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" M ,1) i l//I/////I////IllI/l/lI/l/ll/l/lIllll/lI/llll/I/l/l ' ““‘W 3 1293 10481 6333 TH E55 3 mt! ”3.75331423‘33": 73!..‘3'MXIA This is to certify that the thesis entitled THE RELATIO‘ISHIP AMIIG FIRST-TIME MHERS' AN'I‘ICIPA'IORY SCIIIALIZATICN FOR PARENTHCDD, ACIIURACY OF PREXXNCEPTICNS OF THE POSTPARI‘IM PERIOD, AND EASE OF TRANSITICN IN'IU THE PARENTAL ROLE presented by Roxann Rohrs Hamblin has been accepted towards fulfillment of the requirements for Master of Science degree in Nursing flaw A» Major professor Date 34/1/81 / I 0-7639 MS U is an Affirmative Action/Equal Opportunity Institution MSU LIBRARIES W RETURNING MATERIALS: Place in book drop to remove this checkout from your record. FINES will be charged if book is returned after the date stamped below. in us 85337 ' AP 5mm , U M93 JUN 1‘ N90 ‘ 157‘. *' THE RZLA SOCIALIZ OFT inp THE RELATIONSHIP AMONG FIRST-TIME MOTHERS' ANTICIPATORY SOCIALIZATION FOR PARENTHOOD, ACCURACY OF PRECONCEPTIONS OF THE POSTPARTUM PERIOD, AND EASE OF TRANSITION INTO THE PARENTAL ROLE BY Roxann Rohrs Hamblin A THESIS Submitted to Michigan State University in partial fulfillment of the requirements for the degree of MASTER OF SCIENCE IN NURSING College of Nursing 1982 TEE REL S IALI OF A explore cipatorj caption: hood. 1 POStpart Parenthc hood Won ease of ABSTRACT THE RELATIONSHIPS AMONG FIRST-TIME MOTHERS' ANTICIPATORY SOCIALIZATION FOR PARENTHOOD, ACCURACY OF PRECONCEPTIONS OF THE POSTPARTUM PERIOD, AND EASE OF TRANSITION INTO THE PARENTAL ROLE BY Roxann Rohrs Hamblin A longitudinal, correlational study was conducted to explore the relationships among first-time mothers' anti- cipatory socialization for parenthood, accuracy of precon- ceptions of postpartum, and ease of transition into parente hood. Hypotheses were that accurate preconceptions of postpartum would be related to ease of transition into parenthood, and that_anticipatory socialization for parent- hood would be related to accuracy of preconceptions and to ease of transition into parenthood. A convenience sample of 44 healthy firstfitime mothers completed Prenatal and Postnatal Questionnaires. Pref natally, subjects described their preconceptions of post- partum and their anticipatory socialization experiences; postnatally, they described their postpartum.experiences and the amount of ”bother" these caused. Product-moment cor- relation demonstrated that the higher the Difference bee tween preconceptions and experiences, the higher the Bother for several aspects of postpartum. The expected negative relationships between Anticipatory Socialization and Diff ference, and between Anticipatory Socialization and Bother, were not found. To my husband, Jug, whose love, faith, and encouragement sustained and nourished me throughout my graduate education. ii Thi the inva like to Blaassie me throx sincere Given, \ right t: her will I Could I a Without; q“lestio: Eymesl l ACKNOWLEDGEMENTS This research would not have been completed without the invaluable assistance of many individuals. I would like to thank the members of my thesis committee 5 Bonnie Elmassian, Mary Horan, and Jacqueline Wright — for guiding me through the research process. I extend my special and sincere appreciation to my thesis chairperson, Barbara Given, whose notes of encouragement always came at the right time. A Special "thank you" goes to Patty Peek for her willingness to become a proxy committee member so that I could graduate on time. I am immeasurably grateful to my research consultants. Without Rita Gallin's expert advice, constructing my own questionnaires would have been a futile endeavor. And Rob Hymes' patience in assisting me with my data analysis will always be remembered and appreciated. I would like to thank LeAnn Slicer for all the work she did for me by phone so that I could avoid extra trips to E. Lansing, and for never seeming impatient with my endless questions. Finally, I thank my loving parents for instilling in me a love of learning and a desire to excel. iii CHAPTEI Backgr Purpos Resear Hypoth Defini Paren Role Ease Preco Postp Antic the P. Soci. Antlt FirSt. Assump‘ CHAPTER Bdegr< Role T] The M: Antici: ROle T3 C0n3e< the Pa Relat: Summar: TABLE OF CONTENTS CHAPTER I - INTRODUCTION 0 o o o o o 0 Background of the Problem . . . . . Purpose and Importance of the Study Research Questions . . . . . . . Hypotheses . . . . . . . Definition of Concepts . Parental Role . . . . . Role Transition . . . . Ease of Role Transition . . Preconceptions of the Parental Postpartum Experiences . . . . Anticipatory Socialization Expe the Parental Role . . . . . . Socialization . . . . . . . . Anticipatory Socialization . n coco-Howooooo PO ooooo‘Dof—loooooo (D First-time Mothers . . . . . Assumptions and Limitations . coo-000 CHAPTER II - CONCEPTUAL FRAMEWORK . . Background . . . . . . . . . Role Transition . . . . . . . The MOdel O O O O O I O O O Anticipatory Socialization . Role Transition and Health . . . Consequences of Difficult Transition the Parental Role . . . . . . . . (D in ooooofhoooooooooo to oooooHoooooooooo Relationship Between Nursing and Role Transition smary O O O O O O O O O O O O O O 0 CHAPTER III - REVIEW OF THE LITERATURE Postpartum Experiences . . . . . . . Preconceptions of the Postpartum Period Transition into Parenthood . . Discussion . . . . . . . Sample variables . . . Measuring variables . . Scoring variables . . . Summary . . . . . . . . . . a e Anticipatory Socialization for P r nth 0 iv 0 9.400000... \oooooooooxtxlan-a H H O snare 043:: Hra n+4 14 14 16 18 31 31 35 38 41 41 51 58 64 65 66 67 Retros Prospe Senna: GQPTER Overvie Hypothe Operati Indepe Depend Sample Settin Data Co Protect Instrum Pretes Reliab Scoring Precon EXperi Differ Bother Antici Data An Study HYpoth Analys Sociod Sufimary CHAPTER Overvie Descrio Retrospective Studies . . . . . . . Prospective Studies . . . . . . . . Summary . . . . . . . . . . . . . . CHAPTER IV - METHODOLOGY AND PROCEDURES Overview . . . . . . . . . . Hypotheses . . . . . . . . Operational Definition of the Independent Variables . . . Dependent Variables . . . Sample . . . . . . . . . . Settings . . . . . . . . . Data Collection Procedures Protection of Human Rights Instrumentation . . . . . Pretests . . . . . . . Reliability and Validity Scoring . . . . . . . . . Preconception Scores . . Experience Scores . . . a iab Difference Scores . . Bother Scores . . . . Anticipatory Socializatio Data Analysis . . . . . . Study Questions . . . . . Hypotheses Operationally Stated Analysis Plan for Hypotheses . . . or V O smog-00000000.. 0500000000 1: O O 0 e O O O O O O O O O O O O O O O O O O O O H. O Sociodemographic variables and Dependen smary O O O O O O O O O O O O O O O (D t CHAPTER V - DATA PRESENTATION AND ANALYSIS Overview . . . . . . . . . . Description of the Study Sample . . . Sociodemographic Characteristics . . Anticipatory Socialization Experiences ‘ smary o o o o o o o 0 Subjects' Index Scores . . Scales . . . . . . . . . . Preconception Scores . . . Experience Scores . . . . Bother Scores . . . . . . Anticipatory Socialization s Study Questions . . . . . Accuracy of Preconception Ease of Transition . . . Hypotheses . . . . . . . Hypothesis 1 . . . . . . Hypothesis 2 . . . . . . - Hypothesis 3 . . . . Sociodemographic Variables Sc 00000000000000 H O 0 es 0 V 35 0 0 3 7 Total 44 100% 44 100% The subjects' educational achievements ranged from some high school to an advanced degree. A large majority (75%) had had at least some college. Only 4 women (9.1%) had not completed high school. The data describing the sample's educational achievement are shown in Table 2. 116 The level Of education attained by subjects' husbands ranged from some high school to an advanced degree. A large majority Of husbands (70.5%) had finished at least some college. Only 5 husbands (11.4%) did not have a high school diploma. Table 2 shows complete data for husbands' education. Table 2 Highest Level Of Education Attained by Subjects and Their Husbands Subjects Husbands 2121.2. 321.3. Level Of Education Some High School " 4 9.1 s 11.4 High School Diploma 7 15.9 7 15.9 Some College 20 45.5 16 36.4 Bachelor's Degree 10 22;7 8 18.2 Advanced Degree 3 6.8 7 15.9 Military Training 0 0 l 2.3 Total 44 100% 44 100% A majority Of the women (32 women, or 72.7%) had worked outside the home for money within the year preceding their completion Of the Prenatal Questionnaire. Of these, 9 (28%) indicated they planned to return to work right away after their postpartum check-up; 23 (72%) indicated they did not plan to return to work right away. When asked at 6 weeks postpartum whether they intended to return to work right away, 11 (34%) said "yes," and 18 (56%) said "no." 117 Data were missing for 3 women (see Table 3). Two more women postpartally than prenatally planned to return to work right away; it is not known whether the women who planned prenatally to return to work at 6 weeks postpartum are the same ones who later planned to return to work right away. Table 3 Working Women's Intention to Return to Work at 6 Weeks Postpartum (N=32) Intend to Return Did Not Intend Missing to Work to Return to Work Data NO. % NO. % NO. ' % Prenatal 9 28 23 72 0 0 Postpartum 11 34.4 18 _ 56.2 3 9.4 Women who had worked outside the home within the previous year were asked to state their occupation. Their stated occupations were coded according to categories pros posed by Hollingshead (1967). These categories, and the number and percent Of women whose occupations are repre- sented by each category, are presented in Table 4. Half Of the employed women (16) worked in jobs rated "3” or higher; half worked in jobs rated "4" or lower. It is interesting tO note that none of the women worked in a skilled manual position. Forty of the subjects' husbands (90.9%) were employed; 4 (9.1%) were unemployed. Their occupations, by category, are presented in Table 4. By combining education and 118 occupation, a Social Position Score (Hollingshead, 1967) was calculated for 39 Of the employed husbands (data were missing for one case). These scores were translated into one Of five possible social classes, where Class I is the highest, and Class V the lowest. Over one quarter Of the husbands (11) were in the highest social class. NO emf ployed husbands were in the lowest social class. The mean social class was 2.77, or somewhat above the middle class (Class III). Husbands' ratings by sOcial class are listed in Table 5. Table 4 Occupations, By Category (Hollingshead, 1967) Subjects Husbands Categories NO. ‘_3 NO. .:1 1 Higher Executives, Proprietors Of Large Concerns, Major Professionals 4 12.5 12 30 2 Business Managers, Proprietors of Medium-Sized Businesses, Lesser ProfesSionals 6 18.7 3 7.5 3 Administrative Personnel, Small Independent Businesses, Minor Professionals 6 18.7 4 10 4 Clerical and Sales Workers, Owners Of Little Businesses 12 37.5 5 12.5 5 Skilled Manual Employees 0 0 10 25 6 Machine Operators and Semi-Skilled Employees 2 6.3 5 12.5 7 Unskilled Employees 2 6.3 l 2.5 Total 32 100% 40 100% 119 Table 5 Social Class of Subjects' Husbands (Hollingshead, 1967) (N=43) Social Class I II III IV v Unemployed Total NO. 11 3 9 16 o 4 43 .i 25.6 7 20.9 37.2 o 9.3 100 Respondents were asked how long they had been married. The range was from less than one year to nine years Of marriage. Seven women (15.9%) had been married less than one year at the time they completed the Prenatal Question- naire. A majority of the study sample (54.5%) had been married for two years or less. Data describing how long the women in the sample were married are shown in Table 6. Table 6 Length Of Time Subjects Had Been Married (N=44) Years <1 1 2 3 4 5 6 7 9 Total NO. 7 8 9 7 6 3 2 l l 44 %_ 15.9 18.2 20.5 15.9 13.6 6.8 4.5 2.3 2.3 100 Anticipatopy Socialization Experiences ( Subjects were asked in the prenatal period whether they had had formal learning experiences preparing them for parenthood (see Appendix A, questions 81-84). Only three women (6.8%) had not taken prenatal classes; the remainder 120 (41 women, or 93.2%) had taken Lamaze preparation classes. Only 16 women (36.4%) indicated they had taken courses in parenting or marriage and the family. Three women (6.8%) had attended one La Leche League meeting each. Subjects indicated that they had read between 0 and 50 books and articles about parenting or child care. Data are missing for two cases. Of the remaining 42 subjects, only 2 women (5%) had done no such reading. The average number of books and articles read was approximately 11. Subjects were also asked about life experiences that exposed them to children and child care (see Appendix A, questions 85e87). Thirtyethree women (77%) stated that at least one of their close friends or relatives who lives locally had had a baby within the past year. Ten women (23%) had no close friends or relatives in the area who had had a baby within the past year. (Data are missing for one case.) Four women (9.1%) had children living with or visiting them regularly. The study subjects were asked to estimate the amount Of experience they had had caring for infants. Thirtyefive women (79.5%) estimated they had had "a lot" or "some" infantfcare experience. Only 7 women (15.9%) had had "very little” experience, and 2 women (4.8%) admitted to having no previous experience caring for infants. Complete inf formation about the amount of infantecare experience respone dents had is displayed in Table 7. 121 Table 7 Amount Of Infant-Care Experience Subjects Stated They Had Had N=44) A Lot Sgge' Very Little None Total 9.9.; 17 18 7 2 44 3 38.6 41.0 15.9 4.5 ' 100 It is interesting tO note that all four Of the sub- jects who were later deleted from the final sample because they or their infant had experienced early postpartum health complications had indicated prenatally that they had had little (3 women) or no (1 woman) infant-care experience. Had these women been included in the final sample, the per- centage Of women reporting ”very little" or no infant-care experience would have risen frOm 20.4% to 27.1%. Women who indicated they had had ”a lot” or "some" infant-care experience were asked to choose from a check- list the types Of experiences they had had. Most Of these women (94.3%) noted they had done babysitting as a teen- ager. Other responses are displayed in Table 8. (Because Of the way the infant-care question was worded, it is not possible to determine what kinds of experiences were had by women who indicated having had "very little” infant-care experience). Summary The women in the study pOpulation were, on average, in their midetwenties and educated beyond high school. They had been married for two years, and had been employed within 122 Table 8 Type of Experiences Cited by Respondents Who Had ”A Lot" or "Some” Infant-Care Experience (N=35) NO. % Babysitting as a teenager 33 94.3 Babysitting as an adult 23 65.7 Caring for siblings 16 45.7 Working in a day care center or nursery 6 17.1 Caring for nieces and nephews 5 14.3 WOrking in a health care setting 4 9.1 Other 2 5.7 * Subjects could mark more than one response. 123 the previous year. Between one quarter and one third Of the employed women planned to return to work when their baby was 6 weeks Old, depending on whether the women's prenatal or postnatal statement of intent indicated their true plans. On average, the women whose husbands were employed (90.9%) were middle to upper-middle class; none were in the lowest class. Almost all the women had attended Lamaze classes, but only a little more than one third had participated in formal parenting or marriage and the family classes. A large ma- jority of the women had read at least one book or article about child care or parenting, had close friends or rela- tives with new babies, and believed they had had at least some experience caring for infants. Subjects' Index Scores Scales The Preconception, Experience, and Bother Indexes all consist of the same items: sample experiences women may have during the postpartum period. Some of the items repre- sent similar experiences, and it was speculated that related items would measure a unitary concept, i.e.,_wou1d comprise scales. Items seamed empirically to belong in the following categories of experiences: those resulting from the physie cal and emotional aftermath Of childbirth; those related to the impact of a first infant on the woman's ability to manage her time; those reflecting the impact Of a first infant on the woman's roles as wife, friend, relative, 124 employee; and those related to child care (see Appendixes J and K). Alpha coefficients were computed for each predicted scale: Physical, Emotional, Time, Wife Role, Friend/ Relative Role, Career, and Child Care. All alpha coeffie cients were .65 or above for all three indexes (see Appen- dix I). Thus, the Preconception, Experience, and Bother Indexes are comprised Of the same scales, all of which attain an acceptable level of reliability. Since cor- relations among the scales were low, it was assumed that the scales were not intererelated. Preconception'Scores Subjects responded to each Preconception Index item by marking, on a 5-pOint Likert-type scale, the degree to which they agreed or disagreed they were likely to have the eXperie ence in the postpartum period: "Strongly Disagree" = l; "Strongly Agree" = 5 (see Appendix A). Individual scores could range from 1 to 5. A low score indicated-a relative degree of disagreement that the respondent would have the experiences. A high score indicated a relative degree Of agreement that the respondent would have the experiences. Individual scores for each scale were averaged, and a group mean reported for the Physical, Emotional, Time, Wife Role, Friend/Relative Role, Career, and Child Care Scales. The group means for the Preconception Index Scales ranged from 2.94 to 3.79. A summary Of the Preconception Scores is found in Appendix L. 125 EXperience Scores Subjects responded to each EXperience Index item by marking, on a S-pOint Likert-type scale, the degree to which they agreed or disagreed they had had the experience during the postpartum period: "Strongly Disagree" = l; "Strongly Agree" = 5 (see Appendix B). Individual scores could range from 1 to 5. A low score indicated a relative degree Of disagreement that the respondent had had the experiences. A high score indicated a relative degree Of agreement that the respondent had had the experiences. Individual scores for each scale were averaged, and a group mean reported for the Physical, Emotional, Time, Wife Role, Friend/Relative Role, Career, and Child Care Scales. The group means for the Experience Index Scales ranged from 2.65 to 3.80. A summary of the Experience Scores is found in Appendix M. Bother Scores Subjects were instructed to report, on a 5-point Likert-type scale, an amount of bother for each item on the Experience Index to which they had agreed (see Appendix B). Individual scores could range from 0 to 4. A high score indicated high bother; a low score indicated low bother. Individual scores for each scale were averaged, and a group mean reported for the Physical, Emotional, Time, Wife Role, Friend/Relative Role, Career, and Child Care Scales. Mean Bother Scores ranged from 1.66 to 2.33. Complete data 126 on mean Bother Scores are displayed in Appendixes N and O. Anticipatory Socialization Scores . Individual Anticipatory Socialization Scores repre- sent the total number of preparation for parenthood experi- ences the subject reported having. One point was assigned for each affirmative response to an item on the Anticipa- tory Socialization Index (see Appendix G). The possible range Of Anticipatory Socialization Scores was 0 to 7; the actual range was 2 to 6. The mean Anticipatory Socializa- tion Score was 3.56; the standard deviation was 1.087. An- ticipatory Socialization Score frequencies are shown in Appendix P. Study Questions Two study questions were posed. Because the data analysis answering these questions provides insight into the meaning of the Index Scores, the study questions will be considered before the hypotheses. Accuracy of Preconceptions The first study question was, "How accurate were firstetime mothers in anticipating their postpartum experi- ences, or concerns?" This question was answered by searching for significant differences between mean Preconf ception Scores and mean Experience Scores. Mean Preconception Scores and mean Experience Scores are presented in Table 9. There were no significant dif- ferences between these two scores for the Physical, 127 Emotional, or Career Scales. The interpretation_given this finding was that women's expectations and their experiences were congruent for items comprising these scales. Table 9 Comparison Of Mean Preconception Scores and Mean Experience Scores Mean PreConcepr Mean Experience Significance Tim-Scores Wores Scales Physical 3.80 3.80 NS Emotional 3.12 3.02 NS Time 3.57 3.78 p'< .03 Wife 3.07 3.33 p'< .008 Friend/ Relative 2.97 2.65 p'< .004 Child 2.94 2.70 p_< .03 Career 2.94 2.70 NS Significant differences were found between Preconcepe tions and Experiences for the remainder of the scales. For the Time and Wife Role Scales, the mean Experience Score was significantly higher than the mean Preconception Score, ‘3 (42) = 52.17, p,< .03; and t (42) = -2.76, p’< .008,_ respectively. The difference was in the direction Of agreeing more strongly, or agreeing more Often, that the experiences had occurred, as compared with what was expected. This finding can be interpreted to mean that the preconceptions the women had concerning Time and Wife Role Scale items were inaccurate. It appears that they had 128 more "negative" experiences related to time management and their wife role than they had anticipated before their babies were bOrn. For the Friend/Relative Role and the Child Care Scales, the difference was in the Opposite direction: the mean Preconception Score was significantly higher than the mean Experience Score, 5 (42) = 3.06, p.< .004; and t (42) = 2.21, p.< .03, respectively. The difference is in the direction of stronger agreement, or agreement more Often, that the experiences had been expected, as compared with what actu- ally happened. This finding can be interpreted to mean that expectations concerning Friend/Relative Role and Child Care Scale items were also inaccurate. However, it appears that the women had feyer ”negative” postpartum experiences re- lated to their role as friend and relative and to child- care responsibilities, than they had expected. Other findings concerned which experiences women most and least expected, and which they most and least had. High scores were in the direction Of agreeing with scale items. The highest mean score was found for the Physical Scale On both the Preconception Index (§'= 3.80) and the Experience Scale (§’= 3.80) (see Table 9). The interpretation is that women most Often expected, and most Often had, "nega- tive” experiences related to physical recovery from child- birth and the physical effects of new parenthood. Low scores were in the direction Of disagreeing with scale items. The lowest mean Preconception Scores were 129 found for the Child Scale (Y’= 2.94), Career Scale (§'= 2.94) and the Friend/Relative Role Scale (i'= 2.97). The lowest mean Experience Scores were found for the Friend/ Relative Role Scale (§'= 2.65), the Child Care Scale (i'= 2.70), and the Career Scale (§'= 2.70). The interpretation is that women least expected and also least had "negative" experiences related to child care, their relationships with friends and relatives, and not returning to work right away. It would seem, then, that the women's preconceptions of child care, friend and family relationships, and career changes, were accurate. This appearance is borne out for the Career Scale: there was no significant difference bee tween Preconception Scores and Experience Scores for the Career Scale (see Table 9). However, significant differ- ences were found between mean Preconception Scores and mean Experience Scores for Friend/Relative Role and Child Care Scales in a "positive" direction. That is, although mean Friend/Relative Role and mean Child Care Preconception Scores were low, mean Friend/Relative Role and mean Child Care Experience Scores were even lower. The interpre- tation is that women did not expect many ”negative" experi- ences related to these aspects Of parenthood, and in fact, they had even fewer "negative" experiences than expected. Ease of Transition The second study question was, ”How difficult was transition into the parental role for these first-time 130 mothers, as measured by their bother scores?" As in pre- vious transition to parenthood studies (e.g. Hobbs, 1965; Russell, 1974), this question was answered by examining both group mean Bother Scores and the frequency distribu- tion Of individual Bother Scores. Mean Bother Scores are diSplayed in Appendix N. The difference between the highest mean Bother Score (Physical: i’= 2.33) and the lowest mean Bother Score (Child: §'= 1.61) is very small--only .72. The means are distributed nearly equidistant from 2, the scale mid-point. The frequency distribution Of individual Bother Scores is presented in Appendix 0. Four Bother Categories were devised (see Scoring, Chapter IV): None, Slight, Moderate, and Severe. As it turned out, the entire range of mean Bother Scores (1.61-2.33) fell under the "Moderate" cate- gory (Range: l.34-2.66--see Appendix 0). ' Another way Of looking at these data is to determine under which category the mode fell. The mode fell under the "moderate” category for all scales except the Friend/Rela- tive Role Scale (see Appendix 0). A reasonable interpreta- tion Of these findings is that the women in this study sample experienced a moderate degree of bother in response to their postpartum experiences. Hypotheses Data analysis was undertaken to test the study hypothe- ses. Results Of analysis will be reported in this section. 131 Hypothesis 1 The first hypothesis states that the more congruent a first-time mother's preconceptions Of the parental role are with her actual postpartum experiences, the easier will be her transition into parenthood. Operationally stated, the hypothesis reads, "Difference Scores will be positively correlated with Bother Scores.” Product-moment correlation was used to compare Differ- ence with Bother. Significant positive correlations were found for five of the seven scales (see Table 10). Dif- ference was positively and significantly correlated with Bother for the Physical (5 = .42, p_< .003), Emotional (£.= .38, p_< .005), Time (£.= .36, p.< .008), Wife Role (£_= .38, p'< .005), and Child Care (a = .37, p’< .008) Scales. NO significant correlation was found between Dif- ference and Bother for the Friend/Relative Role or Career Scales. Thus, analysis supported H1 for five Of the seven scales. Hypothesis 2 The second hypothesis states that the more selected anticipatory socialization experiences a firstetime mother has had for the parental role, the more congruent her pre- conceptions of the postpartum period will be with her subs sequent experiences. Operationally stated, the hypothesis reads “Anticipatory Socialization Scores will be negatively correlated with the absolute value of Difference Scores." 132 Table 10 Correlations Between Difference Hypothesis 1: Scores and Bother Scores, by Scale Physical Emotional Difference Physical .42a Emotional .38 Time Wife Friend/Relative Child Career a: p = .003 b: p = .005 .008 O 'U ll Bothgr Time Wife Fr./Re1. .36 .38 .07 .37 Child Career -.12 133 When computing the correlation between Anticipatory Socialization and Difference, the absolute value Of the Difference Score was used. The sign Of the Difference Score was ignored for the following reason. Women who held ac- curate preconceptions Of postpartum would have a Difference Score approaching zero, indicating little or no difference between their preconceptions and their experiences. Women who had inaccurate preconceptions would have a Difference Score with a high absolute value: a high positive score indicating an overly Optimistic woman; and a high negative score indicating an overly pessimistic woman. Since anticipatory socialization should engender accurate preconf ceptions of postpartum, it was predicted that low Antici- patory Socialization Scores would be positively associated with high Difference Scores, with either a negative or a positive sign. Thus, the absolute value of the Difference Scores was used to test H2. Product-moment correlation was used to compare Anticie patory Socialization with Difference. Analysis failed to find the predicted relationships. NO significant correlaf tion was found between Anticipatory Socialization and Dife ference for six of the seven scales. A significant positive correlation was found between Anticipatory Socialization and Difference for the Friend/Relative Role Scale (5 = .26, py< .04). Thus, analysis failed to support H2. 134 Hypothesis 3 The third hypothesis states that the more selected anticipatory socialization experiences a first-time mother has had for the parental role, the easier will be her tran-. sition into that role. Operationally stated, the hypothee sis reads "Anticipatory Socialization Scores will be nega- tively correlated with Bother Scores." Product-moment correlation was used to compare Antif cipatory Socialization with Bother. NO significant correla- tions were found for any of the scales; analysis failed to support H3. Sociodemographic Variables Several sociodemographic characteristics of the study sample were compared with the dependent variables, Differ- ence and Bother. Sociodemographic Variables and Difference The Difference Score is a measure Of the congruence Of a woman's preconceptions Of and her experiences during the postpartum period. It is computed by subtracting the Preconceptions Score from the Experience Score for each scale: Physical, Emotional, Time, Wife Role, Friend/Rela- tive Role, Career, and Child Care. Care needs to be taken in interpreting the Difference Scores. A Difference Score represented by a negative num- ber indicates that the Preconception Score was higher than the corresponding Experience Score. A negative Difference Score thus means that the woman expected to have more 135 experiences than she actually had. As explained in the Instrumentation section, Chapter IV, the scale items were designed to describe "negative" postpartum experiences, or concerns. Thus, expecting more Of these "negative" experi- ences than in fact occurred means that the woman's precon- ceptions were inaccurate, but that things were "better" than expected. Therefore, the interpretation given a negative Difference Score is that the situation was better than expected. A Difference Score represented by a positive number indicates that the Preconception Score was lower than the Experience Score. This score means that the woman expected fewer "negative" experiences than she actually had. Thus, her preconceptions were inaccurate, and things were "worse" than expected. Therefore, a positive Difference Score is interpreted as meaning that the situation was ygrge_than expected. These concepts must be kept in mind when examining correlations between Difference Scores and sociodemographic variables. A low (negative) Difference Score indicates that things were better than expected. A high (positive) Difference Score means that things were worse than ex- pected. A Difference Score approaching zero indicates that things were similar to what was expected. Difference Scores for all seven scales were compared with ten sociodemographic characteristics--subject's age, husband's age, years married, highest level of education 136 achieved by the subject, her major field of study if she attended college, husband's highest level of education, subject's employment status, her occupation, husband's employment status, and husband's social position. The purpose of these comparisons was to determine whether there were any relationships between these variables and Differ- ence Scores. Only seven significant correlations were discovered. A subject's age was negatively correlated with her Dif- ference Score on the Friend/Relative Role Scale (£_= f.29, {p < .03). This finding indicates that the Older the woman, the lower her Difference Score on the Friend/Relative Role Scale. Recalling how Difference Scores are interpreted, it can be said that the Older the woman, the better she found the situation than expected for aspects Of postpartum measured by the Friend/Relative Role Scale (see Appendixes J and K). Husbands' education was measured on a scale Of l to 7, where 1 = less than 7th grade and 7 = advanced degree. Using these numbers, productemoment correlation was used to determine the relationship between husbands' education and Difference Scores. A significant, positive relationship was found only for the Wife Role Scale (£_= .33, p|< .02). Thus, the more uneducated the woman's husband, the better she found the situation than expected with respect to the wife role. 137 Using pointebiserial correlation, significant negative relationships were found between a woman's employment status and her Difference Scores on the Emotion Scale (Ebis = 5.29, p < .03) and on the Child Care Scale (Ebis = 5.28, p.< .03). Since Employed = l, and Unemployed = 2, these correlations mean that unemployed women tended tO have lower Difference Scores than employed women. Thus,_employed women tended to find the situation worse, and unemployed women better, than expected for aspects Of postpartum.mea- sured by the Emotion Scale and the Child Care Scale (see Appendixes J and K). Point-biserial correlation was used to compare hus- bands' employment status with Difference Scores. A signifie cant negative relationship was found between husbands' employment status and Difference Scores for the Wife Role Scale (Ebis = 5.30, p.< .03). A significant positive relae tionship was found between husbands' employment status and the Difference Score for the Career Scale (ibis = .45, p_< .03). These significant correlations must be intere preted with caution, as only four husbands were unemployed. However, the tentative interpretation is that women whose husbands were unemployed found the situation better than expected in terms Of their wife role, but worse than exe pected when it came to quitting their jobs to stay home with their babies. The final significant association found was that be- tween husbands' social position and the Difference Score 138 on the Wife Scale (£'= 5.31, p < .02). On the scale measuring Social Position, 1 = the highest position and 7 = the lowest position. Thus, the lower the social position, the lower the Difference Score on the Wife Role Scale. The interpretation is that the higher the husband's social posi- tion, the worse the woman tended to find her situation than expected in terms Of her wife role. To summarize, Difference Scores on seven scales were compared with ten sociodemographic variables. Out Of a total of 70 possible relationships, only seven were found to reach significant levels. A general conclusion is that the woman's sociodemographic characteristics exerted very little influence over the accuracy Of their preconceptions Of the postpartum period. Sociodemographic Variables and Bother Bother Scores for all seven scales were compared with the same ten sociodemographic variables described above. The only significant associations were between the wives' and the husbands' highest level Of education and Bother Scores for some scales. A significant positive relationship was found between the women's educational level and their Bother Scores on the Time Scale (£_= .26,_p s .04). Thus, women who were more highly educated tended to report-more bother as a result Of factors measured by the Time Scale (see Appendixes J and K) than less educated women. 139 Significant positive relationships were found between husbands' level of education and Bother Scores for the following scales: Career (5 = .43, p'< .03); Wife Role (r_= .33, p;< .02); Child Care (£’= .31, p’< .02); and Time (£.= .27, p'< .04). Thus, women whose husbands were more highly educated reported more bother relative to the aspects Of postpartum measured by those four scales (see Appendixes J and K) than women whose husbands were less highly educated. TO summarize, out Of 70 possible relationships between the sociodemographic characteristics and Bother, only five significant correlations were found. -All were related to the subject's or to her husband's level Of education. Thus it appears that the women's sociodemographic characteristics exerted very little influence over their Bother Scores except in the area of education. 'Summary 'Data analysis revealed that the subjects accurately anticipated the effect of parenthood on their physical and emotional selves, and on their careers. They were overly Optimistic about the effect Of the infant on their wife role and on their usual routines. They were overly pessimistic about the effect of the infant on their friend/relative role and about their ability to care for their infant. Sociodemoe graphic variables exerted very little influence over the accuracy Of subjects' expectations of postpartum. 140 Data analysis also revealed that, contrary to reports in recent studies that parenthood results in only slight bother, most of the women reported a moderate degree Of bother as a result Of their postpartum experiences. An unexpected finding was a significant relationship between education and Bother for some scales: the more educated the woman was, the more bother she reported as a result of Time Scale experiences; and the more educated her husband was, the more bother she reported as a result Of Career, Wife Role, Child Care, and Time Scale experiences. The data analysis used to test the study hypotheses found a significant correlation between Difference and Bother for five Of the seven scales: Physical,_Emotional, Time, Wife Role, and Child Care. Contrary to expectations,' no significant negative relationships were found between Anticipatory Socialization Scores and either Difference Scores or Bother Scores. In Chapter VI, an overview Of the entire study will be presented. Following the overview, the findings will be interpreted and discussed. Conclusions will be drawn,_and implications of the study findings for nursing research, practice, and education will be presented. CHAPTER VI SUMMARY AND IMPLICATIONS OF THE STUDY Overview Purpose A longitudinal, correlational study was conducted to determine the relationships among first-time mothers' anti- cipatory socialization for parenthood, the accuracy of their preconceptions of the postpartum period, and their ease of transition into the parental role. Study Questions Insufficient documentation was found in the literature to permit formulation of a hypothesis regarding the ac- curacy of preconceptions of the postpartum period. In addi- tion, because Of conflicting existing evidence, no hypothe- sis was made regarding the difficulty experienced by first- time mothers during the transition into parenthood. How- ever, study questions were formulated that asked: "How accurate were these first-time mothers in anticipating their postpartum experiences, or concerns?" and "How difficult was transition into the parental role for these first-time mothers, as measured by their Bother Scores?" Hypotheses Based on a role transition model proposed by Burr (1972), it was hypothesized that anticipatory socialization would be related to accurate preconceptions Of the post- partum period and to ease Of transition into the parental 141 142 role. It was further hypothesized that accuracy of pre- conceptions would be related to ease of role transition. Method A convenience sample Of 44 first-time mothers completed two questionnaires. The first questionnaire (see Appendix A), administered during the third trimester Of pregnancy, attempted to measure the women's preconceptions of the post- partum period in terms Of their confidence in their child- care abilities; in terms Of the effects Of motherhood and the infant's presence on their physical and emotional selves, their ability to manage their time, and their ability to continue performing their wife and friend/rela- tive roles; and in terms of their feelings about quitting a job to stay home with their baby. The first questionnaire ' also attempted to measure their anticipatory socialization, i.e. preparation for parenthood, experiences. The second questionnaire (see Appendix B), admini- stered between 6 and 8 weeks postpartum, attempted to mea- sure the women's actual postpartum experiences, and the amount Of bother their experiences caused them. Study’Sample The women in this study sample were, on average, middle class or higher, educated beyond high school, and employed outside the home before the baby was born. Most Of the employed women did not plan to return to work at 6 weeks postpartum. The majority of women were in their midf twenties and had been married for two or fewer years. The 143 women's husbands were also in their mid-twenties, were em- ployed, and were educated beyond high school. A large majority of the women had attended Lamaze classes, had read at least one book or article about parenting, had close friends or relatives with new babies, and stated they had had at least some infant-care experi- ence prior tO their pregnancy. Only a little more than one third Of the women had attended parenting or marriage and the family classes. In terms of sociodemographic characteristics, the current study sample most closely resembles those Of the two earliest transition into parenthood studies (Dyer, 1963; LeMasters, 1957). All three studies used convenience samples. The earlier study samples were comprised entirely of middleeclass, college-educated couples wherein the wife was not employed after the child's birth. While the current study's sample was more varied, the majority of subjects fit this profile. The characteristics of the study sample may have af- fected the study results. This possibility will be ex- plored in the Interpretation and Discussion section Of this chapter. Findings Study questions. Data analysis provided answers to the study questions. The first Study question concerned the accuracy of first-time mothers' preconceptions Of posts partum.experiences. Using the t-test for paired means, no 144 difference was found between preconceptions and experiences for items comprising the Physical, Emotional, or Career Scales. WOmen agreed to having significantly mgre Time and Wife Scale experiences then they expected; they agreed to having significantly £3325 Friend/Relative and Child Scale experiences than they expected. The second study question concerned the amount of bother reported by first-time mothers as a result Of their postpartum experiences. Mean Bother Scores for the seven scales clustered about the scale midpoint. When ”Bother Categories" were devised, it was found that the mode response fell under the "Moderate" category for every scale except for Friend/Relative, for which the mode re- sponse was "Slight." . Hypotheses. Data analysis provided grounds for ree jecting or failing to reject the study hypotheses. Producte moment correlation was used to test all three hypotheses. H1 stated that the more congruent a first-time mother's preconceptions of the parental role are with her actual postpartum experiences, the easier will be her transition into parenthood. Operationally stated, "Difference will be positively correlated with Bother." Data analysis revealed a significant, positive relationship between Difference Scores and Bother Scores for every scale except for Friend/ Relative and Career. Thus, it was decided not to reject H1 for the Physical, Emotional, Time, Wife, and Child Scales (see Appendixes J and K). 145 H2 stated that the more selected anticipatory sociali- zation experiences a first-time mother has had for the parental role, the more congruent her preconceptions Of the postpartum period will be with her subsequent experiences. Operationally stated, ”Anticipatory Socialization Scores will be negatively correlated with the absolute value Of Difference Scores." A significant correlation was found between Anticipatory Socialization Scores and Difference Scores for only the Friend/Relative Scale, and the relation- ship was in the Opposite direction from the predicted one. That is, the more anticipatory socialization experiences the woman had for parenthood, the higher her Difference Score. Therefore, H2 was rejected for all scales. ' H3 stated that the more selected anticipatory socialie zation experiences a first-time mother has had for the parental role, the easier will be her transition into that role. Operationally stated, "Anticipatory Socialization Scores will be negatively correlated with Bother Scores." NO significant correlations were found between Anticipatory Socialization Scores and Bother Scores for any of the scales. Therefore, H3 was rejected. Sociodemographic variables. NO hypotheses or study ! questions here formulated about the relationships among selected sbciodemographic variables and the dependent vari- ables, Difference and Bother, but these relationships were sought for descriptive purposes. Seven significant 146 relationships were found between sociodemographic variables and Difference. . 1. The younger the woman, the worse she found the situ- ation than expected for aspects of postpartum measured by the Friend/Relative Scale. 2. The lower the woman's husband's education, the better she found the situation than expected for aspects Of post- partum measured by the Wife Scale. 3. Women who had been employed within the year previous to participation in this study found the situation worse than expected for aspects of postpartum measured by the Emotion Scale. 4. Women who had been employed within the year previous tO participation_in this study found the situation worse then expected for aspects Of postpartum measured by the Wife Scale. 5. WOmen whose husbands were unemployed found the situ- ation better than expected for aspects Of postpartum measured by the Wife Scale. 6. Women who had been employed within the year previous to participation in this study, and who did not intend to return to work right away, and whose husbands were unemployed, found the situation worse than expected for aspects Of postpartum measured by the Career Scale. 7. The lower the woman's husband's social class, the better she found the situation than expected for aspects of postpartum measured by the Wife Scale. 147 Five significant relationships were found between sociodemographic variables and Bother. l. The higher the woman's educational level, the more bothered she was by aspects Of postpartum measured by the Time Scale. 2. The more highly educated the woman's husband, the more bothered she was by aspects of postpartum measured by the Time Scale. 3- The more highly educated the woman's husband, the more bothered she was by aspects Of postpartum measured by the Wife Scale. 4. The more highly educated the woman's husband, the more bothered she was by aspects of postpartum measured by the Child Scale. 5. The more highly educated the husband Of a woman who had been employed within the year previous to participation in this study, and who did not plan to return to work right away, the more bothered the woman was by aspects of post- partum.measured by the Career Scale. Interpretation and Discussion Studnguestions The first study question was whether first-time mothers' preconceptions Of postpartum were accurate. It was found that preconceptions were accurate for experiences com- prising the Physical, Emotional, and Career Scales; overly Optimistic for experiences comprising the Time and Wife Scales; and overly pessimistic for experiences comprising 148 the Friend/Relative and Child Scales (see Appendix J for scale items). The accurate preconceptions will be discussed first. A likely explanation for the accuracy Of preconceptions found for Physical and Emotional Scale experiences is that these two aSpects Of childbirth and postpartum have tradi- tionally been included as content in prenatal classes. Only 3 subjects did not attend prenatal classes; the re- mainder may have learned what to expect at the classes they attended. Also, the Physical and Emotional Scale experi- ences are more concrete than experiences related to changing relationships or altering lifelong habits and activities. Perhaps this type Of information is more easily conveyed to and retained by pregnant women than information about more complex postpartum experiences. The explanation for women's holding accurate expectae tions for Career Scale experiences may be found by looking at the nature Of the scale items. Essentially, the Pree natal Career Scale asks working women to predict what it will be like not tO work outside the home. Perhaps the respondents had grown up with their mothers at home, and thus were provided with a role model for being a noneworking mother. Or the respondents may have been unemployed at some time in the past, and based their accurate predictions on their own experiences. Even if a respondent has always worked outside the home, it may be easier to predict the 149 effect of deleting a familiar role from one's life than the effect of adding an unfamiliar role. The picture the women held about experiences comprising the Time and Wife Scales were overly Optimistic. The Time Scale was designed to include experiences dealing with the respondents' ability to manage their time, and to cope with the baby's unpredictable schedule. Women may have failed to predict Time Scale concerns because of the possibility that no amount of caring for other people's children can prepare one for the readjustment of one's usual schedule neces- sitated by the presence of and the 24-hour-aeday responsi- bility for an infant in the home. Clinical experience suggests that many new mothers are unprepared for the amount of time needed to care for their infant. Some research findings support this observation. For example, Pellegrom and Swartz (1980) found that new mothers spent less time than expected doing household tasks, being by themselves, being with their husbands, and engaging in recreational activities. The women were also overly optimistic about the poten- tial effect of the baby on their wife role. As with Time Scale experiences, perhaps no amount of previous baby care experience can prepare one for the effect of an infant on the marital relationship. The introduction of a third per- son into an established dyad is a complex process. .When the third person is a demanding infant whose needs may get met 150 at the expense of a spouse's needs, this process can be even more difficult. Expectations regarding difficult postpartum eXperiences measured by the Friend/Relative and the Child Scales were low, but even so were overly pessimistic. It is difficult to explain why this should be so for the Friend/Relative Scale, which attempted to measure changes in these relation- ships. Perhaps 6 weeks postpartum is too soon for these changes to be noticed. It is easier to explain the Child Scale findings. Re- spondents were initially confident in their child care abilities. By 6 weeks postpartum, they were having even fewer problems than predicted. It is probable that six weeks of intensive baby care experience increased the woman's confidence, resulting in a lower postnatal than prenatal score on the Child Scale. The second study question focused on how bothered the mothers were by their "negative" postpartum experiences. Most of the women reported a moderate amount of bother. Not only did the mean Bother Score for all scales cluster about the scale midpoint, but when responses were categorized, the mode response fell into the "moderate" category for 6 of the 7 scales. This finding conflicts with those of the most recent transition into parenthood studies, in which the mode Bother Category was ''slight" (Hobbs, 1965; Hobbs, 1968; Hobbs & Cole, 1976; Russell, 1974). Only in Dyer's study (1963) was the mode response also "moderate." The mode 151 response in LeMasters' study (1957) was "extensive or severe." Caution must be used in comparing results of the current study with those of previous studies. Not only were Bother Scores calculated differently, but sampling, population, and instruments differed. Nevertheless, the results suggest that participants in the current study re- ported more bother as a result of their postpartum.experie ences than those in previous studies. An attempt will be made to account for this phenomenon. The amount of bother reported may be a result of the characteristics of the study sample. For example, a large majority of both husbands and wives had had at least some college education and most belonged to the middle class. Highly-educated, middleeclass parents may have high expece tations for their ability to cope with a newborn. If these expectations are violated, parents may undergo a difficult role transition. Also, highly-educated individuals are likely to have lifeegoals in addition to parenthood. A newborn's interference with these life-goals may impede a smooth transition into parenthood (see Figure 1). There has been some speculation in the literature that a high level of education is positively associated with dif- ficulty in the postpartum period. LeMasters (1957) and Dyer (1963), whose subjects were all college-educated, both reported high crisis scores. Russell (1974) reported no correlation between education and bother, but did find a 152 negative correlation between education and gratification scores for both husbands and wives. In addition, wives' and husbands' education was positively associated with Bother Scores for some scales in the current study. Some countervailing evidence does exist. In two studies (Hobbs, 1968; Hobbs & Cole, 1976), scores of a sube sample of college graduates were no different from scores of nonecollege graduates. Dyer (1963) found that husband's education was negatively related to the couple's crisis score. The disagreement in the literature concerning the relationship between education and bother thus precludes concluding that the-high level of education of this study sample accounts for their relatively high bother scores. A second characteristic of the study sample may account for the degree of bother reported. A majority of women were employed prior to the birth of their baby; most of these employed women did not plan to return to work at 6 weeks postpartum. WOrking women who decide not to return to work once they become mothers experience both a drop in family income and a large degree of lifestyle change. Both drop in income and lifestyle changes may be expected to increase the amount of difficulty adjusting to parenthood. A second explanation for the amount of bother reported is the narrow age range of the babies belonging to this study sample. Participants' babies were between 6 and 8 weeks old when the Postpartum Questionnaire was completed. Other studies included subjects whose first child was up 153 to 5 years old (LeMasters, 1957), up to 2 years old (Dyer, 1963), between 3 and 18 weeks old (Hobbs, 1965), between 6 and 52 weeks old (Hobbs, 1968), and between 6 and 56 weeks old (Russell, 1974). Perhaps parents report more bother during an initial period of readjustment than they report as the baby grows older. This supposition receives mixed support in the literature. While some researchers report no relationship between the baby's age and adjustment difficulty (Hobbs, 1968; Russell, 1974; Wente & Crockenberg, 1976), others report a positive relationship between the baby's age and difficulty (Hobbs, 1965). In only one study reviewed did parents of younger babies report more diffi- culty than parents of older babies (Dyer, 1963). Given these study results, no case can be made that the age of the babies in the current study accounted for the relatively high amount of bother reported by this sample. A third explanation for the amount of bother reported is the method of data collection used. There is some sup- port in the literature for concluding that subjects will report more bother during an interview than when completing a questionnaire. For example, LeMasters' (1957) interviewed subjects admitted to a great deal of difficulty. Hobbs' (1968) subjects reported higher crisis scores in response to interview questions than in reponse to a questionnaire, ale though this difference was not tested for statistical signi- ficance. Perhaps the opportunity to build rapport during 154 an interview creates an atmosphere conducive to admitting to difficulties with the parental role. The same reasoning may be applied to explain the bother scores reported by the current study sample. While it is true that the instrument was a questionnaire, not an inter- view schedule, the circumstances surrounding data collection may have created sufficient rapport to increase the chances of obtaining honest responses. First, subjects were ini- tially asked to participate in the study by their physician, or by an office nurse or medical assistant. Some of the trust the women placed in their health care provider may have been transferred to the researcher, whose study may have been perceived as approved by the physician. Second, the researcher, as a nurse, may have been perceived to be a trustworthy person in her own right-because of her profese sion. Finally, at least one telephone contact was made with each participant. This brief interaction may have contrif buted to a willingness to be honest in answering the ques- tionnaire items. A final explanation for the finding of moderate bother is that 100% of the eligible women who agreed to participate returned both questionnaires. It is possible that the same trust-enhancing circumstances that may have promoted honest responses also resulted in the inclusion of more women exf periencing high stress levels than were included in previous studies. Russell (1974) followed up non-respondents to her study, and found that they were more likely to have been 155 premaritally pregnant than respondents. Russell suggested that these couples may undergo more stress than postmari- tally pregnant couples, so that if they had responded, the mean difficulty score would have been higher. While it is not known how many women in the current study were premari- tally pregnant, nearly 16% had been married less than a year when they completed the first questionnaire. The 100% ref sponse rate may indicate that women experiencing all levels of difficulty were included in this study. Inclusion of all these women may account for the moderate levels of bother found. To summarize, participants in the current study re- ported more bother as a result of their postpartum experi- ences than participants in the most recent transition into parenthood studies reported in the literature. Several factors may account for this phenomenon. The women's high education and their plans not to return to work right away may have led to disappointments, life-style changes, and loss of income. Also, the Postpartum Questionnaire was administered at 658 weeks postpartum, at which time adjust- ment difficulties may not yet have been resolved. These factors may account for the amount of bother experienced. Data collection techniques that enhanced rapport may account i for the amount of bother reported. Hypotheses The three study hypotheses are statements regarding the relationships among anticipatory socialization, accuracy of 156 preconceptions of the parental role in the postpartum period, and ease of transition into the parental role (see Figure 2). The assumption underlying H1 is that holding accurate expectations about postpartum should result in less bother when these expectations are fulfilled, i.e., a relatively easy transition into the role. The assumption underlying H2 is that it is anticipatory socialization (AS) that is responsible for an individual's holding accurate preconceptions of what the postpartum period will be like. The assumption underlying H3 is that AS also facilitates role transition through role mastery achieved as a result of the role encumbent's having learned in advance the skills, knowledge, and values needed to enact the parental role. - In fact, the results of this study support only one of the hypotheses--that there is a relationship between accur-. acy of preconceptions (Difference) and ease of role transif tion (Bother). The predicted relationships between AS and Difference, and AS and Bother, were not found. In this section, an attempt will be made to interpret these findings. Hypothesis 1. Difference Scores correlated with Bother Scores for the Physical, Emotional, Time, Wife, and Child Scales. A high Difference Score indicated high discrepancy between preconceptions and experiences. Thus, failure to anticipate the postpartum experiences measured by the 157 above 5 scales was related to reports of increased bother as a result of those same experiences. Difference was correlated with Bother, but it Cannot be concluded that inaccurate preconceptions led to more difficult role transition. When two variables are cor- related, it is known only that they are related. Either variable could have caused the other, or a third factor could be responsible for the findings related to both vari- ables. Since the current study was prospective,_it is known that the preconceptions held by respondents about postpartum occurred before transition into parenthood. Thus, Bother could not have caused Difference. But a third unknown factor could have caused both Difference and Bother. A second reason why causation cannot be inferred from the correlations found between Difference and Bother is that the correlations were not perfect. A correlation coef- ficient of 1.0 would allow one precisely to predict a woman's Bother Score by knowing only her Difference Score. Perfect correlations are rarely found in behavioral studies, and indeed the correlations found between Difference and Bother were only between .36 and .42. These coefficients indicate that Difference Scores accounted for only between 13% and 18% of the variance on Bother Scores. Other unknown factors must have accounted for the remaining 82% to 87% of the variance observed among the women's Bother Scores. Previous researchers have sought to describe variables associated with ease or difficulty of 158 transition to parenthood, or attainment of the maternal role. Some of the factors they have found are the quality of the marital relationship (Dyer, 1963; Hobbs, 1968; Russell, 1974); the infant's temperament (Mercer, 1981; Russell, 1974); whether the pregnancy was planned (Dyer, 1963; Russell, 1974); the woman's perception of her birth experience (Entwisle & Doering, 1980; Mercer, 1981); the health of the mother (Mercer, 1981; Russell, 1974) and the baby (Hobbs, 1965); and the amount of social support the mother perceives (Mercer, 1981). These or other variables not measured in the current study, must have accounted for the remaining variability of scores on the Bother Scale. Although the study results do not allow one to conclude that accurate preconceptions of postpartum led to an easy transition into parenthood, the fact that a statistically significant relationship was found between Difference and Bother for most of the scales is meaningful. It indicates that the more unrealistic a first-time mother's preconcep- tions of the Physical, Emotional, Time, Wife, and Child Scale aSpects of postpartum, the more likely she was to be bothered by these aspects of her postpartum experience. Seemingly, if a mother's preconceptions were later cone firmed, ”negative" postpartum experiences did not trouble her too much. Conversely, if a mother's preconceptions were later violated, she found these same experiences bothersome. It may be that mothers who accurately anticipated their postpartum experiences had an Opportunity mentally to 159 rehearse their responses to these experiences in advance. Having engaged in preparatory problem-solving, these mothers may have readily found solutions to their concerns. Mothers who did not realize in advance that having "negative" experi- ences was a possibility had no mentallyerehearsed solution to rely on. Another explanation for the finding may be found in the concept of "secondary anxiety." A mentally-prepared mother may have experienced some concern as a result of postpartum events and feelings. But, having anticipated them, she was aware that they were normal, and so may have had confidence that she could cope with them. A surprised mother, on the other hand, may have experienced not only the concern ité _self, but secondary anxiety as well. This anxiety could have resulted from the mother's wondering if she was normal, or if she was alone in having her problems. She may even have wondered if experiencing difficulty meant she was not a good mother, or was lacking "maternal instinct." These additional worries could have led the unprepared women to experience and report a high degree of bother. The finding of a relationship between accurate precon- ceptions and amount of difficulty assuming a new role supe ports previous research. Kramer (1974) found that student nurses who held realistic preconceptions of their profes- sional role functioned more effectively in the work setting than student nurses whose expectations were unrealistic. Curley and Skerrett (1978) concluded that the amount of 160 stress newly married couples eXperienced in the first year of marriage was related, in part, to the congruence of their preconceptions of and experiences in marriage. Thompson (1958) found that accurate preconceptions of ree 'tirement facilitated adjustment to retirement. In addition to supporting previous research findings, the study results provide limited support for the conceptual framework. According to Burr's (1972) model (see Figure l), anticipatory socialization facilitates role transition. Thornton and Nardi (1975) make explicit that, in order to be functional in promoting role transition, AS must be ace curate. AS is accurate to the extent that 1) it provides for acquisition of the skills, knowledge and values actuf ally needed to master the role and 2) it leads one to hold a realistic picture of what the role will be like. It is the second result of accurate Ase-the accuracy of preconceptions of the parental roleeethat was the focus of H1. The data supported Hl for the Physical, Emotional, Time, Wife, and Child Scales, suggesting that one proposition of the conceptual framework is tenable.- The support for the conceptual framework is diminished, however, by the data's failure to support the relationship between AS and accuracy of preconceptions of the parental role (H2). The rejection of H2 will be considered next. Hypothesis 2. Burr's (1972) model (see Figure 1) depicts AS as a factor that facilitates role transition. Based on Thornton and Nardi's (1975) observation that only 161 accurate AS facilitates role transition, it wa8~proposed for this study that AS promotes ease of role transitions indirectly through providing the future-role occupant with an accurate idea of what the role will be like. Producte moment correlation revealed,_however, no significant rela- tionship between AS and the Difference, i.e. the measure of accurate preconceptions, for six of the seVen scales.~ In addition, it revealed a relationship in the Opposite direcf tion from that predicted between A8 and Difference for the remaining scale. Thus, AS did not lead to an accurate'picf ture of the postpartum period for the participants in this study, and H2 was rejected. There are three possible explanations for the fact that H2 was not supported. The first explanation is that the proposed relationship exists, but that the hypothesis could not lead to its discovery because it did not logically def rive from the conceptual framework. The second explanation is that the relationship exists, but that the tools designed to measure the concepts were incapable of leading to its discovery. The third explanation is that the relationship does not, in fact, exist. The study contains a conceptual flaw that may account for the failure to find a relationship between anticipatory socialization for parenthood and realistic preConceptions of the postpartum.period. The model for this study (see Figure 2) shows a relationship between accurate anticipatory socialization and congruence of preConceptions/experiences. 162 The hypothesis, however, states that there will be a rela- tionship between the number of selected anticipatory social- ization experiences and congruence of preconceptions/experi- ences. Thus, the conceptual framework concept is quality of anticipatory socialization, and the hypothesis concept is quantity of anticipatory socialization experiences. These concepts are clearly not equivalent. The existence of one thing is proposed by the conceptual framework; the existence of another is sought by the hypothesis. This inconsistency between the conceptual framework and the hypothesis constitutes a major obstacle to finding the proposed relationship. That no relationship between anti- cipatory socialization experiences, without reference to their accuracy, and accuracy of preconceptions was found is, in fact, not surprising: "accuracy" was added to the cone cept of AS in the study model to reflect a belief that AS alone was not a facilitating factor. Unfortunately, this flaw in the formulation of H2 was discovered only upon reflection as to the possible explanations for its not being supported by the study data. Future research seeking the relationship between accurate anticipatory socialization and accurate preconceptions of the parental role should certainly be guided by a more precisely-worded hypothesis. Flaws in the instruments used to measure the study cone cepts may also have accounted for the failure of the data to support H2. If the concepts were not accurately measured, existing relationships between the variables may 163 have been missed. Defects in the instruments fall under three categories: reliability and validity problems; the possibility of a response set on the Preconceptions and Experience Indexes; and an inadequate method of scoring the Anticipatory Socialization Scale. Reliability and validity were discussed in Chapter IV. The alpha coefficients for the scales comprising the Pre- conception, Experience and Bother Indexes were above .65, and were considered acceptable.) However, it is clear that some scales were more reliable than others (see Appendix I). If a scale did not measure an entirely unitary concept, it might not have been reliable enough to measure the relation- ship sought by H2“ In addition, the reliability of the Anticipatory Socialization Scale is unknown. A more serious concern is the lack of information about the validity of any of the study's instruments. An attempt was made to design the scales to measure approprié ate aspects of postpartmm and anticipatory socialization experiences, i.e., to ensure content validity. But there is no way of knowing whether the scales measure what they were intended to measure-fi.e. to what degree they possess construct validity. If, instead of measuring the study variables, the instruments measured other, unknown vari- ables, it would not be surprising that no relationship between the variables was found. A second potential defect in the instruments is the possibility of response set. Because all scale items 164 comprising the Preconception and Experience Indexes were negatively worded, some respondents may have had a tendency to agree--or more likely, to disagreeefwith every item, regardless of content (Polit & Hungler, 1978). This prob- 1em could be overcome in the future by counterbalancing positively and negatively worded statements. Lack of reliability and validity information about the Anticipatory Socialization Scale has been discussed. It is possible that the scale items are not experiences that pres pare people for parenthood, or that other life experiences that dg_socialize people for parenthood are missing from the scale. In addition, a question exists as to whether the method of scoring the Anticipatory Socialization Scale (see Appendix G) was adequate. When scoring this scale, distinctions made among the women may not have been fine enough to find the sought-for relationship. For example, no differentiation was made between the following groups of women: those who had read several books on parenting and those who had read just one; those who had attended several marriage and family courses and those who had attended just one; those who judged they had had "a lot" and those who judged they had had "some" previous infantecare experience; or those who judged they had had "very little" and those ‘who judged they had had no previous infant-care experiences. Nor was a distinction made between women who had had actual "hands on" babyecare experience and those whose learning had been through classes or books alone. By placing groups of 165 women with diverse experiences into one large group, im- portant information about their levels of anticipatory socialization for parenthood was probably lost. The final explanation for the failure of the data to support H2 is that the proposed relationship between ac- curate anticipatory socialization and realistic preconcepe tions of a role does not, in fact, exist. However, by defi- nition, accuracy of anticipatory socialization is the extent to which it results in an accurate picture of a role (Thornton & Nardi, 1975). Because of this fact, and because the relationship seems empirically sound, the first two explanations offered in this section are the most likely explanations for the failure to find the relationship. To summarize, H2 was not supported by the data. It is possible that the proposed relationship between accurate anticipatory socialization and accuracy of preconceptions does not exist. It is more likely that H2 was not supported because the concept "accurate anticipatory socialization" was not adequately operationalized. An additional explanae tion is that the instrwments used and the method of scoring them may not have adequately measured the critical variables. Hypothesis 3. According to the conceptual framework, anticipatory socialization facilitates ease of role trane sition directly, as well as through promotion of realistic preconceptions about a role. This relationship was tested by H3, which was not supported by the data. The failure to 166 breast-feeding. Finally, Shereshefsky and Yarrow (1973) concluded that previous experience with children was asso- ciated with good maternal adaptation. A specific means of preparation, attendance at prenatal classes, had been examined in terms of its relationship to postpartum outcomes. Wente and Crockenberg (1976) reported no difference between Lamaze fathers and non-Lamaze fathers on a measure of ease of adjustment to their babies. Entwisle and Doering (1981), however, reported that fathers who participated in prenatal classes scored higher on a measure of good fathering than fathers who did not partici- pate in such classes. Attendance at prenatal classes had a negative direct effect on lower-lass women's mothering scores, but a positive indirect effect on mothering scores for both middle- and lowerfclass women (Entwisle & Doering, 1981). 'Results of experimental studies in which an attempt was made to enhance desirable postpartum outcomes by providing formal anticipatory socialization interventions are also mixed. Gordon and Gordon (1960) concluded that women who attended classes offering anticipatory guidance about what to expect in the postpartum period scored lower on a measure of postpartum emotional difficulties than members of a control group. However, Meleis.and Swendsen (1977) found no difference between scores of role supplementation group members and members of two control groups for any of the outcome variables examined. Additionally, Shereshefsky and 167 Yarrow (1973) concluded that prenatal social work counseling did not enhance women's scores on a measure of maternal adaptation. To summarize, the results of some studies support the prOposition that anticipatory socialization experiences assist parents adjust to their new role. Others, including those of the current study, fail to find evidence for the existence of an association between A8 and ease of role‘ transition. It is therefore difficult to conclude whether a relationship does exist between AS and ease of transition into the parental role. However, it is worth noting that none of the noneexperimental studies cited above measured the accuracy of the AS content, that is, whether the ideas the experiences engendered in the future parents' minds bore any resemblance to reality. A relationship between accurate AS and ease of transition into parenthood could exist, and it would not have been found because it was not sought in any of the studies reviewed. The mixed results of experimental studies indicate that helping professionals may not know what kinds of prenatal interventions assist new parents adjust to their role. Be- fore nurses advocate more preparation for parenthood edue cation for new parents, much more experimental research needs to be conducted to determine what kinds of programs lead to the desired results. 168 Sociodemographic Variables Relationships between sociodemographic variables and the dependent variables were examined for descriptive pur- poses only. While these relationships do have implications for nursing research and practice, to be discussed later, they are not central to the study and will be interpreted only briefly. Interpretation of these relationships is not necessarily guided by theory, and so the explanations offered for the findings are tentative. Sociodemographic Variables and Difference. The first finding was that the younger the woman, the worse she found the situation than expected for Friend/Relative Scale experiences. Younger women apparently held more preconcep- tions that were found to be inaccurate about the effect of the baby's arrival on these relationships than older women. Perhaps their preconceptions were comparable to those of older women, but because of their youth, theyhad more of these experiences. For example, their peers may not have children yet, and may pressure them to continue recreational activities, while older mothers may not experience this pressure, as their friends are more-likely to be mothers, too. Or perhaps, being younger, these women may not have yet emotionally separated frdm their families. If not, they may be more prone to experiencing interference from their families, or conflicts such as whose mother should come to help with the baby. 169 women whose husbands had a low level of education and belonged to a low social class expected more negative exe periences relative to their wife role than they actually had. Any interpretation of this finding would be purely speculative. Employed women had more negative emotional experiences than they expected. There is no way of knowing why this occurred, but perhaps the stress of either knowing one has to return to work when staying home is preferable; or that one has to stay home when returning to work is preferable, increased emotional upsets to a higher level than expected. Employed women whose husbands were unemployed, and who planned to stay home after the baby's birth, found the situe ation worse than expected for Career Scale experiences. The purpose of the Career Scale was to determine women's feelings about quitting work. It makes sense that women whose husbands were not working would have experiences re- lated to missing their jobs. Perhaps all employed women expected a similar number of Career Scale experiences, but those whose husbands were out of work actually had more of them because of their financial situation. Sociodemographic variables and Bother. The only exe traneous variable found to have a statistically significant association with Bother was level of educationffeither the respondent's, or her husband's. The wife's education was associated with Bother only for the Time Scale. An educated woman.may be accustomed to planning and being in control of 170 her situation. The very nature of a baby's unpredictable schedule and the immediacy of its needs precludes the ability to "take charge" of the infant. If the woman's usual means of coping with stress is to exert control over the situation, she will be frustrated when this method fails with her baby. Thus, she may report more bother as a result of Time Scale experiences than a less educated woman. The more highly educated the woman's husband, the more bothered she was by Time Scale, Wife Scale, and Child Scale experiences. Possibly a highly educated husband has high expectations for his wife in terms of her ability to maine tain her usual schedule, continue her usual wife role tasks and her ability to meet his needs, and to do well at child care activities. The wives of these men may internalize these expectations for themselves, setting themselves up to do everything they did before in addition to being a parent. The stress they feel at their inability to meet these expectations may account for these women's higher Bother Scores. The more highly educated the husband of an employed woman who did not plan to continue working, the more bothered she was by Career Scale experiences. Educated men may tend to marry women who can be intellectually stimue lating companions. Both the husband and wife may have high expectations for her success in the work world. When the wife quits her job to stay home with a baby, her husband may 171 fear that she will become uninteresting. If this is the case, his anxieties may be transferred to her, and be re- flected in a high Bother Score for the Career Scale. The interpretations of the relationships between edue cation and Bother are admittedly speculative. They repree sent a "best guess" as to the reason for a surprising phe- nomenon. No study reviewed found a correlation between wife's education and bother. Russell (1974) did find sig- nificant negative relationships between a measure of the gratifications of parenthood and both the husband's and the wife's educational level. Dyer (1963) found that the higher the husband's education,the lower the couple's crisis score. But no study reviewed found a relationship between the husband's education and the wife's bother score. The findings were surprising not only because they were not supported by the literature review, but also because together, they comprise a unitary finding that one would not expect to find by chance. Of the 70 possible relation- ships between sociodemographic variables and Bother, only 5 were found, and they were all relationships between eduf cation and Bother. An explanation for this finding is not immediately apparent, but it appears that women whose huse bands are highly educated are at a risk for a difficult transition into parenthood. Further research should attempt to replicate this finding as well as seek an explanation for it. 172 Conclusions 1. There was a positive relationship between the accuracy of first-time mothers' preconceptions of several aspects of postpartum and their ease of transition into the parental role. Therefore, women whose preconceptions of the post- partum period were overly optimistic were at risk for a difficult transition into the parental role. 2. The study design was incapable of testing the proposed relationship between accurate AS and the congruence between preconceptions of and experiences during the postpartum period. However, the hypothesized negative relationship between A8 (without reference to accuracy) and Difference was not found. The validity of the AS Scale was not es- tablished prior to the study. Only by assuming the Anticif patory Socialization Scale was valid can it tentatively be concluded that the women's AS experiences did not lead to their holding an accurate picture of what the postpartum period would be like. 3. Again assuming the Anticipatory Socialization Scale was valid, it can tentatively be concluded that AS experiences did not lead to an easier transition into the parental role. 4. Firstetime mothers accurately predicted their postf partum experiences relating to physical problems, emotional upsets, and quitting work to stay home with the baby. They failed to anticipate some of the "negative" aspects of paste partum relating to organizing their time, and to the effect their baby's birth and presence in the home on their marital 173 relationship. They experienced less difficulty with ree lationships with friends and relatives than they expected, and they had more confidence in their child care abilities than they anticipated. 5. First-time mothers expressed a moderate amount of bother as a result of their "negative" postpartum experiences. 6. Highly educated women may be at risk for having diffif culty c0ping with the rearrangement of their routines and with the maintenance of a flexible attitude toward their schedules necessitated by the presence of an infant in their home. 7. Women whose husbands are highly educated may be at risk for experiencing difficulty with transition into the paren- tal role. Nursing Implications Research Future nursing research should build on the current study's strengths and rectify its weaknesses. Three main categories of studies should be undertaken: replication and modification of the part of the current research that found a relationship between accurate preconceptions and ease of role transition; exploratory studies aimed at refining the Anticipatory Socialization Scale; and experimental studies designed to discover what types of prenatal nursing intere ventions will result in more realistic expectations of postpartum.and an easier transition to the parental role. 174 Because a non-random sample was used for this study, the finding demonstrating a relationship between accurate preconceptions of postpartum and ease of transition into the parental role cannot be generalized beyond the study sample. Therefore, replication using random samples, and samples having different characteristics from those of the current study sample, would increase support for the finding. Certain modifications of the current study might make replication more valuable. For example, the format for obtaining information about the amount of bother women experienced was not entirely satisfactory. Several women were confused by the questionnaire format, and interpreting their responses to the Bother Index was a difficult task. This section of the Postpartum Questionnaire should theref fore be revised. Also, concepts should be re-operationale ized to more accurately derive from the conceptual frame- work. In addition, the current study obtained information about careers only from women who intended to quit their jobs to stay home with their babies. As more and more new mothers return to the workplace at 6 weeks postpartum, it would be informative to prolong the study and ask these working mothers about their expected and actual experiences related to integrating their work and parental roles. A final suggestion for instrument revision before replication is to write half the Prenatal Questionnaire items to begin, "It is unlikely I will experience..." Re-wording items in this way will help avoid the potential problem of response 175 set. Similar revisions should be made of the wording of Postpartum Questionnaire items. Another goal of future nursing research should be the exploration for possible reasons for the rejection of H2 and H3. Prenatal class instructors, marriage and family living course teachers, and perinatal nurses inform future parents about the parental role based on the assumption that such anticipatory socialization is helpful. It is therefore important to know why the data used to test H2 and H3 failed to support this assumption. The first step in researching the usefulness of antici- patory socialization experiences would be an exploratory study to determine which life experiences new mothers found most helpful in adjusting to the parental role. (New mothers could be asked openfended questions concerning exf periences they found helpful, experiences they had assumed would be helpful, but were not, and experiences they wish they had had in preparation for parenthood. The specific qualities of the experience that made it helpful should be elicited from mothers as well. The results of such a preliminary study could then be used to devise a more inclusive Anticipatory Socialization Scale. An attempt should be made to design the scale so that the accuracy of the anticipatory socialization experie ences can be evaluated. This would be the most problematic step in creating this scale. The possibility that what was taught differed from what was learned would confound any 176 find the proposed relationship may have resulted from the inadequate operationalization of the variables or the in- sufficient sensitivity of the instruments cited above. In addition, the difficulty encountered in scoring the Bother Index may be a factor in the failure to find the proposed relationships. This difficulty was explained in Chapter IV. Briefly, some respondents disagreed with an item on the Experience Index, yet marked a degree of bother the experi- ence caused (usually "none") on the Bother Index. Inter- pretation of what the subjects meant by these responses was difficult, and may have been in error. Incorrect interpree tation of the Bother Scores could account for the rejection of H3. Another interpretation of this result is that the proe posed relationship does not exist. Results of previous studies exploring the relationship between preparation for parenthood and postpartum outcomes are mixed.- Dyer (1963) found that either spouses' having taken a preparation for marriage course in school was related to lower courses on a measure of the amount of crisis resulting from the first birth. Russell (1974), however, found that having had preparation for parenthood experiences was not associated with either husbands' or wives' scores on a scale designed to measure bother resulting from the first birth. Entwisle and Doering (1981) concluded that previous babyfcare exe perience was indirectly related to mothering behavior through the quality of the birth experience or through early 177 evaluation of the socialization's accuracy. Would "accuracy” be defined in terms of the ”actual" message of the experience, or in terms of how the future parent had interpreted the message? If the problem of evaluating the quality of anticipa- tory socialization experiences could not be overcome, the Anticipatory Socialization Scale could at least be improved by a revised method of scoring. The current scoring method probably did not discriminate finely enough among women who had had various levels of anticipatory socialization. In the future, care should be taken to design a scoring method that remedies this shortcoming. Anticipatory socialization is only one variable proe posed by Burr's (1972) model to facilitate ease of role transition (see Figure 1). An interesting study would be one designed to test the other facilitating factors in terms of their impact on transition into parenthood. Perhaps the most pressing need is for experimental nursing research designed to test the efficacy of a formal anticipatory socialization program in promoting ease of transition into the parental role. The current Prenatal Questionnaire could be administered to randomly selected,. randomly assigned control and experimental groups. Experie mental group expectations of postpartum could then be com- pared with those of the current study sample, with research reports of postpartum concerns, and with the researcher's knowledge, based on clinical experience, of commonly 178 occurring postpartmm experiences. A program could then be developed to narrow the gap between any overly optimistic preconceptions and the probable reality of postpartum. At the end of the program, the Prenatal Questionnaire could be re-administered to the experimental group to determine whether the intervention succeeded in changing preconcep- tions of postpartum. At six weeks postpartum, the Post- partum Questionnaire could be administered to both groups; group scores could be compared to determine whether the experimental group scored lower on Difference and/or on Bother than the control group. Practice In recommending incorporation of the study findings into nursing practice, it must be pointed out that the ’study results are not generalizable to other populations. Therefore, implications for nursing practice are tentative. One study finding was that first-time mothers experie enced a moderate amount of bother as a result of their poste partum experiences. This finding has implications for nursing practice. If mothers experience only slight diffi- culty adjusting to parenthood, as some research has re- ported, nursing intervention might not be needed to facili- tate adjustment. However, the moderate amount of bother found in this study, if supported by further research, justifies devising nursing interventions to reduce the difficulty. Reduction of postpartum difficulty would 179 enhance mothers' ability to engage in both self-care and infant-care. A second, major finding of the study was the relation- ship between accurate preconceptions of postpartum and ease of transition into the parental role. This finding suggests that a desirable nursing goal for new mothers is to diminish any discrepancies between overly Optimistic preconceptions and probable postpartum experiences. Nurses can approach this goal either by attempting to assist the pregnant woman to adopt preconceptions more in line with commonly occurring experiences, or to assist the new mother to bring her experi- ences more in line with her preconceptions. Examples of each type of intervention will be given. Before nurses can intervene to promote congruence be- tween preconceptions and reality, they must know the prege nant woman's ideas about postpartum. The Prenatal Question- naire could be used as an assessment tool for this purpose. Based on research and clinical experience, the nurse could evaluate whether the woman's preconceptions are accurate, overly pessimistic, or overly optimistic. This evaluation would certainly be general, since no one can know exactly what experiences an individual woman will have. But the nurse could point out aspects of postpartum that commonly concern new mothers, and could assist the mother to devise coping strategies in advance in the event she experiences these same concerns. Helping the mother engage in anticipa- tory problemesolving is aimed at the nursing goal of 180 promoting the mother's ability to engage in self-care in the postpartum.period. Nursing intervention should continue into the immediate postpartum period. The Postpartum Questionnaire could be used to assess the new mother's experiences after she has had the baby home for only one or two weeks, before minor difficulties have become complex problems. The nurse could determine what unexpected concerns the mother has by com: paring her answers on the Prenatal Questionnaire with those on the Postpartum Questionnaire. Nursing interventions can then be directed at helping the mother cope with these unexpected concerns, since these are likely to bother her more than those she was prepared for. One way to assist a mother in COping is to help her shape her experiences to more closely match her preconcep- tions. For example, a mother may have expected she would know how often to feed her baby, but finds she does not. By teaching the mother about breastfeeding, or formula ref quirements, and about interpreting the infant's hunger cues, the nurse could adjust the woman's ”reality" to be more commensurate with her expectations. As another example, a mother may experience unexpected fatigue. By assisting the mother to enlist help with household chores, reforder her priorities, and see the need for napping at every oppore tunity, the nurse could help her reduce her fatigue. As the mother begins to feel more rested, her experience becomes more congruent with her preconceptions. 181 Mothers may need assistance in accepting and coping with experiences that differ from their preconceptions and that cannot be readily altered. For example, a mother may unexpectedly experience postpartum depression. While the nurse may be unable to alleviate this condition, it may be possible to support and comfort the mother by reassuring her that she is experiencing a common, normal, and self- limiting condition. The nurse can also teach family members about the mother's depression, and encourage them to be understanding and supportive. A third study finding was that an accumulation of ane ticipatory socialization experiences did not lead either to accurate preconceptions of, or ease of transition into, the parental role. Conclusions made about this finding were tenuous. However, an implication for nursing practice is that nurses should not assume that_women who have had a great deal Of formal and informal child care experiences are immune from a difficult transition into parenthood. These women's expectations and experiences should be assessed just as thoroughly as those of women with less child care experiences. A fourth finding was that first-time mothers accurately anticipatedgtheir physical and emotional postpartum cone cerns. However, they failed to anticipate postpartum concerns related to their wife role and to the changes in their routine necessitated by having an infant. Perhaps perinatal nurses could do more to prepare women for 182 possible changes in their marital relationship and the effect of a baby on their current lifestyle. Conversely, nurses may be able to reassure women about their ability to competently carry out child care activities, and about the effect of the baby on their relationships with friends and relatives. This reassurance would be based on the study finding that mothers were overly pessimistic about these aspects of postpartum. A fifth, and surprising, finding was that women whose husbands were highly-educated seem to be at risk for ex- periencing a difficult transition to parenthood. It might be expected that a low educational level would be related to adjustment difficulties, due to the likelihood of fewer problem-solving skills and resources being available to poorly-educated families. However, the data suggest the Opposite, and, if supported by further research, would indi- cate that nurses should not assume that wives of highlye educated husbands do not need nursing intervention in the postpartum period. On the contrary, it appears they may need intervention more frequently than wives of less-edu- cated husbands. Education Nursing implications for education can be derived from the current research study for nurses both in learning and teaching rOles. Student nurses and nurses in practice can learn nursing interventions based on the research findings. In turn, they can teach others what they have learned. 183 Traditionally, the nurses' role in postpartum nursing has been to promote the mother's physical and psychological comfort. Study results showed that new mothers were well informed about the physical and emotional effects of child- birth, but poorly informed about the effects of a first birth on their wife role and on their ability to revise their schedule to meet their own as well as the baby's needs. More emphasis should therefore be placed in nursing schools on the effect of the first birth on the marital re- lationship and on the parent's lifestyle. Part of the reason for the emphasis in nursing programs on the biological and emotional aspects of childbirth, versus the role and family development aspects of first parenthood, may be the in-patient focus of traditional nursing education. The full impact of a first birth is not felt until a mother goes home with her baby and the couple attempts to integrate the newborn into their family. As nursing programs begin to focus more on nursing in non- hospital settings, nurses will have to be educated about family health needs exhibited outside health care facili- ties. Among these are the needs related to postpartum concerns demonstrated by the study sample. In order to address the new family's health problems, nursing curricula must include content on new mothers' postpartum concerns. As was seen in Chapter III, these concerns go beyond medical problems. Mothers expressed concerns about their body image, their childecare ability, 184 and their ability to continue carrying out their usual activities, roles, and responsibilities. Nursing students need to understand these concerns so they can assist their clients to resolve them. Study results showed a relationship between the degree to which postpartum concerns were unexpected and the amount of bother mothers experienced as a result Of those concerns. Nurse educators should teach students to assess firstftime mothers' expectations of postpartum as well as their poste partum experiences. Students should be taught that any discrepancies they assess could indicate a potential for increased difficulty in that area. Students should be taught to reduce these discrepancies by promoting realistic preconceptions of postpartum,_based on a knowledge of common postpartum concerns; and by supporting the new mother in the early postpartum period to make her experience as pleasant as possible. To complete the nursing process, the student should be taught to evaluate the nursing intervention in terms of the amount of difficulty the mother expresses, and in terms of the mother's ability to provide selfecare for herself, and care for her infant. Practicing nurses can benefit from inservice or cone tinuing education programs based on the study results. For example, nurses should be taught that women whose husbands are highly educated may be at risk for a difficult poste partum adjustment, and that women with previous child care experience may not be immune from a difficult role 185 transition. In addition, continuing education seminars could alert Office nurses, public health nurses, and nurse practitioners that intervention may be needed in the early postpartum period, before difficulties reach the prOportion reported by mothers at 6-8 weeks. An inservice program could teach nurses on Obstetrics units about the study findings. Such a program could be the impetus for implementing a telephone service to check up on new mothers a week or so after they go home. Conti- nuity of care and ease of role transition would be the goals of such a service. Obstetric nurses could be taught to assess a mother's expectations about postpartum. When calling the mother at home, the nurse could then assess the mother's experiences, and compare them with her preconcep- tions. Support and teaching could focus on areas of dis- crepancy; referral to a public health nurse or to the woman's primary health care provider could be made if dif- ficulties were detected. Family physicians and obstetricians also should be taught that mothers have nonfmedical needs during postf partum. These needs may necessitate an Office or home visit prior to the usual 4 or 6 weeks check up. Ideally, the physician's nurse colleague could arrange a family visit at 2 weeks postpartum. At this visit, the nurse could assess how the family's experiences differ from their expectations, and could intervene to enhance their adjuste ment to parenthood. 186 Nurses could be instrumental in devising learning eXperiences for the general public. School nurses should be involved in designing and teaching family life classes for high school students. These classes should provide realistic child-care experiences for these future parents. Realistic experiences could include having students work in a day-care center located on the school campus; assigning students a "marital partner," with whom they must solve problems of family life; or directing students to take responsibility for a fragile, inanimate object twenty-four hours a day to simulate parental responsibilities. Although evaluation of such programs would be difficult, the goal would be realistic preconceptions of parenthood and ease Of transition into the parental role. Nurses teaching prenatal classes could incorporate material designed to promote realistic preconceptions of the postpartum period into the course content. Nurses could also teach groups of new parents in the hospital, or in the community at 258 weeks postpartum. The groups could provide peer support as well as education. The content could be based on the study findings: promoting realistic preconceptions of postpartum, and coping with the effect of a newborn on the couple's marital relationship and on their lifestyle. . In summary, practicing nurses, student nurses, and other health care professionals could be taught to incor- porate the study results into their practices. In turn, 187 they could teach the general public what to expect during the postpartum period and how to cope with common posts partum concerns. The goal Of such education would be to promote ease Of transition into parenthood by promoting realistic expectations of the parental role. Summary In Chapter VI, an overview of the research was pre- sented. In addition, the findings were discussed and interpreted, and conclusions were drawn. The signifie cance of the study results for nursing research, practice, and education was discussed. 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Chrmic respiratory disease 7. Chrcnic kidney disease 8. Major psychiatric disorder 9. Major endocrine disorder Prmatal Flow Record 10. Multiple fetuses ll. Pre—eclaupsia/eclatpsir}? proteinuria, edana of the faceandhands, anddiastolicBPg'reaterthan90 Initial Pregnancy Profile 1.2. Viral infection first 12 weeks of this pregnancy Postpartum 4. Vaginal delivery? 5. Full-tent, single infant? 6. maxer&babyD/Cfranlxospita15thdayorless postpartum? 7. Any abnonnalities of baby (:1 newborn PE? Telephcne Call 8. Married, not separated? 9 . Any hospitalizations this pregnancy? gesticnnaire 10. Children living with or step—children visiting? 11. Hospitalization of mm or baby since D/C? 207 888 888888888 III I IIIIIII fig 8 5 8 588888888 IIIIIIIIII 855 II 8 I I 8 8 8 I815 IE I I I 8 '5 I 5 I8 I ..5..M.$fi.filk§iu§i§3$a ..:.___.._..4.. .. - APPENDIX D - Hospital Center July 6, I98] Ms. Roxann Hambiin, R.N., B.S.N. 71] Kenny Court Dear Ms. Hambiin: This is to advise you that your proposed study with regard to pregnant patients through the Famiiy Practice Center at the Hospital Center has been approved. However, the patients must have the consent of their physician to participate in the study. Rober S. Brown, M.D., Chair n Research Committee Sincerely, RSB/bw 208 APPENDIXE Prenatal EXpectations and Postpartun Experiences Michigan State University College of Nursing Consent Form June 24 , 1981 Yazrdoctorhasagreedtoassistme,agraduate studentofnursingat Michigan State University, withmynaster's research. Iamdoinga shadyofpregnantwmenwhowillbemthersforthefirsttjme. I muldlikeyuirpennissiontolookatymlrmaternal/newbomrecord toseeifyouareeligibletobeaparticipantinmystudy. Ifyou areeligible,Iwm11dalsolfl