Critical Evaluation of a Middle-Range Nursing Theory

Answer

Critical Evaluation of a Middle-Range Nursing Theory

The postpartum period happens to be the moment when most women are susceptible to a range of emotional symptoms. Postpartum depression is considered the most prevalent emotional or mental problems associated with childbirth (Abdollahi, Lye, & Zarghami, 2016). In developed and developing nations the prevalence of postpartum depression ranges from 5.2 to 74 percent and 1.9 to 82.1 percent respectively (Abdollahi et al., 2016). Besides, the prevalence of this form of depression has been established to range from 0.1 to 26.3 percent (Norhayati et al., 2015).  According to Stewart and Vigod (2016), the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5) includes postpartum depression as a significant episode of depression “with peripartum onset in situations where the commencement of mood symptoms transpire during the pregnancy period or within 4 weeks after childbirth. The psychiatric-mental health nurse practitioners (PMHNPs) can employ Beck’s Postpartum Depression Theory in meeting the care need for patients suffering from postpartum depression and assisting such patients to make informed choices concerning their treatment (Huminsky, 2019). This paper critically evaluates Beck’s Postpartum Depression Theory, which is a middle-range nursing theory. The paper discusses three major areas with various components including theory description, theory analysis, and theory evaluation. The paper then concludes by summarizing the contents of the paper and restating the thesis statement.

Theory Description

Purpose

Beck’s Postpartum Depression Theory is descriptive and focuses on biological factors that subject women to depression after birth (Lasiuk & Ferguson, 2005).

Concepts

The main concepts associated with Becker’s Postpartum Depression Theory are as follows:

1. Postpartum mood disorders

• Postpartum depression
• Maternity blues
• Postpartum psychosis
• Postpartum-onset panic disorder
• Postpartum obsessive-compulsive disorder

2. Loss control
3. Life stress
4. Child care stress
5. Prenatal depression
6. Prenatal anxiety
7. Social support
8. History of depression
9. Marital satisfaction
10. Infant temperament
11. Marital status
12. Socioeconomic status
13. Self-esteem
14. Maternity blues
15. Unwanted or unplanned pregnancy
16. Emotional liability
17. Anxiety and insecurity
18. Loss of self
19. Sleeping and eating disturbances
20. Suicidal thoughts
21. Mental confusion
22. Guilt and shame

Definitions 

The key concepts associated with Becker’s Postpartum Depression Theory are defined below:

Postpartum mood disorders

These disorders include postpartum depression, maternity blues, postpartum psychosis, postpartum-onset panic disorder, and postpartum obsessive-compulsive disorder (Maeve, 2017). Postpartum depression refers to a non-psychotic major disorder associated with depression within distinctive diagnostic criteria that always commences as early as one month or four weeks following birth (Maeve, 2017). Maternity blues, which is also known as baby blues or postpartum blues, is a comparatively transient, as well as self-limited phase of mood swings and melancholy during initial postpartum period (Maeve, 2017). Postpartum psychosis refers to a psychotic disorder accompanied or typified by inability to sleep, agitation, delusions, and hallucinations along with irrational and bizarre behavior (Maeve, 2017). Postpartum-onset panic disorder is associated with acute onset of rapid breathing, fear, anxiety, a feeling of impending danger or doom, and heart palpitations (Maeve, 2017). Postpartum obsessive-compulsive disorder is characterized by recurrent, intrusive imaginations of harming the infant, fear of being abandoned alone with the baby, and hyper-vigilance in safeguarding the infant (Maeve, 2017).

Loss control

According to Maeve (2017), loss control is the process women undergo with postpartum depression including encountering terror, dying of self, struggling to survive, and regaining control.

Life stress

Maeve (2017) defines life stress as an index associated with stressful events of life during pregnancy and following delivery.

Child care stress

Maeve (2017) defines child care stress as stressful happenings associated with childcare including infant health issues and problems in infant care relating to sleeping and feeding.

Prenatal depression

Depression occurring during all or any of the trimesters associated with pregnancy that robustly predicts postpartum depression (Maeve, 2017).

Prenatal anxiety

This condition happens in the course of any trimester or during the entire pregnancy duration (Maeve, 2017). Anxiety involves feelings of apprehension or uneasiness concerning an unclear or nonspecific threat (Maeve, 2017).

Social support

This refers to emotional support and instrumental aid including assistance with household chores and babysitting (Maeve, 2017).

History of depression

This refers to a report detailing depression bout prior to the current pregnancy (Maeve, 2017).

Marital satisfaction

The magnitude of a woman’s fulfillment with a marital affair in relation to her marital aspects such as affection, communication, decision-making and mutual activity, global wellbeing, and  similarity values such as child care and finances (Maeve, 2017).

Infant temperament

This refers to the infant’s personality and disposition (Maeve, 2017).

Marital status

This involves a woman’s position in relation to marriage, whether married, single, divorced, cohabiting, separated, partnered, or widowed (Maeve, 2017).

Socioeconomic status

An individual’s status or rank within society involving a mixture of economic and social factors such as education, occupation, and income (Maeve, 2017).

Self-esteem

This refers to a woman’s global emotions of self-acceptance and self-worth (Maeve, 2017).

Maternity blues

This refers to a non-pathological condition occurring following child birth (Maeve, 2017). 

Unwanted or unplanned pregnancy

This refers to conception that not desired or planned (Maeve, 2017).

Emotional liability

This involves a woman’s feeling that her emotions are out of her regulation or unstable, commonly associated with crying for no specific reason, explosive anger, fear of never being merry again, and irritability (Maeve, 2017).

Anxiety and insecurity

This refers to being over-attentive to comparatively minor matters, feelings of pacing and the need to keep moving (Maeve, 2017).

Loss of self

A woman’s sense that the self aspects that mirrored her personal identity have been transformed since their infant’s birth to the extent of not being able to establish who she really is and is fearful that she might never manage to become her self-self again (Maeve, 2017)

Sleeping and eating disturbances

This is defined as the inability to sleep despite the infant being asleep accompanied by turning and tossing prior to the actual falling asleep, rising in the course of the night, and problems returning to sleep (Maeve, 2017).

Suicidal thoughts

This refers to women’s regular imaginations of harming themselves or terminating their lives as a means of escaping the living or existing nightmare associated with postpartum depression (Maeve, 2017).

Mental confusion

This refers to marked inability to focus on an activity, concentrate, or make a choice or decision (Maeve, 2017).

Guilt and shame

This refers to a woman’s perception or view that she is performing dismally as a mother and possesses negative imaginations concerning her infant (Maeve, 2017).

Relationship 

Beck’s Postpartum Depression Theory highlights a four-stage process associated with “teetering on the edge into after childbirth depression (Huminsky, 2019). The first stage involves experiencing terror which entails terrible anxiety attacks, persistent fogginess, and obsessive thinking. The second stage is associated with the dying of self, which involves the isolation of self, disturbing “unrealness” and thoughts of self-harm (Huminsky, 2019). The fourth stage is associated with struggling to survive, which entails searching for consolation and praying for reliefs. The fourth stage entails regaining control, which is associated with making changes, increase of lost time, and recovery. The diagrams showing the relationship between the major concepts in Beck’s Postpartum Depression Theory are shown in the subsequent section.

Structure

Figures I and II below exemplified the relationship of concepts in Becker’s Postpartum Depression Theory:

Figure I: Becker’s Four-Stage Process of Postpartum Depression Involving Loss of Control

Source: Huminsky (2019)

Figure II: Key Concepts Associated with Postpartum Depression

Source: Huminsky (2019)

Assumptions

Three assumptions from Beck’s theory are as follows (Maeve, 2017):

• The is capable of biochemically accommodating different stressors whether associated with external events or internal biology
• Women’s normal and unique brain, as well as hormonal chemistry leads to susceptibility to mood disorders at critical moments within their lives including following child delivery
• Postpartum depression arises from a combination of economic, relational, social, psychological, and biological situational life stressors.

Theory Analysis

Theory’s Origin

Beck’s Postpartum Depression Theory has its theoretical origin from the work executed by Sichel and Driscoll (1999), who established an earthquake framework for conceptualizing how interactions between life and biology result in biochemical loading (Maeve, 2017). In the course of time, with persistent chemical challenges associated with stressors, the brains of women may establish a form of fault line that has a lower likelihood of remaining intact during critical times within women’s lives including challenges experienced by women around childbirth, leading to a form of earthquake. Beck comprehended the model developed by Sichel and Driscoll to imply that the genetic makeup, life experiences, reproductive history, and hormonal history of women unite to predict their risk of an earthquake, which happens when their brains cannot be stabilized and mood issues erupt (Maeve, 2017). Even though it is easy to comprehend the hormonal and psychological challenges related to pregnancies for women, the earthquake model was significant in assisting Beck to attain a holistic conceptualization of the phenomena that might influence postpartum depression for women (Maeve, 2017). Robert Gable played a vital role in the advancement of Beck’s theory. After establishing adequate knowledge concerning postpartum depression, Beck’s logical step involved the development of instruments that could be employed in predicting and screening postpartum depression. Gable helped Beck to theoretically roll out her theory for practical use or application. Gable has continued to be a significant figure in the step-by-step advancement of the PDSS with the inclusion of the Spanish version of the theory (Maeve, 2017).

Unique Focus

Beck attributes women’s experience with PPD to biological factors (Abdollahi et al., 2016). However, there exist differing views from those advanced by Beck in relation to women’s experience with postpartum depression (PPD). For instance, proponents of psychodynamic theory hold that women’s psychological problems after birth are attributed to some unaccomplished business in their family or childhood (Abdollahi et al., 2016). On the other hand, proponents of the cognitive psychology theory claim that certain features of personality predispose novel mothers to PPD, whereas advocates of the social and interpersonal theory attributed the experience of novel mothers with PPD to their environment (Abdollahi et al., 2016).

Content 

Beck’s Postpartum Depression Theory is associated with four assumptions related to nursing, person, health, and environment. Beck considers nursing a caring profession with obligation of caring to patients, students, and practitioners (Maeve, 2017). Moreover, interpersonal interactions between patients and nurses are the key ways nursing attains goals of wholeness and health (Maeve, 2017). Beck describes persons in relation to wholeness with psychological, sociological, and biological components. There is also a robust devotion to the notion that personhood or persons is comprehended within the community and family context (Maeve, 2017). Even though Beck does not provide an explicit definition of health, her writings take into consideration conventional ideas of mental and physical health. Health is considered the consequence of responses of women to contexts associated with their lives and environment (Maeve, 2017). Furthermore, health contexts are vital for the comprehension of any singular health issue (Maeve, 2017). Beck describes the environment in broad terminologies that take into consideration individual aspects and the world external to every person (Maeve, 2017). The external setting includes culture, events, physicality ecosystems, sociopolitical systems, and situations. There is also the recognition that women within the period of childbearing receive care within an environment of health care structured within the medical framework and infiltrated with patriarchal ideology (Maeve, 2017).

Theory Evaluation

Significance

The significance of Beck’s theory lies in its emphasis on the significance of comprehending motherhood, birth, and pregnancy through women’s eyes (Maeve, 2017). This theory also provides insight into the contribution of medical, social, and economic factors to PPD in novel mothers following childbirth, which informs decisions aimed at addressing this problem by nurses (Huminsky, 2019). Culturally, the theory enables the society to comprehend the reasons for bizarre mannerisms exhibited by some women after childbirth, which encourages societal members to be tolerant and supportive to such women.

Comprehensiveness

Beck’s Postpartum Depression Theory is thorough and with immense utility. Beck’s theory plays a vital role in addressing a range of biological factors that can be attributed to the experience of novel mothers with PPD (Maeve, 2017) For instance, Beck proceeds to highlight and explain twenty two concepts that can be employed in screening women for PPD. Moreover, Beck acknowledges that child delivery transpires within various simultaneous contexts including economic, social, and medical, and that the reaction of mothers to motherhood and childbirth are influences by their responses to these aspects (Maeve, 2017).

Logical Congruence

According to Maeve (2017), Beck’s Postpartum Depression theory is consistent and clear as its evolution or development can be traced to the earthquake model established by Sichel and Driscoll (1999) after which it evolves to include various factors that contribute to PPD in novel mothers after child delivery.

Credibility

Beck’s Postpartum Depression theory is legitimate owing to the existence of findings of empirical research that reveal its relevance and effectiveness. For instance, the findings of the empirical studies conducted by Li et al. (2020) and Peng et al. (2021) highlight the contribution of clinical and social factors to the establishment of PPD, which are emphasized in Beck’s theory.

Contribution to Nursing 

Beck’s Postpartum Depression Theory bears a great significance to nursing practice. According to Huminsky (2019), Beck’s Postpartum Depression theory informs nurse practitioners of the frequency and importance of postpartum depression so that proper screen can be executed to identify novel mothers who may be experiencing problems or suffering due to this disorder. This theory also open up research to a range of issues that influence PPD development in women after childbirth including social, economic, situational, and psychological life stressors among others.

Conclusion

This paper has effectively conducted a critical evaluation of Beck’s Postpartum Depression Theory. The paper has accomplished this goal by adequately discussing key major areas including theory analysis, theory evaluation, and theory description.