THE EFFECT OF PLANNED NURSING INTERVENTION

ON PRIMIPARA POSTPARTUM ROLE STRAIN

BY

Elizabeth I. Price

A THESIS

Submitted to
Michigan State University
in partial fulfillment of the requirements
for the degree of

MASTER OF NURSING

School of Nursing

1978

 

 

a: a... T-

ABSTRACT

THE EFFECT OF PLANNED NURSING INTERVENTION
ON PRIMIPARA POSTPARTUM ROLE STRAIN

BY
Elizabeth I. Price

New mothers experience role strain. Family supports
no longer assist new mothers. A role socialization program
administered by nurses can reduce role strain.

The experimental design used a small narrowly
defined sample of new mothers, one half serving as control.
The program consisted of three components: social self,
role language, and role performance administered on the day
of discharge.

At term, mothers completed a basic profile and Ideal
Mother Index. At three weeks postpartum, mothers repeated
the Ideal Mother Index and a Self Mother Index, both scored
on a six-point response scale, the difference between scores
revealing role strain. Role strain was evident and decreased
through planned nursing intervention. Of the three compo—
nents, only role performance showed a significant trend.

The trends for social self and role language were less
pronounced. The ideal self data supports theories concerning

ideal self stability.

To my friend, Chris

ii

ACKNOWLEDGMENTS

I would like to convey my appreciation to my committee
chairperson, Dr. Barbara Given, Ph.D., for her support and
assistance in the preparation of this thesis. She was an
excellent role model and made research exciting. To each
of my committee members, Joyce Conley, Bonnie Elmassian,
Ruth Johnston, and Dr. LouAnna Simon, Ph.D., a heartfelt
thanks for the time and energy spent guiding and directing
my research inquiry.

I am grateful to Le Ann Slicer for always being there
with the right answers to my countless questions. A special
thank you to the Kellogg Foundation for providing the grant

which helped make this program possible.

iii

TABLE OF CONTENTS

Chapter

I.

II.

III.

IV.

INTRODUCTION . . . . . . . . . .

Statement of the Problem . . .
Hypothesis 1 . . . . . . . . .
Hypothesis 2 . . . . . . . . .
Operational Definitions. . . .
Limitations of the Study . . .
Assumptions. . . . . . . . . .

THEORETICAL FRAMEWORK. . . . . .
REVIEW OF THE LITERATURE . . . .

Role Theory. . . . . . . . . .

Family Support and Kin Structure
Nursing Intervention in Maternal

Deve10pment. . . . . . . . .
summary. 0 O O O O O O 0 O O O

METHODOLOGY AND PROCEDURE. . . .

Overview . . . . . . . . . . .
Population . . . . . . . . . .
Data Collection Procedure. . .
Methodology of the Study . . .
Instruments. . . . . . . . . .
Socialization Program. . . . .

DATA PRESENTATION AND ANALYSIS .

Overview . . . . . . . . . . .
Descriptive Information of the

Population . . . . . . . . .
Non-Program Group Description.
Program Group Description. . .

Study

Descriptive Information Relative
Program and Non-program Groups
Data Presentation for Each of the Hypotheses

Presentation of Hypotheses . .

iv

to the

Page

H

anxibwwro

10
24

24
28

31
45

47

47
48
50
57
58
61

63
63
63
64
66

66
69

Chapter

VI. SUMMARY OF FINDINGS . . . . . . . . . . . .

Summary of Inferential Findings . . . . .
Other Findings. . . . . . . . . . . . . .
Recommendations . . . . . . . . . . . . .
Conclusions . . . . . . . . . . . . . . .

APPENDIX A:

APPENDIX B:

APPENDIX C:

APPENDIX D:

APPENDIX E:

APPENDIX F:

APPENDIX G:

APPENDIX H:

APPENDIX I:

APPENDIX J:

BIBLIOGRAPHY.

PROCEDURES TO BE USED IN THE PROJECT
TO OBTAIN CONSENT AND TO SAFEGUARD
THE RIGHTS AND WELFARE OF RESPOND-
ENTS O O O O C O O O O C O O I C O

INVESTIGATOR'S STATEMENT AND SUBJECT'S

STATEMENT O C O O O O O O C O C C 0
RESEARCH DESIGN. . . . . . . . . . .
BASIC DATA PROFILE . . . . . . . . .

IDEAL MOTHER INDEX AND SELF MOTHER
INDEX 0 C C O O O O O O O O O C O O

CRITERIA FORM. 0 O O O O O O O O I 0

PROGRAM OF POSTPARTUM ROLE SOCIALI-
ZATION C O O O O C O O O C O O O O

POSTPARTUM ROLE SOCIALIZATION:
INSTRUCTION SHEET. . . . . . . . .

EXAMPLE SCORING PROCEDURE. . . . . .

HYPOTHESES IN STATISTICAL NOTATION/
FORMULAS O O I O O C O C O O O O O

Page
75
76
77

80
84

85

86
88

89

90
94

96

100
102

104

106

ILLUSTRATIONS

Figure Page
1. Operational Model of Orem's Theory Applied to
the Clinical Situation: Acquisition of the

Maternal Role. . . . . . . . . . . . . . . . 18

2. Mother Role Acquisition . . . . . . . . . . . . 23

vi

LIST OF TABLES

Table Page
1. Descriptive Data for Program and Non-Program

Groups . . . . . . . . . . . . . . . . . . . 65

2. Summary . . . . . . . . . . . . . . . . . . . . 71

. 72

3. Summary of Statistical Tests. . . . . . . . .

vii

CHAPTER I
INTRODUCTI ON

The first pregnancy is a time when a woman anticipates
the role of mother and begins to realize within herself what
behavioral changes the adoption of this role will bring.

The cultural image of motherhood is ideal surrounded with
myth and fantasy. New mothers have little time to ease into
the behaviors and responsibilities of their new roles; they
must perform as mothers immediately. In the past, extended
families provided role models, support, and guidance for the
new mother and assisted her to perform the new role. How-
ever, in a society where one of five families moves each
year (1970 census), these strong role models are no longer
available to young mothers. Because of this change in the
traditional extended family structure, support systems are
removed which could help new mothers learn to perform
mothering behaviors and ease the acquisition of the maternal
role (Gruis 1977).

Role strain, the difficulty of fulfilling role
demands, occurs normally during any role acquisition (Goode
1960). The time of greatest role strain in maternal role

acquisition is when the formal, or ideal, role behaviors

of the position are tested in reality (Thornton and
Nardi 1975).

In my experience, both as a maternity nurse and a
mother, I have observed the difficulties mothers have
adjusting to first babies in the weeks immediately after
delivery. Too often they lack family and peer support to
guide them in those early days, and in general the health
care system does not intervene until the sixth week post-
partum.

The purpose of this study is to determine if a
selected program of role socialization provided for new
mothers during the informal stage of maternal role acquisi—
tion will reduce role strain. By recognizing the role strain
involved in becoming a new mother, the health care system
can provide support and guidance during the postpartum
period, in addition to the customary re—entry examination

six weeks postpartum.

Statement of the Problem

 

What is the effect of a selected role socialization
program provided new mothers during the informal stage of
maternal role acquisition on role strain at three weeks

postpartum?

 

In

ne

du

Hypothesis 1

 

New mothers who receive a program of role socialization
during the informal stage of role acquisition will not have
significantly lower scores on a measure of role strain than

those mothers who did not receive the program.

A. New mothers who receive a program of role socialization
during the informal stage of role acquisition will not have

significantly different scores on a measure of social self

 

than those mothers who did not receive the program.

B. New mothers who receive a program of role socialization
during the informal stage of role acquisition will not have

significantly different scores on a measure of role language

 

than those mothers who did not receive the program.

C. New mothers who receive a program of role socialization
during the informal stage of role acquisition will have no

significantly different scores on a measure of role perform-

 

ance than those mothers who did not receive the program.

Hypothesis 2

There is no significant difference on the ideal
mother measure between the pre and post-test scores for the
new mothers who received a program of role socialization

during the informal stage of role acquisition.

Operational Definitions

Social Self: a set of descriptions held by an actor for
himself developed out of interaction between the organism
and stimulus, objects and events, and projected in his
role behavior (Biddle and Thomas 1966); a set of reflected
appraisals (Mead 1934). Social self, for the purpose of
this study, is defined by the following items on the Ideal

Mother Index. A mother:

. . . is happy

. . . is concerned about her family

. . . is consistent and dependable

. . . is also a woman separate from her baby
. . . is strong

. . . feels good about herself

. . . is important

Role Language: "Linguistic devices are the tools which aid
in the further development of the social self." The learning
of language, both verbal and body, particularly that which
has social referents, and aids in the perceiving, identifying,
and conceptualizing of roles and role expectations (Sarbin
1954, pp. 242-243). Role language, for the purpose of this
study, is defined by the following items in the Ideal Mother

Index.

A mother:

talks to her baby

understands her baby's different cries

touches her baby gently

communicates with her baby through looks

and gestures

cuddles her baby tenderly

is able to interpret what her baby wants

and needs

listens to her baby when her baby talks to her

Role Performance: Overt activity, including gross skeletal

 

movements, verbal and motoric gestures, posture, styles of

speech and accent, the wearing of certain forms of dress

and the use of material objects (Sarbin 1954, p. 232). Role

performance,

the following

for the purpose of this study, is defined by

items on the Ideal Mother Index. A mother:

is skillful in feeding and burping her baby
is competent with tasks of bathing and
dressing her baby

protects her baby

holds and rocks her baby

changes her baby's diaper with ease
provides physical care for her baby

adapts to change

Note: The Self Mother Index contains all the items designed
to define social self, role language, role performance:
however, they are worded slightly differently to reflect

the reader "I." For clarification, refer to the instrument

section where both tools are included.

Role Socialization: (1) the process of learning the real-

 

istic limits of role behaviors, and qualities which are
congruent with the internalized set of norms; (2) the
process of a) identifying the ideal internalized actions
and qualities of a given role, b) cognitively establishing
self in relation to the standard. The Role Socialization
Program is designed to provide support and education for
new mothers: to assist in the acquisition of the maternal
role based on the following role concepts: social self,

role language, and role performance.

Role Strain: the felt difficulty in carrying out the rights

 

and obligations of a given role in reality, balanced against

internalized standards and the ideal used to evaluate action.

Role Acquisition: a developmental process in the adapting
of a new role encompassing four stages: (1) anticipatory,
(2) formal, (3) informal, and (4) personal. Time has been
used to mark the stages in the acquisition of the maternal

role.

(1) Anticipatory--from early childhood through pregnancy.

(2)

(3)

(4)

Formal--hospital confinement post-delivery,

3-4 days.

Informal--includes the time from hospital
discharge to three weeks postpartum.

Personal--is ongoing, as the tasks of the mother
change and continually require testing the formal
expectation against the informal reality, striving

for a comfortable medium.

Limitations of the Study

 

(1)

(2)

(3)

(4)

The limitations of the study are as follows:

The sample size is small, and therefore the findings
of this study may not be generally applicable to a
large population, only to the population under study.
The same researcher was both teacher and evaluator
of the program. This may affect the research out-
come. Replication of the research using at least
two researchers, one as teacher and one as evaluator,
should eliminate any effects.

The use of office staff for the initial client
contact may have affected the sample population.
Clients who agreed to c00perate in the study may

be different from those who did not. Therefore,

it is possible they would have had different

outcomes.

(5)

(6)

The limited time and small number of contacts may
not have covered the time role strain occurred.
Rubin's theory related to "binding in" is untested,

so no research correlations are possible.

Assumptions

 

(1)

(2)

(3)

(4)

(5)

Assumptions of the study are as follows:

The relationship between the ideal self and the

real self is one that can be measured.

The testing instrument is sensitive enough to
pick up differences between subjects and

within the time frame identified.

The period of time studied is representative of

the time role strain occurs.

Clients who seek medical care from a specialty
group of obstetricians are basically the same as
those found in other health care settings offering

maternity care.

Unplanned assistance provided the mother postpartum
by family and friends would be distributed

randomly in both the program and non-program
groups. Therefore, the outcome would not be

affected.

This study is organized into six chapters. Chapter I
provides an introduction, a statement of the problem,
hypotheses, limitations, assumptions, and definitions of
terms underlying this study.

Chapter II presents a theoretical framework for
this study, drawing on related theory from sociology and
nursing.

Chapter III provides a review of the literature
pertaining to this investigation and supporting the need
for this study.

Chapter IV presents the methodology, design, and
procedures used in this study, a discussion of the research
sample, a delineation of the procedures for collection of
the research data, and an explanation of the method of
data analysis.

Chapter V contains all of the data collected in
response to the research hypotheses.

Chapter VI provides a summary of the findings and
conclusions drawn from the study, as well as recommendations

for further research.

CHAPTER II

THEORETICAL FRAMEWORK

The theoretical framework for this investigation
draws from both the sciences of sociology and nursing.

Role theorists assume that role performance or
behaviors are learned either by intentional instruction
or by incidental learning (Heiss 1976). The family and
greater kinship network play a vital part in socializing
individuals into various role behaviors both intentionally
and incidentally (Elkin 1958). Therefore, the absence of
this support when assuming a new role may place some
individuals at risk due to the stress of change (Hrobsky
1977). Role acquisition is a developmental process, one
which requires individual adaptation, and is often accom-
panied by difficulty in fulfilling the obligations of the
new role. Difficulties may result in role strain or an
incongruency between what the individual ideally believes
to be the role rights and obligations and how comfortable
he is actually performing the role (Goode 1960). This

study focuses on the acquired role of mother.

10

11

To better understand how maternal role acquisition
might be accomplished, the developmental approach model of
role acquisition described by Thornton and Nardi (1975),
incorporating both social and psychological dimensions,
seems appropriate. This model divides role acquisition into
four stages. The first stage is the anticipatory stage.
This stage preceeds the actual performing of the role.
Generalized sources (i.e., radio, TV, movies, and ideals)
identify appropriate role behaviors which lead to the
development of unrealistic and ambiguous role expectations.

The anticipatory stage begins in early childhood
with doll play, modeling behavior and other role gender
specific activities. During pregnancy, all of the cultural
norms, values, and expectations of what motherhood entails
are intensified for the pregnant woman in preparation for
taking on the role. In Thornton and Nardi's (1975) terms,
the match between what she has learned to anticipate and
what she subsequently expresses will likely determine the
speed and ease of role adaptation. The discrepancies between
anticipation and realization will vary from mother to mother.

The second stage of role acquisition is the formal
stage. Here the correct behaviors are derived mainly from
significant others (i.e., her own and other mothers, the
father of the baby, and the baby itself) and from within

herself. Delivery of the baby marks the passage from the

12

anticipatory to the formal stage of role acquisition for
the new mother. She spends the early part of the postpartum
in the hospital where the new family-centered approach to
maternity care provides the new mother an opportunity to
practice the behaviors now expected of her (i.e., infant
care, positive mothering). The mother identifies a new
reciprocal role set--that of her infant, the one that truly
makes her a mother. She is playing at the role, acting out
the formal behavior which is expected of her. During this
time the new mother has the support of health care providers
to teach her skills, answer her questions and encourage her
attempts as she cares for her baby. The new mother is free
from the stress that other roles might place on her (i.e.,
those of wife and homemaker); free to act her part. When
she is discharged and she returns to the community to make
her debut as a mother, she will still attempt the formal
behaviors. Shortly, however, the new mother faces the strain
of the real against the ideal, and she begins stage three,
the informal stage of role acquisition.

The informal stage of role acquisition is a time
for confusion and disillusionment (Thornton and Nardi 1975);
the time when the musts of the formal role are questioned.
The individual attempts to find her way, bending the fixed
and rigid rules of the formal role to allow the new mother

the freedom of self-expression within the role, modifying

'9.
“l

13

behaviors and techniques to fit her ability, personality,
and environment. It is during the six weeks postpartum
that such modification takes place. Physically the new
mother lacks strength because of the insult of labor and
delivery, and the new responsibility of infant care leads
to disturbance in sleep patterns and fatigue. Psychologi-
cally, the new mother may be feeling the loss of a self-
identity, one separate from the baby. She may fear the
role of mother will consume her in total. The psychological
struggle may produce guilt feelings which make adapting the
formal behaviors even more difficult because the new mother
cannot live up to her own standard. The availability of
role models, support, and guidance at this time appears
critical to ease these physical and psychological elements
of role strain.

The final stage of role acquisition in Thornton
and Nardi's model is the personal stage; the individual
has worked out the discrepancies between anticipated and
actual behaviors and is comfortable in the role. The new
mother has imposed her own expectations and conceptions on
the role, modifying role expectations according to her own
unique personality (Thornton and Nardi 1975).

The inability to work through the incongruence
between formal and informal role behaviors of a new role

with a personalized role set can lead to role strain. The

14

family assumes a key position in situations of role strain
(Goode 1960) by providing role models, counsel, and support.
Historically, families were extended to include several
generations: however, the contemporary nuclear family tends
to be isolated from these generations. Thus, role models,
counsel, and support may be absent (Parsons 1965). Clearly,
the health care system can provide these missing elements.
Within the health care system, nursing seems most able to
assist in minimizing role strain.

Nursing theory interfaces role acquisition theory
at all four stages.- In the anticipatory stage, nursing is
part of the generalized other, helping shape the accepted
behaviors surrounding the role of mother by virtue of the
nurses' contributions to establishing cultural norms. In
the formal stage, nursing can affect role development by
using the hospital confinement period to teach role behaviors
such as how to diaper, bathe, and feed the new baby. Often
the nurse is seen by the new mother as "the baby care
expert." However, when the new mother began the informal
stage (the most difficult of the developmental processes),
the nurse does not normally provide any assistance because
the new mother exits the health care system at this time,
entering again only briefly, six weeks postpartum, for the

"routine” check-up with the doctor.

15

It is apparent that maternal role acquisition may
require nursing intervention at the informal stage because
nuclear families of today are independent of kin, and the
presence of role strain may interrupt the mother's
state of health and inability to pursue her own self-care.
The anticipated outcome of this process is acceptance of
self in the role and comfort with the obligations the role
entails. If she has help, then role strain will be eased.

The focus of Dorothea Orem's nursing theory of
self—care is "the practice of activities that individuals
personally initiate and perform on their own behalf in
maintaining life, health and well-being" (Orem 1971, p. 913).
Self-care is learned behavior and is the product of the
cultural norms of a given social group.

A self-care practice is therapeutic "to the degree
that it actually contributes to the maintenance of normal
growth, development, and maturation" (Orem 1971, p. 20).
There are two kinds of self-care: (1) universal human
needs, and (2) health deviation (illness focused). Orem
further subdivides universal self-care into six categories:
(1) air, water, food; (2) excrements: (3) solitude and
social interaction; (4) activity and rest; (5) hazards to
life; and (6) being normal. The category of solitude and
social interaction proposes that social contacts provide

conditions essential for socialization, and to be therapeutic

16

self-care must "(1) provide social warmth and closeness
essential for development as well as conditions which
permit development and use of individual talents; (2)
stimulate the continuing development and adjustment by the
person of a realistic concept of himself which will be
expressed in what he strives for, what he expects, and what
he values; (3) promote both individual autonomy and group
membership; and (4) prevent personality impairments"

(Orem 1971, pp. 25-26).

When the mother is unable to provide her own
self-care, nursing, a health service designed to assist a
person to achieve a level of self-care, should intervene
(Orem 1971). Orem defines nursing intervention within
three systems, each of which represents a variation in the
role of the nurse and patient in the performance of health
care activities by the patient. The nurse's method of
assistance determines which system.will be selected in any

situation. The three intervention systems are:

(l) Wholly Compensatory System: situations in which
the patient has no active role;

(2) Partly Compensatory System: both patient and
nurse perform care measures;

(3) Supportive-Educative System: the patient is

able to perform or can learn to perform the
therapeutic self-care (Orem 1971, p. 978).

In the case of acquisition of the maternal role, a wholly-

compensatory system does not exist except for the extreme

l7

complication possible during the normal reproductive

cycle. The partly compensatory system can be utilized

well during the intrapartum.where the mother is a very
active participant within the limits of her ability. The
postpartum period most frequently requires the use of the
supportive-educative system with the mother playing a

vital role in its planning and execution. Orem has identi-
fied two parts of this system, support and teaching, which
can be used to assist the mother in learning to perform the
therapeutic self-care measures she needs to be comfortable
in her new role. Incorporating role theory and using the
teChniques of nursing assistance in the supportive-educative
nursing system as proposed by Orem, a program can be
designed to provide realistic role socialization at the
point where the formal and the informal stages of maternal
role acquisition meet. The anticipated outcome of such a
program is the reduction of role strain through the use of
education and support (see Figure 1).

Three basic role concepts, the social self, role
language, and role behavior, are central to maternal role
acquisition. Knowledge of the social self as manifested in
the maternal role enables the nurse to devise appropriate
interventions for assisting the mother in acquiring the new
role. The social self is defined by Meade (1934) as a

person's view of himself, "a reflection of the attitudes

18

Figure 1

OPERATIONAL MODEL OF OREM'S THEORY APPLIED

TO THE CLINICAL SITUATION:

 

THE MATERNAL ROLE

 

Self care demand:
reduction of dis-
comfort/role
strain relative

to assuming the
maternal role.

 

 

 

 

Actions to complete
self-care: seek
socialization through
interaction with
family/kin/significant
others designed to
help in the achieve-
ment of comfort with
perceived role strain.

ACQUISITION OF

 

   
 

 

 

No family/kin/
significant
others

 

 

 

 

Requirement for nursing:
absence of socialization
in the form of the know-
ledge and skill needed
to be comfortable with
the incongruence between
the ideal role standard
and perceived self-
ability.

 

 

1

Determine nursing goal :]

 

comfort with the role.

J

Design a nursing system:
supportive-educative.

 

J.

Implement the system:fi[

Self care
completed :
comfort in the
new role.

 

 

 

program of role
socialization. I

 

19

that others hold toward him," and by Thomas and Biddle
(1966, p. 10) as "a sense of personal identity, the set

of all standards, descriptions, and concepts held by an
individual for himself." The social self is included in
this study because of the high level of interrelatedness
between role and self, and because if inconsistency between
role expectations and self-appearance and performance
exists, role strain develops (Sarbin 1954). The nursing
function is to assist the mother to identify the range of
acceptable performance with which she is comfortable.

The concept of social self also includes body image, how
she "appears" in the role, e.g., Does she look like a
mother should look? Rubin (1967, p. 240) incorporates

body image within the concept of social self, believing
"Status role achievement is contingent upon body image.
Therefore, a new mother needs to feel she has some control
over her body and needs to relate satisfaction with how she
looks."

Role interactions are circular in that each encounter
provides information to the social self regarding performance,
information that can be either positive or negative
(Heiss 1976). Nursing intervention during the transition
between the formal and the informal stages of the mother's
role dealing with dimension of the social self development
can help to provide the information necessary to establish

a positive role base.

20

Along with knowledge of the social self, the nurse
needs to understand role language as manifested during the
maternal-infant interaction, so important to role acquisition.
Role languages are defined as: symbols, verbal and non-
verbal, that have social referents and are "aids in the
perceiving, identifying and conceptualizing of roles and
role expectations" (Sarbin 1954, pp. 242-243). The verbal
and non-verbal communication of the infant is a language
the mother is unfamiliar with and one which has a great
impact on the development of the mother/infant relationship.
Because the infant has not learned the expected social
behavior (i.e., speech, smile), he lacks a means of reinfor-
cing those maternal behaviors which best attend to his
needs.

The nurse can assist the mother to develOp an
awareness of how the infant gives and takes within the
relationship and the importance of their interaction. This
awareness forms the basis for developing some feedback
mechanisms until the infant is capable of employing the
appropriate response to the provided maternal stimuli. A
better understanding of infant language will be useful in
role performance behavior since the mother will continue to
evaluate her role performance in relation to how the infant
responds to her. If the mother can understand and interpret

the infant's behavior and see positive reinforcement for

21

her own, she should become more confident in performing,

or taking on the role of mother. However, if she does not
understand the cues of the infant, or if she is confused
regarding appropriate action, incongruence will occur between
the ideal role of mother and the mother's actual performance.
She will likely view this incongruence as lack of success,
and role strain will result.

Finally, along with knowledge of social self and
role languages, the nurse must understand the dynamics of
the actual role performance. Role performance is defined
as overt activity including gross skeletal movements, verbal
and motoric gestures, posture, styles of speech and accent,
and wearing of certain forms of dress and the use of
material objects (Sarbin 1954, p. 232), "action behavior"
(Thomas and Biddle 1966, p. 26), and "role enactment"

(Sarbin 1954, p. 232), or role behavior related to infant
care, (i.e., diapering, bathing, and feeding). The new
mother, having discovered the actions involved in role
performance during the anticipatory and formal stages of
maternal role acquisition, must now perform. Any incongruence
between the obligations and expectations of her role and

her performance will cause role strain (i.e., lack of
confidence, anxiety over her clumsiness or incompetent

actions).

22

The need to assist the new mother to learn the
manual skills necessary in infant care has been addressed
by providing postpartum classes during the hospital stay.
However, demonstration of skills is not enough. Role strain
develops when the new mother does not feel comfortable
modifying formal (ideal) role behaviors. The nurse must
also, according to role theory, help the mother to under-
stand that modifications of the formal role behaviors can
be, and rightfully will be, incorporated into her inter-
pretation and personalization of the role of mother. An
understanding of the three concepts of role theory discussed
here, social self, role language, and role performance,
provide nursing with the tools necessary to support and
teach new mothers therapeutic self-care practices designed
to ease the normal role strain involved in maternal role

acquisition.(see Figure 2).

23

Figure 2

MOTHER ROLE ACQUISITION

 

Anticipatory Stage

Ideal norms and
attitudes

 

 

 

 

Formal Stage

Acting the ideal
role standard

 

 

 

 

Informal Stage

The mother tests the ideal role standard
against the reality of her individual
ability. The difficulty to achieve a
level of acceptable role performance
results in role strain.

 

 

 

 

Role Strain

 

x

Nursing
Supportive-Educative

Program of role
socialization:
role concepts:
social self
role language
role performance

I

 

 

 

 

 

 

Personalized Stage Personalized Stage

Comfort with the Comfort with the
role role

 

 

 

 

 

CHAPTER III

REVIEW OF THE LITERATURE

The review of the literature will focus on role
theory, family structure, and nursing intervention in role
development. The objective of the review of the literature
is to isolate the complimentary aspects of these areas as
they describe the acquisition of the maternal role in the
postpartum period and as they direct the formulation of a
nursing intervention program.

The postpartum period is an important time in
maternal role acquisition. The changing shape of the Ameri-
can family increases the role strain normally associated
with initial development of the mother-child relationship.
It is appropriate to begin with a discussion of roles, role

acquisition, and role strain.

Role Theory

 

The discussion of role theory provides a perspective
of how individuals function and affect each other within a
social context. Contemporary role theory regards human
conduct as the product of the interaction of self and role.
Sarbin (1954) described culture as "an organization of

learned behaviors and the products of behavior which are

24

25

shared and transmitted" (p. 224). A social position
involves sets of learned behaviors, called roles. Social
positions are either achieved, based on what the person can
do, or ascribed, based on what the person is in terms of
sex, age, or family connections. Roles generally involve

a complex combination of both achieved and ascribed behavior
sets.

The concepts of self, role expectations, and role
performance are central in role theory. The concept of
self in role theory combines fairly constant cultural norms
with the psychological variations of the individual person-
ality. An organized system of role expectations is cognitive;
and serves as a significant guide and standard for appropriate
conduct and behavior. Biddle and Thomas (1966) refer to
the "shoulds" and "oughts" that are internalized as norms,
while those that are overtly expressed are referred to as
role demands.

Role performance refers to relevant role behaviors
displayed by a person. The amount Of discrepancy between
role expectations and actual role performance is a source
of conflict especially when the role expectations are unclear,
when the individual has not had adequate experience and
:practice, or when the role is in the process of changing
(Thornton and Nardi 1975).

When the individual mother attempts to fulfill the

role expectations which surround a position and is unable to

26

perform the behaviors or exhibit the qualities needed to
meet her expectations, she will experience role strain
(Goode 1960). Goode p0sits that role strain is a normal
outgrowth of any role acquisition.

The process of new role acquisition as described by
Thornton and Nardi (1975) uses a developmental approach
containing both social and psychological dimensions. The
authors believe social adjustments, or the ability of the
individual to perform the role within the level of society's
expectations, and psychological adjustment, the "fit" between
the individual's expectations of self in the role and the
actual role performance, are necessary for comfortable role.
acquisition. Since there is a high degree of individuality
in any role enactment, these adjustments include a certain
amount of flexibility as the new role is taken on. Adapta-
tion occurs when the role and the person become inseparable.
Thornton and Nardi (1975) suggest that role acquisition
involves four basic stages: (1) the anticipatory stage,

(2) the formal stage, (3) the informal stage, and (4) the
personal stage.

Individuals first develop preconceptions from
observing others in the role or from the general socialization
process of the culture. Anticipatory and Formal Stage--
Once in the new role, formalized behaviors are enacted and

tested in the "real" situation. Informal Stage--Social

27

roles do allow for latitude in performance; therefore,

informal behavior with individual interpretation emerges
to provide the balance between formal and informal. As
the final process of adjustment, adaptation occurs
(Personal Stage). Although Thornton and Nardi's model
has not been directly investigated, this theoretical
approach lends itself to use in this study.

As previously mentioned, role strain increases
when individuals lack adequate experience and practice or
when the role is being redefined. The changing shape of
the family in America today places just such a burden on
the new mother. Kennedy's research (1976) supports this.
Kennedy studied 10 normal mother-infant couples during the
first two weeks of the postpartum period. She found
positive and negative responses to the acquaintance process.
The mother embarks on this process to discover what her baby
is actually like. Kennedy isolated 2 key factors involved
in the acquaintance process: (1) the mother's past life
experiences; (2) her capacity for human interaction.
Kennedy found that the mother who perceives her baby's
attitudes toward her as positive is inclined to feel positive
in return, continuing the acquaintance process. Through
observation and interaction she learns to enjoy her baby and

is comfortable with herself in the role of mother. Negative

28

feelings emerged in part because of inadequate experience
and role training. If Kennedy's findings are correct, the
mother's past life experience with role models and her
capability to communicate with others are important data
to obtain when planning health care for new mothers.

In summary, role theory provides a developmental
model for the maternal role acquisition process. Role theory
also provides a framework to identify the factors involved
in role strain. The next section of the literature review
will focus on family support and kin structure, and their

relationship to maternal role.

Family Support and Kin Structure

 

Because mother is such a central family role,
becoming a mother for the first time clearly involves the
family as individual members and as a group of role performers.

A century ago, the family unit was larger, often
physically close and multigenerational; being born, working,
playing, and dying together, drawing on each other's
strengths, offering support during times of stress, and
teaching the expected behaviors of the variety of roles with-
in the social unit, including "mothering." Due to this
structure, young girls had many opportunities to observe
mothering behavior and be actively involved with child care
activities with siblings. Assuming the mother role was a

social expectation, and during the postpartum period,

 

so
fa.
ea:
ecc
to

the

kin
prO‘
fine
nar:
wit}
atte
Suss
wor}
the

Poi:
the

(am

pars

29

education, support, and guidance from the females within
the family were available. If nursing was available,

it was provided in the home and supplemented much of the
actions already provided by close family members.

With the movement from an agrarian to an industrial
society, large families began to disperse and nuclear
families became "relatively isolated" (Parsons 1965). As
early as 1943, Parsons emphasized this residential and
economic isolation of the nuclear family. He believed it
to be a result of the geographic mobility brought about by
the demand of increased industrialization (Parsons 1943).

Sussman and Burchinal (1962) would argue that the
kin network is still a very active part of family life,
providing the exchange of services, gifts, advice, and
financial assistance. The controversy seems to be one of
narrowed vision. Parsons chose to contrast the contemporary
with the American family of the past, focusing particular
attention to how the nuclear unit has changed. However,
Sussman et a1. (1959) has evaluated the role kinship net-
works play in relation to the nuclear family and has chosen
the term "modified extended family." But as Gibson (1972)
points out, the criterion for the Sussman (1962) research is
the quantity of interaction between nuclear and extended
family members and not the quality of that interaction.

Parsons does not argue that the modern nuclear family is

30

"totally" isolated, only relatively so. "Of course, with
the independence, particularly the marriage of children,
relations to the family of orientation are by no means
broken. But separate residence, very often in a different
geographical community, and separate economic support
attenuate these relations" (Parsons and Bales 1955, p. 11).
Goode (1960) indicates that family members support each
other in the taking on of roles by providing "advice" and
"concern." The geographic and economic isolation Parsons
identifies clearly alters a family's ability to directly
support role acquisition and reduce role strain. Sussman's
"modified extended family" (1962) does not allow for such
qualitative changes in role support. The problem of mater-
nal role acquisition in Parsons' "isolated family" (1943)
becomes one of providing new supports to replace the
traditional support systems.

In summary, the acquisition of familial roles depends
upon the support provided by the family structure. Tradi-
tional family units provided intimate multigenerational
education and support. The contemporary American family is
less extended and more isolated, creating gaps in the
traditional structure, resulting in increased role strain
for new mothers. In the next section the literature review
will focus on nursing intervention in the maternal role

acquisition process, specifically the postpartum period.

31

Nursing Intervention in Maternal
Role Development

 

 

Child birthing practices have changed, with more
and more deliveries taking place in sterile hospitals,
separating the mother from a familiar and comfortable
environment, separating the mother and her infant, and
separating the mother from significant supporting family
members (Newman 1976). Nurses in the 1940-1950's took on
the appearance of baby care experts and often made the new
mother feel she was inadequate when caring for her baby
(Seiden 1976). Thus, the system sent her home from the
hospital to take on her new role without sufficient practice
or support. LeMasters (1957) reported, after conducting
semi-structured interviews with 46 couples between the
years 1953-1956, that 83% of the sample identified the
adjustment to the parental role as an extensive or severe
crisis. During the early adjustment period, LeMasters
found the mothers in the study to be chronically tired,
suffered feelings of social isolation, were concerned about
their body image (added weight, muscle tone), and felt
guilty because they were not better mothers. LeMasters'
study gives some content targets for nursing intervention.
Crisis, however, seems too narrow a term and denotes some
type of pathology when in fact the role strain in the
adjustment period is part of the normal transition in roles.

Because LeMasters' research did not incorporate as tight a

C0

he;

90:

32

research design as those who followed, and because crisis
is too limited in scope, this research design will not use
crisis as a term for adjustment, but rather view taking on
the new role as a developmental process (Hobbs 1965).

Hobbs (1965) concluded the beginning experience of
parenthood was a period of transition. His sample of 53
couples was selected at random from the public birth records,
and responded to an objectively scored check list of 23
items, using a five-point response scale: none, slight,
moderate, extensive, severe. Of the sample, 86.8% described
as a slight crisis the experience of becoming parents for
the first time. Mothers reported significantly greater
amounts of difficulty than did fathers. The check list
contained several useful items, including: physical tired-
ness and fatigue, interruptions of routine habits of sleeping,
going places, etc., worry about wife's personal appearance
in general, worry about wife's "loss of figure," and
doubting worth as a parent. When reviewing his results, Hobbs
found that couples having difficulty adjusting did not agree
upon the variables responsible. No one variable identified
seemed related to difficulty in adjusting to the first
child. Hobbs concluded that much remains to be done to
identify predictor variables which might differentiate
between persons with regard to the amount of difficulty

they will experience in taking on paternal roles.

33

Hobbs and Cole (1976) repeated the original study, receiving
65 responses to his questionnaire from couples selected at
random from county birth records. The findings confirmed
the original research.

Rossi (1968) views becoming a new parent as a
developmental phase in the life cycle; for American adults,
one where there is little support. Rossi's description
of the American family closely resembles Parsons' (1943).
"Our family system of isolated households, increasingly
distant from kinswomen to assist in mothering, requires that
new mothers shoulder total responsibility for the infant
precisely for that stage of the child's life when his need
for mothering is far in excess of the mother's need for the
child" (Rossi 1968, 3p. 27). Rossi theoriZed the phases
of the role transition involved in becoming a parent to
encompass the following: the anticipatory phase (the period
of pregnancy), the honeymoon phase (post-delivery period
of parent/child attachment), the plateau phase (the middle
period of the role cycle when the role is "fully exercised"),
and disengagement--termination phase--(the end of role
responsibility often seen as the marriage of the child).
Rossifis phases are global in scope; other role theorists
propose more specific phases that parallel Rossi's.. The
anticipatory, honeymoon, and plateau phases closely follow

the more indepth theory of role acquisition of Thornton and

Cs

ck

fo

34

Nardi (1975), proposing that within each of Rossi's phases
are repeated the four subphases, anticipatory, formal,
informal, and personal. Providing role support for the
"isolated new mother" will entail understanding these sub-
phases in order to devise nursing intervention strategies
appropriate to the particular moments or subphases the new
mother undergoes.

The works of Rossi (1968) and Thornton and Nardi
(1975) integrate nicely, providing a model for maternal
role acquisition that nursing can use to devise effective
support and education programs to fill the gap left by the
changing family structure.

Within Rossi's (1968) honeymoon phase, Thornton
and Nardi's (1975) subphases manifest themselves. Of
interest to this study is the initial period of mother-
child adjustment, Thornton and Nardi's transition between
formal and personal subphases.

Rubin has long been recognized as a scholar and
researcher in nursing who has acknowledged the importance
of role theory in understanding the adjustments made in the
family when a new member is added. Rubin's early work (1964,
1967) provides a background for the later identification of
specific factors which assist the mother in the acquisition
of the maternal role. Rubin (1964) defines a role as half
a relationship. "For each role there is a complimentary

reciprocal role" (p. 36), i.e., mother and child.

35

It is important that each member in the relationship identify
the other. This process allows each member to "assess the
personal implications of this new relationship in terms of
the scope and limitations of one's role. The new mother who
finds her baby so '1ittle and helpless' feels she should be
big, protective, and a pillar of strength and wisdom" (Rubin
1964, p. 37). New mothers then need to understand the
"nature of infant communication" (Rubin 1964, p. 38).

Rubin's statement is supported by the findings of
Robson and Moss (1970) who studied 54 primiparous mothers
in relation to their feelings of infant attachment. The
study included pre and postpartum interviews, tape recorded
18 hours long, and home observation from birth to 3 months
of life. They concluded that patterns of attachment are
determined by the interplay of maternal attitudes and
specific infant behaviors.

During the first 3 to 4 weeks at home, mothers were:
tired and insecure, focused energies on mastering the tasks
of infant care, fearful of injuring the babies by handling
them ineptly, and concerned with their inability to control
their infants' crying, food intake, and sleeping patterns.
The mothers were uneasy because they felt they could not
communicate with their babies.

Communication with the partner in the relationship

is essential. Because the infant often does not contribute

36

to the interaction in a way that the new mother understands
or expects, the relationship may be strained. "A one-way
relationship is difficult to bear" (Robson and Moss 1970).
Continuing to use role theory as a base, Rubin (1967)
conducted a research study to determine how the maternal
role was acquired. Five long term tracer subjects, primi-
paras, were interviewed in an unstructured style an average
of 23 times, while four long term tracer subjects, multi-
paras, were interviewed in an unstructured style an average
of 11 times, during their pregnancies and up to four weeks
postpartum. At the same time, 70 control subjects were
interviewed to provide cross-sections in time situations.
The sample came from 2 hospitals, drawing from both private
and university maternity services. The interviews were
conducted during the antepartum, either with office visits
or in the home, and in the hospital daily during the post-
partum stay. By not directing or structuring these interviews
Rubin gathered spontaneous responses to parental adjustment
inquiries. The data collected was classified in three
dimensions: (1) the self system, including the ideal image,
the self-image, and the body image; (2) the taking-in process;
and (3) role models. The results demonstrated a higher
frequency of role-taking statements by multigravidas than

primiparas.

37

The greatest number of statements made regarding
the self system by primiparas during the antepartum were
those related to the ideal image defined as "those qualities,
traits, attitudes, and achievements that each subject found
desirable for maternal behavior" (Rubin 1964, p. 240).
During the postpartum period the self-image, or the self
in the here and now, was of greatest concern. The taking-
in process encompassed five distinct operations: (1) mimicry,
(2) role playing, (3) fantasy, (4) introjection-projection—
rejection, and (5) griefwork. The end goal of the process
Rubin identified as identity or "I am the role." Selection
of role models tended to be gender and situation specific,
beginning with the subject's own mother and progressing to
peers. Primiparas tended to select peer models outside the
family. This research allows Rubin to further expand on her
theory regarding the need to identify the partner with whom
the anticipated role is to be enacted. She established that
the identification of the partner followed the same five
Operations of role taking, and the extent of role achieve-
ment was largely dependent on the extent of partner (infant)
identification.

Rubin's research identifies the individual process
of role taking. The focus is on the antepartum and only
briefly on the postpartum period (her contact with postpartum

subjects was limited to the time of hospital confinement).

38

In a paper dealing specifically with the postpartum period,
Rubin (1977) introduces "binding-in" as a term describing the
initial role development between mother and child. Binding-
in as a process "is active, intermittent and accumulative,
and occurs in progressive stages over a period of 12-15
months" (p. 67). This process begins during the pregnancy
itself with the perception of fetal movement. After delivery
the process accelerates, moving from a symbiotic relationship
to one of separate reciprocal roles, mother and child.
Maternal "binding-in" during the postpartum period
has three mutually dependent aspects: (1) polarization,
the psychological loosening of the infant from herself to
accepting the infant as an independent human being; (2)
identification of the infant in reality instead of fantasy;
(3) claiming of the infant by association with significant
others (i.e., the baby looks like Aunt Sue). Factors that
determine the length of time required to bind-in to the role
relationship are: (1) the mother's own recovery and state
of well-being; (2) the amount and kind of socially signifi-
cant support available; and (3) the endearing inputs of the
baby itself. Rubin (1964) believes nurses are viewed by
family members as knowledgeable resource people when the
family is trying on new role relationships, and therefore is
in an opportune position to influence the outcome of the

changing roles and family relationships.

39

Recognizing the transitional nature of role
acquisition and the "binding-in" process in maternal role
acquisition, this study will develop a complete intervention
program, implemented by nursing in the postpartum adjust-
ment period and designed to reduce role strain and ease
the postpartum adjustment necessary for new mothers.

To support nursing's role in this process, Brazelton,
drawing on his experience with infant and maternal attach-
ment, believes professionals can provide supports. "If we
can support parents to feel secure, and if we can then
support them in developing awareness of their baby's assets
as well as deficits, we should be able to play an important
role in starting them on the road to parenthood" (Brazelton
1976, p. 379). The postpartum period is a time when support
and concern are greatly needed. Benedek (1949) stated,

"The postpartum mother, for many reasons, has a regressive
tendency, and therefore has a great desire to be mothered"
(p. 644). It is through receiving love from others that she
is able to give to her child. Therefore, a key function for
nursing is to provide the support, concern, and guidance
needed either directly or through the identification of
support structures in the environment which could meet the
new mother's needs.

Researchers have recognized the importance of the
postpartum period, but have not tested intervention programs

for this period. Gordon and Gordon (1960) were able to

40

reduce the incidence of postpartum "emotional upsets" by
including two antepartum classes focusing on the psycho-
logical adaptation to motherhood. Control and experimental
groups of prenatal couples attended identical antepartum
classes conducted by the Public Health Service of the
community hospital. The experimental group participated

in an additional two 40-minute instruction periods on the
psychological and social adjustment of the postpartum period.
Some important points covered included: (1) The responsi-
bilities of being a mother are learned; therefore, ask for
help and advice; (2) get plenty of rest and sleep; (3) don't
give up outside interests. The experimental group did
significantly better than controls when their adjustment
was judged at six weeks and six months by the attending
obstetricians. This demonstrated that using anticipatory
guidance to facilitate role acquisition is a technique which
can be used to reduce role strain. However, this approach
is not the total answer. Gruis (1977) found, when question-
ing a total of 40 mothers one month after delivery, that
providing anticipatory guidance for the puerperium during,
the prenatal care may be convenient for health care. It ‘
should not be viewed as a "catch all" for areas of need.

The new mother needs to be provided some link with the

support structure of the health care system. Gruis

suggested (1) 2-week rather than 6-week checkup,

41

(2) 24-hour hotline linked to the hospital maternity
unit, (3) home visits by public health nurses.

In this study, Gruis identified the foremost concerns
of primiparas as: (1) return of figure to normal, which
Gruis sees as part of the accomplishment of the task of
physical restoration; (2) regulating family demands or
incorporation of the new member into the family system and
adjusting to the changes in life style that this requires;
(3) understanding infant behavior, encompassing the develop-
ment of a satisfying relationship between mother and infant.
Concern for physical care of the infant seemed minimal, and
the author reasoned this was due to the prenatal emphasis
given this area and postnatal classes in the hospital.

Cronenwett (1976), first looking at the effective-
ness of group support for childbearing families and ways of
coping with the experience, established a group designed to
help new parents during the postpartum adjustment period.
These support groups give information and advice, and provide
reassurance and support. While the Cronenwett experience
is limited, the results of the group are positive. The
group did indeed fill the need for support and education
felt by new parents. However, as Cronenwett (1976) points
out, several questions are still to be answered, "(1) For
what.segments of society are lay support groups effective?

(2) What factors contribute to the success or failure of

42

the groups? (3) Should groups be formulated on the basis
of a particular focus (e.g., cesarean section mothers)?
(4) When is the best time for initial formulation of the
group--during the antepartum period" (p. 187)? This
approach may be one way of dealing with the anxiety and
stress of new parents.

Various methods of nursing intervention to assist
in the alleviation of these role adjustment problems have
been proposed: the specific inclusion of postpartal concerns
into expectant parent curricula (Gordon and Gordon 1960);
nursing's continued involvement in teaching infant care
tasks; actively including exercise and diet regimens in
postpartum classes (Gruis 1977); establishing community
support groups (peer and professional) for encouragement
and assistance (Summer 1977).

For this study, a program to meet the new mother's
need for support and education included the following con-
cepts: the social self, infant communication, and role
performance, and was supported by the following research
Studies.

Perdue et al. (1977) stresses the importance of
maternal self-development. She points out that to focus
exclusively on the infant's growth and development does not

take into consideration the mother's progress as a person.

43

The task for the nurse, then, is one of anticipatory
guidance to help mothers identify areas where infant and
mother's needs may clash, and assist the mother to identify
strategies designed to reduce role strain. This can be
done by educating and supporting her as she assumes the
new role, providing her with a realistic picture of the
infant's needs, and her abilities and resources; helping
her to see that she need not lose her self-identity in

the mother role.

Brown and Hurlock (1977), while conducting a study
on the effectiveness of accepted methods on preparing the
breasts for breastfeeding in a sample of 60 mothers, with
contact every day in the hospital and every other day after
discharge for a total of 2 weeks from the day of delivery,
determined that new mothers need to be mothered themselves.
The researchers (all nurses or student nurses) felt comfort-
able providing the support and knowledge requested by‘the
sample. One recurrent question had to do with diet and
weight loss, demonstrating interest in body image. Corbeil
(1971) points out that the quality of the disturbance in a
changed body image is much more related to the individual's
perception of it than to the actual fact. This closely
parallels Rubin's (1967) thinking that a positive body image
is necessary; without it the mother risks role failure and

low self-esteem. The mothers in Brown's study expressed

44

concerns about the baby centering around the following
areas: crying, feeding, sleeping, stooling, and weight
gain. The need to provide a gender specific teacher to
instruct new mothers regarding mothering skills and to
provide her with emotional support was verified by the
mothers in the study, who almost always expressed gratitude
for the nursing service.

Kennedy (1973) stresses the need to teach new
mothers about infant communication and individualize to
assist the mother-infant identity process in a positive
manner. The importance of the infant's behavior in eliciting
positive or negative interpretations from the mother is now
being recognized. Kennedy found that mothers thought their
infants liked them if their babies nursed eagerly, cuddled,
smiled after feeding, listened to voices, quieted when
touched, and slept for long periods. Mothers felt their
babies did not like them if the infant refused to suck,
vomited, cried during or after feedings, turned away from
touch, resisted being held closely, or closed their mouths
firmly.

The findings of Adams (1963) conclude that a large
pOpulation of new mothers experience relatively inadequate
role behavior education. Adams studied the concerns of
40 primigravida mothers regarding their ability to provide
the care-taking needs of the infant. It was found that the

areas of concern ranked in the following order: feeding,

45

bathing, crying, care of the navel and/or circumcision.
One general finding of interest is that of her total sample,
only 25% had prior experience caring for a newborn.

Summer (1977) identified the need for support.
When conducting a study of phone call concerns of new
patients to health care facilities, found that while many
new mothers phoned to ask questions related to infant care
instruction, the real reason for the call seemed to be

validation of their ability to handle the problem.

Summary

Acquiring a new role inevitably involves some role
strain, especially during the transition periods between
anticipatory, formal, informal, and personal stages of role
development. Role studies indicate the value of intimate
role models and supports in the easing of role strain. The
maternal role is typical in this respect. The woman under-
goes anticipatory and formal socialization throughout her
childhood and up through delivery. .Birth clearly divides
these formal stages of role development from the informal
and personal stages. Traditionally, family structures have
provided the educational and psychological supports new
mothers needed to move comfortably into their new roles.

The increased isolation of the nuclear family has
necessarily weakened or even removed these traditional

supports. Given the importance of the mother-child

In

In

46

relationship to the overall health of the family, the
health care system can logically intervene and assist
new mothers to adapt and adjust to motherhood.

Currently, the health care system treats mothers
extensively during the antepartum and intrapartum periods.
If role and family theorists are correct, and role adjust-
ment involves informal and personal stages where support
and education ease adjustment, then the health care system
should continue intervention into the postpartum period.

Some programs now in existance identify considera-
tions and concerns valuable to new mothers. But these
programs tend to be selective and limited, focusing prima-
rily on teaching mothering skills. Only rarely do they
deal with helping the mother to feel positive about her
self or teach the mother infant communication skills neces-
sary for effective mother-child "binding-in."

This study proposes integrating these separate
concerns; the mother's social self, knowledge of infant
communication, and mothering skills into a nursing program
of education and support designed to supplement traditional

family role support.

CHAPTER IV

METHODOLOGY AND PROCEDURE

Overview

 

This research was designed to implement and test the
effect of a program of role socialization on new mothers in
the immediate postpartum period.

The program applied a nursing intervention in the
form of role socialization designed to facilitate acquisition
of the maternal role. The program involved the following
role concepts: social self, role language, and role perform-
ance as they applied to acquisition of the maternal role.

Using a two-stage screening process, a subject group
of pregnant women was selected from several large group
obstetric and gynecology practices located in an urban com-
munity with a population of approximately 200,000. The
majority of the client population for this study was white
and paid privately for their care. i

The primary data collection instruments for this study
were the Basic Data Profile, the Ideal Mother Index, and the
Self Mother Index. The research questions were formulated
based on a review of the literature and personal experience as

a practitioner. Data were collected from subjects prior

47

48

to labor and delivery, from the medical record, and three

weeks postpartum. The results were analyzed to determine

if a program of role socialization provided to new mothers
early in the postpartum could reduce the strain felt while
adapting to the maternal role.

A pilot study using eight patients was conducted
to test the procedure and the instruments. Revisions that
resulted from the pilot test included rewording several
items on the indices and refining program content to limit
interaction time and to standardize the program content.
After revisions were made, the study was conducted.

The purpose of this chapter is to present the
methodology and procedure used to provide an experimental
program of role socialization to new mothers. Included is
an outline of procedures and an explanation of how the
testing instruments were developed (for complete program

content and a c0py of the instruments used, see Appendices).

ngulation
The initial step in selecting the subjects was to
develop the following criteria for identifying subjects to
be included in the study.
(1) 38-42 weeks pregnant
(2) low-risk pregnancy identified by an absence of the

following:

(3)
(4)
(5)
(6)
(7)

(a)
(b)
(c)
(d)
(e)

(f)

(g)
(h)
(i)
(j)
(k)

49

chronic kidney disease

cancer of the cervix or uterus

diabetes

history of rheumatic fever

toxemia: 3+ proteinuria, edema of the face
and hands, dystolic blood pressure above 90
viral infections during the first 12 weeks
of pregnancy

heart disease

chronic hypertension

chronic respiratory disease

major endocrine disorder

psychiatric disorders

married at least one year before this pregnancy

This pregnancy is the first carried to term.

literate with the English language

verbalize a willingness to participate

unable to identify a sustained support individual

to assist her with assumptiOn of the maternal role

The researcher reviewed office records to identify possible

study participants who met the Stage I criteria.

This stage in the screening process included approxi-

mately twice as many subjects as the design of the proposed

study required, to allow for attrition due to an inability

to meet the criteria for continued participation.

50

Forty-two subjects were identified from the total
possible population of three private group office practices
of obstetricians. This group was obtained by review of
each office record of primiparas clients due to deliver
their first babies between February 20, 1978, and April 3,
1978. The office practices were large, each seeing a volume
of between 40-60 new obstetric clients each month. The
three were in different geographical locations of the
community, providing access to a cross-section of clients
from the outlying areas to the inner city. The community
had a large number of childbearing-age women who are re-
located here to use the educational setting of the state
college. Perhaps this added to the number of clients found
in this population who were separate from a sustained

support individual.

Data Collection Procedure

 

After 42 pregnant women were identified from the
records, the office nurse contacted each by phone, generally
introducing the study, requesting participation of the
subject, and asking questions to determine if she would

or would not have a sustained support individual1 to

 

1Sustained support individual defined as: a female
who is trusted and depended on for support and information
regarding infant care, and who will live in with the new
family for more than ten consecutive days, starting at the
time of hospital discharge (or within the first week) and
extending through the first six weeks postpartum.

51

assist her with assumption of the maternal role. Any woman
with access to such a support person was not included in the
research sample. The office nurse made the initial contact
for two reasons. First, it was believed that if the office
supported the study, the client would be more apt to become
involved and perceive the interaction as positive. Secondly,
providing a neutral party to obtain consent, the client
would feel free to refuse without threat or pressure. The
nurse allowed questions and assured the individual she did
not have to agree to be part of the research group. All
42 identified subjects were asked to participate in the
study. Twenty-seven agreed. Upon consent, the name of each
client, having met Stage I criteria, was given to the
researcher and the criteria form (see Appendisz) was begun
for each study subject. This information (consent form,
Basic Data Profile, and Ideal Mbther Index) was filed by the
researcher until the subject delivered. Because the program
was designed to be implemented in the postpartum, no further
contact with any of the subjects was made until after
delivery.

The researcher checked the delivery records of the
local hospital daily to ascertain when each subject delivered.
Continued participation in the study was dependent on

meeting the Stage II criteria:

(1)

(2)

(3)
(4)

(5)
(6)
(7)

52

Completes an uncomplicated labor and delivery
course.
Uncomplicated defined as:
(a) labor not to exceed 24 hours (Pritchard and
Hellman 1971, p. 396)
(b) a vaginal delivery which may be assisted
by low forceps, episiotomy, analgesia, and
anesthesia
Infant Apgar scores of 6 or above at birth, 1 and
5 minutes
Physical exam findings on the infant are normal.
Physician's statement of mother's health is
satisfactory.
Satisfactory defined as: hemoglobin level greater
than 10 gm. Delivery blood loss of less than 500 cc.
Infant admitted to term nursery.
Infant discharged with mother.

Expresses a willingness to continue in the study.

These criteria were selected based.on the literature as being

within normal limits of pregnancy outcome for mothers and

indicative of a normal adaptation pattern for the newborn.

Group assignment (socialization program and non-

socialization program) was alternated depending on the order

of delivery. The first subject to meet the criteria for

continued participation was assigned to the program group,

PE

q:

in

on

re:
CO]
the

dis

was

firm

53

the second such subject was assigned to the non-program
group, until there were 10 in the program group and 10 in
the non-program group and all of the original sample had
delivered.

Both groups were exposed to the same in-hospital
postpartum course. They had the opportunity to attend
classes taught by a registered nurse covering the following
topics: "Infant Care"--how to bathe and diaper; "Infant
Feeding"--including both breast and bottle feedings;
"Parenting"--discussion and film centered around concerns
parents have about being adequate; "Birth Control"--methods
and reliability. Each had an equal opportunity to ask
questions and practice infant care and feeding.

During the hospital stay, all subjects were contacted
in person by the researcher. This face-to-face interaction
on the maternity unit occurred during the first or second
day postpartum. After a brief statement to the subject
regarding her group assignment, for the non-program group
contact would be made at the three-week follow-up, and for
the program group contact would be made on the day of
discharge.

For each subject in the program group an appointment
was made by the researcher, at the subject's convenience, for
a meeting in her home during the afternoon or evening of the

day of hospital discharge. The purpose of this appointment

54

was to provide a program of role socialization to the new
mother. This could be done with or without family or
friends present. This contact required no less than 60
minutes or more than 90 minutes.

The day of discharge was selected for program
intervention because the researcher felt that it was at
this critical point when the formal role behaviors would
clash with the informal. A pilot test of the program indi-
cated that 90 minutes was sufficient to present the program
and still provide the new mother the opportunity to ask
particular questions or address concerns not included in the
program.

The program of role socialization began with an
overview. This nursing intervention was designed to help
new mothers become comfortable with their role by providing
information to help them understand themselves and their
babies, develOp confidence in their maternal role (i.e.,
diapering, bathing, understanding baby language), skills,
and satisfaction with their abilities as mothers. Next, the
researcher proceeded with a discussion designed to foster
a positive social self and body image. It was necessary
to discuss social self and body image because ego strength
is weak during the early postpartum period (Benedek 1949),
and mothers traditionally are dismayed over the changes
their bodies have undergone. Rubin (1967) found every

change in body image to be significant. "Loss of

55

functional control lowers self-esteem and raises the risk
of role failure. When the pregnancy is terminated, all
vestigial traces in body and clothing must be abandoned
quickly" (p. 240). Open-ended questions which were
exploratory, clarifying statements, and active listening
were employed by the researcher to gain an understanding
of the mother's view of self in the new role. The researcher
then selected the appropriate anticipatory guidance and
support information necessary to improve the subject's
social self-image.

Following social self concept, the researcher
introduced the concept of mother/infant role language.
This allowed the new mother the opportunity to become aware
of how her infant communicates with his environment and how
her care can enhance emotional and physical development.
Since the baby and mother are active participants, the
emphasis here was on the reciprocal nature of the social
interaction. This understanding allowed the Opportunity for
positive feedback during the early weeks of their relation-
ship before the infant responds with the expected social
language.

Discussion of comfort with role performance and
learning role behaviors, or the skills necessary to care for
baby, were individualized, allowing time for demonstration,

practice, and further clarification of mothering skills.

56

These skills included diapering, bathing, formula preparation,
breast care, circumcision care, and various caring and
holding techniques which provide support and stimulation,
i.e., football, sling, papoose, infant seat, dressing skills,
and comforting measures. Emphasis was placed on the fact
that mothering is a learned skill, one that takes time and
practice to acquire. Finally, this stage included some
anticipatory guidance related to the changes the new baby
will bring to the mother's life style such as altered family
pattern, changes in the husband and wife relationship, and
ways she might adapt to lessen the stress and more comfort-
ably assume the new role. The freedom to change and modify
the role to "fit" the individual was discussed as formal
behaviors contrasted with the informal. Each subject in the
program group was given a packet of material that was
developed to reinforce these concepts and to be used as
reference. At this time, appointments for three-week follow-
up visits for the program subjects were made.

Evaluation of the impact of this program consisted of
all subjects repeating the Ideal Mother Index and completing
the Self Mother Index questionnaire 3 weeks postpartum.

This time window was selected because it was believed that
role strain would be at its peak at this point; any later
and some adjustment occurs (Caplan 1959; Aquilera and

Messick 1974).

57

Methodology of the Study

 

The experimental design of this study used a small
sample t test to identify differences between the program
and non-program groups, because the total sample did not
exceed thirty.

The t test is based on the following assumptions:

(1) random assignments of the sample, (2) normal distribution
of the characteristics in the population, (3) equality of
population variance with an equal u in each group. Assign-
ment of the sample to the program or non-program group does
not conform to the strict definition of the random assignment
of the first assumption. However, because the procedure can
be defined to be a series of random samples of one, because
of the measurement scale used, and because of the robustness
of the technique with respect to the other two assumptions,
the t test is the most appropriate measure of statistical
analysis.

Hypotheses were developed to address questions about
the differences in role strain between the program and non-
program group, in addition to questions about the components
of role strain that were measured by particular items on
the Self Mother Index.

The alpha level for the t test was set at .10 because
of the nature of the study (testing a program) and because
the chance of a type one error (rejecting a true null) is

not potentially harmful to the research subject.

58

In addition, a second part of the study was to
address the question of the difference between pre-Ideal
Mother Index scores and post-Ideal Mother Index scores in
the program group. In this hypothesis using a difference
score, two assumptions were made: (1) random selection of
paired observations (scores), and (2) normality of differ-
ences in the sample. The t test was again selected as

the appropriate measure of statistical analysis.

Instruments

 

The following section will deal with the development
of data collection instruments, instrument pre-testing and
scoring procedures (see Appendix E).

The initial content for the ideal self index was
suggested to this researcher by Deborah Tanzer (1967), while
the scales, administration, and scores were developed from
the techniques of Elsie Broussard (1971).

The instrument was developed by the researcher after
it was determined that none existed. One study that used
the self/ideal difference as a measure of self-image adminis-
tered one month after delivery was conducted by Tanzer in a
study regarding natural childbirth. The instrument itself
was not available for this researcher to peruse; however,

a phone conversation with Tanzer (Summer 1978) was helpful
in providing understanding regarding procedures for devel-

oping such an instrument.

59

Broussard (1971), investigating maternal perception
of the first born, used a neonatal perception inventory
which asked the mother (on the first or second day post-
partum) to describe the average baby and then to describe
her own baby on a six-item inventory scored on a five-
point scale. The mothers repeated the two inventories when
the infant was four weeks of age. The scoring was of
particular interest to this researcher. Each item added to
total an "average baby score" and "your baby score"; the
two were then subtracted to determine the discrepancy score.

In preparing the research instrument, a list of 25
ideal qualities and actions was generated from the literature;
pregnant and newly delivered women were asked to rank the
qualities and actions in order of importance. In addition to
these rankings, the women were asked to generate response to
the following open-ended statements:

"A mother is ."

 

"A mother does ."

 

No limit was placed on the number of responses a woman could
list. Seven individuals completed the task, 4 who had yet
to deliver and 3 second day postpartum mothers. Using the
responses of these subjects, a new list was developed using
the top ten ranked statements plus ten suggestions offered
by the subjects. The new instrument had only 20 items,
asking the subject to rank the statement, connect with

lines those they saw as the same, and fill in the blanks.

60

"A mother is .

 

"A mother does ."

 

These suggestions were pooled to avoid duplicates
and added to the list of 20, while the statements which
were consistently unranked were deleted from the total.
This new instrument was submitted to 12 additional subjects
who identified no new qualities or actions.

To pre-test the refined instrument, it was given to
eight subjects who met the prOposed research criteria on
their second day postpartum. The Ideal Mother Index was
completed first, taken from the subject, and then the Self
Mother Index was completed. A period of 8-22 hours elapsed
before each subject again responded to the questionnaire.
The test re-test correlations for the Ideal Mother Index and
the Self Mother Index were r = .858 and r = .823, respec-
tively. These correlations are sensitive to sizes of the
sample, but were acceptable for this study. Each of the
eight subjects, after completing the questionnaires, were
asked if there were any statements which were unclear, and
if the directions were understandable.

A few editorial changes were made to take the
suggestions into account. One new statement was added to
even the number of statements for each variable, and the
Self Mother Index was rephrased to refer directly to the

subject as "I."

61

The scoring procedure was as follows: Role strain,
the dependent variable, was the difference between the
post-ideal mother score and the self mother score at the
three-week follow-up. The Self Mother Index was designed
to allow the researcher to score each of the three sub-
concepts, i.e., social self, role language, and role perform-
ance (see Appendix I for complete scoring instructions).

The pre and post-ideal scores of the program group
were evaluated for differences to determine if the ideal
model was changed 3 weeks after assuming the role. By
subtracting the pre-ideal from the post-ideal score of each
individual a mean and variance of the difference scores was

then calculated and a t score computed.

Socialization Program

 

The program consisted of the content found in
Appendix G. The concepts presented were the social self,
role language, and role behavior. After a brief intro-
duction, the order of the presentation was determined by the
subject. The discussion of social self dealt with body
image, feelings about role changes, with anticipatory guid-
ance and nursing intervention designed to foster positive
feelings about self. The program provided information
regarding infant communication which could help the new
mother understand more fully infant behavior. The "hows" of

caretaking skills or role performances were reviewed and

62

each mother was given an opportunity to ask questions, have
techniques demonstrated, or practice a particular skill
with which she felt uncomfortable. Briefly, the main areas
of caretaking skills identified in the literature were
reviewed for each mother. To ensure all areas were covered,
an instruction sheet (see Appendix H) was completed by the
researcher on each program subject.

To ensure human subject protection (see Appendix A),
careful consideration was given to the selection of subjects,
the design of the study, and the manner in which the data was
displayed. Written permission was obtained from each

subject.

CHAPTER V
DATA PRESENTATION AND ANALYSIS

Overview

In this chapter, findings based on the interaction
with the new mothers and data collected from the 20 subjects
included in the study will be presented. The presentation
of the findings will be divided into: (1) descriptive
information of the study population, (2) descriptive
information relative to the program and non-program groups,
and (3) data presentation for each of the hypotheses.

Descriptive Information of the
Studnyopulation

 

 

A total of 42 subjects who met Stage I criteria

was identified. Fifteen of that number, when contacted by
the office staff, preferred not to participate in the study.
Nine of the fifteen were already involved in another study,
and six had other reasons for opting not to become research
subjects. The remaining 27 comprised the original study
group. One subject was lost to the study because she deliv-
ered before the pre-delivery Basic Data Profile and pre-
Ideal Mother Index could be administered. Another subject
was lost because she developed toxemia prior to delivery.

Four subjects were omitted because they were delivered by

63

 

64

cesarean section. One subject was deleted from the study
because her infant was born with multiple anomalies. The
final sample consisted of 20 subjects, 10 in the program

group and 10 in the non-program group.

Non-Program Group Description

 

The Basic Data Profile revealed the following
descriptive information about the non-program group. The
mean age was 25.9 years, with ranges from 22-34 years.

The average number of years married for this group was

2.6, with a range of l-4.5. The mean for the item related
to adequacy of experience caring for infants was 2.7 (on

a 4-point scale). The mean for the item related to feelings
of adequacy in observing care of infants was 2.9 (on a
4-point scale). The group rated their mothers' performance
as a role model more satisfactory than unsatisfactory, with
a mean of 3.6. Subjects in the non-program group had an
average length of labor of 13.1 hours, with a range of

8-20 hours. The second day postpartum hemoglobin values
averaged 12.1 and ranged from 10.6-13.4. Eight of the ten
pregnancies in this group were planned by the couple. Nine
of the ten subjects attended prenatal education classes in
the area. A summary of the descriptive data for the non-

program group appears in Table l.

65

TABLE 1

DESCRIPTIVE DATA FOR PROGRAM AND
NON-PROGRAM GROUPS

 

 

 

 

 

 

N=10 ‘ N=10
Program Group Non-Program Group

Descriptive Item Range 'i Range 'i
Age 22-29 25.1 22-34 25.9
Years married 1.5-5.5 3.2 1-4.5 2.6
Length of labor 6.5-23 13.9 8-20 13.1
Hemoglobin 2nd

day postpartum 10.8-13.4 .12.3 10.6-13.4 12.1
Experience caring

for infants

(scale: inade-

quate l -

adequate 4) 1-4 2.2 1-4 2.7

Experience observ-
in care 0
in ants (scale:
inadequate l -
adequate 4) 1-4 2.6 2-4 2.9

Mother's perform-
ance as a role
model (scale:
satisfactory 1-
unsatisfactory
4) 3-4 3.8 2-4 3.6

 

Prenatal classes 10 9

Separation from
infant 9 3

Planned preg-
nancy 9 8

 

 

 

66

Program Grouprescription

 

The Basic Data Profile provides the following
information for the program group. The mean age was 25.1
years with ranges from 22-29. The subjects had been married
an average of 3.2 years with a range of 1.5-5.5. In addi-
tion, the data profile provided information dealing with
adequacy of past experience caring for and observing care
of infants. The means of these measures were 2.2 and 2.6,
respectively. On the item designed to evaluate the subjects'
satisfaction with their mother's performance as a role model,
the mean was 3.8. Data obtained from the hospital record
during the intrapartum identified the average length of
labor for the program group to be 13.9 hours with a range
of 6.5-23 hours. On the second day postpartum the hemoglobin
level for program mothers was 12.3 with a range within the
group of 10.8-13.4. Nine of the ten pregnancies for this
group were planned by the couple. All subjects in this
group attended prenatal education classes. A summary of
the descriptive data for the program group appears in
Table 1.

Descriptive Information Relative to
the Program and Non-progpam Groups

 

 

The program was provided in the subject's home on
the day of discharge from the hospital at a time convenient

for the new mother. Only two of the subjects were alone

67

with their babies during the program presentation. Five

of the sample had their husbands present and they were
included in the discussion of program content. One subject
had her mother with her and another had her mother-in-law
present. The last subject was at home with her baby and

her father-in-law who played with the baby during the
program and did not enter into the discussion. The program
length ranged from 60-90 minutes with an average of 81.5
minutes. After an introduction, an overview of the program
was provided by the researcher, and the mother then directed
the program. Six subjects selected the content related to
the social self to be first. Four subjects selected role
language and the areas related to infant communication first.
Role performance or skills was not addressed by any subject
first. The program subjects were instructed not to contact
the researcher during the three-week interval before the
second set of criteria was collected.

When the program group was asked the open-ended
question at the three-week follow-up visit, "What about the
program was most helpful?" one respondent identified the
information concerning mothering skills, four identified the
added information about infant communication, and five
identified the material related to social self.

Both groups were asked the question "What questions

have you had since you came home from the hospital related

 

tc
mc
hc
we
Po
an
we
by
f0.

al:

in.
Of]

”Tia:

68

to yourself or your baby?" In the program group, six
mothers identified infant care concerns (i.e., bathing,
how to know when baby is sick, feeding, normals for infant
weight gain, understanding crying) as areas for questions.
Four mothers had concerns dealing with their own health
and body functions (i.e., lochia, chronic fatigue, minimal
weight loss, breast care). The sources of help identified

by these mothers to answer questions and provide information

T.1_Mmm

for their concerns were: four of the ten asked profession-
als (doctors and nurses), three asked family members, and
the remaining three turned to friends.

The non-program group had questions dealing with the
same concerns. Four mothers raised questions related to
caretaking skills (i.e., infant sleep patterns, feeding
schedules, and infant skin care). Three mothers expressed
concerns about their own bodily functions and unhappiness
related to their view of themselves in other roles (i.e.,
wife, job, friend). The remaining three had questions
regarding the infant's crying, behavior, and infant person-
ality factors. The non-program group also asked help of
family, friends, and professionals. However, two subjects
in the non-program group were unable to identify a source
of help. Consequently, their questions had remained

unanswered.

[-t-

huu

69

At the three-week follow-up visit when the mothers
were asked if they had left their babies with others for
at least 1 hour, nine of the ten subjects in the program
group had separated, while only three of the non-program
group had.

Data Presentation for Each of
the Hypotheses

 

 

As indicated in Chapter IV, hypotheses were developed
to compare scores of the program and non-program groups
(see Appendix J for the null and alternative hypotheses for
statistical analysis) of the study. The results of this
analysis demonstrate impact of the program of role sociali-
zation on role strain and its component parts social self,
role language, and role performance. The formulas for this
analysis (see Appendix J) computed means and variances,
becoming the information that was used to calculate (l) a
pooled variance, and (2) a t score. The remainder of this
section will address each hypothesis, present the research
findings, and state an acceptance or rejection of the null

hypothesis based on the statistical evidence.

Presentation of Hypotheses

 

Hypothesis 1: New mothers who receive a program of role
socialization during the informal stage of role acquisition
will not have significantly lower scores on a measure of

role strain than those mothers who did not receive the

pr

th«

1m

Vi:

Wag

rar

aCc

Sta

and

yd:
flue
huu

will

OfI

70

program. The role strain raw score was the difference
between the self and the ideal index at the three-week
follow-up visit. The range for the program group was 0-13
with a mean of 5.3. The non-program group range was 0-37
with a mean of 10.8. This hypothesis is rejected because
there is statistical significance with a critical t = -l.59

(see Tables 2 and 3).

Hypothesis 1A: New mothers who receive a program of role
socialization during the informal stage of role acquisition
will not have significantly different scores on a measure

of social self than those mothers who did not receive the

 

program. The social self score was obtained by scoring

the seven items which define social self on the Self Mother
Index which was administered at the three-week follow-up
visit. Seven items covered this concept and a scoring total
of 42 points was possible. The range for the program group
was 34-42 with a mean of 38.2. The non-program group had a
range of 32-41 with a mean of 37.6. This hypothesis is
accepted since the calculated t, .467, demonstrated no
statistical significance at a .1 alpha level (see Tables 2

and 3).

Hypothesis 18: New mothers who receive a program of role
socialization during the informal stage of role acquisition
will not have significantly different scores on a measure

of role language than those mothers who did not receive the

 

71

TABLE 2

SUMMARY

 

 

Variable

Program Group

Non-Program Group

 

Hypothesis 1:
role strain

 

 

 

 

 

 

 

i 5.3 10.8
$2 22.9 97.51
32 = 60.21
P
t = -1.59
Hypothesis 1A:
social self
2 38.2 37.6
$2 9.29 7.16
52 = 8.23
P
t = .467
Hypothesis 1B:
role language
2' 37.5 37.9
$2 4.5 16.54
$2 = 10.52
P
t = -.276
Hypothesis 1C:
rolepperformance
i 38.9 37.2
$2 6.32 12.84
52 = 9.58
P
t = 1.23

 

Hypothesis 2:
ideal score

d = .3
S = 3.9

 

2
d

 

.482

 

 

72

TABLE 3

SUMMARY OF STATISTICAL TESTS

 

 

Decision Regarding

 

 

Hypotheses Calculated t the Null Hypotheses
1 : Role strain -l.59 reject
1A: Social self .467 accept
1B: Role language -.276 accept
1C: Role performance 1.23 accept
2 : Difference pre
and post-ideal
scores .482 accept

 

 

 

73

program. The role language score was obtained in the same
manner as the social self. The range for the program group
was 35-40 with a mean of 37.5. The non-program group had a
range of 27-40 with a mean of 37.9. This hypothesis is
accepted. The calculated t score = -.276, showing no
statistical significance at a .1 alpha level (see Tables 2

and 3).

Hypothesis 10: New mothers who receive a program of role
socialization during the informal stage of role acquisition
will not have significantly different scores on a measure

of role performance than those mothers who did not receive

 

the program. The role performance score was calculated
in the same manner as social self and role language. The
program group scores range was 34-41 with a mean of 38.9.
The non-program group range was 28-41 with a mean of 37.2.
This hypothesis was accepted with the t = 1.23 below the
point of significance with a .1 alpha level (see Tables 2

and 3).

Hypothesis 2: There is no significant difference between
the pre and post-test scores of the Ideal Mother Index for
new mothers who received a program of role socialization
during the informal stage of role acquisition.

The raw data showed a range of difference scores

from 0-4 points. Four of the ten subjects received identical

74

scores on both the pre and post-test. The value of the t
test of difference scores was .482. Therefore, the hypothe-
sis was accepted (see Tables 2 and 3).

In this chapter, data was presented relative to
each research hypothesis. The general characteristics of
the study groups were presented. Discussion of the findings,
conclusions, and recommendations for future study will be

presented in Chapter VI.

CHAPTER VI

SUMMARY OF FINDINGS

The purpose of this study was to design and
implement a role socialization program for new mothers during
the informal stage of maternal role acquisition in an attempt
to determine if the program would reduce role strain. The
model and design used are displayed in Figure 2 (p. 23) and

in Appendix C. Specifically, the hypotheses were:

Hypothesis 1: New mothers who receive a program of role
socialization during the informal stage of role acquisition
will not have significantly lower scores on a measure of
role strain than those mothers who did not receive the

program.

A. New mothers who receive a program of role socialization
during the informal stage of role acquisition will not have

significantly different scores on a measure of social self

 

than those mothers who did not receive the program.

B. New mothers who receive a program of role socialization
during the informal stage of role acquisition will not have

significantly different scores on a measure of role language

 

than those mothers who did not receive the program.

75

76

C. New mothers who receive a program of role socialization
during the informal stage of role acquisition will not have

significantly different scores on a measure of role perform-

 

.ance than those mothers who did_not receive the program.

Hypothesis 2: There is no significant difference between
pre and post-test scores of the Ideal Mother Index for new
mothers who received a program of role socialization during

the informal stage of role acquisition.

Summary of Inferential Findings

 

Hypothesis 1: The evidence supports the hypothesis that

role strain exists for new mothers and that a program of

role socialization can be one way of reducing that strain.
New mothers who received a program of role socialization did
have lower scores on role strain measure; the data identified
a significance at the .1 alpha level. These findings suggest
the impact of the program was consistent with the theoretical

base of the study.

Hypothesis 1A: New mothers who received the program of role
socialization did not have a significantly different score

on the component of social self.

 

Hypothesis 18: New mothers who received the program of role
socialization did not respond significantly different on

role language items.

 

77

Hypothesis 10: New mothers who received the program of role
socialization did not demonstrate statistical significance

on items related to the concept of role performance.

 

However, it was the closest of the program components to

reach a statistically critical level.

Hypothesis 2: There was no significant difference on
different scores on pre and post-Ideal Mbther Index for the
program group, indicating a relatively stable ideal mother

image.

In summary, role strain exists for new mothers,
and a program of role socialization focusing on social self,
role language, and role performance, and administered by
nurses, reduces that strain. Means were very close. Of the
three program components, role performance seemed most
important to the subjects in the sample, indicating that
traditional emphasis in this area is valuable and effective.
The ideal mother image appears relatively stable, supporting

theoretical discussions.

Other Findings

 

Comparison of the two groups revealed that the
program group had a lower mean on both items dealing with
past experience with infants than did the non-program group
(see Table 1). Despite this practice and exposure disadvan-

tage, the program group rated their mother's role model

78

performances slightly more satisfactory (see Table 1). This
may have contributed to their decreased role strain. The
program group was slightly younger and had been married
longer than the non-program group. Having been married
longer, the mothers of the program group may have moved into
the new role more comfortably due to the fact that they had
already had time to adjust to the role of wife. Nine of the
ten pregnancies in the program group were planned by the
couples, while eight of the ten pregnancies in the non-
program group were planned. This information suggests that
if role strain is identified in a group where the pregnancies
were planned, how "strained" are pregnancies which are not
planned? The sample of three was too small to draw any
conclusions.

The average lengths of labor for both groups were
similar, as were hemoglobin levels. Only one of the couples
of the entire sample of 20 had not attended prenatal
classes.

The evidence of reduced role strain in the program
group is significant, and lends support to further research
on the effect of a nursing intervention program to facilitate
role acquisition and reduce role strain. A discussion of
some additional information regarding program components is

needed.

 

79

Social self means were very close, but the items
designed to test for this may not have been sensitive enough
to reveal the wide variation in group behavior. For example,
the item designed to test physical separation from the baby:
"A mother is also a woman separate from her baby," did not
discriminate well if means are evaluated. The non-program
group mean was 5.2, or slightly past moderately comfortable,
while the program group mean was 5.9, or just below very
comfortable. But the individual groups demonstrated a
much greater difference, with 9 subjects of the program group
leaving their babies with others for fairly long periods
(one hour or more), and only 3 of the non-program group
completing this task. These findings suggest that social
self, especially the distinction between the roles of mother
and woman, is an important program component, but the instru-
ments must be refined or further tested.

The role language component of the role socialization
program produced conflicting results: mothers agreed it was
a helpful component; but mothers exhibited increased dis-
comfort over communication performance. Were mothers in the
program overloaded with new information? Did they become so
aware of how the baby interacted in the role set that their
level of frustration and discomfort,re1ated to meeting demands
placed on them by the new baby, only increased as they

strived harder to provide positive communication?

(n

[EU

1e
85
mi

CU

80

The hypothesis for role performance approached the
critical level. The concerns the program mothers identified
closely paralleled Robson and Moss's findings (1970).
Careful evaluation of this result suggests that actual
caretaking skills are necessary to fill role requirements
immediately. Role performances can be seen and evaluated by
significant others whose feelings the mother respects in
judging herself. Perhaps the need to be successful at
these skills is so primary that this is what the new mother
heard and remembered during the program, even though the
content was not covered first. Since this is the area for
the hospital postpartum classes, mothers might be more
sensitized to role performance.

The findings relative to Hypothesis 2 support
theoretical discussions of ideal roles; they appear before
pregnancy, and, as ideals, undergo little change themselves,
instead forming a standard against which the new mother

measures her performance.

Recommendations

 

To further clarify and validate the findings of this
study, questions will need re-investigation using a much
larger sample population. Testing the hypotheses using a
sample of all cesarean section clients, or multigravids
might further define the questions and help to plan changed

curricula for the program. Additional testing of large

 

81

samples not confined to narrow geographic, national, or
socioeconomic groups or obstetricians should provide data
from which generalizations might be drawn. Certainly it
is evident that one encounter for implementation of the
program is not adequate to meet the needs of new mothers.
Some of the content could be incorporated into antepartum
classes. More than one encounter should be planned for
the postpartum period. Only further research can indicate
how many contacts will be needed, and whether contacts
need to be face to face, phone, group, or one to one.

One point was made very evident while conducting
this study: fathers need help also. The volume of litera-
ture deals only with the mother-child relationship. Clearly
motherhood and fatherhood are complimentary roles (hence
the growing interest in parenting research and education).
Paternal role acquisition involves role strain and obviously
affects maternal role acquisition. Only further research
can pinpoint effective components of a role socialization
program for fathers. How much do couples support each other?
Does the father need a role model? What information and
support can nursing provide new fathers? Husbands whose
wives were involved in this study's program group indicated
interest in information about infant communication. They
also remained during discussions of social self and role

performance, suggesting their interest in these components.

 

 

61
11
ma
an

ma

re

81

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DE

la

IC

(1}

31
PI
CE
at
te

ir.

82

Given the complimentary nature of parental roles, it is
likely that fathers would benefit from much of the same
material that new mothers need, and new mothers need some
anticipatory guidance about the role strain new fathers
may experience.

Since the program group requested information
related to social self, support is provided for this content
area to remain in the program. Incorporating the role
language concept much earlier in the role acquisition
process seems appropriate with only review and demonstration
necessary during the postpartum period. Comfort with role
language is important, however; new mothers did identify it
(regardless of increased discomfort) as the second most
helpful component of the role socialization program. It
appears that a mother needs an opportunity to learn about
role language before actually assuming the role.

If repeated, this study needs to be carried further
than 3 weeks into the postpartum period. Role performance
is an important issue at 3 weeks postpartum. This study
supports its inclusion in any postpartum intervention
program. The possibility exists that social self or communi-
cation with the role partner would assume greater importance
‘at six or nine weeks as comfort is achieved with the
technical skills (role performance) necessary to meet the

infant care needs.

83

Other uses for the instruments by nursing need to
be explored. Perhaps using the Ideal Mbther Index as an
assessment tool during the antepartum would provide
information to direct the focus of teaching and individual
anticipatory guidance.

It is recommended by this researcher to better
control and/or monitor the assistance or help provided new
mothers by others during the time covered in the study.
Further research should collect additional information about
specific support when it was obtained, what it was about,
and how it was obtained. Researchers could gather this
information by phone, during home or office visits, or by
asking participants to keep a diary of questions asked of
other people. Evaluating both quantitative and qualitative
assistance may also provide further insight into the ques-
tions, problems, and intervention necessary to reduce role
strain.

This program could be incorporated into the present
system with little expense, except the initial outlay for
teaching nursing staff the content. This could be done by
several staff continuing education units. By using this
existing health care structure and staff, cost is not
increased. The existing support systems such as prenatal
education could also be used for_sections of the program.

Nursing staff is available 24 hours a day at local hospitals.

84

A worried or anxious mother would be greatly relieved at

2 a.m. if she could address her questions to a knowledgeable
support individual. Providing additional information on
areas included in this program at postpartum visits to
physicians' offices might also support new mothers and

facilitate maternal role acquisition.

Conclusions

 

l. Primiparas post normal vaginal deliveries experienced
less role strain during the early postpartum period after
receiving a program of role socialization. This finding is
compatible with theories on role strain and is enough
evidence to support the need for further exploration and
research into the use of the proposed role socialization

program.

2. The findings related to the ideal self evaluation
provided additional research support, and are compatible
with role theories which address the stability of the ideal
self.

3. Following the lead of nursing theorists such as Orem,
nurses in their capacity as client educators and counselors
occupy an ideal position to present programs to facilitate
self care. The hypotheses related to the three concepts:
social self, role language, and role performance, though
accepted, require closer examination to better understand

the impact of each on adaptation of the maternal role.

 

 

APPENDICES

APPENDIX A

PROCEDURES TO BE USED IN THE PROJECT TO OBTAIN
CONSENT AND TO SAFEGUARD THE RIGHTS AND

WELFARE OF RESPONDENTS

Procedures to be Used in the Project to Obtain Consent and
to Safeguard the Rights and Welfare of Respondents

 

 

Potential Risks to Sample: There are no physical risks

 

involved in the study, and at any point the subjects are

free to withdraw from the study.

Consent Procedures: (copy enclosed) Participation in the

 

study is voluntary. Verbal consent is obtained by the
office staff rather than the researcher to allow more free-
dom for the subject to ask questions and refuse if so

desired.

Protecting Respondents: The identity and responses of all

 

subjects will remain confidential. Never will the subject's
name be associated in discussion or displayed with data.
The subjects will be assigned a letter (i.e., "A" in the

non-program group, or "AA" in the program group).

Potential Benefits of the Study: The information will
provide nursing with better understanding of how to help

mothers with their adjustment to the new role.

Study Instruments: (copy enclosed) Each have been carefully

 

prepared using both literature and client input. Several
members of the review committee have had active input in

instrument development and have critiqued each periodically.

85

APPENDIX B

INVESTIGATOR'S STATEMENT

AND SUBJECT'S STATEMENT

Michigan State University
School of Nursing
For: Master' 3 Thesis

Investigator's Statement:

This research study involves completing a questionnaire now
(time involved: 10 minutes) and if you are randomdy selected as one
of the experimental group, you will be asked to participate in a
scheduled 1-15 hour interaction with me on the day you and your baby
are discharged from the hospital. This interaction will be a teaching
program designed to facilitate your adaptation to the maternal role.
‘All_participants will be contacted three weeks after the baby is born
and, at your convenience, you will be asked to complete two more
questionnaires similar to the one completed today (time involved:

15 minutes).

This study is being conducted with new mothers who anticipate
and subsequently experience a normal labor, delivery, and postpartum
course. Therefore, if any problems are encountered during the 6-8
week contact time, you would not continue as a study subject.

The information obtained from this study will provide me with
a better understanding of how nurses can assist new mothers with the
adjustment each woman makes to her role as mother. Your name will
never be associated with the data and your identity and all responses
will remain confidential.

Thank you for your time and cooperation.

Elizabeth Price, R.N.
Graduate Student

86 Family Nurse Clinician, MSU
Home phone 627-7527

87

Subject' 5 Statement
I voluntarily consent to participate in this activity. I have
had an opportunity to ask questions, and I understand that I can

change my mind before the study is completed if I choose to.

 

 

Signature of Subject Date

APPENDIX C

RESEARCH DESIGN

Research.Design

Subjects Activity

 

Pregnant woman
identified from records
and contacted by phone

Researcher Activity

 

 

 

 

 

 

Office contact: Consent
form signed, basic sub-
ject profile, Ideal

ther Index completed

 

 

 

 

 

Hospital Delivery:
Group Assignment

 

Stage I
Criteria

 

 

 

 

 

 

/\

 

 

Non-program

 

Stage II
Criteria

 

 

 

 

Grouo

 

 

 

it

Program Group

 

 

 

 

In Subject
home day of
discharge

 

 

 

 

 

 

 

3 weeks post-
partum
Ideal-Self
Index

Supportive-Educative
Program of role socializa-
tion

 

 

 

 

 

3 weeks post-
partum
Ideal-Self
Index

 

 

 

 

 

A

 

Contact with both groups
by researcher for follow-

uP

 

 

 

 

88

‘7‘!

1i. ’u’CW-flnt ‘1.
i

APPENDIX D

BASIC DATA PROFILE

Basic Data Profile

Name :

 

Age:
Number of years married prior to birth of this child:

Years of school completed (circle): grade school

high school
college
Did you attend childbirth preparation classes? yes no

Number of children in the family in which you.were reared:
Your position in the family (circle; 1 indicates the oldest):

1 2 3 4 5 6 other

With discharge from the hospital, will you have a woman (friend or
family member) stay with you for at least 1 week, but not more than
10 days, who will help you care for the baby? yes no

Is this a pregnancy which was planned? yes no

The amount of experience a young woman has caring for infants prior to
assuming the role of mother is said to assist in becoming a mother.
Circle the number of the response on the right which best describes how
adequate you believe your premotherhood experience has been as prepara-
tion for your own role as mother.

 

Inadequate Adequate
. . . experience you had caring for
infants (birth-3 mos. of age) 1 2 3 4
. . . experience you had observing others
caring for infants (birth-3 mos. of
age) 1 2 3 4

Much of what we learn about being mothers has to do with what we learned
from our basic role models. How would you describe your own mother's
performance as a role model? (check one)
unsatisfactory mostly satisfactory
slightly satisfactory satisfactory

89

APPENDIX E

IDEAL MOTHER INDEX AND

SELF MOTHER INDEX

IDEAL MOTHER INDEX

The statements below list qualities and actions identified
with the mother role as she interacts with her baby. Using the six
numbered responses listed below, circle the number on the right which
best describes your idea of how important the attitude or skill in
each statement is to being an IDEAL mother.

1 2 3 4 5 6
very moderately slightly slightly moderately very

unimportant unimportant unimportant important important important
A mother:
. . . is happy 1 2 3 4 5 6
. . . talks to her baby 1 2 3 4 5 6
. . . is skillful feeding and burping her

baby 1 2 3 4 5 6
. . . is concerned about her family 1 2 3 4 5 6

. . . understands her baby's different
cries l 2 3 4 5 6

. . . is competent with the tasks of

bathing and dressing her baby 1 2 3 4 5 6
. . . is consistent and dependable l 2 3 4 5 6
. . . touches her baby gently 1 2 3 4 5 6
. . . protects her baby 1 2 3 4 5 6
. . . is also a woman separate from her 4

baby 1 2 3 4 5 6
. . . communicates with her baby through

looks and gestures l 2 3 4 5 6
. . . holds and rocks her baby 1 2 3 4 5 6
. . . is strong 1 2 3 4 5 6
. . . cuddles her baby tenderly l 2 3 4 5 6

. . . changes her baby's diaper with ease l 2 3 4 5 6

. . . feels good about herself 1 2 3 4 5 6

90

91

IDEAL MOTHER INDEX (Cont.)

. . . is able to interpret what her baby
wants and needs

. . . provides physical care for her baby
. . . is important

. . . listens to her baby when baby talks
to her

. . . adapts to change

92

SELF MOTHER.INDEX

the mother role as she interacts with her baby.

The statements below list qualities and actions identified with

Using the six numbered

responses listed below, circle the number on the right which best
describes how comfortable you now feel with the attitude or skill in
each statement.

2 3
very moderately slightly slightly
uncomfort- uncomfort- uncomfort- comfort-
able able able

am.happy
talk to my baby

am skillful feeding and burping
my baby

am concerned about my family
understand my baby's different cries

am competent with the tasks of
bathing and dressing my baby

am consistent and dependable
touch my baby gently
protect my baby

am also a woman separate from my
baby

communicate with my baby through
looks and gestures

hold and rock my baby

am strong

cuddle my baby tenderly

change my baby's diaper with ease

feel good about myself

moderately

6
very
comfort-
able
5 6
5 6
5 6
5 6
5 6
5 6
5 6
5 6
5 6
5 6
5 6
5 6
5 6
5 6
5 6
5 6

93

SELF MOTHER INDEX (Cont.)

. . . am able to interpret what my baby
wants and needs

. . . provide physical care for my baby
. . . am important
. . . listen when my baby talks to me

. . . adapt to change

APPENDIX F

CRITERIA FORM

Program
Criteria Form

 

Non-program

 

 

 

 

 

STAGE I

Name

Address Phone

Age Years married

Number of pregnancies £1
m: g
Low risk pregnancy according to established criteria: ____ yes ____ no ’7
Sustained support individual identified: ____yes _____no

STAGE II

Labor length Delivery (type)

Episiotomy: ____yes ____no

Anesthesia/analgesia

 

Infant Apgar score: 1 minute 5 minutes

Infant physical exam findings: normal abnormal

variations from normal: (1)

 

(2)

 

Nursery assignment

 

Mother's health: Hgb 2nd P.P. day

Blood loss post-delivery

 

Temp. range during the postpartum period

 

Elevation above 1004: yes no
Episiotomy intact with discharge: yes no
Infant and mother discharged together: yes no
Date Time

 

 

94

Program group appointment time

95

 

3-week follow-up: Time

 

Non-program group 3-week follow-up:

Time

Date

Date

 

 

 

APPENDIX G

PROGRAM OF POSTPARTUM ROLE SOCIALIZATION

Progpam of Postpartum Role
Socialization

 

Environment: Subject's home the afternoon or evening of the

day of discharge from the hospital.

Individuals present: Mother, infant, researcher, and perhaps

significant others.

The researcher will be dressed in street clothes and will be
known to the subject because of the earlier hospital con-

tacts .

Content of experimental program:
1. Introduction regarding the general nature and purpose

of the study.

2. Information related to the normal anatomy and physiology
of involution:

(a) What physical changes occur during involution?
What she can expect (i.e., afterpains, ochea, the
return of menstruation).

(b) When she will regain control over body functions.

(c) Female hormones (i.e., estrogen, progesterone,
Pitocin, and prolactin) and their influence over
the mother‘s physical and psychological self.

3. Questions concerning role expectations. Example:

”Share with me some of your ideas about what being a

mother will be like." "What are some of your expecta-

tions of the next six weeks?" Depending upon the answers

to the questions: anticipatory guidance.

96

4.

97

Questions regarding the mother's sense of her new role.
Example: "What is it like for you to be a mother?"
"Tell me how it feels for you to be in this new role."
"How do you feel when you have the baby with you?"
Depending upon the answers of the questions: statements
of support and encouragement. Examples: "The baby may
look different than you imagined. You expected a boy,
you had a girl. It is normal for you to feel some
disappointment." "You may not feel the instant unquali-
fied love for your baby you might have expected. This
doesn't mean you are not a 'good' mother. You just need
time to get to know each other." "Being awkward in no
way means you are inadequate. It may simply mean you
haven't been a mother long enough to feel comfortable

100% of the time."

Questions concerning body image and its relation to role.
Examples: "What is it like not to be pregnant any

longer?" "How do you feel about yourself, your body

shape?"

Information related to weight loss and body shape.

(a) normal expected weight loss in six weeks.

(b) diet and exercise programs.

(c) suggestions designed to promote positive feelings

about appearance.

. '——""‘—r:

If

98

Demonstration and/or discussion of the infant's

communication patterns.

(a) perceptual abilities, visual, auditory, response
to touch.

(b) basic reflexes (i.e., rooting, sucking, swallowing,
grasp, mono, and dancing).

(c) reasons for crying (i.e., overstimulation, lone-
liness, tension and tiredness, comfort).

(d) behavior modes for quieting fussy baby (i.e.,

touching, holding, rocking, cuddling).

Questions concerning mother's caretaking skills.
Examples: "How do you feel about caring for the baby?"
"New mothers often have concerns regarding infant care.
How do you feel about your skills in taking care of the
baby?" "Mothers often are uncomfortable holding a brand
new baby for fear he will break. How do you feel?"
Given negative response, the researcher will provide
strategies to improve role performance.
(a) encourage positive reinforcement and support her
performance.
(b) relating past positive accomplishments to transfer

positive feeling related to learning a new skill.

Identification of a possible peer gender specific support

person in the environment.

10.

11.

99

COping strategies to deal with the anticipated changes

in family life style. Example:

(a) limit visitors

(b) modify housekeeping tasks

(c) get plenty of rest

(d) open communication with significant others in the
environment to share feelings of joy, anxiety, and
frustration surrounding the new role (i.e., husband,
mother, close friend)

(e) plan time just for herself

Two booklets, Caring for Yourself After the Baby is

 

Born, Ross Laboratories, Columbus, Ohio, 1975; and

Becoming a Parent, Ross Laboratories, Columbus, Ohio,

 

1973, designed to provide reinforcing information for
home reference. The following topics were included:

(a) content related to normal anatomy and physiology
(b) high protein, modified calorie diet

(c) postpartum exercise program

(d) list of behaviors designed to reduce stress during

the early postpartum period

APPENDIX H

POSTPARTUM ROLE SOCIALIZATION:

INSTRUCTION SHEET

Postpartum Role Socialization: Instruction Sheet

Subject

Date

 

 

Introduction of study

(a) nature

(b) purpose

Information

(a) physical changes and hormones
(b) control of body functions
Discussed role expectations

(a) for herself now

(b) for the next six weeks

Discussed feelings about the new role
(a) for mother

(b) about baby
Discussed how mother views body image
Information about weight loss

(a) normal expectations

(b) diet and exercise program

Demonstration and/or discussion of infant
communication

(a) perceptual abilities
(1) visual

(2) auditory

(3) response to touch

100

Time

 

Accomplished

 

(b)

(c)

(d)

101

reflexes

(1) rooting

(2) sucking/swallowing

(3) grasp

(4) mono

(5) dancing

discussed reasons for crying

(I) overstimulation

(2) loneliness

(3) tension and tiredness

(4) discomfort (hunger, wet, etc.)
discussed ways to quiet fussy baby
(1) touching

(2) holding

(3) rocking

(4) cuddling

-8. Asked questions related to caretaking skills.

9. Identified a woman to be used as a support.

10. Discussed coping strategies.

(a)
(b)
(c)
(d)
(e)

limit visitors

modify housekeeping tasks

increase rest
open communication

time for self

11. InfOrmation packet given.

Accomplished

APPENDIX I

EXAMPLE SCORING PROCEDURE

Example Scoring Procedure

 

Ideal Mother Score

Each subject in the study was asked to complete the
Ideal Mother Index some time between the 38-42 week of
gestation. A raw pre-ideal score was obtained by adding
the response numbers 1-6 together to equal a total; Three
weeks postpartum each mother was again given the Ideal
Mother Index; the post-ideal scoring was identical to the
pre-ideal. To obtain a difference score for the testing
of Hypothesis 2, the pre-ideal score was subtracted from
the post-ideal score. Then the statistical technique was

applied to these scores.

Self Mother Score

 

The scoring of the Self Mother Index was divided into
two parts. Part 1 was the self mother score. This score
was obtained by adding the number for each response (a
possible choice of 1-6) for all 21 items to obtain a raw
score for each individual subject in-the study. The second
part of the scoring procedure consisted of arriving at a
score for each of the three subcomponents of the instrument:
social self, role language, and role performance. The
following illustration will demonstrate how these two steps

were accomplished.

102

103

Given the following responses to each item:

 

 

 

Item # Response Item # Response Item # Response
1 = 6 8 = 5 15 = 6
2 = 4 9 = 6 16 = 6
3 = 5 10 = 4 17 = 5
4 = 6 11 = 5 18 = 4
5 = 3 12 = 5 19 = 5
6 = 5 13 = 4 20 = 3
7 = 6 14 = 5 21 = 4

Social Self is measured by the sum of items: 1, 4, 7, 10,

 

13, 16, 19. In the example, Social Self = 37.

Role Language is measured by the sum of items: 2, 5, 8, ll,

 

14, 17, 20. In the example, Role Language = 30.

Role Performance is measured by the sum of items: 3, 6, 9,

 

12, 15, 18, 21. In the example, Role Language = 35.

(The subscores were then added:

37 + 30 + 35 = 102 Total Self Mother Score

Role Strain: The role strain score was obtained by sub-

 

tracting each subject's self mother score from her post-ideal
mother score. After tallying scores for each subject in each
group, scores of the program and non-program group were

analyzed by the statistical technique selected.

APPENDIX J

HYPOTHESES IN STATISTICAL

NOTATION/FORMULAS

Hypotheses in Statistical
Notation/Formulas

HYPOTHESIS 1: (difference of means) t scores small sample

 

 

 

 

theory because: N1 + N2 < 30
or t ='§ -'Y 2 2
1 2 S: = (N1 l)S1 + (N2 1)S2
fl2(%+%) Nl'iNz’2
P 1 2
o
H >
uP-unP
H1 <
11P unP
a = .1 t critical = -1.33

HYPOTHESES 1A, 1B, 1C:

 

P nP

P nP

a = .l t critical = 11.729

104

105

HYPOTHESIS 2: will be tested by using different scores on

 

repeated measures.

t =‘H ' '1d d =

 

 

X - X
-—§-—- post pre
d
A?
8:31
n
S2 = N2d2 - (26)2
d N(N-l)
ud - UXZ - “X1 = 0
o
H “d - 0
1
H “d # 0

a = .1 t critical = 11.833

BIBLIOGRAPHY

BIBLIOGRAPHY

Adams, Martha. "Early Concerns of Primigravida Mothers
Regarding Infant Care Activities." Nursing Research
12 (Spring 1963):72-77.

 

Aquilera, D. C., and Messick, J. M. Crisis Intervention:
Theory and Methodology. St. Louis: C. V. Mosby,
1974.

 

 

Benedek, T. "The Psychosomatic Implications of the Primary
Unit: Mother-Child." Orthopsychiatry XIX (1949):
642-653.

 

Biddle, B., and Thomas, E., eds. Role Theory: Concepts
and Research. New York: John WiIey and Sons, Inc.,
19661

 

 

Brazelton, T. "The Parent-Infant Attachment." Clinical
Obstetrics and Gynecology 19 No. 2 (June 19 6 :
373-389.

 

Broussard, Elsie, and Hartner, Miriam. "Further Considera-
tions Regarding Maternal Perception of the First Born."
Exceptional Infant. Edited by Jerome Hellmuth.

Vol. 2. New York: Brunner-Mazel, 1971, pp. 432-447.

Brown, M., and Hurlock, J. "Mothering the Mother."
American Journal of Nursing (March 1977):439-44l.

Bureau of the Census. 1970 Census of Population. U. S.
Department of Commerce; Social and Economic Statistics
Administration.

Caplan, G. Concepts of Mental Health and Consultation.
Washington, D. C.: U. S. Department of Health,
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