[논문]Effects of a Community-based Follow-up Program for Parents with Premature Infants on Parenting Stress, Parenting Efficacy, and Coping

Ji, Eun Sun; Shim, Ka Ka

doi:10.4094/chnr.2020.26.3.366

Effects of a Community-based Follow-up Program for Parents with Premature Infants on Parenting Stress, Parenting Efficacy, and Coping 원문보기

CHNR : Child health nursing research, v.26 no.3, 2020년, pp.366 - 375

Ji, Eun Sun (Department of Nursing, KonKuk University Glocal Campus) , Shim, Ka Ka (Department of Nursing, SangMyung University 2Campus)

Abstract ▼ AI-Helper

Purpose: This study was conducted to evaluate the efficacy of a community-based follow-up program on parenting stress, parenting efficacy, and coping among parents with premature infants. Methods: A non-equivalent control group pre-post quasi-experimental design was used. This program consisted of structured home visits and self-help group meetings for 6 months. The experimental group (n=29) received visits by an experienced neonatal intensive care unit (NICU) nurse and the control group (n=27) was visited by a visiting nurse. Data were analyzed using the χ2 test, t-test, and analysis of covariance. Results: Parents' coping behavior significantly differed in the experimental group compared to the control group (t=3.14, p=.003). In particular, coping subscale I, for maintaining the family situation (t=2.63, p=.011), and subscale III, for understanding the infant's medical situation (t=4.30, p<.001), showed significant differences in the experimental group. There were no significant between-group differences in parenting stress or parenting efficacy. Conclusion: The findings of this study suggest that home visits by an experienced NICU nurse provided through a community-based follow-up program were an effective intervention to improve coping behavior among parents with premature infants.

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문제 정의

In order to improve parenting stress, parenting efficacy, and coping among parents of premature infants, it is necessary to develop guidelines and provide educational programs to improve the quality of care provided by visiting nurses with responsibility for premature infants. Consequently, this study provides evidence for the need to develop and implement a community-based parenting follow-up program based on a social support system involving home visiting by specialists within the community and support group sessions for the future establishment of public healthcare support policies regarding post-discharge management of premature infants.
The findings of this study show the importance of the participation of an experienced NICU nurse in a community-based follow-up program for parents of premature infants. These home visits enabled effective cooperation and partnership with the mothers of premature infants through the establishment of appropriate solution plans.
The goal of this study was to examine whether mothers with premature infants who received a follow-up program providing tailored parenting support, including home visits by an experienced NICU nurse, had improved parenting stress, parenting efficacy, and coping compared to those who received traditional home visits.
Since reemployment can be difficult for inactive nurses in this position due to their job satisfaction and career history, community visits by experienced NICU nurses should be encouraged as a way to enhance nursing professionalism and clinical self-efficacy [23]. This study may contribute to the expansion of the role of nurses with NICU experience in the community to include not only medical nursing interventions for preterm infants, but also support for children with developmental delays and systematic management of family health promotion. Additionally, support group meetings in accordance with the educational needs of parents of premature infants facilitated ongoing improvements in parenting competencis.
In order to develop a community-based follow-up program for premature infants, it was important to strengthen the capacity of home visiting personnel, who can participate in community programs involving parents of premature infants; therefore, a preliminary project was planned for this purpose. This study served as the basis for the development of a community-based follow-up program for parents of premature infants.
In accordance with the increase in the number of premature infants in Korea, specialized healthcare, information dissemination, and communication with the parents of premature infants are necessary to promote optimal growth and development among these infants upon returning home after discharge. This study was conducted to evaluate a community-based follow-up program with home visits by an experienced NICU nurse designed to decrease parenting stress and to increase parenting efficacy and coping behaviors among mothers of premature infants. Monthly home visits and support group meetings provided professional education and counseling, as well as a framework for maintaining interactions among the members.

가설 설정

The participants in the experimental group were recruited in 2013, while the control participants were recruited in 2016. The following inclusion criteria were applied to the infants: 1) gestational age of less than 37 weeks, 2) no congenital anomalies or serious complications, and 3) corrected age of less than 6 months. Mothers were required to meet the additional following criteria: 4) having no postpartum complications, 5) being the primary caregiver of the child, and 6) understanding the purpose of the study and providing consent to participate in the study.

제안 방법

Each item is evaluated using a 4-point scale ranging from 'not helpful' to 'extremely helpful,' with a higher mean score indicating better use of coping behaviors.
The PSI evaluates a total of 35 items divided into three categories, including 12 items concerning stress experienced by parents during parenting (parent domain), 12 items concerning dysfunctional interactions between parents and children (parent-child relationship domain), and 11 items concerning the temperamental characteristics of children (child domain). Each item is evaluated using a 5-point scale, with the score ranging from a minimum of 0 points to a maximum of 140 points. Higher scores indicate a higher level of parenting stress.
For the physical domain, measurements were made of the infant's height, weight, and head circumference, and growth was checked using a growth chart.
The experienced NICU nurse assessed the degree of developmental delay according to the child's health conditions and the corrected age by evaluating the child's vital signs, physical measurements, and physical assessment of whether any serious events were predicted.
The scale evaluates a total of 45 items and is composed of 3 subscales, including 19 items on maintaining family integration, cooperation, and an optimistic definition of the situation (coping behavior subscale I); 18 items on maintaining social support, self-esteem, and psychological stability (coping behavior subscale II); and eight items on understanding the medical situation through communication with other parents and consultation with medical staff (coping behavior subscale III).
At the self-help meetings, members asked questions each other about the changes experienced by the infant during the past month and communicated about possible solutions. The support group meetings were conducted monthly in the lecture room of the S district office for 2 hours each, and on average were attended by nine parents each month, with their children or alone.
This interventional study was conducted to evaluate the effect of a community-based follow-up program including home visits by an experienced NICU nurse for parents of premature infants on their parenting stress, parenting efficacy and coping.

대상 데이터

One participant in the experimental group and three participants in the control group dropped out for reasons including relocation (two participants), change of mind(one participant), and aggravation of the child's health condition (one participant); in total, 29 participants in the experimental group and 27 participants in the control group were included in the final data analysis.
The data collection period of the experimental group was 6 months, beginning on April 1, 2013, when the home visit program for premature infants involving the participation of the experienced NICU nurse was initiated in S county of Seoul.
The home visits in the experimental group were conducted by one visiting nurse and one specialized nurse with 10 years of work experience in the NICU. The experienced NICU nurse assessed the degree of developmental delay according to the child's health conditions and the corrected age by evaluating the child's vital signs, physical measurements, and physical assessment of whether any serious events were predicted.
80, as in a preceding study [9]. This calculation indicated that 28 participants were needed for each group. Sixty participants (30 in each group) were designated in consideration of the expected dropout rate.
This study used convenience sampling to enroll mothers of premature infants who joined the infant service in S county, Seoul, South Korea. The participants in the experimental group were recruited in 2013, while the control participants were recruited in 2016.

데이터처리

Reliability testing of the instruments used in the study to evaluate continuous variables was performed using Cronbach's ⍺. Differences between the two groups in the continuous variables were analyzed using the independent t-test. A significance level of a=.
The participants' general characteristics, parenting stress, parenting efficacy, and coping behaviors were analyzed using descriptive statistics, and homogeneity testing was performed using the x2 test and the t-test.

이론/모형

Coping was assessed using the Coping Health Inventory for Parents (CHIP), which was developed by McCubbin et al. [11] and modified by the researchers of this study after receiving consent for use via email.
Parenting efficacy among mothers of premature infants was assessed using the Parenting Sense of Competence (PSOC) scale, which was developed by Gibaud-Wallston [15] and modified by Shin [16]. This instrument evaluates parents' self-awareness regarding their capabilities of parenting and problem-solving.
Parenting stress was assessed using the Parenting Stress Index (PSI), which was developed by Abidin [13] and later standardized by Chung, Lee, Park and Kim [14]. The PSI evaluates a total of 35 items divided into three categories, including 12 items concerning stress experienced by parents during parenting (parent domain), 12 items concerning dysfunctional interactions between parents and children (parent-child relationship domain), and 11 items concerning the temperamental characteristics of children (child domain).

성능/효과

For hypothesis 2, the score of parenting efficacy was 33.93 ±4.81 points after home visits in the experimental group, and 31.44±5.79 points after home visits in the control group.
Hypothesis 3 was accepted, as the score of coping behaviors was 109.37±11.81 points in the experimental group, and 100.88±8.21 points in the control group, which was a statistically significant difference (t=3.14, p=.003) (Table 3).
Second, although there was no statistically significant difference between the two groups in parenting efficacy, the score increased to a greater extent in the experimental group. The quality of care of the program provided in this study was insufficient to meet the needs of the participants.
The score on coping behavior subscale II (social support and psychological stability) was 42.93±5.96 points after the program in the experimental group, and 40.66±3.23 points in the control group; however, this difference was not statistically significant (t=1.78, p=.082).
The study results showed that parenting stress decreased in both groups after home visits; however, the difference was not statistically significant.
Third, the significantly greater increase in coping behaviors in the experimental group in comparison with the control group demonstrates the positive effects of home visits by the experienced NICU nurse on mothers' coping behaviors.

후속연구

Moreover, data were collected separately in 2013 and 2016; therefore, the exogenous variables that may have affected participants' characteristics were not controlled. The reliability score of the measurements used in this study was low; therefore, in subsequent research it will be necessary to identify and exclude the items that reduced reliability.

참고문헌 (23)

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