Escolar Documentos
Profissional Documentos
Cultura Documentos
Jasmine Wrenn
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
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
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
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).
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
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
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,
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
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
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
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
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
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
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
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
Hurst, A. M., & Schiebel, D. F. (2017). Breastfeeding and Postpartum Depression. CINAHL
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.
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
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