Running Head: LEADERSHIP PROJECT PAPER 1

Jasmine Wrenn

Leadership Project Paper

Dr. Ellcessor

Nur 4144

I Pledge
LEADERSHIP PROJECT PAPER 2

Nurses are leaders in many instances. They lead their patients, community, healthcare,

and even each other. A leader exhibits these qualities: caring, servant, progressive, approachable,

understanding, and more. Leaders not only direct but inspire and empower other individuals to

lead. As a nurse leader it is important to use knowledge and experience to initiate quality

improvement within healthcare. On the Mother and Infant unit there are many initiatives driven

to help patients reach goals of wellness. An initiative that will be addressed in this paper is

quality improvement to decrease the number of mothers exhibiting postpartum depression. This

initiative is not to only to decrease the incidence but to improve support in place for mothers that

have this problem.

Postpartum Depression is common among many communities. Almost 15% of new

mothers experience postpartum depression (Letourneau et al., 2011). This affects roughly

400,000 infants according to The American Academy of Pediatrics (Hurst, 2017). The problem is

not taken as serious as it should. “Postpartum depression is characterized by the development of

depressive symptoms such as lack of enjoyment in life, insomnia, intense irritability, impaired

mother-infant bonding, withdrawal, and thoughts of harming oneself or the infant beginning

during the first 6-8 weeks postpartum” (Hurst, 2017). A mother’s symptoms can range from mild

to postpartum psychosis. The idea with providing support early on is so that mothers are not

alone in their fight and depression does not progress to psychosis.

The important thing for nurses is to recognize signs and risk factors for mothers.

Education is critical for mothers, support person/s, and nurses. Nurses must know that

postpartum depression can occur anywhere between two days of life and one year after

childbirth. Suicide and/or infanticide are at increased risk for a mother that is experiencing

postpartum depression (Schub & Avital, 2018). Securing a plan before discharge can be the
LEADERSHIP PROJECT PAPER 3

difference of a mother understanding that help exist and suffering alone. Nicole Letourneau and

peers found that mothers favored a controlled support group with a professional nurse rather than

talking to a peer, a mother that recovered from postpartum depression (Letourneau et al., 2011).

A nurse can provide knowledge based trustworthy relationship.

Having a child is thought of as an exciting moment in some mother’s life, but this is not

always the case. Some women become pregnant due to other circumstances. This topic is

connected to the heart because mothers are raising our next generation of life. All children

deserve a safe and loving environment which can be complicated by postpartum depression. This

is a major problem as it is not recognized enough within the United States. Complications for

babies can include poor developmental outcomes. This can happen because maternal-infant

interactions are decreased with mothers who are depressed (Maternal Depression 2004). As a

country it is important to protect and care for the most vulnerable populations, mothers and

infants.

Postpartum depression does not affect everyone the same and it takes many people to

support someone who is experiencing depression. Initiating protocol or policy around postpartum

depression falls under one of the four domains of leadership, head. The idea is to connect the

belief system and values of Bon Secours to those we serve. Working on postpartum depression

holds true to Bon Secours core value of being good help to those in need. As a unit with the

population of mothers and infants, care is directed to the whole person before, during, and after

their stay. Improving the rates of depression speaks to the mental state of the mothers, which

must not be ignored. Mental health plays a vital role in wellness, now and in the future once

discharged. Nurses teach mothers coping mechanisms to combat the physiological changes that

affect mental status.

LEADERSHIP PROJECT PAPER 4

The leadership domain hands require action. As a nurse, assessment of the patient and use

of evidence based practice to direct care is essential. To understand if mothers are at risk for

developing postpartum depression before their discharge date they are required to complete the

Edinburgh Postnatal Depression Scale (EPDS). EPDS “is a patient-rated screening tool that is

interpreted by healthcare clinicians to assess for the presence and severity of depressive

symptoms in postpartum women” (Mennella & Balderrama, 2017). The outcome of this

subjective assessment is to help clinicians develop a psychological plan before discharge to keep

mother and infant safe.

In addition to the EPDS the nurse is proactive in finding the risk factors and using other

tools to develop an action plan. After completing the 10 item questionnaire the nurse reviews the

results which can range from 0-30. If a patient scores >9 in total and/or >1 on question 10 then

the nurse should immediately request a psychological consult (Cox, Holden, & Sagovsky, 1987).

With trust and open communication the nurse actively work with the patient using clinical

judgment to put supportive actions in place. Some of these supportive measures include,

information on resources, psychology consult, or extended stay.

As a leader creating habits fosters a community built on responsiveness. Nurses must

continue to carry out research to educate the team but also to find new innovative ways to help

mothers. St. Mary’s mother and infant unit created a free depression support group. Nurses run

the group which meets every first and third Saturday of each month for an hour. After discharge

it can be hard for mothers to get out of the house. Getting out of the house can be even harder for

a mother with postpartum depression.

LEADERSHIP PROJECT PAPER 5

Taking it a step further, implementation of a program that meets the mother in their home

to discuss barriers can provide a different level of support. Normalizing nurses within

community not only helps the mother but also fosters community support in building visibility.

Creating this habit keeps nurses grounded and forges the right relationships with patients, one

that is trustworthy. The image of nurses will be improved and the character assessment will be

validated through their habits.

Discharge paperwork that includes community events and initiatives to follow up with

once discharged would be given to mothers. Postpartum hot lines that mothers can call in, could

be extended to Skype calls that provide a sense of visibility. Topics that not only include

depression but things that may be added like trouble breastfeeding, understanding your baby's

cues, returning to work, involving your partner, and learning to juggle multiple tasks. Nurse

navigators can be used to facilitate the transition from hospital to the home.

As a nurse manager it is important for the team to see equal participation. If a standard of

the unit is to participate in Unit Based Council, the manager should be an active participant. A

goal would be to Model the Way. This would be achieved by the manager conducting the

introductory meeting intended to decrease rates of postpartum depression. The team would

understand that all members high and low are not exempt from participating in the further

development of the unit. Specifically for postpartum depression, initiatives would be clearly

explained, reasons of concern and outcomes that the unit can accomplish together will be

documented. Once a standard is established it is important to allow others to lead.

In order to get other leaders involved it is important to inspire them to share the vision.

How does postpartum depression affect everyone on the unit? The solidification of future
LEADERSHIP PROJECT PAPER 6

generations start with postpartum nurses once the baby is delivered. Nurses can guide mothers

and influence them to live improved lives once they return home. Purpose in our community can

reside with healthcare providers. We all take pride in building a healthier and well rounded

world.

Peer to peer workshops can bring about new ideas of shared vision but also challenge the

process. Progression is essential as the world changes. Using new innovative minds and

collaboration across healthcare providers as tools will help to create a shared vision. A workshop

could include an anonymous box that the team would throw in balled up pieces of paper with

ideas of a world with postpartum depression and then a world absent of it. Someone would draw

the pieces of paper out of the box and then add it to two different boards. The idea is that similar

ideas will come about, new ideas will push other people to expand perspectives, and the current

process will be challenged.

Having a bi-monthly meeting will provide a regular habit of revisiting the results and

make changes. A change that will occur every meeting is the leader. As the nurse manager it is

important that the meeting is not lead by the same person especially someone in charge. Names

will be draw out of a hat; this gives all members an opportunity to lead. Whether it is believed or

not everyone has good ideas and new structures that can move the team forward. Collaboration is

fostered because it does not seem that only one subjective agenda is being pushed. Recognizing

notes of encouragement of each leader encourages the heart. Team members can write notes in a

jar that will be used to spotlight a leader during the meeting. This can encourage participants to

push themselves to inspire their partners in efforts to be recognized. Special gifts can also be

attached like gift cards.

LEADERSHIP PROJECT PAPER 7

The overall goal of the project is to decrease postpartum depression. As a nurse manager

I will lead with the four domains: heart, head, hands, and habits. Setting a culture of acceptance

and forward thinking through modeling the way, inspiring a shared vision, challenging the

process, enabling others to act, and encouraging the heart. My team will understand the

implications postpartum depression has on our population such as decreasing readmission of

mother or infants. There are a few outcome evaluations that can be used to assess the team

progress. As a team we will sit down to look at the fiscal year reports of readmission of either

patient, attendance to follow-up appointments, and self-survey of well being post discharge. The

quality improvement initiatives can lead to new ground breaking research that can act as a guide

for other healthcare organizations.

LEADERSHIP PROJECT PAPER 8

References

Cox, J. L., Holden, J. M., & Sagovsky, R. (1987). Detection of postnatal depression:

development of the 10-item Edinburgh Postnatal Depression Scale. The British journal of

psychiatry, 150(6), 782-786.

Hurst, A. M., & Schiebel, D. F. (2017). Breastfeeding and Postpartum Depression. CINAHL

Nursing Guide. Retrieved from

http://search.ebscohost.com/login.aspx?direct=true&db+nup&AN=T703721&site=nup-

live&scope=site

Letourneau, N., Stewart, M., Dennis, C. L., Hegadoren, K., Duffett-Leger, L. & Watson, B.

(2011). Effect of home-based peer support on maternal-infant interactions among women

with postpartum depression: A randomized, controlled trial. International Journal of

Mental Health Nursing, 20(5), 345-357.

Maternal depression and child development. (2004). Paediatrics & Child Health, 9(8), 575–583.

Mennella, H. A., & Balderrama, D. M. (2017). Depression Assessment: Using the Edinburgh

Postnatal Depression Scale. CINAHL Nursing Guide.

http://search.ebscohost.com/login.aspx?direct=true&db=nup&AN=T903344&site=nup-

live&scope=site

Schub, T.B., & Avital, O.M. (2018). Postpartum Depression. CINAHL Nursing Guide.

http://search.ebscohost.com/login.aspx?direct=true&db=nup&AN=T700287&site=nup-

live&scope=site
LEADERSHIP PROJECT PAPER 9