach from the day. Your focus is shifted from your own worries to the needs and appreciation of your furry friend. If you don’t have a pet yourself, perhaps you can visit a friend or neighbors’ dog. Petting an animal lowers blood pressure and facilitates the release of relaxation hormones.
Taking a nap or reading something simple and calming can help bring you back to balance by focusing your mind on something other than the friction of the day you’ve had.
Even if your work isn’t necessarily as grimy as some careers, most nurses make it a point to bathe after a shift. A shower or a soak in the tub cleanses off the residue of the day and leaves you fresh and ready for bed.
However you choose to spend your time after a rough shift, it’s important to make sure that you know how to take care of yourself.
The use of medical cannabis is becoming more widespread now that it’s legalized in 33 states and the District of Columbia. If you’re a nurse or doctor who can legally prescribe medical cannabis, teaching your patients about this treatment and how it works can bring them one step closer toward achieving better health and improving their medical conditions.
The following tips can help you advocate for patients who
may be seeking medical cannabis.
Explain How Medical Cannabis Works
The cannabis (marijuana) plant contains more than 100
cannabinoids—each of which produces different effects depending on which
receptors they bind to in the body and brain. THC and CBD are the most
well-known cannabinoids when it comes to cannabis. THC offers therapeutic
effects of reducing pain, nausea, and inflammation. CBD offers similar health benefits and
more without producing a psychoactive high like THC.
When explaining to your patients how medical cannabis works,
discuss the differences between different cannabinoid ratios and how that will affect their symptoms. If your
patients are concerned about a psychoactive high, assure them that you can
prescribe medical cannabis that can effectively improve their condition or
symptoms without producing a psychoactive high. Recommend
your patient discuss this concern with a licensed medical cannabis pharmacist
for best results.
Talk About How Medical Cannabis Can Be Used
Medical cannabis can be smoked, vaporized, ingested, applied topically, or taken as a liquid extract. Each consumption method has a different onset time and depends on your patient’s tolerance level. Smoking or vaporizing medical cannabis produces near-immediate effects, while medical cannabis edibles can take up to 2 hours to start producing medical effects. Smoking cannabis is not medically recommended since this method burns off the majority of the therapeutic medical cannabinoids.
Talk to your patients about their options for using medical cannabis and about which method may be most ideal for them based on their personal preferences and medical condition.
Discuss Possible Drug Interactions
Medical cannabis is highly therapeutic when used on its own, but may cause unexpected adverse reactions when used with certain types of medications. When discussing medical cannabis with your patients, ask about the medications they’re currently using and help them stay safe by educating about possible drug interactions. Medications that may cause adverse reactions when used with medical cannabis include warfarin, pentobarbital, oxymorphone, and disulfiram.
