3. POSTPARTUM DEPRESSION THEORY
~Cheryl Tatano Beck~
(1949-present)
I. Background of the Theorist
 She graduated from the
Western Connecticut
State University with a
baccalaureate in nursing
in 1970.

4.  After graduation, Beck worked as a
registered nurse at the Yale New Haven
Hospital on the postpartum and normal
newborn nursery unit.
 In 1972, Beck graduated from Yale
University with a master’s degree in
maternal-newborn nursing and a
certificate in nurse midwifery.

5.  In 1982, she received a doctorate in nursing
science from Boston University.
 She has served as consultant on numerous
research projects for universities and state
agencies in the northeastern United States.
 She has given more than 30 awards,
including Distinguished Researcher of the
Year by the Eastern Nursing Research
Society in 1999.

6.  She has authored more than 100 journal
articles and given scores of research
presentations locally, nationally, and
internationally.
 Served on the executive board for the
Marce Society, an international society for
the understanding, prevention, and
treatment of mental illness associated with
childbirth and on the advisory

7. committee of the Donaghue Medical Research
Foundation in Connecticut.
 Fittingly, she began her research career with
women in labor, examining their cognitive and
emotional responses to fetal monitoring.
Beck’s research wound its ways through the
labor and birth process and became firmly

8. planted in the postpartum period, with a
specific focus on postpartum mood disorders.
 This body of work resulted in a substantive
theory of postpartum depression and the
development of Postpartum Depression
Screening Scale (PDSS) and Postpartum
Depression Predictors Inventory (PDPI).

9. A. Major Concepts and Definitions
1. Postpartum Mood Disorders
 Postpartum depression- a nonpsychotic major
depressive disorder with distinguishing
diagnostic criteria, postpartum depression
often begins as early as 4 weeks after birth.
 Maternity blues- is a relatively transient and
self-limited period of melancholy and mood
swings during the early postpartum period.

10.  Postpartum psychosis- a psychotic disorder
characterized by hallucinations, delusions,
agitation, inability to sleep, along with desire
and irrational behaviour
 Postpartum obsessive-compulsive disorder-
symptoms include repetitive intrusive
thoughts of harming the baby, a fear of being
left alone with the infant and hyper vigilant
in protecting the infant.

11. 2. Loss of Control- it was identified as the
basic psychosocial problem in the 1993
substantive theory development phase of
Beck’s work. Loss of control was an aspect
women experience in all aspects of their lives.
The process of loss of control left women
“teetering on the edge” and consisted of the
following four stages:

12.  Encountering terror- consisted of horrifying
attack, enveloping fogginess, and relentless
obsessive thinking.
 Dying of self- consisted of alarming
unrealness, contemplating and attempting
self-destruction, isolating oneself.
 Struggling to survive- consisted of battling
the system, seeking solace at support
groups, praying for relief.

13.  Regaining control- consisted of
unpredictable transitioning, guarded
recovery, mourning lost time.
3. Prenatal Depression- was found to be the
strongest predictor of postpartum depression.
It occurs of any or all of the trimesters of
pregnancy.

14. 4. Child Care Stress- is stressful events related
to child care involve factors such as infant
health problems and difficulty in infant care
pertaining to feeding and sleeping.
5. Life Stress- is an index of stressful life
events during the pregnancy and postpartum.
Stressful life events could either be positive or
negative and can include experiences such as
the following:

15.  Marital changes- divorce, remarriage
 Occupational changes- job change
 Crises- accidents, burglaries, financial crisis
and illness requiring hospitalization
6. Social Support- consists of receiving both
instrumental support (eg. Baby-sitting, help
with household chores) and emotional support.

16. Structural features of a woman’s social
network (husband or mate, family, and friends)
include proximity of its member, frequency of
contacts and number of confidants with whom
the mother can share personal matters.
7. Prenatal Anxiety- it can occur during any
trimester or throughout the pregnancy.
Anxiety refers to feeling of uneasiness or
apprehension concerning a vague, non-specific
threat.

17. 8. Marital Satisfaction- the degree of
satisfaction with a marital relationship is
assessed and includes how happy or satisfied
the woman is with certain aspects of her
marriage, such as communication, affection,
similarity of values (eg. Finances, child care),
mutual activity and decision making, global well-
being.

18. 9. History of Depression- any report by a
mother of having had a bout of depression
before this pregnancy must be noted.
10. Infant Temperament- refers to the infant’s
disposition and personality. Difficult
temperament describes an infant who is
irritable, fussy, unpredictable and difficult to
console.

19. 11. Maternity Blues- was defined as non-
pathological condition found in many women
after birth. Prolong episodes of maternity blues
(lasting more than 10 days) can be predictive of
postpartum depression.
12. Self-esteem- refers to a woman’s global
feelings of self-worth and self-acceptance. It is
her confidence and satisfaction in herself.

20. 13. Socioeconomic Status- is a person’s rank or
status in the society, involving a combination
of social and economic factor such as income,
education, and occupation.
14.Marital Status- this demographic
characteristic focuses on a woman’s standing

21. in regard to marriage. The ranking denotes
whether a woman is single, married or
cohabiting, divorce, widowed, separated, or
partnered.
15. Unplanned or Unwanted Pregnancy- this
refers to a pregnancy that was not planned or
wanted by the woman.

22. 16. Sleeping and Eating Disturbances- this
disturbances consist of an inability to sleep
even the baby is asleep, tossing and turning
before actually falling asleep, waking in the
middle of the night with difficulty going back
to sleep, loss of appetite, consciously being
aware of the need to eat but still unable to
eat.

23. 17. Anxiety and Insecurity- manifest in
hyperattention to relatively minor issues,
feeling as if one is jumping out of her skin and
feeling the need to keep moving or pacing.
18. Emotional Lability- refers to a woman’s
sense that her emotions are unstable and out
of her control, commonly characterized as
crying for no particular reason, irritability,
explosive anger, and fear that she may never be
happy again.

24. 19. Mental Confusion- is a marked inability to
concentrate, focus upon a singular task, or
make decisions.
21. Loss of Self- women sense that those
aspects of self that reflected their personal
identity have changed since birth, so that
women cannot identify who they really are and
become fearful that they might never be able
to become their real selves again.

25. 21. Guilt and Shame- feeling of guilt and shame
are related to a woman’s perception that she is
performing poorly as a mother and has negative
thoughts regarding her infant. It results in an
inability to be open with others about how she
feels and contributes to delay in diagnosis and
intervention.

26. 22. Suicidal Thoughts- concern women’s
frequent thoughts of harming themselves or
ending their own lives to escape the living
nightmare of postpartum depress.

27. B. Major Assumptions
1. Nursing is a caring profession with caring
obligations to persons we care for, students
and each other. Interpersonal interaction
between nurses and those for whom we care
are the primary ways nursing accomplishes
goals of health and wholeness.

28. 2. Persons are described in terms of
wholeness. Persons have biological,
sociological and psychological components.
3. Health is the consequence of women’s
responses to the context of their lives
physically and to the context of their
environments. All context of health are vital
to understanding any singular issue of health.

29. 4. Environment in broad terms might include
individual factors, but also includes the world
outside of each person. The outside
environment includes event, situation, culture,
physicality, ecosystems, and socio-political
systems.

30. A.Empirical Evidence
In 1993, after 4 major studies regarding
postpartum period, Beck developed a
substantive theory of postpartum depression
using grounded theory methodology. This
theory developed was entitled “teetering on
the edge” with the basic psychosocial problems
identified as loss of control. Also during this
period, meta-analyses were

31. conducted on predictors of postpartum
depression, the relationship between
postpartum depression and infant
temperament, and the effects of postpartum
depression on mother-infant interaction. In
addition, two qualitative metasyntheses were
conducted on postpartum depression and
mothering multiples.

33.  America’s one of the
foremost nursing
theorists was born in
Baltimore, Maryland, in
1914.
 She began her nursing
career at Providence
Hospital School of
Nursing in Washington,
D.C.

34.  In 1939, she later received a BS in nursing
education from the Catholic University of
America (COA) and in 1946, she received an
MS in nursing education from the same
university.
 From 1940-1949, Orem held the directorship
of both the nursing school and the
department of nursing at Providence
Hospital, Detroit.

35.  In 1957, she worked as a curriculum
consultant at the office of education US
department of Health, Education and
Welfare.
 She became an assistant professor of nursing
education at CUA. Subsequently became
acting dean of the school of nursing.

36.  In 1971, her first published book was Nursing:
Concepts of Practice.
 In 1972, she was the editor for the Nursing
Development Conference Group (NDCG) as
they prepared and later revised Concept
Formalization in Nursing: Process and
Product.
 In 1976, Georgetown University conferred

37. on Orem the Honorary Degree of Doctor of
Science.
 She was awarded the Doctor of Nursing
Honoris Causea from the University of
Missouri in 1998.
 Subsequent editions of Nursing: Concepts of
Practice were published in 1980, 1985, 1991,
1995, 2001.

38.  She retired in 1984 and continued working
alone and with colleagues on the
development of Self Care Deficit Nursing
Theory (SCDNT).

39. A. Major Concepts and Definitions
1. Self-Care---comprises the practice of
activities that maturing and mature persons
initiate and perform, within time frames, on
their own behalf in the interest of
maintaining life, healthful functioning,
continuing personal development, and well-
being through meeting known requisites for
functional and developmental regulation.

40. 2. Self-Care Requisites---a formulated and
expressed insight about actions to be
performed that are known or hypothesized to
be necessary in the regulation of an aspect of
human functioning and development,
continuously or under specified conditions and
circumstances.

41. 3. Universal Self-Care Requisites---universally
required goals are to be met through self-care
or dependent care and have their origins in
what is known and what is validated or what is
in the process of being validated about human
structural and functional integrity at various
stages of the life cycle. The following eight
self-care requisites common to men, women,
and children are suggested:

42.  The maintenance of a sufficient intake of
food
 The maintenance of a sufficient intake of
water
 The maintenance of a sufficient intake of air
 The provision of care associated with
elimination processes and excrements
 The maintenance of balance between activity
and rest
 The maintenance of balance between
solitude and social interaction

43.  The prevention of hazards to human life,
human functioning and human well-being
 The promotion of human functioning and
development within social groups in
accordance with human potential, known
human limitations, and the human desire to
be normal.

44. 4. Developmental Self-Care Requisites
3 sets of DSCR:
 Provision of conditions that promote
development
 Engagement in self-development
 Prevention of or overcoming effects of
human conditions and life situations that can
adversely affect human development

45. 5. Health Deviation Self-Care Requisites---these
exist for person who are ill or injured, who have
specific forms of pathological conditions or
disorders, including defects and disabilities, and
who are under medical diagnosis and treatment.
6. Therapeutic Self-Care Demand---consists of
the summation of care measures necessary at
specific times or over a duration of time for
meeting all of an individual’s known self-care
requisites particularized for existent condition
and circumstances

46. 7. Self-Care Agency---is a complex acquired
ability of mature and maturing persons to know
and meet their continuing requirements for
deliberate, purposive action to regulate their
own human functioning and development.
8. Agent- it engages in a course of action or
has the power to do so.

47. 9. Dependent-Care Agent---a maturing
adolescent or adult, accepts and fulfills the
responsibility to know and meet the
therapeutic self-care demand of relevant
others who are socially dependent on them or
to regulate the development or exercise of
these persons’ self-care agency.
10. Self-Care Deficit---is a relation between the
persons’ therapeutic self-care demands and

48. their powers of self-care agency in which
constituent developed self-care capabilities
within self-care agency are not operable or not
adequate for knowing and meeting some or all
components of the existent or projected
therapeutic self-care demand.
11. Nursing Agency- comprises developed
capabilities of persons educated as nurses
that empower them to represent themselves as

49. nurses within the frame of a legitimate
interpersonal relationship to act, to know, and
to help persons in such relationships to meet
their therapeutic self-care demands and to
regulate the development or exercise of their
self-care agency.
12. Nursing Design- a professional function
performed both before and after nursing
diagnosis and prescription, allows nurses on the

50. basis of reflective practical judgements about
existent conditions, to synthesize concrete
situational elements into orderly relations to
structure operational units.
13. Nursing Systems- are series and sequences
of deliberate practical actions of nurses
performed at times in coordination with
actions of their patients to know and meet
components of their patient’s therapeutic self-
care demands and to protect and regulate the

51. care demands and to protect and regulate the
exercise or development of patient’s self-care
agency.
14. Helping Methods- helping method from a
nursing perspective is a sequential series of
actions which, if performed, will overcome or
compensate for the health-associated
limitations of persons to engage in actions to
regulate their own functioning and
development or that of their dependents.

52. Nursing care and their health-associated
action limitations are as follows:
 Acting for or doing for another
 Guiding and protecting
 Providing physical or pathological support
 Providing and maintaining an environment
that support personal development
 Teaching

53. B. Major Assumption
1. Human beings require continuous, deliberate
inputs to themselves and their environments
to remain alive and function in accordance
with natural human endowments.
2. Human agency, the power to act deliberately,
is exercised in the form of care for self and
others in identifying needs and making needed
inputs.

54. 3. Mature human beings experiences privations
in the form of limitations for action in care for
self and others involving and making of life-
sustaining and function-regulating inputs.
4. Human agency is exercised in discovering,
developing and transmitting ways and means to
identify needs and make inputs to self and
others.
5. Groups of human beings with structured
relationships cluster tasks and allocate
responsibilities for providing care to group

55. members who experience privations for making
required, deliberate input to self and others.
C. Empirical Evidence
Orem formulated her concept of nursing in
relation to self-care as part of a study on the
organization and administrations of hospitals,
which she conducted at the Indiana State
Department of Health. This work enabled her
to formulate and express her concept of
nursing. Her knowledge on the features of
nursing practice situations was acquired over
many years.

56. Orem used philosophical and scientific
methods in developing her insights and
validating her conclusions. Since the SCDNT
was first published, extensive empirical
evidence was contributed to the development
of theoretical knowledge. Much of this is
contributed to the theory; however, the basics
of the theory remain unchanged.

57. I. Comparison of the 2 theories (Analysis)
POSTPARTUM SELF-CARE
DEPRESSION THEORY DEFICIT THEORY
SIMPLICITY The development The development of
follows a simple and the theory using the 8
logical progression. entities (SCDTN) is
Postpartum parsimonious. The
depression is a relationship between
complex experience and among these
and theory to entities can be
research. It makes presented in a simple
sense, simply and diagram. The depth of
useful. the concepts’
development gives the
theory the complexity
necessary to describe

58. POSTPARTUM SELF-CARE DEFICIT
DEPRESSION THEORY THEORY
and understand a
human practice
discipline.
CLARITY Beck’s purpose was to The term Orem uses
explain her theory in a are defined precisely.
clearly understanding The language of the
manner. theory is consistent
with the language used
Theory is clearly
in action theory and
defined and easily philosophy. The
understood with clear terminology of the
ideas, definitions, and theory is congruent
language for all to throughout.
understand.

59. POSTPARTUM SELF-CARE DEFICIT
DEPRESSION THEORY THEORY
GENERALITY Specific as it focused Orem has commented
on a very narrow on the generality of the
subject area. General theory:
in that within the “The self-care deficit
narrow spectrum it
theory of nursing is not
affects different
cultures and contexts. an explanation of the
individuality of a
particular concrete
nursing practice
situation, but rather
the expression of a
singular combination of
conceptualized
properties or features

60. POSTPARTUM SELF-CARE DEFICIT
DEPRESSION THEORY THEORY
It serves nurses
engaged in nursing
practice, in
development, and
validation of nursing
knowledge and in
teaching and learning
nursing.
APPLICABILITY or Beck and Gable (2000) Orem’s theory has been
EMPERICAL examined psychometric used for research using
properties of the scale both qualitative and
PRECISION with regard to quantitative
reliability of the methodologies. The
measure within the theoretical entities are

61. POSTPARTUM SELF-CARE DEFICIT
DEPRESSION THEORY THEORY
developmental and are well defined d lend
diagnostic samples. themselves to
Validity analyses were measurement; however,
conducted with the instrument have not
two samples, as where been developed for all
procedures used to entities. Empirical
establish cut-off precision is dependent
scores for clinical on the operational
interpretations. These definitions
studies indicated that constructed by the
the PDSS is a reliable researcher for the
and valid screening population to be
instrument for studied.
detection of
postpartum depression.

62. POSTPARTUM SELF-CARE DEFICIT
DEPRESSION THEORY THEORY
DERIVABLE The value of Beck’s is It is useful in
CONSEQUENCES of growing importance developing and guiding
within nursing and practice in research. It
within other gives direction to
disciplines. The nursing specific
Importance of SCDNT outcomes related to
evident in every aspect knowing and meeting
of the nursing the therapeutic self-
discipline clearly care demands,
defined nursing and regulating the
built upon basic development and
concepts to develop an exercise of self-care
all-encompassing agency, and
framework all nursing establishing self-care
disciplines and areas of and self-management

63. POSTPARTUM SELF-CARE DEFICIT
DEPRESSION THEORY THEORY
of specialty can be systems.
practiced within this
It is useful in designing
framework.
curricula for pre-
service, graduate, and
continuing nursing
education.

64. Case Study: Sheela’S Story
Sheela was a 30 year-old mother of four children
who had been married for eight years. She lived with
her husband and in-laws in a small village. She had
given birth to her fourth child three months
previously. Her pregnancy and labor had been
uneventful, and an untrained traditional midwife
helped conduct the home delivery. Because
pregnancy was viewed in her village as a normal
occurrence that did not require any medical attention,

65. Sheela did not received any antenatal or postnatal
care. For a month after the birth, Sheela felt normal,
but then she began to exhibit unusual behavior. She
became reclusive and stopped speaking to anyone at
home, losing interest in her daily activities and
ceasing to care for her children. The rest of the
people in her family, however, were busy with their
own lives and seemed indifferent to her condition.
One day, she decided to visit her friend and share
everything about her condition. And she was advised
to have a consultation to a doctor.

66. Sheela was convinced by her friend to undergo
consultation. After several assessment, the doctor
found out that she have postpartum depression. She
was advised to take some anti-depressant drugs and
to undergo therapy. The family were also informed
about Sheela’s condition and they were able to
realize that she needs care and assistance. After
several months, Sheela was able to manage her
condition.
*Being educated and aware of this condition is the
best way to be more accepting, accessible, and
accommodating to those with postpartum depression.