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Citation: Tzitiridou-Chatzopoulou,
M.; Orovou, E.; Zournatzidou, G.
Digital Training for Nurses and
Midwives to Improve Treatment for
Women with Postpartum Depression
and Protect Neonates: A Dynamic
Bibliometric Review Analysis.
Healthcare 2024,12, 1015. https://
doi.org/10.3390/healthcare12101015
Academic Editor: Abdel-Latif
Mohamed
Received: 15 February 2024
Revised: 7 May 2024
Accepted: 11 May 2024
Published: 14 May 2024
Copyright: © 2024 by the authors.
Licensee MDPI, Basel, Switzerland.
This article is an open access article
distributed under the terms and
conditions of the Creative Commons
Attribution (CC BY) license (https://
creativecommons.org/licenses/by/
4.0/).
healthcare
Review
Digital Training for Nurses and Midwives to Improve Treatment
for Women with Postpartum Depression and Protect Neonates:
A Dynamic Bibliometric Review Analysis
Maria Tzitiridou-Chatzopoulou 1, Eirini Orovou 1and Georgia Zournatzidou 2, 3, *
1Midwifery Department, School of Healthcare Sciences, University of Western Macedonia, Koila,
50100 Kozani, Greece; mtzitiridou@uowm.gr (M.T.-C.); eorovou@uowm.gr (E.O.)
2Department of Accounting and Finance, Hellenic Mediterranean University, 71410 Heraklion, Greece
3Department of Business Administration, University of Western Macedonia, 50100 Kozani, Greece
*Correspondence: zournatzidou.georgia@gmail.com or zournatzidou@hmu.gr or aff01667@uowm.gr
Abstract: The high prevalence of postpartum depression makes it necessary for midwives and nurses
to implement prenatal interventions for expectant mothers. The current study aims to investigate
and highlight the importance of the digital training of nurses in order to help women mitigate
the symptoms of postpartum depression and protect infants. To approach this, we conducted a
bibliometric analysis to address the study’s main objective. Articles were retrieved from the Scopus
database for the timeframe 2000–2023. Data analysis was conducted using the statistical programming
language R (version R-4.4.) and the bibliometric software VOSviewer (version 1.6.20) and Biblioshiny
(version 4.1.4), focused on year, journal, and country. For this investigation, we selected a total of
31 MeSH keywords and sub-headings that exhibited significant frequencies. We consistently used six
significant clusters of MeSH keywords. We obtained a total of 585 articles from the Scopus database
that were major contributors to the field of PPD, as evidenced by their extensive publication of
research articles and their influential role in the domain. The studies included a thorough analysis
of depression research, the use of scales for diagnosing and screening PPD, psychological studies
related to PPD, and the exploration of causes, mechanisms, outcomes, and genetic factors. Our
study’s results demonstrate a steady and significant increase in the availability of information on
PPD. Importantly, the novelty of the current study lies in highlighting the need for a transition in
the ways in which nurses and midwives are trained to mitigate postpartum disease by integrating
emerging technologies into their practices. The knowledge provided here has the potential to serve
as a foundation for future advancements in obstetric psychology, both presently and in the future.
Keywords: psychological training; postpartum depression; obstetric psychology
1. Introduction
Postpartum depression (PPD) is a common condition that impacts approximately
14% of new mothers, and it can be characterized as a mood disorder that manifests in the
year following childbirth. It is characterized by depressive, anxious, or hopeless thoughts
and emotions that may hinder a mother’s ability to provide for herself and her infant
during that crucial first year [
1
]. PPD can result in various detrimental outcomes, including
strained conjugal and social relationships, strained attachment between mother and infant
and, in rare cases, maternal suicide or infanticide. The absence of treatment for PPD among
women raises the probability that their neonates will experience enduring physical and
developmental challenges, in addition to behavioral disorders [2,3].
There is a potential for new mothers to exhibit hesitancy in disclosing symptoms
of PPD to healthcare providers for fear of social stigma. Furthermore, these mothers
might perceive insomnia and anxiety as typical occurrences during the postpartum phase.
Additionally, medical professionals, like nurses and midwives, may overlook warning
Healthcare 2024,12, 1015. https://doi.org/10.3390/healthcare12101015 https://www.mdpi.com/journal/healthcare
Healthcare 2024,12, 1015 2 of 20
signs or neglect to evaluate new mothers for PPD [
4
,
5
]. To promote favorable long-term
outcomes for both mothers and infants, early detection of PPD is critical.
Thus, it is essential to augment the information and training offered to perinatal nurses
about the identification and guidance of new mothers concerning PPD [
6
]. Education
and advocacy are essential nursing skills for obtaining positive postpartum outcomes.
Nevertheless, nurses may find it impractical to engage in face-to-face training due to their
demanding schedules or remote geographical placement. Instead, online training offers a
flexible method for providing clinical education and training to healthcare practitioners,
which may also be beneficial for nursing students. The digital education and training
program significantly improved the expertise and self-assurance of nurse practitioners in
screening for antepartum depression and providing information to expectant mothers [
7
,
8
].
Potential improvements can be observed in the knowledge and understanding of peri-
natal nurses regarding PPD and its treatments, as well as in their confidence in delivering
critical care to new mothers, through the integration of digital educational training into
the curricula of midwives and nurses. Despite their initial limited understanding of PPD,
nurses’ comprehension of the risk factors linked to its development significantly improved
after concluding the digital training [
9
,
10
]. Furthermore, although digital training may
assist nurses in acquiring critical knowledge and instruction regarding PPD, professional
development may require a greater emphasis on PPD’s risk factors. Moreover, nurses
can enhance their confidence in providing PPD treatments to new mothers by utilizing
digital training modules integrated into online learning platforms. Increasing one’s self-
efficacy may result in a greater propensity to implement PPD teaching practices, which
is one potential advantage [
11
,
12
]. Ultimately, nurses with a greater sense of self-efficacy
may administer these critical interventions more frequently, potentially leading to better
outcomes for the mother and infant.
Therefore, given the current need for nurses and midwives to be trained to mitigate
postpartum disease by integrating emerging technologies into their practices, this study
aims to focus on investigating and highlighting the importance of the dignitary training of
nurses to help women mitigate the symptoms of PPD and protect infants. We conducted
a bibliometric analysis, using the R statistical programming language and the software
Biblioshiny, to address the research objective of this study. The use of computerized data
analysis, like that of bibliometrics, has greatly improved these approaches, resulting in a
large increase in the number of publications on this issue in recent years. This may be partly
due to the use of automated approaches, along with the need for a bibliometric strategy that
incorporates a significant quantity of data to ensure statistical dependability. Furthermore,
the current research used bibliometric analysis in five crucial steps: First, the search criteria,
time periods, and keywords were established. The second step of data selection involved
acquiring data for the present study using the Scopus database. The third step included
modifying and enhancing the research criteria. Ultimately, the concluding stages included
exporting the results and thereafter analyzing, visualizing, and discussing them.
Furthermore, the remainder of this study is organized as follows: Section 2presents
a thorough summary of the existing literature on the studied issue. Section 3delineates
the specific materials and procedures employed to tackle the research question. Section 4
entails the examination of the data obtained from the Scopus database, while Section 5
deliberates on the findings and prospects for future study. Finally, Section 6concludes
the paper.
2. Literature Review
2.1. PPD: A High-Risk Health Concern
The postpartum period is a critical time for maternal mental health, presenting unique
challenges and vulnerabilities. PPD mental health difficulties can occur during pregnancy
or after birth, and mental illness is a leading cause of maternal death. Therefore, it is crucial
to identify the barriers and facilitators to implementing and accessing PPD healthcare [
13
].
Identifying effective and accessible strategies to improve postnatal mental health and well-
Healthcare 2024,12, 1015 3 of 20
being is essential and could yield substantial benefits for both mothers and babies, along
with broader implications for healthcare systems. However, due to the limited data and a
lack of consistency in study design and measures, high-quality investigation is necessary
to establish these effects and explore the potential benefits on other aspects of maternal
well-being and infant outcomes. Trends and gaps in perinatal anxiety research remain
unknown [
2
,
4
,
14
–
16
]. The bibliometric analysis indicates that perinatal anxiety is a growing
field of research, with publications increasing over time. Paternal anxiety is understudied,
and gaps linked to maternal postnatal anxiety and paternal perinatal anxiety exist [17,18].
Specifically, healthcare practitioners worldwide prioritize the psychological well-
being of pregnant women. Perinatal depression (PND), affecting more than 12% of the
global population, has a substantial influence on the physical and mental well-being
of both mothers and newborns. Furthermore, it is crucial to recognize that depression
greatly endangers the overall well-being and safety of expectant mothers, increasing their
vulnerability to suicidal ideation [
19
–
21
]. Multiple studies have shown that mothers
experiencing PPD have less emotional bonding with their children and use inefficient
parenting strategies. These characteristics can greatly influence the mental and behavioral
development of their offspring.
The National Institute for Health and Care Excellence (2020) has dedicated significant
resources to creating comprehensive treatment recommendations for PND over the last
twenty years. Healthcare practitioners may use these concepts as a beneficial instrument for
addressing emotional difficulties in women. Comprehensive inquiry and statistical analysis
have demonstrated that psychological interventions delivered in primary care settings
significantly reduce depressive symptoms in women after delivery. Furthermore, these
therapies enhance social support, effectively handle stress and anxiety, and improve the
quality of parent–child and marital relationships [
22
,
23
]. Nevertheless, women with PPD
often encounter obstacles when attempting to access conventional counseling interventions
for this illness at public health institutions with constrained resources. Research has shown
that healthcare professionals specializing in PPD care often face challenges in effectively
recognizing and managing its signs in their patients [
24
,
25
]. To address the problem of
insufficient comprehension, a growing number of experts advocate for ongoing training
programs focusing on the clinical care of PPD for midwives and nurses. Moreover, the
authors propose that obstetric nursing practices should include the administration of
interventions for melancholy [26].
Considerable research has focused on investigating psychological nurse training
programs aimed at enhancing the quality of care for perinatal mothers suffering from
depression. A Queensland-based randomized controlled experiment showed that pregnant
women’s confidence in the delivery process substantially rose while their apprehension
about labor greatly reduced when they received psychological education from qualified
midwives. Viveiros and Darling (2019) emphasized the capacity of midwives to enhance
women’s access to PPD mental health treatment through more training in this domain, as
shown in their review study. Perinatal mothers and midwives may address mental health
concerns by using established screening techniques [
27
]. Brugha et al. (2016) found that
midwives viewed training in psychological nursing techniques as beneficial and as a good
addition to their current professional knowledge, as shown by qualitative interviews [
28
].
The delivery of emotional assistance to pregnant mothers relies on the crucial elements of
midwives’ evaluation and provision of support. Furthermore, comparable results were
recorded in a distinct investigation. Training public health nurses in cognitive–behavioral
therapy (CBT) may enhance their professional competence and significantly benefit patients
with mental health conditions. Moreover, this training offers nurses and their clients a
wider range of clinical and professional advantages.
Healthcare 2024,12, 1015 4 of 20
2.2. Transitioning from Traditional to Digital Education for Healthcare Professionals
Regarding PPD
The importance of continuing education in the development of human resources and
the maintenance of up-to-date skills in a given profession has been constantly acknowl-
edged [
29
]. Inadequate training has the capacity to hinder the clinical competence of
healthcare workers. Bluestone et al. (2013) emphasized the importance of training methods
in influencing the academic achievements of healthcare workers [
30
]. For example, the
duration of the training program might influence the performance of trainees.
The use of digital education is progressively replacing conventional lectures. Digital
PND screening seems to be appropriate, valid, and safe. The enhanced flexibility, accessi-
bility, and autonomy of digital instructional approaches sometimes make them seem more
student-centric. Specifically, they enhance the speed and ease of the educational process
for healthcare practitioners working in distant and rural locations. Research conducted
by Quinn et al. (2019) found that online training programs significantly enhanced the
comprehension of 233 nurses about reproductive concerns affecting cancer patients [
31
].
These issues include the possible hazards linked to infertility, fertility preservation, and
sexual health. Geraghty et al. (2019) found that online courses provide midwives with
flexibility but may also lead to feelings of loneliness and inadequate support throughout
the learning process [
32
]. In addition, Lahti et al. (2014) conducted a meta-analysis and
did not find any empirical evidence to support the idea that digital learning is superior to
conventional training when it comes to enhancing learning outcomes for nursing students
and practitioners [33].
Intervention fidelity is a vital component of study design that pertains to the extent to
which an intervention is executed in accordance with its initial blueprint. This is due to its
direct impact on the accurate comprehension of research findings. Failure to adhere to the
intervention process may result in statistically insignificant outcomes. The effectiveness
of nursing practice may be reduced if individuals without the necessary qualifications
are employed to supervise community midwives during the provision of psychological
treatment. The fidelity review approach, developed by Reiser and Milne (2014), was used
to assess the supervision of treatments in order to precisely identify the specific qualities
that define effective psychological training for midwives and nurses [
34
]. The framework
comprises five components: supervision design, supervisor training, supervision delivery,
supervision reception, and supervision enactment.
Improving patients’ mental health requires the collaborative engagement and syn-
chronization of several healthcare professionals. Primary healthcare facilities provide
comprehensive prenatal and postnatal care to most women throughout the perinatal period.
Midwives and nursing staff have a substantial influence on the emotional well-being of
women throughout the perinatal period. Studies have shown that the implementation of
succinct psychological interventions by auxiliary nurse midwives and nurses is a successful,
readily achievable, and highly valued method [
13
,
35
–
37
]. Through an extensive exami-
nation of pertinent studies, it has been shown that in low- and middle-income countries
it is feasible and effective for non-specialized healthcare personnel to provide psycholog-
ical treatment. Nevertheless, more verification is required to address concerns over the
insufficient disclosure of results. According to a previous meta-analysis conducted by
Wang et al. (2021), psychological treatments administered by midwives and nurses were
shown to be efficacious in alleviating symptoms in patients diagnosed with PND. Presently,
there is an insufficiency of scholarly investigation on instructing medical professionals
in efficient methodologies for handling patients with PND. The optimal duration and
structure of training, as well as the criteria for guaranteeing training excellence, have not
yet been established. Therefore, the objective of this systematic review was to evaluate the
effectiveness of various psychological training methods in enhancing the competence of
midwives and nurses in the management of PND in women [
15
,
38
]. The characteristics that
were studied included the genuineness of the intervention, strategies used in the training,
and duration.
Healthcare 2024,12, 1015 5 of 20
3. Materials and Methods
A bibliometric approach was utilized in this study, as a systematic review of the
selected research publications that can contribute to detecting recurring themes, deficiencies,
and emergent subjects. Through the implementation of bibliometric analysis, one can
ascertain the current state of research and identify reputable academic journals, publishing
houses, or authors within the field. As this provides a comprehensive view of the academic
landscape in the field and can enhance comprehension, it is therefore appropriate to employ
the bibliometric method to examine digital training for nurses who specialize in assisting
new mothers to alleviate the symptoms of postpartum depression (PPD). An analysis of
aggregated literature data sourced from databases including Scopus, Web of Science (WoS),
and Google Scholar was employed to carry out this research. Over the past few years,
the use of quantitative and bibliometric techniques to assess the output of research has
increased substantially. A critical analysis should be conducted on the efficiency, validity,
and reliability of the assessment method [39–42].
The data used in the current study were obtained from Scopus in June 2022. Scopus,
founded in 2004, is a well-regarded bibliographic database. The collection consists of
abstracts and citations sourced from respected scientific publications. The database contains
a total of 36,377 titles from 11,678 publishers. Thus, the data for this research specifically
revolve around four crucial terms: postpartum depression, nurses, digital training, and
distress. The process for conducting keyword searches is well explained and provided in
Table 1.
Table 1. Keyword search formula.
Step Keyword Search
1 (“postpartum depression” AND “training”)
2 ((“postpartum depression” OR “postpartum disease”) AND “training”)
3((“postpartum depression” OR “postpartum disease”) AND (“training”
OR “knowledge”)
4((“postpartum depression” OR “postpartum disease”) AND (“training” OR
“knowledge”) AND “digital transformation”)
5((“postpartum depression” OR “postpartum disease”) AND (“training” OR
“knowledge”) AND (“digital transformation” OR “emerging technologies”)
6
((“postpartum depression” OR “postpartum disease”) AND (“training” OR
“knowledge”) AND (“healthcare personnel” OR “nurses”)AND (“digital
transformation” OR “emerging technologies”)
7
((“postpartum depression” OR “postpartum disease”) AND (“training” OR
“knowledge”) AND (“healthcare personnel” OR “nurses”) AND (“distress”) AND
(“digital transformation” OR “emerging technologies”)
8
((“postpartum depression” OR “postpartum disease”) AND (“training” OR
“knowledge”) AND (“healthcare personnel” OR “nurses”) AND (“distress”) AND
(“digital transformation” OR “emerging technologies” OR “advanced services”)
9
((“postpartum depression” OR “postpartum disease” OR (“postpartum treatment”)
AND (“training” OR “knowledge”) AND (“healthcare personnel” OR “nurses”)
AND (“distress”) AND (“digital transformation” OR “emerging technologies” OR
“advanced services”)
10
((“postpartum depression” OR “postpartum disease” OR (“postpartum treatment”)
AND (“training” OR “knowledge”) AND (“healthcare personnel” OR “nurses”)
AND (“distress”) AND (“digital transformation” OR “emerging technologies” OR
“advanced services”) AND (LIMIT-TO (DOCTYPE, “ar”)) AND (LIMIT-TO
(PUBSTAGE, “final”) OR LIMIT-TO (PUBSTAGE, “aip”)) AND (LIMIT-TO
(SRCTYPE, “j”))
In addition, the PRISMA flow diagram illustrates the essential steps involved in
selecting a reliable collection of articles for bibliometric analysis (Figure 1). The search
query for the collection resulted in 1854 sources, which were further narrowed down to
956 by choosing only articles. Subsequently, a total of 731 papers underwent scrutiny to
exclude those that seemed unrelated or had a wide-ranging scope that was unsuitable for
Healthcare 2024,12, 1015 6 of 20
the present investigation, which specifically aims to emphasize the advancements of the
new digital age in the domain of nurse and midwife training for effectively addressing
postpartum depression (PPD). Upon manual examination of the articles, it was found that
a number of the chosen sources do not explicitly state the size and nature of the researched
area in the title or keywords. Consequently, the search was modified to only include
publications that are relevant to the current research subject, thus excluding any irrelevant
mentions. A total of 585 scientific publications remained after using this filtering process,
and these papers were included in the bibliometric analysis.
Healthcare 2024, 12, x FOR PEER REVIEW 7 of 21
Figure 1. Selection process of the articles for bibliometric analysis using the PRISMA flow diagram
method.
4. Results
4.1. Evolution of the Number of Articles
The present research assessed a total of 585 original publications published between
2000 and 2023. Table 2 indicates the main information about the sample used in the cur-
rent research to approach the main objective of the study.
Table 2. Main information. Source: Biblioshiny.
Description Results
Main Information about Data
Timespan 2000:2023
Sources (journals) 391
Documents 585
Average years from publication 6.24
Average citations per documents 38.08
Average citations per year per doc 3.8
References 62,646
Document Types
Figure 1. Selection process of the articles for bibliometric analysis using the PRISMA flow dia-
gram method.
4. Results
4.1. Evolution of the Number of Articles
The present research assessed a total of 585 original publications published between
2000 and 2023. Table 2indicates the main information about the sample used in the current
research to approach the main objective of the study.
Figure 2depicts the yearly scientific output in the study area of the influence of digital
training for nurses and midwives on reducing postpartum depression. The substantial
increase in publications in the research area in 2022 may be described as the pinnacle year.
The increase in publications during this specific year may be related to the conditions
caused by the COVID-19 pandemic. This situation required a change in healthcare staff
training to focus on managing PPD via the use of telemedicine. The use and scope of
telehealth technologies throughout the prenatal and postpartum periods have seen a signif-
Healthcare 2024,12, 1015 7 of 20
icant increase as a result of the onset of the COVID-19 pandemic. The removal of earlier
obstacles to telemedicine has enabled the assessment of novel adaptable care models and
the investigation of telehealth applications to tackle urgent clinical concerns. When con-
sidering the use of telehealth during the prenatal and postpartum periods, it is important
to strike a balance between enhancing appointment attendance and providing necessary
screening, monitoring, and treatment that are more suitable for in-person consultations.
The increasing incidence of maternal mortality, especially among women belonging to
ethnic minority groups, underscores the need for tackling these issues. Hence, in light of
our recuperation from the COVID-19 pandemic, it is essential to assess the present progres-
sions in telehealth and contemplate its potential applications throughout the prenatal and
postnatal phases in the forthcoming times.
Table 2. Main information. Source: Biblioshiny.
Description Results
Main Information about Data
Timespan 2000:2023
Sources (journals) 391
Documents 585
Average years from publication 6.24
Average citations per documents 38.08
Average citations per year per doc 3.8
References 62,646
Document Types
Articles 585
Document Contents
Keywords plus (ID) 2796
Author’s keywords (DE) 1318
Authors
Authors 2576
Author appearances 2843
Authors of single-authored documents 78
Authors of multi-authored documents 2498
Authors’ Collaboration
Single-authored documents 90
Documents per author 0.228
Authors per document 4.39
Co-authors per documents 4.84
Collaboration index 5.07
Telehealth, as defined by the Health Resources and Services Administration (2022),
is the provision of clinical healthcare, professional and patient health education, health
administration, and public health services using electronic information and telecommu-
nications technology. Telehealth encompasses a broader spectrum of services, including
both clinical and non-clinical activities, in contrast to telemedicine. Telehealth technology
can be categorized into four main groups: (i) telemedicine services, which utilize video-
conferencing or audio-only communication for consultations, diagnostics, and treatment;
(ii) the transfer of medical information, such as digital images, through store-and-forward
imaging systems; (iii) the electronic gathering and transmission of health and medical
data for remote patient monitoring; and (iv) the support of healthcare and medical op-
erations [
43
–
45
]. Telehealth technology has the capability to provide a diverse range of
services pertaining to pregnancy [
46
–
50
]. Continued telehealth application aims to provide
equitable access to perinatal care [
51
]. Telehealth has the potential to enhance standard
prenatal care by facilitating consultations with specialists, providing genetic counseling,
Healthcare 2024,12, 1015 8 of 20
interpreting ultrasound images, remotely monitoring patients, and offering other special-
ized services. Enhanced continuity of care in the postpartum period may be achieved
using virtual follow-up visits, provision of breastfeeding support, and delivering guidance
on contraception. Patients may receive supplementary medical interventions, including
surveillance for arterial hypertension and diabetes, therapy, and assessment of mental
well-being, throughout the perinatal period [52,53].
Healthcare 2024, 12, x FOR PEER REVIEW 9 of 21
terventions, including surveillance for arterial hypertension and diabetes, therapy, and
assessment of mental well-being, throughout the perinatal period [52,53].
Figure 2. Annual scholarly publications on digital postpartum depression training for nurses and
midwives.
4.2. Most Impactful Journals, Countries, and Publications
Table 3 displays the journals with the highest volume of research submissions re-
lated to the study subject from 2000 to 2023. The table highlights the most relevant
sources, prioritizing those with the highest number of publications based on the research
methodology outlined in Section 3. The Cochrane Database of Systematic Reviews stands
out as having the highest number of very relevant papers (23 articles) published in the
field of research throughout the studied period. The Journal of Medical Internet Research
follows, with sixteen (16) publications specifically addressing digital training for nurses
and midwives to mitigate postpartum depression. Furthermore, BMC Pregnancy and
Childbirth and the Journal of Affective Disorders have published a total of thirteen (13) and
ten (10) publications, respectively. Our research identified the International Journal of En-
vironmental Research and Public Health as the most significant source, with nine (9) publi-
cations related to the investigation area.
Table 1 illustrates that the chosen journals cover various fields, including medicine,
obstetrics and gynecology, psychiatry and mental health, and health informatics. Health
informatics emerges as the second most influential field in terms of published works,
underscoring the importance of creating new understandings and designing technolog-
ical interventions to promote a healthy postpartum lifestyle by encouraging behavioral
changes. Furthermore, all of the selected journals are indexed in both the Scopus and
Scimago databases. Regarding the h-index, the mean value is approximately 186, indi-
cating that the research publications in the examined topic receive more than 186 cita-
tions on average. This metric underscores the relevance, significance, and wide-ranging
influence of research on the digitization of training for nurses and midwives in address-
ing postpartum problems.
Figure 2. Annual scholarly publications on digital postpartum depression training for nurses and
midwives.
4.2. Most Impactful Journals, Countries, and Publications
Table 3displays the journals with the highest volume of research submissions related
to the study subject from 2000 to 2023. The table highlights the most relevant sources,
prioritizing those with the highest number of publications based on the research method-
ology outlined in Section 3. The Cochrane Database of Systematic Reviews stands out as
having the highest number of very relevant papers (23 articles) published in the field of
research throughout the studied period. The Journal of Medical Internet Research follows, with
sixteen (16) publications specifically addressing digital training for nurses and midwives
to mitigate postpartum depression. Furthermore, BMC Pregnancy and Childbirth and the
Journal of Affective Disorders have published a total of thirteen (13) and ten (10) publica-
tions, respectively. Our research identified the International Journal of Environmental Research
and Public Health as the most significant source, with nine (9) publications related to the
investigation area.
Table 1illustrates that the chosen journals cover various fields, including medicine,
obstetrics and gynecology, psychiatry and mental health, and health informatics. Health
informatics emerges as the second most influential field in terms of published works,
underscoring the importance of creating new understandings and designing technological
interventions to promote a healthy postpartum lifestyle by encouraging behavioral changes.
Furthermore, all of the selected journals are indexed in both the Scopus and Scimago
databases. Regarding the h-index, the mean value is approximately 186, indicating that the
research publications in the examined topic receive more than 186 citations on average. This
metric underscores the relevance, significance, and wide-ranging influence of research on
the digitization of training for nurses and midwives in addressing postpartum problems.
Healthcare 2024,12, 1015 9 of 20
Table 3. Most relevant publications in the field of digital training of nurses and midwifes for
mitigating postpartum depression.
Sources Number of
Publications Subject Area H-Index Scimago List
Cochrane Database of Systematic Reviews
23 Medicine 309 Q1
Journal of Medical Internet Research 16 Health informatics 178 Q1
BMC Pregnancy And Childbirth 13 Obstetrics and gynecology 103 Q1
Journal of Affective Disorders 10
Psychiatry and mental health
217 Q1
International Journal of Environmental
Research and Public Health 9 Medicine 167 Q2
Plos One 9 Medicine 404 Q1
Archives Of Women’s Mental Health 8
Psychiatry and mental health
89 Q1
Health Technology Assessment 8 Health policy 138 Q1
Jognn—Journal of Obstetric Gynecologic
And Neonatal Nursing 8 Maternity and midwifery 87 Q1
Journal of Advanced Nursing 8 Nursing 169 Q1
Table 4presents the countries that generated the highest numbers of academic works
in the field of digital training for nurses and midwives aimed at mitigating PPD from
2000 to 2023. The index of total citations refers to the average annual number of citations
received by an article. Both developed and developing countries exert a substantial impact
on research in the field of smart agriculture. Developed nations have identified the USA
as the most often mentioned country, with American articles being quoted a total of
3597 times. This recognition is based on the fact that PPD is a widespread disease that
affects around one in every eight women following delivery in the United States. Mothers
belonging to ethnic minority groups or facing financial constraints had a notably higher
incidence of PPD. The enforcement of mandatory stay-at-home orders during the COVID-
19 pandemic has resulted in a doubling of the occurrence of PPD compared to the rate
before the pandemic. Given the exceptional circumstances of the pandemic, utilizing digital
mental health services, which are delivered through technological platforms, could serve
as an innovative approach to overcome obstacles to treatment and provide efficient mental
health support for women during the postpartum period. However, there is a lack of
information about the level of acceptability of this specific treatment among women during
the postpartum period. Hence, the utilization of digital training for nurses and midwives
to address postpartum illness is a very captivating area of focus for researchers in this
sector [20,21,35,38,54].
Table 4. Scientific production per countries.
Country Total Citations Average Article Citations
USA 3597 37.86
United Kingdom 1930 36.42
Canada 1491 51.41
Australia 1358 33.12
Netherlands 396 39.60
Norway 259 37.00
South Africa 152 38.00
New Zealand 141 28.20
China 139 3.86
Israel 99 11.00
On the other hand, Dutch academics present the highest average number of article
citations. Specifically, academics from the Netherlands prioritize the publication of research
articles pertaining to the incorporation of developing technology in the training of nurses
Healthcare 2024,12, 1015 10 of 20
and midwives, with the aim of reducing the occurrence of postpartum morbidity. This
occurs due to the intricacy of the maternity care system in the Netherlands. Pregnant
women are classified into three tiers of healthcare: primary, secondary, or tertiary care [
1
,
16
].
Pregnancy allocation is determined by classifying it as low-, medium-, or high-risk at the
first prenatal checkup. Community midwives provide vital healthcare services to pregnant
women with a low probability of encountering difficulties. Women may choose to give
birth either at home or in a primary care birth center, where they will be attended to
by a community midwife. Gynecologists or clinical midwives in traditional hospitals
are responsible for overseeing the treatment of pregnancy and childbirth in secondary
healthcare settings. Pregnant women with pregnancies at heightened risk of problems,
such as severe preeclampsia occurring before 32 weeks of gestation, are sent to specialist
medical institutes known as tertiary care centers. The Netherlands is equipped with a
total of 12 perinatal facilities that provide this level of medical care. During the third
trimester, maternity care assistants (MCAs) conduct home visits to assess and decide the
optimal degree of postpartum care for each woman. Maternity care groups use MCAs
to provide postpartum care. Thus, eHealth platforms have been developed by the Dutch
government to facilitate remote monitoring, mobile device-assisted care, telemedicine, and
teleconsultations, because of recent technological advancements in the healthcare industry.
By reducing the necessity for hospital visits or admissions, eHealth can empower patients
and improve their access to healthcare. As frequent users of mobile devices and the internet,
postpartum women are adequately equipped to conduct self-assessments at home and
transmit the results to their prenatal care provider in a digital format [6,36,55,56].
Table 5displays the articles that have received the highest numbers of citations in the
area of teaching healthcare staff about postpartum illness. Among all of the papers on this
topic, the one titled “Measuring Health: A guide to rating scales and questionnaires” has
received the most citations. This article provides an overview of several health concerns,
including physical disability, psychological well-being, anxiety, depression, mental status
assessment, social health, pain evaluation, and quality of life. Furthermore, it elucidates
the theoretical and methodological advancement of conventional health metrics to alleviate
the aforementioned occurrences.
Table 5. Most impactful publications in the field.
Paper Total Citations TC per Year Normalized TC
Measuring Health: A guide to rating scales and questionnaires 3780 236.25 10.8584
Preventing Mental, Emotional, and Behavioral Disorders Among
Young People 1139 71.1875 3.2719
Postpartum depression: current status and future directions 1090 90.8333 9.7352
Early childhood adversity, toxic stress, and the role of the
pediatrician: translating developmental science into lifelong health
735 56.5385 8.9771
Magnitude and risk factors for postpartum symptoms: a
literature review 489 48.9 7.4731
Non-specialist health worker interventions for the care of mental,
neurological and substance-abuse disorders in low- and
middle-income countries
431 35.9167 3.8494
Psychosocial and psychological interventions for treating
postpartum depression 378 21 5.411
Behavioural Activation for Depression; An Update of
Meta-Analysis of Effectiveness and Sub Group Analysis 359 32.6364 6.5493
Evidence-based clinical guidelines for immigrants and refugees 328 23.4286 6.6188
Sleep, Health, and Society 302 37.75 6.6583
Additionally, the publication titled “Postpartum depression: current status and future
directions” directs readers towards novel research avenues in the realm of alleviating
postpartum illness. It suggests incorporating mental health screening into regular primary
care for pregnant and postpartum women, and subsequently providing treatment or
Healthcare 2024,12, 1015 11 of 20
referral, as well as follow-up care, based on the results of this screening. This may be
accomplished via the use of telemedicine. Hence, the need to provide digital training to
nurses and midwives is paramount [19,43,44].
Figure 3displays the authors’ keywords organized in a hierarchical structure of
subjects related to digital training for healthcare staff to address PPD. These issues have
been examined by researchers on a yearly basis. The size of the circles in the lines increases
proportionally with the number of references to the topic that they represent. This study’s
results emphasize the importance of mobile applications in conjunction with mindfulness.
Mindfulness-based interventions (MBIs) include the incorporation of mindfulness practice
within a well-organized psychological intervention; they are intentionally crafted programs
that provide participants explicit instructions on how to develop and integrate the practice
of mindfulness into their daily routines [
57
–
60
]. The benefits of these activities have been
recognized in many settings and situations, including the mitigation of stress, anxiety,
sadness, aggression, excessive internet use, and work-related stress. Furthermore, they
include the cultivation of self-compassion and positive perceptions of social support inside
the workplace [
59
,
61
,
62
]. Research indicates that those with lower levels of dispositional
mindfulness are more prone to experiencing heightened levels of despair, stress, and anxiety
throughout the perinatal period.
Healthcare 2024, 12, x FOR PEER REVIEW 13 of 21
Figure 3. Research trends in the field of digital training of nurses and midwifes to mitigate post-
partum depression.
Additionally, Figure 4 depicts the research topics derived from the conceptual
framework of the texts examined in the bibliometric study. The groups shown in the
graph correspond to the principal areas of study, and the size of each cluster reflects the
percentage of words that it includes. Each quadrant of the graphical composition signi-
fies a unique theme. The top-right section of the image strongly showcases motor themes,
characterized by a significant level of centralization and density. The upper-left quadrant
of the thematic map displays the various subjects addressed. High density and reduced
centrality distinguish this group. In addition, the thematic map identifies important
subjects in the lower-right quadrants while highlighting emerging concepts in the low-
er-left quadrants because of their limited prominence and concentration. Telehealth and
telemedicine dominate the niche themes, highlighting their significance in reducing pa-
rental and infant stress during postpartum disease.
The findings of the thematic analysis again indicate the importance of emerging
technologies toward digital and online training of nurses to prepare them for helping
new mothers mitigate PPD symptoms. Specifically, the thematic map highlights the im-
portance of telehealth and its strong connection with simulation. Particularly during the
COVID-19 pandemic, telehealth utilization has increased because, by definition, it does
not necessitate physical proximity. Nurses have encountered difficulties because of this
exponential growth, as they have not historically been provided with pre-professional
training in telehealth service delivery. In reaction, educational institutions are com-
mencing the integration of telehealth instruction into healthcare curricula, which con-
ventionally encompass didactic instruction, practical skill development, and hands-on
learning. By means of experiential learning, telehealth service delivery competencies can
be developed through simulation.
Figure 3. Research trends in the field of digital training of nurses and midwifes to mitigate postpartum
depression.
Additionally, simulation training is another growing practice in the digital training
of nurses that focuses on addressing the symptoms of PPD and assisting new mothers.
This training also recognizes the importance of mobile apps. Nurses may engage in virtual
reality simulation training to immerse themselves in a computer-generated environment
that replicates both physical and social aspects, along with simulated patients. In addition,
the use of virtual training for nurses may facilitate the development of intelligent platforms
that provide automated support, adaptable scenarios, and sophisticated performance
monitoring and assessments for nurses. Furthermore, the integration of an interactive
technology into virtual simulations provides nurse’s apprentices with the chance to replicate
reality within a computer-generated environment, thus enabling them to make decisions in
Healthcare 2024,12, 1015 12 of 20
a low-risk environment. This innovative pedagogical approach serves as a supplementary
strategy to experiential learning.
Additionally, Figure 4depicts the research topics derived from the conceptual frame-
work of the texts examined in the bibliometric study. The groups shown in the graph
correspond to the principal areas of study, and the size of each cluster reflects the percent-
age of words that it includes. Each quadrant of the graphical composition signifies a unique
theme. The top-right section of the image strongly showcases motor themes, character-
ized by a significant level of centralization and density. The upper-left quadrant of the
thematic map displays the various subjects addressed. High density and reduced centrality
distinguish this group. In addition, the thematic map identifies important subjects in the
lower-right quadrants while highlighting emerging concepts in the lower-left quadrants
because of their limited prominence and concentration. Telehealth and telemedicine domi-
nate the niche themes, highlighting their significance in reducing parental and infant stress
during postpartum disease.
Healthcare 2024, 12, x FOR PEER REVIEW 14 of 21
Figure 4. Thematic map.
Furthermore, to enhance the understanding of the interconnections among various
subjects, we implemented an unsupervised machine learning approach to visualize the
author keywords. This visualization depicts an aggregation of the top 50 author key-
words using the multiple correspondence analysis (MCA) technique to combine various
author keywords. This resulted in the development of a map depicting the conceptual
structure of the publications analyzed in this research. The algorithm generated two
clusters: the red and the blue. The red cluster centers on the notion of postpartum de-
pression (PPD) and the contribution of nurses in assisting new mothers to alleviate the
symptoms of this critical yet manageable medical condition. These symptoms include
altered energy levels, appetite, sleep paerns, and feelings of extreme sadness, indiffer-
ence, and/or anxiety. Conversely, the blue cluster emphasizes the critical significance of
digital training for nurses to provide assistance to expectant mothers throughout this
challenging phase of their lives. Mainly, Figure 5 highlights the importance of the im-
plementation of mobile applications to alleviate postpartum depression and anxiety.
Applications for mobile devices and technological interventions, such as online mental
health programs, may facilitate the implementation of antidepressant measures. The
World Health Organization’s Mental Health Action Plan for 2013–2020 proposes the uti-
lization of electronic and mobile health applications to encourage self-care. There exists a
specific propensity among mothers who are undergoing childbirth to utilize mobile
health applications. Although definitive evidence is lacking to support the claim that
mobile applications can prevent depressive symptoms, they have demonstrated en-
couraging results in mitigating moderate-to-severe symptoms of depression. These mo-
bile applications offer individualized care that is effective, flexible, and conveniently ac-
cessible during the postpartum phase; they function as a commendable safeguard against
postpartum depression. Therefore, maintaining the knowledge and abilities of midwives
and nurses to manage delivery complications and enhance maternal and neonatal
healthcare is dependent on the resources.
Figure 4. Thematic map.
The findings of the thematic analysis again indicate the importance of emerging
technologies toward digital and online training of nurses to prepare them for helping new
mothers mitigate PPD symptoms. Specifically, the thematic map highlights the importance
of telehealth and its strong connection with simulation. Particularly during the COVID-19
pandemic, telehealth utilization has increased because, by definition, it does not necessitate
physical proximity. Nurses have encountered difficulties because of this exponential growth,
as they have not historically been provided with pre-professional training in telehealth
service delivery. In reaction, educational institutions are commencing the integration of
telehealth instruction into healthcare curricula, which conventionally encompass didactic
instruction, practical skill development, and hands-on learning. By means of experiential
learning, telehealth service delivery competencies can be developed through simulation.
Furthermore, to enhance the understanding of the interconnections among various
subjects, we implemented an unsupervised machine learning approach to visualize the
Healthcare 2024,12, 1015 13 of 20
author keywords. This visualization depicts an aggregation of the top 50 author keywords
using the multiple correspondence analysis (MCA) technique to combine various author
keywords. This resulted in the development of a map depicting the conceptual structure of
the publications analyzed in this research. The algorithm generated two clusters: the red
and the blue. The red cluster centers on the notion of postpartum depression (PPD) and the
contribution of nurses in assisting new mothers to alleviate the symptoms of this critical
yet manageable medical condition. These symptoms include altered energy levels, appetite,
sleep patterns, and feelings of extreme sadness, indifference, and/or anxiety. Conversely,
the blue cluster emphasizes the critical significance of digital training for nurses to provide
assistance to expectant mothers throughout this challenging phase of their lives. Mainly,
Figure 5highlights the importance of the implementation of mobile applications to alleviate
postpartum depression and anxiety. Applications for mobile devices and technological
interventions, such as online mental health programs, may facilitate the implementation
of antidepressant measures. The World Health Organization’s Mental Health Action Plan
for 2013–2020 proposes the utilization of electronic and mobile health applications to
encourage self-care. There exists a specific propensity among mothers who are undergoing
childbirth to utilize mobile health applications. Although definitive evidence is lacking
to support the claim that mobile applications can prevent depressive symptoms, they
have demonstrated encouraging results in mitigating moderate-to-severe symptoms of
depression. These mobile applications offer individualized care that is effective, flexible,
and conveniently accessible during the postpartum phase; they function as a commendable
safeguard against postpartum depression. Therefore, maintaining the knowledge and
abilities of midwives and nurses to manage delivery complications and enhance maternal
and neonatal healthcare is dependent on the resources.
Healthcare 2024, 12, x FOR PEER REVIEW 15 of 21
Figure 5. Multiple correspondence analysis (MCA).
5. Discussion
The present research underscores the importance of providing midwives and nurses
with digital training to effectively manage postpartum diseases. Without extending these
protections beyond 2024 and making them permanent, the barriers to telehealth that
were previously identified will resurface. Healthcare practitioners must stay updated on
telehealth technology coverage modifications by insurance companies to assist patients in
navigating this fast-changing environment [6,36]. Through the efficient use of telehealth,
a patient-centered strategy to delivering exceptional healthcare throughout the prenatal
and postpartum stages might be effectively executed. Compiling studies in the rapidly
growing field of telehealth is difficult due to the wide range of activities included under
this overarching phrase. Further investigation is needed to evaluate hybrid care models
and further the development of telehealth technology. Although not entirely separate,
both academic fields will enhance each other. Ultimately, more targeted evaluations of
the data will provide vital knowledge on the most effective technology or care approach
to tackle specific diseases, desired results, and unique cases [54,63].
It is crucial to thoroughly record the various telehealth technologies and treatments
from a holistic perspective, and to enhance their implementation in response to new
findings. While there are several mHealth apps for mental health, only a few have un-
dergone clinical testing. Moreover, there is a notable deficiency in the understanding of
the latest advancements in this field, such as wearable gadgets and their corresponding
applications. Thorough assessments, especially those using randomized controlled trials,
are advantageous for assessing the efficacy of new technologies and altered care models
in relation to clinical outcomes, satisfaction of providers and patients, and safety. Inad-
equate investigation has been carried out on the use of telehealth technology and care
Figure 5. Multiple correspondence analysis (MCA).
Healthcare 2024,12, 1015 14 of 20
5. Discussion
The present research underscores the importance of providing midwives and nurses
with digital training to effectively manage postpartum diseases. Without extending these
protections beyond 2024 and making them permanent, the barriers to telehealth that
were previously identified will resurface. Healthcare practitioners must stay updated on
telehealth technology coverage modifications by insurance companies to assist patients in
navigating this fast-changing environment [
6
,
36
]. Through the efficient use of telehealth,
a patient-centered strategy to delivering exceptional healthcare throughout the prenatal
and postpartum stages might be effectively executed. Compiling studies in the rapidly
growing field of telehealth is difficult due to the wide range of activities included under
this overarching phrase. Further investigation is needed to evaluate hybrid care models
and further the development of telehealth technology. Although not entirely separate, both
academic fields will enhance each other. Ultimately, more targeted evaluations of the data
will provide vital knowledge on the most effective technology or care approach to tackle
specific diseases, desired results, and unique cases [54,63].
It is crucial to thoroughly record the various telehealth technologies and treatments
from a holistic perspective, and to enhance their implementation in response to new find-
ings. While there are several mHealth apps for mental health, only a few have undergone
clinical testing. Moreover, there is a notable deficiency in the understanding of the latest
advancements in this field, such as wearable gadgets and their corresponding applica-
tions. Thorough assessments, especially those using randomized controlled trials, are
advantageous for assessing the efficacy of new technologies and altered care models in
relation to clinical outcomes, satisfaction of providers and patients, and safety. Inadequate
investigation has been carried out on the use of telehealth technology and care models
during the postpartum period—a crucial time for ensuring uninterrupted care and treating
ongoing maternal health issues.
Essentially, telehealth was created to enhance the availability of healthcare services.
Nevertheless, disparities continue to exist in the provision of maternity care throughout
the United States, primarily influenced by factors such as socioeconomic level, ethnic
and cultural background, geographic location, and health insurance coverage, among
other determining factors. Introducing telehealth services throughout the prenatal and
postpartum periods has the capacity to mitigate disparities in medical results and healthcare
delivery. However, it is crucial to execute the plan with great attention to detail to avoid
exacerbating these discrepancies [
15
,
16
,
64
,
65
]. It is crucial to analyze research with a focus
on health equality to assess the accessibility, availability, and consumption of telehealth
services, as well as to distinguish the beneficiaries and non-beneficiaries. To promote
the fair adoption of telehealth, laws could be enacted to enhance financing for telehealth
research, guarantee equal remuneration for telehealth services, broaden insurance coverage
for remote monitoring, and enhance access to high-speed internet. While the notion of
reverting back to a pre-COVID-19 era may seem attractive, it is crucial to acknowledge
that the pandemic has brought about substantial changes in the telehealth industry. The
adjustments and flexibilities that were made in response to the COVID-19 pandemic should
be maintained permanently. Undoubtedly, if this paradigm change occurs, telehealth will
firmly establish itself as a lasting component of the healthcare system.
During the postpartum period, the use of telehealth has both advantages and difficul-
ties when it comes to incorporating it into healthcare practices. It can help improve the
adherence to appointments, but there are important aspects like screening, monitoring, and
treatment that are better suited for in-person consultations. Given the rising occurrence of
maternal mortality, particularly among women from ethnic minority groups, these matters
are very significant. Therefore, it is critical to evaluate the telehealth capabilities throughout
the prenatal and postpartum stages and examine the new advancements in telemedicine
as we recuperate from the COVID-19 pandemic [
66
–
68
]. Telehealth, unlike telemedicine,
offers a broader range of services that include both clinical and non-clinical activities.
Telehealth technologies can be categorized into four main groups: (i) methods that facil-
Healthcare 2024,12, 1015 15 of 20
itate immediate, interactive communication for consultative, diagnostic, and treatment
services; (ii) techniques that involve audio-only interactions alongside videoconferenc-
ing; (iii) store-and-forward imaging, which involves electronically transmitting medical
data like digital images; and (iv) remote patient monitoring, which involves electronically
collecting and transmitting personal health information. Telehealth offers the capacity to
provide a variety of services linked to the period after childbirth, including information on
contraception, virtual follow-up consultations to maintain consistent care, and assistance
with breastfeeding.
Furthermore, the integration of telehealth and simulation in nursing education is feasi-
ble, given that simulation has been recognized as an efficacious pedagogical tool that can be
applied to a variety of subject matter. It has been demonstrated that telehealth simulation
is beneficial and acceptable for imparting clinical reasoning to nursing students [
53
,
69
]. By
integrating telehealth simulations into nursing training at an early stage, nurses would
benefit from heightened exposure to telehealth experiences, enhanced engagement and
learning opportunities, and improved readiness for authentic patient interactions. Further-
more, telehealth simulation serves not only to enhance the clinical competencies of nurses
but also to acquaint them with the informational technologies that they will inevitably
come across in their professional lives [70].
Based on the above, the findings of the current research have substantial implications
for real-world implementation in clinical environments and strengthen the core nursing
skills of providing education and support to mothers throughout the postpartum period.
Our organization has the capacity to offer perinatal nurses a user-friendly, versatile, and
adaptable online educational module pertaining to PPD [
2
,
71
]. Based on the findings of
the bibliometric analysis of the current research work, the annual competency training
for perinatal nurses could include an online module on PPD. Instruction regarding the
use of a standardized instrument to evaluate PPD is crucial in order to guarantee that all
mothers are screened. It is expected that substantial progress in the knowledge of perinatal
nurses regarding PPD and the implementation of interventions that leverage emergent
technologies will result in increased confidence in their ability to provide PPD care to
new mothers [
4
]. It is expected that these advancements will lead to enhanced healthcare
outcomes for administrators of hospitals. Pre-licensure nursing programs have the capacity
to integrate instruction on crucial subjects, including PPD, by integrating online modules
into their academic programs. This has the potential to enhance the understanding and
self-assurance of aspiring nurses regarding their capacity to identify and manage perinatal
mental health disorders. These digital modules have the potential to function as an adjunct
to in-person and clinical training. By integrating interactive exercises, such as conducting a
dialogue with a mother who has undergone PPD, into the module, learners can augment
their understanding of the pragmatic obstacles encountered by these mothers. In rural
pre-licensure programs, where opportunities to observe mothers with PPD in a clinical
setting are limited, it may be advantageous to integrate online training into the simulation
process to enhance nurses’ comprehension of PPD [5].
There are notable constraints associated with this study. The prevalence of research
conducted in the United States highlights the need for telehealth to be embraced worldwide,
due to its socioeconomic importance. This study largely focused on Caucasian women who
had advanced levels of education and belonged to a higher socioeconomic status (SES). As
anticipated, a notable fraction of the studies displayed constraints such as limited sample
sizes, imbalanced comparison group sizes, and the inclusion of only pregnancies with little
risk [
37
,
72
,
73
]. Further investigation should assess the occurrence of negative outcomes for
both mothers and newborns, such as adverse events and maternal deaths, in a more diverse
population that encompasses different nationalities and socioeconomic backgrounds, as
opposed to the standard care group. The present study’s results reveal that virtual health is
revolutionizing the healthcare field, providing potential avenues for additional exploration.
Conventional healthcare business models will need to alter to remain competitive and be
accepted by patients. It is recommended to carry out further investigation to analyze the
Healthcare 2024,12, 1015 16 of 20
impact of virtual clinics on the total costs related to treatment and the development of
virtual clinics, so as to ascertain their general cost-effectiveness.
6. Conclusions
Postpartum depression is a widespread kind of depression that affects about one in
nine women worldwide. Despite the presence of accessible medical care, over forty percent
of women do not attend postpartum appointments. Postpartum care offers a beneficial
opportunity to improve the overall well-being of women by addressing matters such as
newborn nursing routines, reproductive healthcare, mental health, postpartum difficulties,
and chronic health disorders. Studies have shown that technology not only improves and
increases the quality of healthcare for patients, it also reduces the incidence of postpartum
depression [1,2,17,35].
The current study has shown that including telemedicine and simulation into nursing
education is crucial for mitigating the symptoms of postpartum depression. More specifi-
cally, considering that simulation has been acknowledged as a potent teaching technique
that may be used in a wide range of subjects, the results suggest that using telemedicine
simulation is beneficial and well appreciated for instructing nursing students in clinical
reasoning. By incorporating telehealth simulations into nursing training at an early stage,
nurses would have more exposure to telehealth experiences, greater engagement and
learning opportunities, and improved readiness for actual patient contacts. Furthermore,
telemedicine simulation enhances nurses’ clinical proficiency and acquaints them with the
technological instruments that they are likely to come across in their professional journeys.
Integrating telemedicine into healthcare procedures during the postpartum trimester
has both advantages and difficulties. Although virtual consultations may help improve
appointment attendance, essential aspects such as screening, monitoring, and therapy
are better suited for in-person consultations [
49
]. These challenges are very significant
due to the rising occurrence of maternal mortality, especially among women from ethnic
minority groups. It is crucial to evaluate telehealth capabilities throughout the prenatal
and postpartum periods and explore the latest advancements in telemedicine as we recover
from the COVID-19 pandemic. Unlike telemedicine, telehealth offers a wide range of
services that include both clinical and non-clinical activities.
The findings of this research have important significance for practical implementation
in clinical settings and improving the essential nursing skill of teaching and supporting
pregnant women throughout the postpartum period. Our business has the capacity to
provide perinatal nurses with an online teaching module on PPD that is easy to use, flexible,
and customizable. Based on the bibliometric analysis of the current study, it is recom-
mended that perinatal nurses include an online module on PDD in their yearly competence
training. It is crucial to provide thorough instructions on the use of a standardized tool for
evaluating PPD to guarantee that every woman undergoes screening. We expect notable
progress in perinatal nurses’ comprehension of PPD and the incorporation of therapies that
use modern technology. This will enhance their confidence in delivering PPD services to
new mothers. Hospital managers expect enhanced healthcare results resulting from the
use of these advancements. Pre-licensure nursing programs can integrate online modules
into their academic courses, allowing them to provide education on important issues like
PPD. This intervention has the capacity to enhance the understanding and self-assurance
of aspiring nurses in identifying and managing perinatal mental health issues. The digital
courses have the capacity to function as an additional resource to clinical and in-person
training. By integrating interactive tasks, including participating in a chat with a mother
who has had PPD, learners may improve their understanding of the real-life difficulties
encountered by these mothers. In rural pre-licensure programs, where there is little op-
portunity for nurses to directly observe women with PPD in a clinical setting, it may be
advantageous to enhance the simulation process by including online training. This would
assist nurses in gaining better knowledge of PPD.
Healthcare 2024,12, 1015 17 of 20
Author Contributions: Conceptualization, M.T.-C.; Methodology, M.T.-C. and G.Z.; Software, G.Z.;
Validation, M.T.-C. and G.Z.; Formal analysis, G.Z.; Resources, M.T.-C., E.O. and G.Z.; Data curation,
G.Z.; Writing—original draft, M.T.-C., E.O. and G.Z.; Writing—review & editing, M.T.-C. and G.Z.;
Visualization, G.Z.; Supervision, M.T.-C.; Project administration, M.T.-C.; Funding acquisition, M.T.-C.
All authors have read and agreed to the published version of the manuscript.
Funding: This research received no external funding.
Institutional Review Board Statement: Not applicable.
Informed Consent Statement: Not applicable.
Data Availability Statement: Dataset available on request from the authors.
Conflicts of Interest: The authors declare no conflicts of interest.
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