Academic journal article Scholarly Inquiry for Nursing Practice

Postpartum Fatigue: Clarifying a Concept

Academic journal article Scholarly Inquiry for Nursing Practice

Postpartum Fatigue: Clarifying a Concept

Article excerpt

This paper describes the multifaceted approach employed to clarify the concept of postpartum fatigue. The process began with a literary analysis, which gave rise to questions about the defining characteristics of postpartum fatigue and its differentiation from related concepts such as tiredness and depression. A series of qualitative and quantitative studies were carried out to examine new mothers' characterizations of their fatigue, the indicators and predictors of postpartum fatigue, and the differences between fatigue and depression. The evolving concept clarification suggests that postpartum fatigue is most effectively conceptualized as a multidimensional concept with physical and mental aspects that is different from tiredness and can be differentiated from postpartal depression or milder "baby blues," with which there is some overlap.

Postpartum fatigue is a common occurrence that is often discussed in casual conversation by laypersons and health professionals. Like many concepts that are central to nursing, it is part of the common parlance, and its meaning is assumed to be clear and mutually understood by those using the term. As nurses work to develop and refine the science, however, it is essential to scrutinize such concepts carefully for consistency and completeness of meaning in various clinical populations and contexts, i. e., consistency and completeness of definitions and dimensions, clarity of boundaries and indicators, and the existence of clear clinical exemplars.

To date, concept analyses by nurses have tended to focus on literary approaches, with most using adaptations of the procedure recommended by Wilson (1963) (see Hupcey, Morse, Lenz, & Tason, in this issue). With the exception of the nursing measurement literature and Morse's (e.g., Morse, 1995; Morse & Carter, 1996; Morse, Solberg, Neander, Bottorff, & Johnson, 1990; Morse & Doberneck, 1996) use of qualitative research for analyzing selected psychosocial concepts, there has been surprisingly little empiricallybased concept analysis and development work reported.

This paper describes a multifaceted approach to concept clarification which was applied over a decade by the first author and her collaborators. The target concept was postpartum fatigue; this was later expanded to the more encompassing concept, childbearing fatigue. The process began with a literary analysis of the concept, but then went beyond the literature to a series of related studies, both qualitative and quantitative. The studies have addressed such issues as identifying commonly experienced indicators or referents and differentiation from related concepts. The approach described here evolved as empirical findings about fatigue generated some answers and many new questions.

BEGINNING STAGES: ANALYSIS OF EXISTING LITERATURE

The first author's interest in the concept of postpartum fatigue began in 1985 and was based on years of clinical experience with new mothers. Of particular interest was the question of whether the common phenomenon of "baby blues" is, in fact, maternal fatigue. Guidance for beginning the initial analysis of the concept was provided by Norris's (1982) book, Concept Clarification. Norris organized diverse phenomena under the rubric of "basic physiological protection mechanisms" (p. 385), one of which was fatigue.

The first step was to analyze and evaluate the existing literature. Evaluation of available nursing literature revealed insufficient information to permit a deductive approach, such as theory testing. A thorough literature search failed to identify studies specifically about postpartum fatigue; however, in the nonempirical maternity nursing literature it was identified as a concern to new mothers. The literature review revealed limitations on the quality of measurement of fatigue. Investigators had identified the existence of postpartum fatigue largely by responses to lists of concerns (e.g., Fawcett & York, 1986; Harrison & Hicks, 1983; Hiser, 1987). …

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