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678 UNIT V Middle Range Nursing Theories

Use of Empirical Evidence Major Assumptions
When Beck began to examine postpartum depression Nursing
in 1993, she noted that only two qualitative studies Beck describes nursing as a caring profession with car-
contributed to the knowledge base of the disorder. ing obligations to persons we care for, students, and each
Most studies were based upon knowledge developed other. In addition, interpersonal interactions between
in disciplines other than nursing. Beck’s background nurses and those for whom we care are the primary ways
as a nurse midwife undoubtedly gave her a view of nursing accomplishes the goals of health and wholeness.
women throughout the postpartum period that was
not commonly available to those in other disciplines Person
involved with women during the perinatal period. Persons are described in terms of wholeness with bio-
In 1993, after four major studies regarding women in logical, sociological, and psychological components.
the postpartum period (Table 34–1), Beck developed a Further, there is a strong commitment to the idea that
substantive theory of postpartum depression using persons or personhood is understood within the con-
grounded theory methodology. The substantive theory text of family and community.
was entitled “teetering on the edge,” with the basic
psychosocial problem identified as loss of control (Beck, Health
1993). Since development of the substantive theory, Beck does not define health explicitly. However, her
Beck has designed 14 other studies to refine the theory writings include traditional ideas of physical and
by examining the experiences of postpartum depression mental health. Health is the consequence of women’s
on mother-child interactions, postpartum panic, post- responses to the contexts of their lives and their envi-
traumatic stress disorder (PTSD), and birth trauma to ronments. Contexts of health are vital to understand-
tease out differences among postpartum mood disorders ing any singular issue of health.
(postpartum depression, maternity blues, postpartum
psychosis, postpartum obsessive-compulsive disorder, Environment
postpartum-onset panic disorder). Metaanalyses were Beck writes about the environment in broad terms
conducted on predictors of postpartum depression, the that include individual factors as well as the world
relationship between postpartum depression and infant outside of each person. The outside environment
temperament, and the effects of postpartum depression includes events, situations, culture, physicality eco-
on mother-infant interaction. In addition, two qualita- systems, and sociopolitical systems. In addition, there
tive metasyntheses were conducted on postpartum is an acknowledgment that women in the childbear-
depression and mothering multiples. ing period receive care within a health care environ-
Beck used ten qualitative studies of postpartum ment structured in the medical model and permeated
depression in women from a wide variety of geographic with patriarchal ideology.
locations and cultures. Women represented in these
studies included Black Caribbean women, Irish women,
Indian women, Hong Kong Chinese women, Hmong Theoretical Assertions
women, Middle Eastern women (living in the UK), The theoretical assertions within Beck’s theory are well
Asian women, Portuguese women, Australian women, represented throughout her writings. She acknowl-
Canadian women, and African American women. These edges the importance of Sichel and Driscoll’s (1999)
new data were used to compare Beck’s original teeter- work related to the biological factors involved in post-
ing on the edge grounded theory with women in other partum depression in the following assertions:
cultures. Beck found that the theory’s modifiability was • The brain can biochemically accommodate various
in keeping with theoretical expectations of a relevant stressors, whether related to internal biology or
substantive grounded theory. Therefore, the theory of external events.
“teetering on the edge,” with “loss of control” as the basic • Stressful events (internal or external), particularly
psychosocial process has functionally expanded to over long periods, cause disruption of the bio-
women in other cultures (Beck, 2006a, 2012b). chemical regulation in the brain. The more insults