Sustainability of Reduced Postpartum Depressive Symptoms and of Innovative Caring Practices Following Continuing Education for Community Nurses: A Longitudinal Quasi-Experiment
BACKGROUND AND OBJECTIVE. The education of community nurses on postpartum distress has been shown to reduce its prevalence. However, there is no evidence on the sustainability of reduced rates of postpartum depressive symptoms and innovative caring practices following a trial period of continuing education for nurses. This lack of evidence is addressed in this study. Therefore, the aim of the study was to evaluate the sustainability of reduced postpartum depressive symptoms and innovative caring practices beyond the duration of the trial period of continuing education for community nurses. METHODS. A community-based, longitudinal, time-series, quasi-experiment was conducted in 3 stages from 2003 to 2005. Sixteen health centers throughout Iceland participated. They were divided into the groups of experimental (EHCs), control (CHCs), and old experimental (OEHCs) centers. From 2003 to 2005, all previous CHCs were crossed over to the EHCs, and all previous EHC were retained as the OEHCs. The nurses at the EHCs participated in continuing education, which had been done previously by the nurses from the OEHCs. Mothers attending the study health centers and scoring 12 points or more on the Edinburgh Postnatal Depression Scale (EPDS) at the 9th week postpartum were eligible and invited to participate in the study. Participants from all study centers answered the EPDS at the 15th and 24th weeks postpartum. Nursing diagnosis and interventions as well as contacts with nurses and referrals to specialists were documented at all study centers. RESULTS. Of the 141 eligible women, 103 participated in the study. There was no significant difference in the EPDS score among the groups of women at baseline 9 weeks postpartum. The depressive symptoms experienced by women in all groups improved over time; however, those from the EHCs improved significantly when compared with the CHC group. For women from the OEHCs, there was no significant difference in depressive symptoms at the 15th week compared with those from either CHCs or EHCs. The follow-up of women from the OEHCs at the 24th week was negligible and prevented the comparison of groups with regard to depressive symptoms. Innovative caring practices were maintained to a large degree by the OEHC with the exception of the 24th week follow-up and a decline in counseling session. CONCLUSIONS. Continuing education for nurses regarding the management of postpartum emotional distress may be related to a significant reduction in depressive symptoms for EHCs. However, the lasting improvements for OEHCs could not be demonstrated. It appears that each innovative caring practice introduced during the trial period with EHCs results in positive outcomes and should become a routine provision. If any innovative practice element is lacking or declines, such as follow-up and counseling at OEHCs, it may jeopardize the sustainability of positive patient outcomes.
Correspondence to M. Thome School of Health Sciences, Faculty of Nursing, University of Iceland, Eiriksgata 34, IS-101 Reykjavik, Iceland. firstname.lastname@example.org