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Experiences of Postpartum Psychosis from the Perspectives of Women with the Diagnosis and Psychiatric Nurses

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Experiences of Postpartum Psychosis from the Perspectives of Women with the Diagnosis and Psychiatric Nurses University of Rhode Island DigitalCommons@URI Open Access Dissertations 2011 EXPERIENCES OF POSTPARTUM PSYCHOSIS FROM THE PERSPECTIVES OF WOMEN WITH THE DIAGNOSIS AND PSYCHIATRIC NURSES Inger Engqvist University of Rhode Island, [email protected] Follow this and additional works at: https://digitalcommons.uri.edu/oa_diss Recommended Citation Engqvist, Inger, "EXPERIENCES OF POSTPARTUM PSYCHOSIS FROM THE PERSPECTIVES OF WOMEN WITH THE DIAGNOSIS AND PSYCHIATRIC NURSES" (2011). Open Access Dissertations. Paper 84. https://digitalcommons.uri.edu/oa_diss/84 This Dissertation is brought to you for free and open access by DigitalCommons@URI. It has been accepted for inclusion in Open Access Dissertations by an authorized administrator of DigitalCommons@URI. For more information, please contact [email protected]. EXPERIENCES OF POSTPARTUM PSYCHOSIS FROM THE PERSPECTIVES OF WOMEN WITH THE DIAGNOSIS AND PSYCHIATRIC NURSES BY INGER ENGQVIST A DISSERTATION SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF DOCTOR OF PHILOSOPHY IN NURSING UNIVERSITY OF RHODE ISLAND 2011 DOCTOR OF PHILOSOPHY DISSERTATION OF INGER M. ENGQVIST APPROVED: Dissertation Committee: Major Professor GINETTE G. FERSZT ______________________________ DONNA SCHWARTZ-BARCOTT ______________________________ KERSTIN NILSSON ______________________________ NASSER H. ZAWIA ______________________________ DEAN OF THE GRADUATE SCHOOL UNIVERSITY OF RHODE ISLAND 2011 ABSTRACT Postpartum psychosis occurs in approximately two out of every 1000 women after childbirth. Although rare, it is a very serious illness with a potential for suicide and infanticide. The suffering associated with this illness and the effects on the entire family system are severe. Nurses need a comprehensive understanding of this disorder, how women present and experience the illness and the nursing care required to keep women and their newborns safe. They also need to promote early detection to facilitate prompt treatment. To date, there is little research examining the women’s experiences and the nursing care provided to this population. Two descriptive qualitative studies were completed. One study analyzed internet narratives of ten women with the diagnosis of postpartum psychosis and the other study analyzed ten interviews with psychiatric nurses working on inpatient psychiatric units in Sweden. These two studies and subsequent secondary analyses addressed four research questions. How do women diagnosed with postpartum psychosis describe their experience? What are psychiatric nurses’ descriptions of women with postpartum psychosis and what are their responses to these women when caring for them on an inpatient psychiatric unit? What nursing care strategies are used by nurses in caring for women with postpartum psychosis? How do psychiatric nurses describe the use of presence when caring for women with PPP? The women described overwhelming fear, a detachment and inability to care for their babies, delusions and hallucinations, shame and guilt, sleep deprivation, a sense of being controlled, disorganized, confused and paranoia during hospitalization. A number also felt abandoned and discontented with the nursing staff and the nursing care they received. The nurses described a kaleidoscope of symptoms and a range of positive and negative emotional responses they had towards the women. Nursing strategies included satisfying basic needs, keeping the women and babies safe and secure, connecting the women with reality, creating a partnership, teaching the women and their family members, giving hope and facilitating recovery. The nurses described their use of physical presence in great detail and the learning that took place in the context of caring for this population. Future research studies need to examine the on-going interaction of patients and nurses on inpatient psychiatric units. Nurses and nursing students need education about disease manifestations, women’s experiences, nursing care strategies and ways to address nurses’ own emotional reactions. ACKNOWLEDGEMENTS I would like to express my deep gratitude to everyone who has contributed to this dissertation. There are some persons I would like to thank in particular. First of all I am most grateful to the participants in these studies who so voluntarily and willingly shared their knowledge and intimate experiences from working with women with Postpartum Psychosis. I also thank the individuals from the Internet that have been sharing their lives with me, without knowing it. Some of the narratives have been heart-breaking to read, and I wish these women all the best in the future. Professor Björn Sjöström initiated this joint PhD program in 2004. He was my main professor until he became seriously ill in 2006. We were all affected by his death in August 2008. Without his encouragement I would not have started this dissertation at all. Associate Professor, Ginette Ferszt , my main professor and supervisor, provided invaluable guidance during my doctoral program in nursing science, and helped me finally reach my goal. We spent many good hours together when I was in the States. We shared numerous conversations and laughed together. Thank you so much! Associate Professor and Vice Dean, Kerstin Nilsson , my Swedish main professor provided invaluable guidance and spent many endless hours talking with me in the early mornings and late evenings. Your patience never stopped! Thanks for all the pushes you gave me and the encouragements that never ceased! iv Arne Åhlin, MD, formerly Division Manager and Carina Linnarsson RN, formerly Chief Manager of the Division of Psychiatry at Skaraborg Hospital, who from the start authorized my education and provided financial support from the Division of Psychiatry. Arne Åhlin was also one of my co- supervisors. Thanks for your skilled support and guidance! Lena Mårtensson and Ingrid Bergh for reviewing my work during different seminars. Thank you for valuable comments! The financial support from the Research fund at Skaraborg Hospitals, the Skaraborg Research and Development Council, the King Oscar II and Queen Sophia Golden Wedding Anniversary Foundation, and the Skaraborg Institute for Research and Development are all gratefully acknowledged. I am grateful to the University of Skövde, School of Life Science for financial support and being able to study at the University of Rhode Island. I appreciated the times I spent with my doctoral student colleagues in the joint PhD-program, Helena Rosén and Catharina Gillsjö, in Sweden as well as in Rhode Island in our small beach house. Marcy Thompsen and Deborah Erickson-Owens , my doctoral student colleagues from University of Rhode Island, shared some good times with me. Thank you Marcy and her husband Mike for the breakfasts we had at your house; you made my stay in a foreign land easier! Thank you , Hilary Hocking , for your skilled and perfect language reviews you handed me! v Thanks to my niece and her husband, Catharina and Raphael Sköldemyr- Amir , for translating interviews and short sentences from Swedish to English, or vice versa. My sister, Ulla Sköldemyr was the first one to believe in me and my ability to do this. Your encouragements and support never ceased! You always listened when I was down and discouraged, and supported me to keep going. My two daughters, Malena and Mathilda , walked with me through this entire journey. Malena, your husband Marcus and my grandchildren, Izabella and Alisa , gave me much happiness, and made me leave the computer now and then. Mathilda , you came with me to Rhode Island and managed the hardship in starting a new school with a new language and new school-mates. You did so well! We had so many good times “over there”, going to movies, Starbucks, traveling and sight-seeing. vi JOINT PhD PROGRAM IN NURSING – University of Skövde and University of Rhode Island This joint PhD program in nursing was developed by Professor Björn Sjöström at the School of Life Sciences, University of Skövde and Professor Emerita Suzie Hesook Kim at the College of Nursing, University of Rhode Island. Its purpose was to prepare nurse scholars and researchers capable of advancing nursing knowledge through the development and testing of nursing theory and the conduct of research in clinical practice. The program cultivated a sense of inquiry and stimulated international collaborative relationships with professional colleagues, both in nursing and other disciplines. INGER ENGQVIST was a student in this JOINT PhD PROGRAM between 2004 and 2011 vii Preface The Manuscript Format has been used for this dissertation . List of Original Papers I Engqvist, I., Ferszt, G., Åhlin, A. & Nilsson, K. (2011). Women’s experience of postpartum psychotic episodes – analyses of narratives from the Internet. Archives of Psychiatric Nursing, doi:10.1016/j.apnu.2010.12.003 II Engqvist, I., Ferszt, G., Åhlin, A. & Nilsson, K. (2009). Psychiatric nurses’ descriptions of women with psychosis occurring postpartum and the nurses’ responses – an exploratory study in Sweden. Issues in Mental Health Nursing, 30 (1), 23-30. III Engq vist, I., Nilsson, A., Nilsson, K. & Sjöström, B. (2007). Strategies in caring for women with postpartum psychosis -- an interview study with psychiatric nurses. Journal of Clinical Nursing, 16 (7), 1333 -1342. IV Engqvist, I., Ferszt, G. & Nilsson, K. (201 0). Swedish registered psychiatric nurses’ descriptions of presence when caring for women with postpartum psychosis – an interview study. International Journal of Mental Health
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