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					POSTPARTUM DEPRESSION: A MULTIMEDIA PATIENT EDUCATION MODULE

         AND PRESENTATION IN A CLINICAL MICROSYSTEM



                                  by



                   Brendan Kober and Suzanne Luger



               N604- Instructional Design and Informatics



                      University of San Francisco

                                CNL 10




                         November 16th, 2010
POSTPARTUM DEPRESSION: A MULTIMEDIA PATIENT EDUCATION MODULE                                        2
AND PRESENTATION IN A CLINICAL MICROSYSTEM
                                   Learning Needs Assessment




Postpartum depression has been described as the “thief that steals motherhood” (Beck, 2006).
The average prevalence rate of postpartum depression is 13%, with more than 50% of cases
going undetected (Beck, 2006). Evidence has indicated that early identification of women at risk
for this mood disorder is the first step in prevention (Beck, 2001). The purpose of this Patient
Education Module is to increase early detection of women at risk for Postpartum Depression
(PPD) through the implementation of an automated screening tool based on the Postpartum
Depression Predictors Inventory-Revised (PDPI).

The implementation of this screening will incorporate a number of learning and testing
technologies. This Module is not designed to replace, but rather to supplement the work of the
nurse educator by providing learners with access to multiple digital media including video,
computer based testing, and electronic resources. It is proposed that the combination of
computer based rather than care provider based screening will increase the validity of screening
tests by bias related to the social stigma of depression in America.

The automated screening will also allow the learner to voluntarily complete a self-assessment in
the privacy of their own home. It will provide prompt feedback and access to materials allowing
for immediate, self-directed learning.

1. Describe the learner, for example, age, sociodemographics, diagnosis, motivation:

       This intervention is intended for a single learner, not a group. The learner is any pregnant
       woman or new mom in a postpartum setting. The learner can also be several months
       postpartum, but since the goal of the intervention is early identification of PPD risk, focus
       will be placed on the pregnant woman and new moms.

       The learner may be of any age, sociodemographic background, does not need any
       specific diagnosis. Nursing research has confirmed the nature of the PPD mood disorder
       is universal, and spans cultures (Beck, 2008). The learner will need to be computer
       literate and have incorporated use of a computer into daily life.

2. Describe and evaluate the setting, for example, privacy, staffing, potential obstacles or
barriers to teaching:

       There are two settings for the intervention. First, the learner will view a video followed
       by self-administered assessment from any computer or cell phone. The client will then
       review the results with their health care provider.

       For the pregnant woman, the video and assessment can be completed in the privacy of
       their own home, as time permits. No staffing is needed, but the woman may place the
       activity as a low priority when other task oriented responsibilities, like preparing the
POSTPARTUM DEPRESSION: A MULTIMEDIA PATIENT EDUCATION MODULE                                          3
AND PRESENTATION IN A CLINICAL MICROSYSTEM
       child‟s room, take precedence. If the mother is still working, she may feel lack of time
       to complete the teaching. She may be feeling stress from pregnancy, and behavioural
       changes due to changing hormones.

       For the postpartum mom, both steps will be completed in the hospital room, were many
       more obstacles exist. Mothers in the postpartum setting are already receiving a large
       amount of information. This teaching is asking a new mom to think about a possible
       future situation, when she is faced with more immediate responsibilities. The new mom is
       also in the process of transition and is experiencing various emotions. She may resist
       discussing PPD due to social stigma attached to Depression. The hospital room is often
       occupied by partner, family members and hospital staff limiting the privacy appropriate
       to discuss PPD with the mother.

       Time may also be an obstacle. The planned intervention is rather time intensive and large
       amounts of time may not be available to care givers in a non-student role.

3. In general, describe the type and extent of content required (the topic):

       The intervention includes: a general introduction to PPD using video; dialogue with
       health provider; a self evaluation by learner using the Postpartum Depression Predictors
       Inventory- Revised (PDPI); a discussion of screening results; and web based access to
       available resources and support groups.

4. Elicit learner input, for example, will the family want to be included, has the learner had this
teaching before, unique circumstances:

       Teaching plan is focused on a single learner. It includes informal assessment of previous
       knowledge concerning PPD. Inclusion of partners, family, friends, and other support
       personnel would follow pre-existing hospital protocols concerning PPD education and
       intervention.

       One learner interviewed for this project at 19 weeks gestation suffered depression prior to
       pregnancy. She was required to change her medication due to pregnancy, and indicated
       she would be very interested in learning more about PPD both during and after
       pregnancy, with or without her support group present. She was most worried about being
       a good mother, and concerned she can do this if she is feeling depressed. She is anxious
       to test the survey when complete.

5. Generate health care team input, for example, do staff or your clinical faculty have any
suggestions or guidelines?

       John Muir hospital evaluates for PPD during follow-up home visits to new moms. No
       formal tool is used.
POSTPARTUM DEPRESSION: A MULTIMEDIA PATIENT EDUCATION MODULE                                       4
AND PRESENTATION IN A CLINICAL MICROSYSTEM
       Instructors at pre-natal courses indicate need to assess both prior to delivery, and with
       mom only after birth. Mother‟s often feel a send of „what about me?” when family and
       friend‟s focus shifts from mom to baby. A different set of teaching can be provided for
       partner and family to notice risk factors.

6. Prioritize needs (mandatory, desirable or possible):

          Mandatory: Learner understands personal risk for PPD.
          Mandatory: Learner understands that left untreated, PPD can have serious
           consequences. It can lead lack of concern for baby, leading to lack of attention to
           baby, which may result in development delays in their new child/children (Beck,
           2008).
          Mandatory: Learner asserts desire and willingness to seek help for PPD if signs and
           symptoms are present.
          Desirable: Learner has increases knowledge concerning PPD.
          Possible: Learner understands that many people suffer from PPD.
          Desirable: Learner demonstrates knowledge of signs and symptoms of PPD
          Desirable: Learner finds support resources that work with learner‟s lifestyle

7. Describe resource availability, for example, a private room, A-V and computer equipment:

       Self-assessment will require computer access (laptop preferable) or cell phone.
       Educational video and access to reference information will require computer access.

       Discussion of assessment and teaching should be in a private room.

8. Summarize organizational demands, for example, meeting regulatory or accreditation
standards, fit with the mission:

       Review and approval of protocols would be expected prior to widespread implementation
       and study. Follow up study of effectiveness of intervention at identifying and directing
       patients towards PPD resources would benefit patients and staff.

9. Anticipate time management issues, for example, the kinds interruptions or delays that
might occur:

       Time requirements of intervention are less than 30 minutes. This time may be hard to
       find during a postpartum visit. In addition, intervention in moderate and high risk cases
       is based upon learner willingness/ability to seek resources. Depression, by definition,
       reduces motivation and initiative taking behaviors.
POSTPARTUM DEPRESSION: A MULTIMEDIA PATIENT EDUCATION MODULE                                      5
AND PRESENTATION IN A CLINICAL MICROSYSTEM
                                         Teaching Plan




GOAL: Expose the learner to Postpartum Depression in a non-judgmental way, and connect the
learner with resources appropriate for their risk factors as identified by the Postpartum
Depression Predictors Inventory- Revised (PDPI).

Learning Objective #1: After reviewing the on-line video on PPD, the patient will recall two
signs of postpartum depression.

Learning Objective #2: After completing the PDPI inventory, the patient will infer and list 1-3
risk factors that they have for PPD. (number of risk factors is based upon their score: 1 for
scores < , 2 for scores - , 3 for scores > ).

Learning Objective #3: On completing a training session with the nurse, the patient will
identify and explain two interventions which they believe would be useful to help someone with
PPD that would work with their lifestyle.

Learning Objective #4: Using the supplied web site, the patient will demonstrate ability to
access at least one PPD intervention (ex. navigate to a webpage recommended by Education
Module).

Content Outline:
1. Video Introduction- http://www.youtube.com/watch?v=yH3WMQO-ooU

2. Discussion Questions-
   1. Tell me what you think of the video. How did it make you feel?
   2. Have you heard of PPD before?
   3. What is your experience/what do you know about PPD?
   4. What do you know about Depression?
   5. What are three signs of PPD identified in the video?
   6. I would like to give you a self-assessment to fill out. Your answers are confidential and
      will help direct you to resources that may be helpful for preventing PPD and help you
      identify signs of PPD after you have given birth. Do you have any questions? Would
      you like to take the assessment?

3. Computer-based Self Assessment Tool- Learner will complete the self assessment

4. Discussion with Care Provider- Identified risk factors will be discussed with learner

5. Development of Care Plan- Learner and Care Provider collaborate to identify two (2)
   interventions the learner believes would be useful to someone with PPD that would work
   with the learners lifestyle. Learner expresses ability to access at least one resource.

Optional Outline for pregnant mom in home setting:
POSTPARTUM DEPRESSION: A MULTIMEDIA PATIENT EDUCATION MODULE                                      6
AND PRESENTATION IN A CLINICAL MICROSYSTEM
       1.      Video introduction
       2.      Computer-based Self Assessment Tool
       3.      In office follow on:
                            Discussion with care provider
                            Development of care plan

Presentation Methods: Video, Discussion, Computer-based Self Assessment Tool, Discussion
of Score, Demonstration by Student

Digital Multimedia Description and Application:
This module was designed using multiple types of media integrated into a web page.

The module starts with an informational video describing postpartum depression, and risk of left
untreated. After the video, the wiki site leads the learning to an assessment. Evidence has
shown that the Postpartum Depression Prediction Inventory screening tool has been successful in
identifying early risk factors for postpartum depression (Beck, 2002).

The module will prompt the learning with a series of question, then score the learner for post
partum risk. In working with Dr. Wolber‟s computer science students, the assessment portion of
the module will also be available on a cell phone application.

Once the assessment is complete, the module directs the patient to appropriate evidence based
interventions which utilize diverse media when available. Some of the media included in the
interventions:
        Postpartum on-line „meet up‟ groups. (http://postpartum.meetup.com/) Patient can
           see groups in their area, join a group, or start a new group.
        Postpartum information and toll-free support line.
           (http://www.ppmdsupport.com/index.html) From this site, patient can navigate to rich
           content regarding PPD. The site includes treatment options, access to support groups,
           and provider referral list. This site is perfect for the patient who wants to speak to a
           „real person‟, not an on-line support group.
        Postpartum action plan.
           (http://familydoctor.org/online/famdocen/home/women/pregnancy/ppd/general/871.ht
           ml) From this site, patient can view a 30 second video, and access both on-line and
           pdf version of a simple action plan to help avoid PPD.
        The final three sites provide additional reference information the pregnant woman or
           new mom may find helpful.

Time Requirement:
1. Video Introduction- 4 minutes
2. Discussion Questions- 5 minutes
3. Computer-based Self Assessment Tool- 5 minutes (learner only)
4. Discussion with Care Provider & Development of Plan for Learner- 10 minutes

Resources:
Only resource required is a computer with internet access.
POSTPARTUM DEPRESSION: A MULTIMEDIA PATIENT EDUCATION MODULE                                      7
AND PRESENTATION IN A CLINICAL MICROSYSTEM


Evaluation Methods:
1. Learning Objective #1:
   1. Objective complete when patient/learner has communicated two signs of PPD.


2. Learning Objective #2:
   1. Patient/learner completes the PDPI assessment.
   2. Patient/learner review the results of the PDPI and list three Risk Factors she has for PPD
       during Discussion with Care Provider. Predictive risk factors include:
           Low social support
           Low self-esteem
           Life stress
           Fatigue
           Prenatal depression, previous PPD
           Prenatal anxiety
           Poor marital relationship or single status
           Unplanned or unwanted pregnancy
           Low socioeconmic status
           Postpartum: difficult infant temperament and maternity blues
      (Number of risk factors to be listed is based upon the learner‟s score: 1 for scores < , 2 for
      scores - , 3 for scores > )

3. Learning Objective #3:
   1. Two interventions will be listed by the learner that meet the following criteria: 1) Learner
      believes the intervention would be useful to someone with PPD, and 2) Learner believes
      that the intervention would fit with their lifestyle.

4. Learning Objective #4:
   1. Learner will use the education module webpage to demonstrate ability to access one
      intervention.

Additional Teaching Concerns:
Computer literacy, time limitations, support for accessing resources, cultural obstacles to
seeking/utilizing resource, overcoming social stigma associated with depression.
POSTPARTUM DEPRESSION: A MULTIMEDIA PATIENT EDUCATION MODULE                             8
AND PRESENTATION IN A CLINICAL MICROSYSTEM




  Figure 1. Postpartum Depression Predictors Inventory Revised Checklist (Beck, 2002).
POSTPARTUM DEPRESSION: A MULTIMEDIA PATIENT EDUCATION MODULE                                   9
AND PRESENTATION IN A CLINICAL MICROSYSTEM


                                           References:

Bastable S. B. (2008). Nurse as educator: Principles of teaching and learning for nursing

       practice, 3rd ed. Jones and Bartlett Publishers.


Beck, C. (2002). Revision of the Postpartum Depression Predictors Inventory. Journal of

       Obstetric, Gynecologic & Neonatal Nursing. 31: 394-402.


Beck, C., Records, K., Rice, M. (2006). Further Development of the Postpartum Depression

       Predictors Inventory-Revised. Journal of Obstetric, Gynecologic & Neonatal Nursing. 35:

       735-45. DOI: 10.1111/J.1552-6909.2006.00094.x


Beck, C. (March/April, 2008). State of the Science on Postpartum Depression: What Nurse

       Researchers Have Contributed – Part 1. The American Journal of Maternal/Child

       Nursing. 33:121-126.


Beck, C. (May/June, 2008). State of the Science on Postpartum Depression: What Nurse

       Researchers Have Contributed – Part 2. The American Journal of Maternal/Child

       Nursing. 33:151-156.


Dennis C., Creedy D. (2005). Psychosocial and psychological interventions for preventing

       postpartum depression. Evidence Based Nursing. 8: 76. DOI: 10.1136/ebn.8.3.76


Hanna, B., Jarman, H., Savage, S., Layton, K. (2004). The Early Detection of Postpartum

       Depression: Midwives and Nurses Trial a Checklist. Journal of Obstetric, Gynecologic,

       and Neonatal Nursing. 33: 191-197. DOI: 10.1177/0884217504262972
POSTPARTUM DEPRESSION: A MULTIMEDIA PATIENT EDUCATION MODULE                                 10
AND PRESENTATION IN A CLINICAL MICROSYSTEM
Le, H-N., Perry, D., Sheng, X. (2009). Using the Internet to Screen for Postpartum Depression.

       Maternal and Child Health Journal. 13:213–221. DOI: 10.1007/s10995-008-0322-8


Schumacher, M., Zubaran, C., Roxo, M., White, G. (2008). Screening Tolls for Postpartum

       Depression: Validity and Cultural Dimensions. International Journal of Psychiatric

       Nursing Research. 14: 1752-1765. ISSN: 0968-0624 CINAHL AN: 2010258397

				
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