Implementation of The City Birth Trauma Scale Screening Tool to Increase Awareness of Post-Traumatic Stress Disorder in NICU Mothers

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Introduction/Purpose: In the early 1990s, conversations on a growing trend emerged in healthcare surrounding traumatic birth experiences and the development of childbirth posttraumatic stress disorder (PTSD). Being exposed to stress-related trauma directly or indirectly or having witnessed death, threatened death, actual or threatened severe injury, or sexual violence predisposes one to post-traumatic stress disorder. It is included in the Diagnostic and Statistical Manual (DSM-5) as a new classification of trauma and Stressor-Related Disorders. The impetus for this DNP project comes from the identified lack of screening for the postpartum patient population to identify and screen for childbirth post-traumatic stress disorder (PTSD). Implementing the City Birth Trauma Scale will help identify those experiencing PTSD needing support and further interventions with referral.

Methods: The evidence-based process improvement project utilized the City Birth Trauma Scale, a proven, reliable, and valid assessment tool to assess postpartum NICU mothers for symptoms of PTSD. This twenty-nine-question instrument was derived from the Diagnostic and Statistical Manual of Mental Disorders fifth edition (DSM-5) and created explicitly for this patient population to identify PTSD. This easy-to-use questionnaire is available in 22 languages and used in 18 countries. It was provided to NICU mothers as a part of the admission process between September and December 2023.

Results: Implementation of the City Birth Trauma Scale screening tool positively impacted the recognition of PTSD and referral for this high-risk patient group. One hundred NICU mothers were provided with the survey and information on participation, with 31 completed surveys returned for analysis. Individuals who answered ‘yes’ to questions one and/or two meet DSM-5 diagnostic criteria for PTSD. Data analysis revealed that of the 31 completed surveys returned, 66% of the respondents answered ‘yes’ to either one of both diagnostic questions, demonstrating a high probability of PTSD in NICU mothers. Further data analysis revealed that of those mothers identified as having PSTD, 42% were at high risk, 42% were at moderate risk, and 16% were not at risk.

Discussion: Data findings demonstrate the significance of PTSD screening and support the continued screening of NICU mothers. The City Birth Trauma Scale has effectively improved recognition and care in this vulnerable population. There is a need for future studies and the creation of departmental standards of care and guidelines for screening for PTSD at different periods in the post-partum period.

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DNP project
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