신생아 중환자실 퇴원 후 미숙아 어머니의 모성 역할 발달

Abstract

전 세계적인 공중 보건 문제로 조명 받는 미숙아 출산 그리고 신생아 집중 치료실 입원은 가족 위기, 부모의 심리 사회적 고통을 초래하는 중대한 사건이다. 미숙아 부모는 만삭아 부모와 다른 ‘부모기로의 전이’, ‘모성 이행기’를 보내며 부모 역할 발달 어려움을 겪는다. 모성 역할 발달(Maternal Role Development)은 양육의 질, 긍정적인 모아 상호 작용을 통해 영아의 성장 발달과 아동의 전인적 건강에 기여할 수 있는 요소다. Mercer의 ‘어머니 되어가기’ 이론에 따르면 모성 역할 발달은 어머니와 영아 간의 애착이 시작되며 일어나는 발달적 상호 작용 과정으로, 일생 동안 어머니 역할 내재화와 적응, 모성 행위의 발달과 확장을 통해 지속적으로 성장하고 그 역할에 대한 만족과 기쁨을 표현하는 것이다. 어머니가 되는 과정 속에 다양한 위기를 겪을 수 있는 미숙아 어머니의 모성 역할 발달 영향 요인에 대해 부부 중심 가족 체계 및 가변적이고 다양한 가족 구조 등 현대의 시대상을 고려한 다각적 접근은 의학적으로 취약한 미숙아의 최적의 성장 발달과 건강을 증진시키는 데 기여할 수 있다. 하지만 미숙아나 초 극소 저체중아 어머니와 같은 취약한 집단을 대상으로 어머니가 되는 과정을 탐색한 연구는 희박하다. 본 연구는 Mercer이론과 관련 문헌 고찰을 근거로 미숙아 어머니의 모성 역할 발달 영향 요인으로서 핵심 변수인 모아 애착, 모성 정체성, 부부 친밀감 외에 어머니의 인구사회학적 및 임신과 출산 관련 특성과 영아의 임상적 특성 변인들을 모두 포함하여 모성 역할 발달과의 관계를 종합적으로 탐색하기 위해 수행되었다. 연구 대상자는 신생아 중환자실 입원 치료 후 퇴원한 미숙아의 어머니로, 1개의 3차 의료 기관에서 영아의 예방 접종 또는 미숙아 발달 검사 또는 추후 관리를 위해 외래를 방문한 미숙아 어머니와 직접 대면을 통한 설문지 조사 및 의무 기록 차트 분석 방법과 미숙아 부모 전용 온라인 커뮤니티에서 인터넷 기반 설문지 조사를 병행하여 자료 수집을 진행하였다. 최종 분석에 포함된 대상자는 총 121명으로, 자료 분석은 SPSS 22.0 통계 분석 프로그램을 이용하였다. 연구 결과는 다음과 같다. 1. 미숙아 어머니의 모성 역할 발달은 9점 만점에 평균 7.53±0.79점으로, 하위 척도 별로 살펴봤을 때 아기 출생으로 인한 삶의 변화에 대한 지각과 적응을 나타내는 ‘삶의 변화’(7.93±0.85), 영아의 ‘중요성’(7.77±0.82), 모성 역할 행위 및 양육 경험에 대한 만족을 나타내는 ‘평가’(7.25±1.06)순으로 높았다. 2. 모성 역할 발달 전체 점수는 어머니의 연령(r=.188, p=.039), 분만 경험 (Spearman’s rho=.201, p=.027), 계획 임신(Spearman’s rho=.221, p=.015), 모아 애착(r=.752, p<.001), 모성 정체성(r=.517, p<.001), 부부 친밀감(r=.398, p<.001)과 통계적으로 유의한 양의 상관관계를 보였고, 선천성 기형 또는 중증의 합병증(Spearman’s rho=-.269, p=.003)과는 음의 상관관계를 나타냈다. 하부 영역 별로 살펴봤을 때, 모성 역할 발달 ‘평가’ 영역은 어머니의 연령(r=.213, p=.019), 분만 경험(Spearman’s rho=.185, p=.042), 모아 애착(r=.694, p<.001), 모성 정체성(r=.558, p<.001), 부부 친밀감(r=.370, p<.001), 선천성 기형 또는 중증의 합병증(Spearman’s rho=-.227, p=.012)과 통계적으로 유의한 상관관계를 보였다. 모성 역할 발달 ‘중요성’ 영역은 분만 경험 (Spearman’s rho=.213, p=.019), 계획 임신(Spearman’s rho=.254, p=.005), 모아 애착(r=.593, p<.001), 모성 정체성(r=.271, p=.003), 부부 친밀감(r=.204, p=.025)과 통계적으로 유의한 양의 상관관계를 나타냈다. 모성 역할 발달 ‘삶의 변화’ 영역은 분만 경험(Spearman’s rho=.222, p=.014), 계획 임신(Spearman’s rho=.194, p=.033), 모아 애착(r=.454, p<.001), 모성 정체성(r=.231, p=.011), 부부 친밀감(r=.391, p<.001)과 통계적으로 유의한 양의 상관관계를 나타냈다. 3. 모성 역할 발달의 영향 요인을 위계적 회귀 분석을 통해 검증한 결과, 모아 애착(β=.606, p<.001), 부부 친밀감(β=.214, p<.001)과 모성 정체성(β=.184, p=.002)변수가 모성 역할 발달에 긍정적인 영향을 미치는 것으로 나타났다. 모성 역할 발달 하위 영역 별 영향 요인을 살펴봤을 때, 모아 애착(β=.460, p<.001), 모성 정체성(β=.334, p<.001), 부부 친밀감(β=.197, p=.002)은 모성 역할 발달 ‘평가’의 영향 요인으로 영아와 상호 작용 또는 관계의 질, 모성 역할 행위 및 양육 경험에 대한 만족에 영향을 미치는 것으로 나타났다. 영아의 중요성을 인식하는 데 영향을 미친 요인은 모아 애착(β=.557, p<.001)으로 모성 역할 발달 ‘중요성’의 25.6%를 설명하였다. ‘삶의 변화’ 하부 영역의 경우 모아 애착(β=.392, p<.001)과 부부 친밀감(β=.312, p<.001)이 아기 출생으로 인한 삶의 변화에 대한 지각 및 적응에 긍정적인 영향을 미치는 것으로 나타났다. 본 연구 결과를 토대로 모성 역할 발달 영향 요인으로 확인된 모아 애착을 증진하고, 부부 친밀감 강화, 긍정적인 모성 정체성 형성에 기여하는 가족 지지와 교육, 부모 대상 중재가 요구된다. 이를 통한 미숙아 어머니의 모성 역할 발달은 궁극적으로 영아의 성장 발달을 촉진할 수 있을 것이다. 따라서 미숙아 출산부터 신생아 중환자실 퇴원 이후까지 다양한 가족 위기와 심리 사회적 고통을 겪는 미숙아 부모의 긍정적인 ‘부모기로의 전이’ 경험과 부모 역할 발달에 기여할 수 있는 부모 참여, 가족 중심 간호 중재 전략이 마련되어야 할 것이다.| Increasing rates of preterm birth, as a high-priority global public health issue, is also the reality for South Korea while the country has been in danger of falling into extremely low birth rate. Although the survival rate of premature infants has risen dramatically owing to medical management of high-risk infants, it is evident that from birth of premature babies to admission to Neonatal Intensive Care Unit(NICU) is a critical event incurring family crisis and psychosocial distress in parents. Moreover, parents of premature infants have difficulty in developing parent role following a premature infants’ discharge from the NICU. In a word, they have different ‘transition to parenthood’ and ‘transition to motherhood’ compared to parents of well babies. Maternal Role Development(MRD) which can determine the quality of mother-infant interaction and parenting behavior is a significant factor contributing wellbeing in children as well as infants’ growth and development. In accordance with Mercer’s Becoming a Mother(BAM) theory, MRD is a developmental interactive process started as attachment between mother and infant is established. During this process, the woman continue to grow facilitated by internalization of the role, adaptation to new reality and developments in mothering ascertaining gratification and pleasure to become a mother. Also, intimacy in marital relationship or marital intimacy, the requisite for MRD, is an irreplaceable element that others cannot substitute for. Realizing the predictors and correlates of MRD in this rare and vulnerable population liable to undergo difficult process to become a mother must be needed to promote optimal growth and development of medically fragile infants. However, little understanding has been given to associated factors of MRD with consideration for challenges and demands that contemporary mothers of premature infants face. To investigate influence factors on MRD, associated factors of MRD such as marital intimacy, maternal attachment, maternal identity were chosen based on not only BAM theory but literature reviews. Data of a total of 121 mothers of premature infants following discharge from the NICU were analyzed by SPSS 22.0 program. They are recruited from online communities using internet based survey and from pediatric outpatient clinic for follow up screening and immunization in the tertiary university hospital using face to face questionnaire survey and medical chart review. The results showed the overall mean for MRD was 7.53 and the subscale mean score for ‘life change’ was 7.93, ‘centrality’ 7.77 and ‘evaluation’ 7.25. Bivariate analysis identified mother’s age(r=.188, p=.039), parity(Spearman’s rho=.201, p=.027), pregnancy intention (Spearman’s rho=.221, p=.015), congenital defect or severe complications(Spearman’s rho=-.269, p=.003), maternal attachment (r=.752, p<.001), maternal identity(r=.517, p<.001) and marital intimacy (r=.398, p<.001) to be statistically significantly associated with MRD. Regarding subscales of MRD, mother’s age(r=.213, p=.019), parity(Spearman’s rho=.185, p=.042), maternal attachment(r=.694, p<.001), maternal identity(r=.558, p<.001), marital intimacy(r=.370, p<.001) and congenital defect or severe complications(Spearman’s rho=-.227, p=.012) were associated with MRD ‘evaluation’. MRD ‘centrality’ was significantly related to the parity(Spearman’s rho=.213, p=.019), pregnancy intention(Spearman’s rho=.254, p=.005), maternal attachment(r=.593, p<.001), maternal identity(r=.271, p=.003) and marital intimacy(r=.204, p=.025). In addition, MRD ‘life change’ was correlated with parity(Spearman’s rho=.222, p=.014), pregnancy intention (Spearman’s rho=.194, p=.033), maternal attachment(r=.454, p<.001), maternal identity(r=.231, p=.011) and marital intimacy(r=.391, p<.001). The results of a hierarchical multiple regression analysis indicated that maternal attachment(β=.606, p<.001), marital intimacy(β=.214, p<.001) and maternal identity(β=.184, p=.002) were positive resources for MRD in mothers of premature infants. With regard to subscales of MRD, maternal attachment(β=.460, p<.001), maternal identity(β=.334, p<.001) and marital intimacy(β=.197, p=.002) to be predicting factors of MRD ‘evaluation’ which means positive perception or satisfaction of quality of mother-infant interaction or relationship, mothering behavior or caregiving practices and parenting experience. Factor that impact on awareness of importance of baby in parent’s life(MRD ‘centrality’) was maternal attachment(β=.557, p<.001) with a predictive power of 25.6%. Furthermore, maternal attachment(β=.392, p<.001) and marital intimacy(β=.312, p<.001) were influencing factors for MRD ‘life change’, realization of birth-related effects or life changes and accommodating to new parent’s life. The primary purpose of this study, testifying propositions and relevance of key concepts to extend established knowledge on MRD targeting mothers of premature infants was achieved. Promotion of maternal attachment and integration of maternal identity with family -centered interventions including parents of premature babies that might be able to strengthen marital intimacy from hospitalization to post-discharge must be desperate to develop maternal role. An in-depth understanding of MRD in mothers of premature infants might give health professionals insights into not only positive experiences during transition to parenthood but also infants’ optimal growth and development.; Increasing rates of preterm birth, as a high-priority global public health issue, is also the reality for South Korea while the country has been in danger of falling into extremely low birth rate. Although the survival rate of premature infants has risen dramatically owing to medical management of high-risk infants, it is evident that from birth of premature babies to admission to Neonatal Intensive Care Unit(NICU) is a critical event incurring family crisis and psychosocial distress in parents. Moreover, parents of premature infants have difficulty in developing parent role following a premature infants’ discharge from the NICU. In a word, they have different ‘transition to parenthood’ and ‘transition to motherhood’ compared to parents of well babies. Maternal Role Development(MRD) which can determine the quality of mother-infant interaction and parenting behavior is a significant factor contributing wellbeing in children as well as infants’ growth and development. In accordance with Mercer’s Becoming a Mother(BAM) theory, MRD is a developmental interactive process started as attachment between mother and infant is established. During this process, the woman continue to grow facilitated by internalization of the role, adaptation to new reality and developments in mothering ascertaining gratification and pleasure to become a mother. Also, intimacy in marital relationship or marital intimacy, the requisite for MRD, is an irreplaceable element that others cannot substitute for. Realizing the predictors and correlates of MRD in this rare and vulnerable population liable to undergo difficult process to become a mother must be needed to promote optimal growth and development of medically fragile infants. However, little understanding has been given to associated factors of MRD with consideration for challenges and demands that contemporary mothers of premature infants face. To investigate influence factors on MRD, associated factors of MRD such as marital intimacy, maternal attachment, maternal identity were chosen based on not only BAM theory but literature reviews. Data of a total of 121 mothers of premature infants following discharge from the NICU were analyzed by SPSS 22.0 program. They are recruited from online communities using internet based survey and from pediatric outpatient clinic for follow up screening and immunization in the tertiary university hospital using face to face questionnaire survey and medical chart review. The results showed the overall mean for MRD was 7.53 and the subscale mean score for ‘life change’ was 7.93, ‘centrality’ 7.77 and ‘evaluation’ 7.25. Bivariate analysis identified mother’s age(r=.188, p=.039), parity(Spearman’s rho=.201, p=.027), pregnancy intention (Spearman’s rho=.221, p=.015), congenital defect or severe complications(Spearman’s rho=-.269, p=.003), maternal attachment (r=.752, p<.001), maternal identity(r=.517, p<.001) and marital intimacy (r=.398, p<.001) to be statistically significantly associated with MRD. Regarding subscales of MRD, mother’s age(r=.213, p=.019), parity(Spearman’s rho=.185, p=.042), maternal attachment(r=.694, p<.001), maternal identity(r=.558, p<.001), marital intimacy(r=.370, p<.001) and congenital defect or severe complications(Spearman’s rho=-.227, p=.012) were associated with MRD ‘evaluation’. MRD ‘centrality’ was significantly related to the parity(Spearman’s rho=.213, p=.019), pregnancy intention(Spearman’s rho=.254, p=.005), maternal attachment(r=.593, p<.001), maternal identity(r=.271, p=.003) and marital intimacy(r=.204, p=.025). In addition, MRD ‘life change’ was correlated with parity(Spearman’s rho=.222, p=.014), pregnancy intention (Spearman’s rho=.194, p=.033), maternal attachment(r=.454, p<.001), maternal identity(r=.231, p=.011) and marital intimacy(r=.391, p<.001). The results of a hierarchical multiple regression analysis indicated that maternal attachment(β=.606, p<.001), marital intimacy(β=.214, p<.001) and maternal identity(β=.184, p=.002) were positive resources for MRD in mothers of premature infants. With regard to subscales of MRD, maternal attachment(β=.460, p<.001), maternal identity(β=.334, p<.001) and marital intimacy(β=.197, p=.002) to be predicting factors of MRD ‘evaluation’ which means positive perception or satisfaction of quality of mother-infant interaction or relationship, mothering behavior or caregiving practices and parenting experience. Factor that impact on awareness of importance of baby in parent’s life(MRD ‘centrality’) was maternal attachment(β=.557, p<.001) with a predictive power of 25.6%. Furthermore, maternal attachment(β=.392, p<.001) and marital intimacy(β=.312, p<.001) were influencing factors for MRD ‘life change’, realization of birth-related effects or life changes and accommodating to new parent’s life. The primary purpose of this study, testifying propositions and relevance of key concepts to extend established knowledge on MRD targeting mothers of premature infants was achieved. Promotion of maternal attachment and integration of maternal identity with family -centered interventions including parents of premature babies that might be able to strengthen marital intimacy from hospitalization to post-discharge must be desperate to develop maternal role. An in-depth understanding of MRD in mothers of premature infants might give health professionals insights into not only positive experiences during transition to parenthood but also infants’ optimal growth and development.