What is Postpartum Anxiety? A Clinical Psychology Podcast Episode.

Over the past few years, I’ve thankfully noticed that there’s more of a conversation within clinical psychology about postpartum mental health struggles, and this is a good thing. Since it helps us, aspiring and qualified psychologists, to understand how childbirth or adoption can be immensely stressful and harmful to a parent’s mental health. Yet this is more challenging than other mental health difficulties because people who give birth are often silenced by society, stigma and prejudice as I’ve discussed in another podcast episode called “How Does Birth Trauma Burden Mothers?”. In this clinical psychology podcast episode, you’ll learn about postpartum anxiety, what it is, how it’s treated and how we can best support new parents whilst they’re experiencing postpartum anxiety. Also, like always, I’ll explain the implications for educational and clinical psychologists too. If you enjoy learning about mental health, clinical psychology and more, then this will be a great episode for you.

Today’s psychology podcast episode has been sponsored by CBT For Anxiety: A Clinical Psychology Introduction to Cognitive Behavioural Therapy For Anxiety. Available from all major eBook retailers and you can order the paperback and hardback copies from Amazon, your local bookstore and local library, if you request it. Also available as an AI-narrated audiobook from selected audiobook platforms and library systems. For example, Kobo, Spotify, Barnes and Noble, Google Play, Overdrive, Baker and Taylor and Bibliotheca.

What is Postpartum Anxiety?

Postpartum anxiety is when a person has severe anxiety after becoming a parent or having a baby. This anxiety is characterised by having overwhelming thoughts that are difficult to manage as well as these thoughts feel uncontrollable to the individual. Also, a parent might feel a constant sense of danger but they won’t be able to calm their thoughts or put their finger on the cause of the sense of danger.

Personally, there are two reasons why I was inspired to do this podcast episode. Firstly, I once had a conversation with someone at work who used to be a prison officer and they mentioned how they first got into mental health courses by learning about postpartum psychosis. This led to a larger conversation about how common postpartum mental health difficulties are, and I really do enjoy the topic. Since postpartum mental health is so important, it is unfortunately not spoken about and a lot of women and parents would benefit from a bit more support. As well as I know from Bronfenbrenner’s Ecological Systems Theory and attachment theory, the importance of the parent-child relationship, and I can see and sort of forecast how a parent with negative mental health might have a negative impact on a child’s education, attainment and motivation in an educational setting.

Therefore, something that I want to continue to do on The Psychology World Podcast is talk about postpartum mental health. I want to help give a voice to this critical mental health topic that’s impacting a lot of parents and women, but so few people are actively talking about it.

Another reason why I was inspired to do this podcast episode was because at the moment, I’m watching the boys’ love/ slice of life anime “Tadaima, Okaeri”. It translates into “I’m Home, Welcome Back” and it’s this lovely romance anime with a fantasy twist because the gay married couple is an alpha and an omega. This means that the omega can get pregnant, and their baby son is just an amazing character. Anyway, this links to postpartum anxiety because there’s this one scene when the Omega is pregnant with their second child and he becomes overwhelmed with anxiety and anxious thoughts about his past. He becomes terrified that the baby will be born an omega, the child will be abused like he was and the Omega briefly considers whether the child should even be born because it might be an omega. Then this also links to the real-world conversation I had and I’ve listened to podcast episodes over the years, and it isn’t uncommon for women to have anxious thoughts or “bad” thoughts during pregnancy. Yet because society is so judgemental and we’ve forced the idea that pregnancy and childbirth are always amazing, positive and lovely experiences that cannot be bad in the slightest. We’ve created a culture of silence for women and parents so they’re too scared of voicing any concerns in case they get portrayed or judged as monsters.

Anyway, I was inspired by the scene in “Tadaima, Okaeri” because this scene is relatable for a lot of parents during pregnancy. Some parents will be scared of passing on their chronic illness, their mental health condition or some other so-called bad trait of theirs or that runs in the family. Or they’ll be anxious about whether they can be a good parent, whether they can provide for their child or if they’re capable of loving them. This might even lead to questions of whether the child should be born in the first place, and these thoughts themselves can be immensely distressing.

That’s why supporting postpartum mental health is so, so important.

As a result, if I jump off my soapbox for a moment, then having a new baby through childbirth or adoption is going to bring a lot of worry into a parent’s life. That’s just normal. Yet if a parent has postpartum anxiety then this worry can be nonstop and all-consuming. Typically, this involves the parent having excessive concerns or irrational fears about events that aren’t likely to happen and whilst these concerns can be vague and generalised, sometimes these concerns are tied to a specific incident from their past.

For example, if a parent had a lot of bullying as a child because they stuttered severely, then they might be anxious about their own child being endlessly bullied in case the baby has a stutter too. Equally, to use the fictional example from Tadaima, Okaeri, the Omega’s worry was tied back to his own bullying and abuse as a child because of the type he was born. These are two examples how the worry in postpartum anxiety can be tied to a specific event from the parent’s past.

This can lead to parents with postpartum anxiety to stay up all night because they’re afraid that their baby will stop breathing in their sleep, they might be terrified of leaving their baby with a trusted adult even if it’s only for a few minutes, and the parent might avoid public places because they’re frightened of someone or something hurting them or their baby. As well as the new parent might experience scary and unwanted thoughts of their child being harmed or them harming their own child.

After that paragraph I just want to take a breather, because I don’t know about you but that was hard for me to read and write about. I’ve had Post-Traumatic Stress Disorder, depression and anxiety before because of sexual trauma, so I can understand how terrifying this is, but to actually have unwanted and terrifying thoughts about harming your own child. That is really tough and that’s why this is important to learn about. If you understand postpartum anxiety and the awful experiences that new parents can go through, then this can help you relate with clients better, and listen and act with kindness, empathy and compassion when parents need it most.

In addition, when it comes to the prevalence rates of postpartum anxiety about 1 in 5 women have the condition, but it’s hard to know the exact number because many women don’t talk about their symptoms. As well as postpartum anxiety typically happens alongside postpartum depression. 

The prevalence rate is another fact that surprised me, because I used to assume that because no one spoke about postpartum mental health struggles that it wasn’t too common. Yet around 20% of new mothers experience postpartum anxiety. That’s moderately high and makes it a common mental health condition. Yet another reason why it’s so important to talk about it, and learning about postpartum anxiety also helps us to become better friends, peers and family members too.

Lastly for this section, postpartum anxiety can start as early as during pregnancy, but it typically starts right after birth but it can begin as late as when the baby is several months old.

What are the Causes and Risk Factors of Postpartum Anxiety?

Whilst there is no single cause of postpartum anxiety, researchers and professionals strongly believe it is caused by several factors. For example, a lack of sleep because caring for a newborn becomes a 24-hour job and can cause sleep deprivation, changes in hormones because the sharp decrease in hormones after the delivery of a baby can cause changes in mood or make it more difficult to manage stress, and stressful events. Since certain events about the baby’s life can trigger anxiety. For instance, a stressful or traumatic delivery or issues with breastfeeding.

A final factor that might contribute to postpartum anxiety is feelings of responsibility because new parents might be overwhelmed with feelings of needing to protect and care for their baby. This might trigger anxiety.

Furthermore, when it comes to the risk factors, having a previous miscarriage of loss of a child, having a baby with health conditions, caring for multiple children or having a personal or family history of anxiety or depression can all increase the risk of postpartum anxiety.

Another set of risk factors includes not having a supportive partner or support network, being a naturally inclined worrier or having a history of eating disorders.

I’ll talk more about this later in the episode, but I want to stress here that none of these risk factors or causes are reasons not to have children. A parent can still be a great one and still be kind, loving and supportive to their child despite their challenges, because a parent can get mental health and physical health support, they can thrive and there are support groups available. Raising a child is never ever going to be easy, even despite what animes and media like “Tadaima, Okaeri” like to have us believe, and it’s equally okay if you don’t want children, but it can be fun, rewarding and a lovely experience.

In terms of applying this knowledge to clinical psychology, and even educational psychology, it’s important that we support our clients to realise that sometimes there isn’t anything they could have done to reduce or prevent the development of their postpartum anxiety. Therefore, it’s important that as aspiring or qualified psychologists, that we help our clients understand that their postpartum anxiety isn’t their fault because it wasn’t caused by anything that they did or didn’t do.

Another implication for clinical psychology is that it might be useful to work with a client to talk through their specific triggers from their past or their history of depression or anxiety. This might help the client to develop coping strategies to deal with the overwhelm and changes that a newborn baby would bring.

Finally for this section, this information is useful to educational psychologists too because if you’re working in a school and a teacher or member of the Senior Leadership Team has come back from maternity or paternity leave and they’re experiencing postpartum anxiety, then this will have a negative impact on the school social system. It might negatively impact the interpersonal relationships within the senior leadership team, then this has an impact on the teacher-SLT relationship and then this negative relationship can filter down and impact the teaching so it has an indirect impact on the children to grossly oversimplify what happens. Therefore, if you, as an aspiring or qualified educational psychologist, understand postpartum anxiety then you can teach the other staff members about the condition and what the person is experiencing and how best to support them. As well as depending on how your service works, you might be able to refer them to get some specific postpartum mental health support.

What are the Symptoms of Postpartum Anxiety?

The symptoms of postpartum anxiety all come back to the primary function of anxiety in the body. The body uses anxiety to respond to perceived or real threats or dangers, so the symptoms that a person experiences are the body’s reactions to this constant sense of fear or worry, and this isn’t only physical. The symptoms of postpartum anxiety can be physical but they can also be behavioural and emotional and these symptoms interfere with a person’s ability to function.

Personally, my favourite caveat in the DSM-5 (the statistical manual that the USA and UK use to diagnose mental health conditions) is that the symptoms must be causing clinically significant levels of distress and impaired functioning across a range of domains of life. For example, school, work, relationships amongst others.

As a result, some emotional symptoms of postpartum anxiety can include feeling on edge, irritability, tearfulness, an inability to relax or calm down, obsessing over irrational fears, panic attacks, generalised anxiety and thinking about worst-case scenarios.

For example, a new parent might be terrified that something will happen to their baby if they go to work and leave them with a childminder. Or they might be concerned that if they leave their baby for even a second then the baby will be hurt, as well as if they don’t watch the baby sleep overnight then the baby might stop breathing and they couldn’t react fast enough.

Equally, if we apply this to the fictional context of “Tadaima, Okaeri” then the omega Makasi was unable to relax, he was tearful and he was thinking about the worst-case scenario of what if his baby girl was born an omega like he was. He was tearful over her future and concerned about things that hadn’t happened yet.

Furthermore, when it comes to the behavioural symptoms of postpartum anxiety, a parent might avoid certain activities, places or people, they might check things repeatedly, like how long ago their baby ate or that objects that could hurt the baby are put away, as well as being overly cautious about situations that aren’t dangerous.

It’s important to note when talking about mental health conditions that on their own none of these symptoms mean that someone has a mental health condition. Since there are times when all parents are overly cautious, they check things repeatedly or they want to avoid certain places because of “what if”. Yet it becomes a mental health condition and a cause for concern when it’s impairing someone’s functioning, it’s creating a lot of distress for them and it’s harming their life. This is why Makasi in “Tadaima, Okaeri” doesn’t have postpartum anxiety because his fears and anxiety don’t impede his ability to be a great parent (or ma-chan) and he can function fine despite his anxiety.

Finally, postpartum anxiety can cause a new parent to have disrupted sleep, feel tense, be unable to breathe or have shortness of breath, increased heart rate or heart palpitations, have a stomach ache, be restless or loss of appetite.

All these symptoms can be difficult and distressing to manage, especially if you’re supporting and dealing with a newborn baby, family, relationships and other matters. This is why seeking mental health support and reducing the shame and stigma associated with postpartum conditions is so important.

If we apply this knowledge to aspiring and qualified clinical psychologists, then I don’t think we need to reinvent the wheel in the slightest. Yes, the anxious symptoms will be related to the newborn baby and the changes that becoming a parent has caused them, but cognitive interventions, behavioural experiments and psychoeducation can still be very useful. As well as the client is likely to have extra motivation to change and engage in the therapeutic process because they have a newborn baby to look after, love and protect, and I would always be interested in what early life experience influenced the parent to have severe anxiety about the safety of their newborn.

Yet that isn’t anything new.

On the other hand, what I think is interesting to think about when it comes to the symptoms is how we could make our workplaces more friendly to new parents returning from maternity and paternity leave. Since we might be able to do some preventative work for parents to reduce their anxiety about returning to work after being off for so long looking after their newborn. They’re already likely to be anxious about forgetting what to do, learning new systems (because organisations love to implement new policies that the new parent is likely to have missed) and they have to deal with anxieties about leaving their newborn baby for the first time.

Of course, the majority of parents will be happy and okay just returning to work, hit the ground running and that’s completely okay. Yet there will be other parents who want to ease back into work and I think we should create options for them in our mental health services and educational settings. Whether this includes half-days, only doing a few days a week then going back into full-time employment. I think it can be important to help new parents to ease back into work, climatise themselves to being away from their newborn and then over time they can see that nothing bad’s happened even though they weren’t with their child constantly so this can make a return to full-time employment kinder, easier and more compassionate.

Just some thoughts.

How Is Postpartum Anxiety Diagnosed?

Whilst there isn’t a clear diagnostic tool available for postpartum anxiety, there are questions designed to understand your postpartum anxiety. Then a medical doctor or a professional will use your responses to gauge whether you need any additional support to manage your mental health.

Furthermore, when you go for a postpartum appointment, you are likely to be scared, nervous or embarrassed to share your symptoms, and this is why I think it’s critical that we do talk more openly about postpartum mental health. Since so many new parents suffer in silence because they’re too scared, they’re nervous and they’re concerned about if social services will be called on them if they open up about their mental health.

The vast, vast majority of parents love their baby and children so much that they would rather die than see their child get ripped away from them. Therefore, if any aspiring or qualified psychologists are involved in postpartum appointments, it might be useful to explain to new parents how that side of the process works and what the conditions are for them to call social services. This might initially sound scary but at the end of the conversation, it might enlighten and ease a parent’s concerns so they feel more able to share their true thoughts, feelings and emotions.

This is important because so many parents do experience intense anxiety that doesn’t go away, so it’s critical that professionals and parents have honest, open and collaborative conversations so the client receives the best possible support moving forward.

How is Postpartum Anxiety Treated?

The exact treatment that a healthcare provider would recommend for postpartum anxiety depends on health history, symptoms, whether the client is breastfeeding or not and other factors. If a client has a mild case of postpartum anxiety then the treatment will typically involve speaking to a counsellor and changes to daily activities to improve their mental health. Whereas if the symptoms are more severe then medication can be an option.

Another reason why treatment is important for postpartum anxiety is because a lot of clients tend to wonder how long it's going to last. Whilst postpartum anxiety doesn't last forever, it never goes away on its own. This is why getting treatment from a healthcare professional is important and it's the best way to recover from the condition. 

How Can Cognitive Behavioural Therapy Treat Postpartum Anxiety?

I talk about this more in my book, CBT For Anxiety, but cognitive behavioural therapy is an effective psychological treatment for anxiety. It involves working with a psychologist to help a client identify emotions as well as change maladaptive thinking patterns. CBT helps a client to unlearn negative behaviours and thoughts so they can become more adaptive and healthier. Therefore, CBT can be useful in postpartum anxiety treatment because it helps a client to change their anxious thoughts and behaviours about their parenting and newborn baby to become healthier.

How Is Postpartum Anxiety Treated Through Lifestyle Changes?

As I mentioned a moment ago, postpartum anxiety can be treated through suggested lifestyle changes, so the client doesn’t need to use medication and they can still change their life for the better and their mental health will improve. Therefore, these lifestyle changes can include finding a support group for new parents and these groups can be local or online. These support groups can be immensely useful for people with postpartum anxiety because it allows them to share their thoughts, feelings and experiences with other people in a similar situation to them. You can find out the other benefits of group therapy in my podcast episode, What are the Types of Group Therapy?

Another useful lifestyle change can include asking for help from friends and family members. I talk more about the benefits of this change in a later section of this episode. As well as new parents with postpartum anxiety can try to take a walk, be active and get exercise every day. This can improve mental health because it gets the body to release hormones and neurotransmitters that make us feel good. Also, I understand that parents with anxiety might be panicking that if they go outside then them or their newborn might get hurt or something might go wrong. Yet you can do something akin to graded exposure, like you could do a walk around the block until you’re used to that and then you can increase the exercise over time, or you can do your exercise in the comfort of your own home.

The final lifestyle change that can be useful is the importance of new parents taking care of themselves by eating healthy meals and sleeping as much as you can. Some other podcast episodes you might find useful as I explore these topics in more depth include What is Behavioural Activation and How Does a Consistent Sleep Schedule Improve Mental Health?

A Quick Note on Postpartum Anxiety and Medication

Whilst medication is another treatment option for postpartum anxiety, I'm not really going to talk about it too much in this episode. Since whilst it can work for people, the science behind SSRIs and other anti-anxiety and anti-depression medication is loose at times as supported by the brilliant work of Reed and Moncrief (2022). As well as the serotonin hypothesis has been debunked time and time again over the years, so I don't want to promote an area of treatment that isn't as good as everyone claims. 

When Should Someone See a Healthcare Professional About Postpartum Anxiety?

You should always seek out and talk to a healthcare professional if you have symptoms of postpartum anxiety. For example, if you're overwhelmed with day-to-day life, if you're feeling worried all day, every day and if you aren't bonding with your baby. As well as if your anxious thoughts are becoming more severe, and if you have any signs of postpartum depression, like feeling sad most of the time or you're losing interest in things you used to enjoy.

These are all symptoms that mean it can be a good idea to speak to a healthcare professional.

Lastly for this section, if you need any immediate help or you're experiencing thoughts of harming yourself or your baby then please contact the 988 Suicide & Crisis Lifeline by texting or calling 988 if you're in the United States and other countries have similar helplines. There is a list of support helplines available at connorwhiteley.net.

Can Postpartum Anxiety Return?

One of the reasons why I don't like medical terminology for mental health conditions, and even more so for the idea of "curing" a condition is that a mental health condition is always a part of you. It might not impact your life, you might be able to manage it fine and you might not even notice it in future, but it's still there. 

I prefer that way to think about mental health because if you've recovered from postpartum anxiety, then it can still return. Anxiety can happen at any time of your life and regardless of the age of your child, even if it's after their first birthday. 

If this happens then it won't be called postpartum anxiety, but the worries and anxiety about your child can still affect you. 

This is why it's important to remember that if you're struggling with anxiety, then always seek out professional support. Regardless of the age of your child. 

A final note for this section, I would add for aspiring and qualified psychologists is that having knowledge about postpartum anxiety will always be useful if your clients almost never have newborn babies. The principles, worries and anxious thoughts reflected in postpartum anxiety can impact clients regardless of their age. So understanding this form of anxiety is always useful.

How Do You Support a Friend with Postpartum Anxiety?

Social networks are flat out critical when it comes to mental health, and especially after giving birth. In fact, having supportive friends around a new parent can be a protective factor against the development of postpartum anxiety in the first place. Yet if your friend or loved one has the condition then the best thing you can do for them is to be there for them and listen. Be a supportive listener, because by allowing them to talk about their thoughts, feelings and emotions, then you're helping them to feel understood, validated and listened to. Whilst it's important that they still seek out professional support, just listening to them can be very helpful. 

In addition, if your friend or loved one is feeling overwhelmed then it can be really nice to offer to do other errands for them or help with household chores. Like doing the cleaning, the laundry or cook them dinner. 

These ideas might seem simple and easy, but they can make a world of difference to a new parent. 

Furthermore, coming at this point from a clinical psychology perspective, aspiring or qualified psychologists might want to explore with a client with postpartum anxiety if they're struggling to ask for help. Since in reality, as individuals, we need to find a balance. If you're too independent then that isn't good or healthy. If you're too dependent on others then that isn't healthy either. We need to learn how to stand on our own two feet and when to recognise that we need help. 

Therefore, if a client with postpartum anxiety is struggling but they're hesitant to ask for help. Why? It could be because they don't have a support network around them or a supportive partner, but equally they might have a lot of friends, but because of early life experiences or events in their own upbringing, the client refuses to ask for help even if they're suffering because of it. 

Something to possibly explore in therapy for sure.

Clinical Psychology Conclusion

This psychology podcast episode has been a lot of fun to research, write about and reflect on. I know that in recent months I’ve been inspired by a lot of boys’ love anime for various psychology topics, like “Tadaima, Okaeri”, but in reality, these animes are just reminding me of topics that I’ve always been interested in. I just needed a little encouragement to look into these fascinating topics a little more, because postpartum anxiety, psychosis, depression and so many more do impact a lot of people. New parents need mental health support but because no one is really talking about it, no one is focusing on it.

I hope in some small way podcast episodes like this can help change that.

Therefore, as a little reminder, Postpartum anxiety is when a person has severe anxiety after becoming a parent or having a baby. This anxiety is characterised by having overwhelming thoughts that are difficult to manage as well as these thoughts feel uncontrollable to the individual. Also, a parent might feel a constant sense of danger but they won’t be able to calm their thoughts or put their finger on the cause of the sense of danger.

However, as scary, terrifying and anxiety-inducing as these symptoms are, it’s important to know that you’re never alone, help is available and life does get better.

I hope you enjoyed today’s clinical psychology podcast episode.

If you want to learn more, please check out:

FREE 8 PSYCHOLOGY BOOK BOXSET

CBT For Anxiety: A Clinical Psychology Introduction to Cognitive Behavioural Therapy For Anxiety. Available from all major eBook retailers and you can order the paperback and hardback copies from Amazon, your local bookstore and local library, if you request it. Also available as an AI-narrated audiobook from selected audiobook platforms and library systems. For example, Kobo, Spotify, Barnes and Noble, Google Play, Overdrive, Baker and Taylor and Bibliotheca.

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Have a great day.

Clinical Psychology References and Further Reading

Ali E. Women’s experiences with postpartum anxiety disorders: a narrative literature review (https://pmc.ncbi.nlm.nih.gov/articles/PMC5983016/). Int J Womens Health. 2018 May 29;10:237-249. Accessed 8/25/2025.

Feldman, N., Hibara, A., Ye, J., Macaranas, A., Larkin, P., Hendrix, E., ... & Liu, C. H. (2025). Postpartum anxiety: a state-of-the-art review. The Lancet Psychiatry.

Field T. Postnatal anxiety prevalence, predictors and effects on development: A narrative review (https://pubmed.ncbi.nlm.nih.gov/29544195/). Infant Behav Dev. 2018 May;51:24-32. Accessed 8/25/2025.

https://my.clevelandclinic.org/health/diseases/22693-postpartum-anxiety#additional-common-questions

Jordan V, Minikel M. Postpartum anxiety: More common than you think (https://pubmed.ncbi.nlm.nih.gov/31039214/). J Fam Pract. 2019 Apr;68(3):165;168;170;174. Accessed 8/25/2025.

Mental Health America. Postpartum Anxiety (https://mhanational.org/resources/postpartum-anxiety/). Accessed 8/25/2025.

Modak, A., Ronghe, V., Gomase, K. P., Mahakalkar, M. G., Taksande, V., & Dukare, K. P. (2023). A comprehensive review of motherhood and mental health: Postpartum mood disorders in focus. Cureus, 15(9).

Nakić Radoš S, Tadinac M, Herman R. Anxiety During Pregnancy and Postpartum: Course, Predictors and Comorbidity with Postpartum Depression (https://pmc.ncbi.nlm.nih.gov/articles/PMC6400346/). Acta Clin Croat. 2018 Mar;57(1):39-51. Accessed 8/25/2025.

Shang, J., Dolikun, N., Tao, X., Zhang, P., Woodward, M., Hackett, M. L., & Henry, A. (2022). The effectiveness of postpartum interventions aimed at improving women’s mental health after medical complications of pregnancy: a systematic review and meta-analysis. BMC Pregnancy and Childbirth, 22(1), 809.

The MGH Center for Women’s Mental Health. Is It Postpartum Depression or Postpartum Anxiety? What’s The Difference? (https://womensmentalhealth.org/posts/is-it-postpartum-depression-or-postpartum-anxiety-whats-the-difference/) Accessed 8/25/2025.

White, L. K., Kornfield, S. L., Himes, M. M., Forkpa, M., Waller, R., Njoroge, W. F., ... & Gur, R. E. (2023). The impact of postpartum social support on postpartum mental health outcomes during the COVID-19 pandemic: LK White et al. Archives of women's mental health, 26(4), 531-541.

Wisner KL, Murphy C, Thomas MM. Prioritizing Maternal Mental Health in Addressing Morbidity and Mortality (https://pubmed.ncbi.nlm.nih.gov/38381408/). JAMA Psychiatry. 2024;81(5):521-526. Accessed 8/25/2025.

Worrall, S., Silverio, S. A., & Fallon, V. M. (2023). The relationship between prematurity and maternal mental health during the first postpartum year. Journal of Neonatal Nursing, 29(3), 511-518.

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