Doctoral Dissertations

Date of Award

12-1982

Degree Type

Dissertation

Degree Name

Doctor of Philosophy

Major Professor

Sandra L. Twardosz

Committee Members

Johnie Mozingo, Marjorie Penfield, Priscilla White

Abstract

This study was an evaluation of the effects of a brief, structured teaching program on mothers' perceptions of and attachment towards their premature infants. Descriptive data also were collected regarding the problems experienced by mothers during the first 2 months following their infants' hospital discharge and parental suggestions for change in the services provided by intensive care nurseries (ICN's).

Thirty premature infants and their mothers participated in the study. The infants were patients in either of two ICN's in a southeastern city. All the infants were Caucasian singletons between 28 and 35 weeks of gestational age and were free of obvious congenital defects. The mothers were randomly assigned to one of three study groups. There were no differences among the groups on a variety of sociodemographic variables including infant gestational age, weight, and Apgar scores, and parental age and income.

Mothers in the control group received routine care and support from the ICN staff. In addition to the usual ICN procedures, mothers in the instruction group received instruction about the unique physical and behavioral characteristics of premature infants. The instruction included discussion of a brochure developed by the researcher and viewing a videotape about preterm infants. Mothers in the attention group were provided with the opportunity to discuss nonmedical concerns about their infants or their situations with the nurse-researcher.

Measures of maternal perceptions and attachment behaviors were obtained by unbiased observers during three home visits at 2, 4, and 8 weeks after the infants were discharged from the hospital. Maternal perceptions of their infants were measured by the Broussard Neonatal Perception Inventory (NPI) adapted for parents of premature infants. There were four measures of maternal-infant attachment; (a) time-sampled observations of maternal attachment behaviors; (b) an adaptation of the Price Assessment of Infant-Maternal Empathy Scale (AI-ME); (c) a tally of the frequency of maternal visits or telephone calls to the ICN; and (d) three subscales of the Caldwell Home Observation for Measurement of the Environment (HOME).

There were no significant differences among the groups on maternal perceptions or attachment behaviors. Scores on the AI-ME scale were significantly higher during the second and third observation periods than during the first observation period. Only four mothers had negative perceptions of their infants during the second home visit.

The parents expressed concerns about their infants' gastrointestinal problems, appearance, development, irritability, breathing patterns, and specific health problems. The parents generally were satisfied with the care provided by the ICN staff, although they made several suggestions for change in hospital practice.

It was concluded that the structured teaching program did not significantly augment the teaching and support currently provided by the ICN staff. The findings were interpreted as supporting the conclusions of two other recent studies that short—term, hospital—based programs for parents of prelatures do not contribute to infant development or parent-infant relationships. These findings plus the results of other studies suggest that more extensive home-based intervention programs may be necessary in order to enhance existing ICN services. This study was significant in that it tested an intervention which has been proposed frequently in the literature but which had not been evaluated empirically. Experimental research such as this is the only way to determine the most effective and efficient ways of helping parents cope with the crisis of preterm birth. No harmful effects of the program were identified and several parents commented that it had been useful. It was suggested that professionals examine their practice with families of high-risk infants to determine whether this teaching program would be a useful supplement to their existing services.

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