Parents' Postnatal Sense of Security: A Concept Analysis

Abstract

ABSTRACT

Aim

Parents' postnatal sense of security is often mentioned in recent publications, but there is no consensus on its definitions and measurement. A concept analysis was conducted to clarify the definition, the attributes, antecedents and the consequences of parents' postnatal sense of security and to promote consistency in its usage.

Design

Walker and Avant's eight‐step concept analysis model was adopted to define the concept of parents' postnatal sense of security.

Methods

A comprehensive search of multiple databases (Sinomed, CNKI, Wanfang database, CINAHL, PubMed, Embase, Web of Science, ProQuest, PsyInfo and Cochrane Library) was conducted to identify relevant articles from the inception of the databases until December 2022. In addition, a manual search was performed to gather any additional papers related to the topic. Ultimately, a total of 48 articles were included in the concept analysis.

Results

Three attributes were identified: perceive one's physical well‐being not being threatened, feel confident and in control of the parenting role, feel confident in one's available relationships. The identified antecedents were: being prepared for child rearing, being in familiar or safe environment, general well‐being of the baby and parents, support from medical staff and family members, being empowered by medical staff. Consequences of parents' postnatal sense of security included successful adaptation to the parental role, decreased postpartum depression symptoms in mothers, successful infant care and the development of parent‐infant relationship.

Introduction

The postpartum period is a crucial stage for childrearing (Paladine, Blenning, and Strangas 2019), managing the relationship with one's partner (Ross et al. 2019), and developing the parent–child bond (Little and Sockol 2020). Evidence has shown that during the transition to parenthood, the postnatal sense of security (PPSS) of expectant parents has a significantly positive impact on their adjustment to their new roles, the relationship between partner, the attitudes towards their infant, and the health of the baby (Werner-Bierwisch et al. 2018). Parents' postnatal sense of security, which is described as a fundamental experience for both mothers and fathers during the postpartum period, is considered a significant indicator of the quality of postpartum care (Wiklund et al. 2018).

Background

Early discharge from the hospital after childbirth has become a common international practice, which may cause insecurity in postpartum parents (Feenstra, Nilsson, and Danbjørg 2019). Additionally, poor recovery of mothers (Magdalena and Tamara 2020), parents' inability to adapt to parental roles (Lehnig et al. 2019), and insufficient medical support (Feenstra, Nilsson, and Danbjørg 2019) can also contribute to the loss of a sense of security in postpartum parents. This lack of security can subsequently impact the physical and mental health of both the parents and the infants (Johansson, Aarts, and Darj 2010). Furthermore, numerous researchers have advocated for the involvement of not only the mother but also the father as a family member in postpartum care, as their involvement can benefit maternal and child health as well as family well-being (Daniele 2021; Wynter et al. 2021). The feelings of fathers during the postpartum period are as significant as those of mothers (Werner-Bierwisch et al. 2018). Therefore, it is crucial for researchers, educators and clinical medical staff to pay attention to the sense of security of postpartum parents.

Nowadays, research on PPSS mainly focuses on the current status (Escribano, Oliver-Roig, Cano-Climent, Richart-Martínez, and Juliá-Sanchis 2020), experiences (Persson et al. 2012), scale development and its psychometric testing (Escribano, Oliver-Roig, Cano-Climent, Richart-Martínez, Persson, et al. 2020; Velagic, Mahmutovic, and Brankovic 2019; Zhu et al. 2019). However, there is a scarcity of studies that have explored the concept of PPSS itself. PPSS is rooted in the notion of security, which encompasses feelings of confidence, control and freedom from fear and anxiety and can be divided into cognitive responses and emotional responses (Escribano, Oliver-Roig, Cano-Climent, Richart-Martínez, Persson, et al. 2020). Thus, PPSS encompasses both cognitive and emotional components, similar to the concept of sense of security (Werner-Bierwisch et al. 2018). Nevertheless, PPSS also has its own unique sources and characteristics that represent cognitive and emotional responses. For instance, the sense of security experienced by postpartum mothers is derived from the support provided by midwives and other medical personnel, the involvement of family members (especially the partner) in caring for the mother and the baby, the good health of the mothers themselves and the adequate feeding of the baby (Werner-Bierwisch et al. 2018). These factors are also closely related to the content of PPSS (Rosen-Carole et al. 2018; Wiklund et al. 2018).

It is evident that the concept of general sense of security encompasses a broad spectrum without specific direction (Göransson et al. 2020). Utilising general sense of security as an indicator of postpartum sense of security in parents may result in the loss of significant information that is specific to PPSS. In contrast to general sense of security, PPSS has the ability to accurately forecast postnatal care outcomes such as postnatal depression (Escribano, Oliver-Roig, Cano-Climent, Richart-Martínez, and Juliá-Sanchis 2020). Hence, it is not recommended to employ the definition of general sense of security to represent postpartum sense of security. Concept is the foundation of theory, its usage is to identify problems and to solve them (Heather 2020; Lingerfelt and Hutson 2021). Although the concept of PPSS is commonly used in nursing (Velagic, Mahmutovic, and Brankovic 2019; Werner-Bierwisch et al. 2018), its definition lacks clarity. The lack of a clear definition inevitably impedes the accurate application of PPSS while a precise definition will enable scholars and healthcare providers to reflect accurately on the theoretical basis of PPSS. Thus, a concept analysis is necessary to develop a clear definition that accurately elaborates the sense of security among postpartum parents. The objective of this study was to clarify and reduce ambiguities associated with the concept of PPSS within the context of nursing, to enhance public comprehension of the concept and to promote its accurate utilisation.

Design

In this study, we utilised Walker and Avant's concept analysis model to delineate the concept of PPSS, which aims to elucidate concepts that are frequently used, ambiguous, or insufficiently defined in clinical practice (Garcia 2020). By establishing a clearer definition, the concept can be effectively and precisely applied in clinical practice, research and public policy.

Method

The concept analysis model includes eight steps (Walker and Avant 2011): (1) selecting the concept; (2) determining the purposes of the analysis; (3) identifying the usage of the concept; (4) determining the defining attributes of the construct; (5) identifying a model case; (6) identifying the borderline, related, contrary, invented and illegitimate cases associated with the concept; (7) confirming antecedents and consequences; and (8) defining its empirical referents. These steps are employed to analyse how PPSS is utilised in the research field.

Data Sources

To identify the attributes, antecedents, consequences and empirical referents of the concept of PPSS, we conducted a comprehensive search of various domestic and international studies from the inception of the searched databases until December 2022. This search was conducted using multiple online databases, including Sinomed, CNKI, Wanfang database, CINAHL, MEDLINE, Embase, Web of Science, ProQuest, PsyInfo and Cochrane Library. The keywords used for the literature retrieve included: ‘feel secure’, ‘sense of security’, ‘feeling* of security’, ‘feel safe’, ‘sense of safety’, ‘feeling* of safety’, ‘postnatal’, ‘puerperal’, ‘postpartum’, ‘perinatal’, ‘after delivery’, ‘after childbirth’, ‘after birth’, ‘after labor’, ‘parent*’, ‘partner’, ‘maternal’, ‘mother*’, ‘father*’, ‘spouse*’, ‘couple*’, ‘lying-in woman’, ‘puerpera*’, ‘parturient*’.

The inclusion criteria for the literature search were as follows: (1) studies that discussed the concept of PPSS pertaining to mothers or partners; (2) studies available ‘in either English or Chinese’; (3) peer-reviewed research articles, including those employing qualitative, quantitative, mixed-methods and review methodologies. The following types of literature were excluded: (1) conference abstracts, editorial notes or commentary papers and (2) studies that merely mentioned the concept without providing a description or definition.

Analysis

Relevant papers were identified by tracing the references provided in the searched papers. Two reviewers independently screened each citation based on the inclusion and exclusion criteria. The titles and abstracts of the articles were screened to determine potentially relevant studies, followed by a thorough review of the full-text to assess contextual details. Then, included articles were extracted in terms of attributes, antecedents, consequences.

Ethics

Ethics approval was not required for this study because all data were derived from existing literature.

Results

Search Results

Based on a comprehensive search, 1949 articles were identified. After screening titles, abstracts and full-text, 48 articles were identified as suitable for concept analysis (see Figure 1 for the flow diagram of the literature selection). The vast majority of literature included in this study pertains to women delivering in hospitals or institutions, with only one study encompassing women delivering at home (Sparks 2019). With the exception of two articles specifically addressing the sense of security in first-time parents (Johansson, Aarts, and Darj 2010; Löf, Svalenius, and Persson 2006), the remaining literature encompasses both primiparous and multiparous fathers and mothers. Among the studies, 11 had a postpartum timeframe within the first week and 11 studies focused on the period within the first month postpartum. The majority of studies included in the review had a postpartum timeframe ranging from 1 to 3 months, with only two studies extending beyond a year (Johansson, Aarts, and Darj 2010; McLeish and Redshaw 2019).

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Common Definitions and Uses

The concept of the sense of security originates from Freud's psychoanalytic theory (Lijuan and Zhong 2003). According to this theory, internal conflicts, anxieties and defence mechanisms arise from insecurities in controlling and fulfilling certain desires during both childhood and adulthood. Maslow, a humanistic psychologist, also explores the notion of the sense of security in his Pyramid of Needs Model, placing it in the second hierarchy (Daphna-Tekoah et al. 2020). He asserts that the sense of security entails feelings of confidence, safety and freedom from fear and anxiety, particularly in terms of meeting one's present and future needs. Since its inception, the concept of the sense of security has found application and promotion in various fields beyond psychology, including sociology, medicine and nursing.

Anderson developed the concept of sense of security in medicine, specifically identifying it as a two-level experience consisting of basic security and situation-related security (Persson and Dykes 2009). Basic security refers to an individual's sense of security that is independent of their surroundings, while situation-related security pertains to the sense of security one feels in relation to their environment. Furthermore, the notion of postnatal sense of security has been further developed. Persson et al. described postnatal sense of security as a sense of midwives'/nurses' empowering behaviour, a sense of being supported by the family, a sense of autonomy/control and a sense of general well-being (Persson, Fridlund, and Dykes 2007). This particular interpretation of sense of security focuses primarily on the parents' sense of security during the initial week following childbirth.

Although Persson narrowed the sense of security among postnatal parents, it is important to note the nuance between his definition and the generalised sense of postpartum security. The latter is not necessarily associated with the first week of the postpartum period. According to relevant studies, the generalised sense of postpartum security mainly refers to the long-term sense of security experienced by postpartum parents. This encompasses various aspects such as infant breastfeeding, partnership, parent–child relationship and other related factors (Werner-Bierwisch et al. 2018). Since infants' sense of security has its specific characteristics, which is difficult to measure and compare, it is not within the scope of discussion in this study.

Attributes

Through literature review, we have identified four key attributes that contribute to the formulation of parents' postnatal sense of security (PPSS). These attributes include feeling that one's physical well-being not being threatened, feeling confident and in control of the parenting role, and feeling confident in one's available relationships. To visually represent this concept, we have included a concept diagram in Figure 2, illustrating the components of PPSS.

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Feel One's Physical Well-Being Not Being Threatened

The primary characteristic of PPSS is the perception of minimal threat to one's physical well-being (Escribano, Oliver-Roig, Cano-Climent, Richart-Martínez, Persson, et al. 2020; Werner-Bierwisch et al. 2018), which manifests as a positive self-awareness of one's own physical state. This perception leads to reduced fear among postpartum parents. Once individuals have evaluated their physical well-being and the available resources (such as medical assistance and family support) to sustain and enhance their well-being, they will experience corresponding affective responses (Werner-Bierwisch et al. 2018). If they perceive themselves as being in good health and have adequate professional support, they will feel a sense of security and absence of threat.

Feel Confident and in Control of the Parenting Role

Feeling confident and in control of the parenting role is another key aspect of PPSS. When a mother is confident in her ability to care for her baby, she can experience a sense of security given no challenging tasks impeding her (Werner-Bierwisch et al. 2018). Mothers who feel in control of child rearing often express a greater sense of security compared to their counterparts, even when receiving care from the same midwife during the early postnatal period (Cummins et al. 2022). This highlights the importance of successfully adapting to the parenting role in developing PPSS.

Feel Confident in One's Available Relationships

Feeling confident in one's available relationships refers to a state in which an individual possesses the courage to confront unknown challenges. This courage stems from a sincere belief that someone will be there to work through any problems if necessary. This feeling of confidence can be fostered through close communication with medical staff and intimate interactions with family members (Escribano, Oliver-Roig, Cano-Climent, Richart-Martínez, and Juliá-Sanchis 2020; Kruse et al. 2021; McLeish and Redshaw 2019). For example, if midwives provide sufficient support in postpartum care, parents will not worry about exacerbating their baby's health problems. Additionally, if families have prepared meticulously for the arrival of a baby, mothers will not view child-rearing as a daunting task. Through positive interactions between parents and their supporters, a belief is formed that routine situations will not disrupt the harmony of their lives.

Model Cases

Mrs. and Mr. Smith have been married for 4 years. After extensive contemplation and preparation, they began trying to conceive 2 years ago, preparing to embark on the new journey of parenthood. Throughout the entire pregnancy, both spouses acquired knowledge about pregnancy through various channels and prepared baby supplies. Now, they have finally welcomed their own child. Upon discharge from the hospital and returning home, according to their original plan, Mr. Smith took responsibility for caring for his recently delivered wife and the newborn, while both sets of parents provided timely assistance with daily life. Mrs. Smith feels extremely happy, and her physical recovery has been rapid. Although they encountered minor challenges in childcare, such as caring for the newborn's physiological jaundice, they ultimately overcame these difficulties with guidance and assistance from healthcare professionals and acquired many skills in newborn care. Currently, they feel physically and mentally well, with sufficient energy and capability to raise their child. They also firmly believe that they can overcome any future challenges with the help of family and healthcare professionals. Nearly a month has passed, Mrs. Smith's body has mostly recovered, the child's sleep and development are normal, and there is little crying. The couple is gradually adapting to their new roles as parents. They embrace potential challenges in the future with a strong sense of security, moving towards a happy life. According to Walker and Avant, the model case exemplifies all the attributes of the concept being examined (Walker and Avant 2011). With no physical threats to the parents or the baby, the Smiths felt supported and displayed confidence in raising their child. Their ability to adapt to their new parenting roles and their sense of control over their lives perfectly illustrated the concept of PPSS.

Constructing Contrary and Related Cases

Contrary Case

Mrs. Lee experienced an unplanned pregnancy last year and gave birth to her baby at 29 weeks gestation. She was discharged from the hospital 48 h after a natural delivery. Due to Mr. Lee's frequent travel for work, he had limited time to care for and support his wife. As a result, Mrs. Lee found herself primarily responsible for taking care of herself and the baby during the postpartum period. Unfortunately, the baby developed pathologic jaundice after being discharged. Mrs. Lee became extremely worried about her baby's health and felt powerless to handle the parenting responsibilities on her own. She experienced feelings of worry, anxiety and helplessness. Her husband shared her concerns about the well-being of her and the baby. They described their life as chaotic and believed that the baby had arrived at an inconvenient time. Walker & Avant explained the contrary cases as ‘the clear examples of not the concept’ (Walker and Avant 2011). In this case, the couple's inability to care for their child and their feelings of insecurity represent a contrary case to the concept.

Related Case

Mrs. Brown was discharged from hospital 48 h after childbirth. After discharge, her husband drove her to the confinement center as they planned earlier. The maternity matron took complete responsibility for the baby's care while her daily diet and post-birth recovery was arranged ideally by other staff in the confinement center. Family members also visited and expressed their concern for Mrs. Brown and the baby. Mrs. Brown was pleased with the recovery environment and felt optimistic about her own recovery, although she did not consult with midwives. She believed she was in good health. When she observed her baby peacefully sleeping in the cot, she experienced joy in being a mother. This is a related case, which refers to ‘a case does not include critical attribute’ (Walker and Avant 2011). Mrs. Brown expressed satisfaction with her postpartum condition, including her health, the baby's well-being, and the close interaction among family members. These feelings are indicative of subjective well-being, which is akin to a sense of security (Steinmayr et al. 2019). However, subjective well-being is characterised by a positive attitude and the feeling of having achieved the desired state of life (Zaninotto and Steptoe 2019). It differs from the concept of a sense of security in that it does not encompass the important attribute of feeling in control of the parenting role. Thus, this case is considered relevant.

Given that the aforementioned cases have already provided ample support for the completion of the concept analysis, devoid of any difficulty or ambiguity, we have made the decision to refrain from incorporating any borderline or illegitimate cases in this study.

Antecedents

Antecedents refer to events or phenomena that precede the concept (Walker and Avant 2011). In the context of PPSS, there are five antecedents that occur prior to its manifestation: (1) being prepared for child rearing; (2) being in familiar or safe environment; (3) general well-being of the baby and parents; (4) support from medical staff and family members; (5) being empowered by medical staff.

Being Prepared for Child Rearing

Having a childbirth experience and being prepared for the birth of their child are important factors for PPSS (Persson et al. 2012; Wiklund et al. 2018). Studies have shown that parents who have previously had one or two children feel more experienced, which in turn provides them with a sense of security (Wiklund et al. 2018). Other studies have also investigated the relationship between mothers' childbirth experience and their sense of security, yielding similar results (Escribano, Oliver-Roig, Cano-Climent, Richart-Martínez, and Juliá-Sanchis 2020; Persson and Dykes 2009). The same conclusion applies to fathers, as previous parenthood experience helps them develop a postnatal sense of security (Escribano, Oliver-Roig, Cano-Climent, Richart-Martínez, and Juliá-Sanchis 2020). However, no studies have yet examined this feeling in first-time couples. Nevertheless, the high likelihood of experiencing a sense of postnatal security in parents who already have one or more children suggests that previous childbirth experience equips them with the feeling of being prepared. This preparation includes material readiness, psychological preparation and skill acquisition.

Being in Familiar or Safe Environment

Being in familiar surroundings, such as being at home during the postpartum period, provided a sense of safety for parents (Nilsson et al. 2015). Askelsdottir et al. conducted a study on women's sense of security in the first week after giving birth and found that early discharge and continued home care increased feelings of security for women who chose to stay at home (Askelsdottir et al. 2013). On the other hand, the hospital environment also plays a role in maintaining a sense of security for postpartum parents, as it offers healthcare technology and professional expertise (Pereda-Goikoetxea et al. 2019). If parents encountered difficulties in caring for their baby, readmission to the hospital provided a sense of security, as hospitals are viewed as safe places that can provide timely treatment for their baby when problems arise (Feenstra, Nilsson, and Danbjørg 2019).

General Well-Being of the Baby and Parents

The third antecedent that precedes the occurrence of PPSS is the general well-being of the baby and the parents (Persson et al. 2011, 2012). Research has indicated that the physical well-being of the baby, including successful breastfeeding and the absence of complications, plays a role in the postpartum security experienced by the parents. Additionally, the mother's good health condition contributes to a sense of security for both herself and her partner (Escribano, Oliver-Roig, Cano-Climent, Richart-Martínez, and Juliá-Sanchis 2020; Persson et al. 2011, 2012). Furthermore, the father's physical well-being also influences his sense of security (Persson et al. 2012).

Support From Medical Staff and Family Members

Support from healthcare professionals and family members helped promote parents' sense of security (Nilsson et al. 2015). A study indicated that support from medical staff, especially midwives, promoted parents' security during the postnatal period (McLeish and Redshaw 2019). Doctor-patient communication and the support provided by medical staff exerted a great influence on PPSS (Feenstra, Nilsson, and Danbjørg 2019). Supportive actions, such as home visits or phone calls (Johansson, Aarts, and Darj 2010; Kruse et al. 2021), listening and providing information support (Escribano, Oliver-Roig, Cano-Climent, Richart-Martínez, and Juliá-Sanchis 2020), as well as timely responses to their needs (Danbjørg et al. 2015) all facilitated parents' PPSS.

A positive partnership also contributes to the establishment of PPSS. The study of Velagic et al. revealed that a close relationship with the father facilitated the mother's postnatal sense of security (Velagic, Mahmutovic, and Brankovic 2019). This is in accordance with a study that indicated the involvement of the partner in early parenthood care offered the mother a sense of security (Wiklund et al. 2018). Meanwhile, the intimate partnership during the postpartum period also promoted the father's own sense of security (Escribano, Oliver-Roig, Cano-Climent, Richart-Martínez, and Juliá-Sanchis 2020).

Being Empowered by Medical Staff

The empowering behaviour exhibited by midwives has a significant impact on the sense of security experienced by parents (Persson and Dykes 2009). Research findings indicate that when parents are fully empowered by the medical staff, they tend to feel secure and are more likely to opt for early discharge (Persson and Dykes 2002). In the case of mothers who are discharged early, their inclusion in the decision-making process regarding the timing of discharge contributes to their feelings of safety and confidence (Danbjørg et al. 2015). As described in the study of Pereda-Goikoetxea et al., mothers' feeling of being empowered gave them security and confidence to cope with puerperal problems (Pereda-Goikoetxea et al. 2019).

Consequences

Consequences refer to events or phenomena that occur after a particular concept (Walker and Avant 2011). However, there have been only seven studies on the consequences of parents' sense of security during the postpartum period. Existing evidence suggests that PPSS leads to successful adaptation to the parental role, decreased postpartum depression symptoms in mothers, successful infant care and the development of parent-infant relationship.

For parents, PPSS contributes to their smooth transition into their parenting roles (Werner-Bierwisch et al. 2018). The study by Feenstra et al. supports the conclusion that PPSS positively influences a mother's journey towards motherhood (Feenstra, Nilsson, and Danbjørg 2019). Feeling secure enhances a mother's confidence in parenting (Werner-Bierwisch et al. 2018). Furthermore, a mother's postnatal sense of security is significantly associated with her postnatal depression symptoms. In the study by Escribano et al., mothers' postnatal sense of security during the first 2 weeks can predict whether postnatal depression symptoms will occur between 6 and 11 months (Escribano, Oliver-Roig, Cano-Climent, Richart-Martínez, and Juliá-Sanchis 2020). Additionally, postnatal sense of security has positive effects on infant care. Research shows that when a mother feels secure, she is more likely to choose early discharge from the hospital, which may influence infant-related outcomes such as fussing and crying (Löf, Svalenius, and Persson 2006; Persson and Dykes 2002). Parents feeling secure during the postnatal period may also contribute to the long-term quality of infant care, including a decrease in the frequency of infant fussing and crying at 12 months (Feenstra, Nilsson, and Danbjørg 2019) which is a positive indicator of infant development. Furthermore, PPSS can promote a strong bond within the family. A study suggests that a mother's sense of security is helpful in developing a favourable mother-infant relationship (Persson and Dykes 2002). Although no studies have investigated the relationship between a father's sense of security and the father-infant relationship, it is reasonable to assume that a positive relationship exists. However, more research is needed to further explore this relationship.

Empirical Referents

Empirical referents refer to means by which one can recognise or measure the defining characteristics or attributes (Walker and Avant 2011). The PPSS instrument is the mostly used tool for detecting the level of security felt by mothers and fathers during the postnatal period. The instrument consists of two parts: the mother's postnatal sense of security and the father's postnatal sense of security (Persson, Fridlund, and Dykes 2007). A higher score indicates a greater sense of security for parents. This instrument has been found to be reliable, with a Cronbach's coefficient alpha of 0.88 for mothers and 0.77 for fathers (Persson, Fridlund, and Dykes 2007). The instrument has also been translated into Spanish, and the Cronbach's coefficient alpha was verified to be 0.89 in Spanish participants (Escribano, Oliver-Roig, Cano-Climent, Richart-Martínez, Persson, et al. 2020).

Another often used questionnaire investigating mothers' postpartum sense of security after first childbirth is the Childbirth Experience Questionnaire (CEQ). This questionnaire includes four dimensions: own capacity, professional support, perceived safety and participation (Boie et al. 2020). The CEQ has been successfully adapted in many countries and has demonstrated good validity and reliability (Kazemi et al. 2020; Patabendige et al. 2020).

Discussion

This concept analysis clarified the concept of PPSS by identifying its uses, attributes, antecedents, consequences and empirical referents. PPSS can be defined as the perception of one's physical well-being not being at risk, feeling confident and in control of the parenting role and having confidence in one's available relationships. The antecedents of PPSS encompass various factors stemming from the family, medical staff and the environment. When experienced, PPSS leads to positive parental adaptation, a reduced incidence of postpartum depression symptoms in mothers, successful infant care and the fostering of a strong parent-infant relationship.

We have identified three attributes for PPSS. These attributes are both independent and interrelated, making them valuable components for differentiating and accurately measuring the concept (Bayrampour et al. 2016). This differs from Persson's scale for measuring PPSS, which primarily utilised the antecedents of the concept as the dimensions of the instrument (Persson, Fridlund, and Dykes 2007). Therefore, it is necessary to develop an instrument from an alternative perspective. This approach would be based on the attributes of PPSS in order to gain insight into the current state of PPSS. Additionally, it would allow for a comparison between the PPSS instrument by Persson and other similar scales. This comparison would help determine which tool exhibits superior reliability and validity.

The antecedents of PPSS have been extensively studied, indicating that research related to the sense of security of postpartum parents has primarily focused on exploring its influencing factors. Among these factors, midwives have been identified as having a significant impact on PPSS, with two out of the five factors affecting it (McLeish and Redshaw 2019; Persson and Dykes 2002). However, research has also indicated that some midwives lack a thorough understanding of the needs of postpartum parents (Dubreucq et al. 2020; Magdalena and Tamara 2020). This suggests that midwives should be provided with guidance and training to better comprehend the behaviours that can enhance parents' sense of security after delivery. Strategies such as increased company or communication, as well as empowering parents in decision-making, can be considered to improve the quality of care and enhance patient satisfaction.

Furthermore, there is inconsistency in the literature regarding whether the hospital environment or home environment contributes to the sense of security felt by postpartum parents (Askelsdottir et al. 2013; Nilsson et al. 2015; Pereda-Goikoetxea et al. 2019). As a result, it is important for healthcare providers to adopt different strategies when dealing with individuals who have different preferences. For parents who feel secure at home, creating a home-like environment in the hospital setting may help enhance their sense of security. However, further studies are needed to evaluate the effectiveness of such interventions.

The PPSS can have a significant impact on both mothers and infants, highlighting the importance of paying close attention to the sense of security experienced by postpartum parents. It is also the responsibility of nursing staff to promote the development and maintenance of this sense of security in order to enhance the quality of care provided. However, the literature on the consequences of PPSS has shown less consistency compared to its antecedents. To address this gap, it is crucial to conduct qualitative studies and prospective cohort studies to better understand the outcomes of PPSS. This area of research is expected to become a major focus in future studies on PPSS. Furthermore, it is important to conduct separate research on the outcomes of PPSS specifically related to fathers in order to gain a comprehensive understanding of the consequences of PPSS.

The duration of postpartum security is an important aspect that warrants discussion, as it indicates the extent of security felt by parents. However, there are few studies that have investigated or measured the duration of these feelings during the postnatal period. Research on measuring, comparing and exploring the factors that influence the duration of postpartum security may provide insights for extending this duration and improving postpartum care.

Currently, there are several tools available to investigate the sense of security experienced by postpartum parents. The PPSS instrument developed by Persson et al. is widely recognised as the most authoritative and scientifically sound tool for this purpose (Velagic, Mahmutovic, and Brankovic 2019). The dimensions of the PPSS instrument are closely related to the antecedents of postnatal parental security. However, this instrument only measures postpartum security during the first week after delivery. There is a lack of a universal tool that can measure postpartum security throughout the entire postnatal period. As a result, the safety experience of parents during the longer postpartum period cannot be adequately investigated and compared. Therefore, there is a need for the development of a questionnaire that has greater universality and generalizability in measuring postpartum security at different time points. Additionally, while the childbirth experience questionnaire (CEQ) is suitable for investigating mothers' postpartum security, there is a need for an instrument targeted at exploring both mothers' and fathers' postpartum security. With proper instruments, PPSS can be measured accurately, allowing for a more thorough investigation into the correlation between the PPSS of mothers and fathers.

Although there are several theories that explain the general sense of security, there is currently no specific theory that exists for postpartum security. The psychoanalysis theory only discusses the function of the sense of security (Lijuan and Zhong 2003), while Maslow's Pyramid of Needs Model defines the sense of security and emphasises its relationship with needs (Daphna-Tekoah et al. 2020). Andersson defines the sense of security within a medical framework (Persson and Dykes 2009). These general theories appear to be closely related to the attributes of PPSS. Persson was the first to provide a definition of postnatal sense of security (Persson, Fridlund, and Dykes 2007), and this definition primarily focuses on the antecedents of this concept. Clearly, there is a need for the development of a theory of postpartum security to guide future nursing research, education and clinical practice. This concept analysis explores the antecedents, attributes, consequences and empirical referents of parents' postnatal sense of security, which provides clues for the theoretical development of this concept.

Limitations

This study only included Chinese and English articles, and related articles from other languages were excluded, which may lead to the loss of information on the results. It is suggested to carry out international cooperation among researchers of different languages in order to enrich the results of the concept analysis if possible.

Conclusion

This study aims to address the limitations of previous research by providing a clear operational definition of PPSS and identifying its attributes, antecedents, consequences, cases and empirical referents. In our analysis, we define PPSS as a feeling of one's physical well-being not being threatened, being confident and in control of the parenting role and being confident in one's available relationships. This comprehensive concept analysis offers valuable insights that can be utilised in the development of future intervention programs to facilitate parents' sense of security within the context of postpartum care. Additionally, this analysis contributes to the expansion of knowledge in the fields of nursing theory, research, education and practice.

Author Contributions

Tieying Zeng, Lingjun Jiang and Deqing Huang designed the study. Deqing Huang and Meiliyang Wu conducted literature retrieval. Tieying Zeng, Lingjun Jiang and Deqing Huang wrote the first draft of the manuscript. Tieying Zeng, Lingjun Jiang, Deqing Huang, Meilyang Wu and Aiqing Tu reviewed and amended the manuscript. All authors approved the final version of the manuscript.

Acknowledgements

Thank Shiyi Jiang for her accompany during drafting the manuscript.

Ethics Statement

The authors have nothing to report.

Conflicts of Interest

The authors declare no conflicts of interest.

Data Availability Statement

All relevant data analysed during this review are included in this published article.

References

Askelsdottir, B., W. Lam‐de Jonge, G. Edman, and I. Wiklund. 2013. “Home Care After Early Discharge: Impact on Healthy Mothers and Newborns.” Midwifery 29, no. 8: 927–934. [DOI: https://dx.doi.org/10.1016/j.midw.2012.11.001].