[논문]The Effects of a Home-Visiting Discharge Education on Maternal Self-esteem, Maternal Attachment, Postpartum Depression and Family Function in the Mothers of NICU Infants

Ahn Young-Mee; Kim Mi-Ran

doi:10.4040/jkan.2004.34.8.1468

[국내논문] The Effects of a Home-Visiting Discharge Education on Maternal Self-esteem, Maternal Attachment, Postpartum Depression and Family Function in the Mothers of NICU Infants 원문보기

대한간호학회지= Journal of Korean academy of nursing, v.34 no.8, 2004년, pp.1468 - 1476

Ahn Young-Mee (Department of Nursing, College of Medicine Inha University) , Kim Mi-Ran (Department of Nursing, College of Medicine Inha University)

Abstract ▼ AI-Helper

Purpose: A quasi-experimental study was performed to investigate the effects of a home visiting discharge education program on the maternal self-esteem, attachment, postpartum depression and family function in 35 mothers of neonatal intensive care unit (NICU) infants. Methods: Twenty-three mothers in the intervention group received the home visiting discharge education while 12 mothers in the control group received the routine, hospital discharge education. Baseline data was collected in both groups one day after delivery. The intervention group received the home visiting discharge education while the control group did the routine hospital-based discharge education. The questionnaire including the data on maternal self-esteem, attachment, postpartum depression and family function were collected within 1 week after the discharge by mail. Results: The scores of maternal self-esteem, and attachment were significantly increased, and the postpartum depression and the family function score were decreased after the home visiting discharge education in intervention group. There were no changes in these variables before and after the routine hospital-based discharge education in control group. Conclusion: These results support the beneficial effects of home visiting discharge education on the maternal role adaptation and family function of the mothers of NICU infants.

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문제 정의

Others who develop positive maternal self-esteem may well develop fine maternal attachment with good family function as social support, which reciprocally decreases postpartum depression. This study was conducted to examine the effects of an enhanced discharge education program, consisting of home visiting discharge education, on the maternal self-esteem, attachment, postpartum depression and family function in the mothers of NICU infants. .
In addition, their infants might still need careful monitoring and skillful hands for their routine care because the graduation from NICU carries no guarantee for problem-free health. All of these factors validate the administration of the home visiting discharge education such as proposed in this study for the NICU graduates and their family.
In this study, a program of home visiting discharge education was developed with these considerations and delivered within the first week of NICU discharge. The study result shows that the home visiting discharge education had a positive effect on maternal role adaptation process and family function.

제안 방법

Once the new mothers were enrolled in the study, baseline data was collected on the demographic and medical information as well as the dependant variables, such as maternal self-esteem, maternal attachment, postpartum depression and family function, before delivering the discharge education at the second day after delivery. For the control group, the hospital-based, routine discharge education was performed by an NICU staff nurse at the time of discharge, which is mostly the second to third day after vaginal delivery, or the fourth to fifth day after cesarean section delivery.
The home visiting discharge education, taking about one hour, involved the guided education with a booklet consisting of the common growth and development concerns focused on high-risk infants, cues of infant behaviors, sequels of high-risks, assessment and support of home environment. After administering the discharge education to both groups, a questionnaire to measure the maternal self-esteem, maternal attachment, postpartum depression and family function was left with a return envelope for the mothers of high-risk infants, who were asked to complete and mail it back within several days. Follow-up calls were made to increase compliance in both groups.
Four variables were measured to investigate the effects of discharge education in this study: maternal self-esteem, maternal attachment, postpartum depression and family function. Maternal self-esteem measures a woman's own reflected appraisal of herself as a mother (McGrath & Meyer, 1992).
Scores of 7-10 suggest a highly functional family; 4-6, a moderately dysfunctional family; and 0-3, a severely dysfunctional family(Gabriel, 1978). For the study, the original version was translated into Korean, and in turn retranslated back into English for comparison check in the authorand applied to the mothers of normal and low-birth weight infants (Ahn & Kim, 2003) . The CronbacE s alpha of 0.
The questionnaire included the above four instruments with demographic information for baseline measurement and without any other information for post-intervention measurement except a numeric code to match the two questionnaires. Confidentiality was assured by assigning a code number to each subject and by analyzing data only with the coded numbers and aggregate data.
Special focus is needed on the outcomes on postpartum depression that were measured with EPDS. A systematic review of the EPDS validation studies reported the predictive values of EPDS on assuming a 5% to 20% prevalence of postpartum depression(Davis, Edwards, M사lay & Wollin, 2003).

대상 데이터

Fifty mothers of high-risk infants, 25 in each group, were enrolled into the study at the beginning, but 15 from the control group did not respond to the mail survey after discharge. The possible reason for this may be no direct beneficial effects from the study for the control group while the intervention group received the enhanced discharge education.

데이터처리

In the same manner, the levels of FAPGAR of all subjects were examined using Chi-square and paired-t test. The FAPGAR level showed the increase in the number of highly functional families with a decrease in the number of dysfunctional families after the discharge education.
The scores of MSRI, MAI, EPDS and FAPGAR were compared before and after the discharge education between the intervention group, the control group and all subjects using paired t-test (Table 6). All scores revealed significant changes after the discharge education in the intervention group but no changes in the control group.

이론/모형

Maternal attachment, a measure of the social relationship between mother and her child, is an affective tie to the child. In this study it was measured using the maternal attachment inventory (MAI) developed by Muller (1994). The original version consisted of a 26-item survey with a 5-rating scale from 0 to 4.
5. Descriptive statistics, paired-t test, and Chi- square were used to explore the nature of the data. Nonparametric statistics were performed to test the effects of the two types discharge education because of the possibility of skewed distribution of variables of research interest with wide variances due to the nonequivalent subject numbers in the two groups.
Postnatal depression was measured using the Edinburgh Postnatal Depression Scale (EPDS) which was developed by Cox et al (1987). EPDS, a 10-item self-rat- ing scale, has been shown to have high sensitivity for detection of postpartum depression.

성능/효과

The demographic and medical information of the mothers and infants are presented in Tables 1 and 2. The mean age of the mother was 29.3 years (SD 二 4.13) with a mean marital period of 3 years and 4 months. Among the mothers, 82.
9% were not employed. Sixty percent of the subjects were in a nuclear family type with a mean number of family members of 3. Of the subjects, 31.4% lived with their parents-in-law, and 40% of the caregivers for postpartum care were the subject's own mothers. The pregnancy was planned for 51.
51) in 나le control, retrospectively. There was no statistical difference in the means of MSRI, MAI and EPDS, but the mean of family function score was higher in the intervention group than in the control group. The item mean was 3.
The EPDS and FAPGAR scores were recorded into three levels: not depressed, probably (or moderately) depressed and presumptive (or severely) depressed for EPDS; and normal, moderately dysfunctional and highly dysfunctional for FAPGAR. Tables 4 and 5 present the degrees of each EPDS and FAPGAR between the intervention and control groups before and after the discharge education.
The differences in the changes of scores before and after the education were analyzed between the intervention group and control using Mann-Whitney U test and are presented in Table 7. The MSRI score significantly increased with a median of 9 after the home visiting discharge education while the median difference score was decreased in the control group which received the routine hospital-based discharge education (Z 二 61.000, p = .007). The median of 3 in the difference of MAI score significantly increased after the home visiting discharge education while the median difference score was decreased to -3 in the control group which received the routine hospital-based discharge education (Z = 51.
In this study, a program of home visiting discharge education was developed with these considerations and delivered within the first week of NICU discharge. The study result shows that the home visiting discharge education had a positive effect on maternal role adaptation process and family function. The traditional, hospitalbased, routine education had no beneficial effects on them.
2%, of the mothers of LBW infants who received the routine, hospital-based discharge education at the time of infant discharge in Korea (Ahn & Kim, 2003). In this study, 40% of the subjects showed an EPDS score above 8 and 11.4% above 12 at about the second day of delivery. The slight lower EPDS scores of the later study may be explained by differences in the infants' condition.
Above all, more attention is paid to two factors: the high incidence and the degree of depressive mood in mothers of high-risk infants including LBW infants and the effects of home visiting discharge education. In this study, the incidence of scores more than 8 decreased to about 22%, including 0% for scores more than 12, after the home visiting discharge education, compared to 25% for scores more than 8, including about 8% for scores more than 12 after the hospital discharge education. This result implies that the mothers of high-risk infants have an increased chance for a depressive mood and that the home visiting discharge education, compared to the routine hospital discharge education, could promptly reduce the incidence and degree of postpartum depression.

후속연구

Therefore, hospitalbased, follow-up management may be more effective in the delivery of high quality nursing care for NICU graduates than public health center-based follow-up. More study is needed to compare the cost-effectiveness and regional accessibiHty-effectiveness between hospital-based and public health centerbased follow up programs, and to determine which is more valuable for long term, overall health care management in the Korean population.

참고문헌 (26)

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[국내논문] The Effects of a Home-Visiting Discharge Education on Maternal Self-esteem, Maternal Attachment, Postpartum Depression and Family Function in the Mothers of NICU Infants 원문보기

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[국내논문] The Effects of a Home-Visiting Discharge Education on Maternal Self-esteem, Maternal Attachment, Postpartum Depression and Family Function in the Mothers of NICU Infants 원문보기

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