1. Theory of Unpleasant Symptoms Practice specialty perspective
Karen Fugate BSN RNC-NIC, CPHQ

2. Clinical focus area Personal clinical focus areas:
Women and Children’s Services
Currently working with L&D, Postpartum and Newborn to implement practices to support breastfeeding
Main focus Neonatal ICU
Perspective for this presentation
Postpartum

3. Current Application of TOUS to postpartum practice
Major focus areas
Postpartum depression
Postpartum fatigue
Duration of breastfeeding

4. Use of theory in practice #1
Pugh & Milligan (1998) – yes, this is the same Pugh who authored the TOUS
Targeted interventions resulted in decreased fatigue at 14 days postpartum and sustained breastfeeding avg of 6wks longer than control group
Physiologic factors (Interventions)
Sleep
rest
diet
exercise
Symptoms
Level of fatigue
Breast discomfort
Situational factors (Interventions)
Warm compresses
Breastfeeding position
Use of social support
Performance
Duration of breastfeeding
Psychologic factors (Interventions)
Build self-esteem

5. Use of theory in practice #2
Relentless postpartum fatigue on PP day 14 significantly correlated to significant postpartum depression on PP day 28 (Corwin, Brownstead, Barton, Heckard & Morin, 2005)
Intervention: Fatigue checklist at PP day 14 could identify women at high risk for PPD
Psychologic factors
Past h/o depression
Family h/o depression
stress
Physiologic factors
Age
Postpartum status
Level of fatigue
Symptoms
Post partum depression
Situational factors
Partner in home
Other children in home
Family support
rurality
Performance
Not specifically mentioned although could be PPD

6. Use of theory in practice #3
Depression, anxiety, maternal sleep, surgical delivery, breastfeeding, infant mood all correlated with fatigue in active duty, postpartum military women; anxiety was strongest predictor of fatigue; higher levels of fatigue were correlated with decreased functional status at 6 wks PP (Rychnovsky, 2007).
Intervention: assessment and treatment of anxiety may reduce fatigue and increase functional status
Psychologic factors
Depression
anxiety
Physiologic factors
Type of delivery
lactogenesis
Performance
Functional status
Symptoms
Level of fatigue
Situational factors
Maternal sleep
Infant mood

7. Future research possibilities
Unpleasant symptoms – post-op C-section pain
Possible factors
Physiological – duration of labor, scheduled or unscheduled C-section, primary or repeat C-section, type of pain medication, age
Situational – sleep, infant feeding method, family support, ethnicity
Psychological – anxiety, depression, past pain experience
Possible performance outcome – functional status - physical activity
Unpleasant symptoms – faintness/dizzy in the immediate PP period
Physiological – hydration, duration of labor, PP day, age, type of delivery, type of pain medication
Situational – time of day, staffing
Psychological – level of knowledge regarding physiology
Possible performance outcome – falls in immediate PP period

8. references
Corwin, E., Brownstead, J., Barton, N., Heckard, S., & Morin, K. (2005). The impact of fatigue on the development of postpartum depression. JOGNN: Journal Of Obstetric, Gynecologic & Neonatal Nursing, 34(5), doi: /
Pugh, L.C. & Milligan, R.A. (1998). Nursing intervention to increase the duration of breastfeeding. Applied Nursing Research, 11(4),
Smith, M.J. & Liehr, P.R. (2013). Middle range theory for nursing, 3rd ed. New York: Springer Publishing Company.
Rychnovsky, J. (2007). Postpartum fatigue in the active-duty military woman. JOGNN: Journal Of Obstetric, Gynecologic & Neonatal Nursing, 36(1), doi: /j x