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Commentary on: Ordan R, Shor R, Liebergall-Wischnitzer M, et al. Nurses’ professional stigma and attitudes towards postpartum women with severe mental illness. J Clin Nurs 2018;27:1543–51. https://doi.org/10.1111/jocn.14179
Implications for practice and research
Healthcare professionals should provide person-centred care to postpartum women with severe mental illness (SMI), promoting their autonomy and the best outcomes for the woman and the child.
Stigma and negative attitudes towards individuals with SMI can have a detrimental effect on patient care.
Future research should evaluate interventions that decrease stigma in healthcare professionals caring for women with SMI.
Healthcare professionals can exhibit stigma and negative attitudes towards individuals with mental illness.1 These negative attitudes influence how they engage with patients with SMI, creating barriers to individualised care. The aim of the study by Ordan et al 2 was to examine the professional stigma of nurses towards postpartum women with SMI and how this can affect the interventions they promote.
The study used a cross-sectional and mixed methods design, which used four questionnaires, one designed specifically for this study: Nursing Interventions that Promote Becoming a Mother Questionnaire. This used three open questions that were subjected to qualitative analysis. The open questions were based on a hypothetical case and dealt with the ethical dilemmas, concerns and factors that can assist in the care of postpartum women with SMI. A convenience sample of 61 registered nurses were recruited from five postpartum units at two tertiary referral hospitals of a university medical centre in Israel.
Increased professional stigma towards postpartum women with SMI was positively correlated with an increase in negative attitudes about their parenting skills and ability to provide for the physical needs of their infant. These attitudes led nurses to embrace a more paternalistic approach to women with SMI, culminating in a decrease in interventions that promote maternal identity. Nurses perceived that their care for these women was inadequate and believed that the input of mental health professionals was required.
This study presented a number of insights into the harmful effect that stigma and negative attitudes from healthcare professionals can have on patient care, which is congruent with previous research findings. When stigma is present, it can become the lense through which postpartum women with SMI are viewed. Instead of treating them as individuals whose abilities and needs may differ significantly from others with SMI, they become members of a group where paternalism risks becoming the norm. Women with SMI are frequently identified as being high risk on admission, priming postpartum nurses to take a more cautious or paternalistic approach regarding infant care, which may be rooted in the best interests of the patient or stigma. It is because of this that individualised—person-centred—care should be provided so that women with SMI can be given care that considers their individual needs and abilities.
Moreover, it should be noted that paternalistic and discriminatory practices towards patients with mental health issues are a pervasive problem across numerous healthcare settings and the different healthcare professions as the authors of the study note.1 3 By reducing interventions that promote motherhood, women with SMI can have their autonomy compromised, leading to practices that create a barrier for them developing the skills, knowledge and confidence to become a mother to the best of their ability. There is also a risk of compounding existing mental health issues and encouraging an insecure attachment, which is already a risk factor in women with some pre-existing mental health issues.4
Postpartum nurses reported perceptions of inadequacy when caring for women with SMI and that this could be diminished with the involvement of mental health professionals. However, mental health professionals have also been shown to stigmatise.5 This means that involving mental health professionals may not be the panacea many can assume it to be—until mental health stigma is addressed at all levels of healthcare provision and among all healthcare professionals.
Competing interests None declared.
Provenance and peer review Commissioned; internally peer reviewed.