One of the important tasks for new parents, especially mothers, is to establish warm, mutually affirming interpersonal relationships with the new baby in the family, with the purpose of promoting the healthy development of the child and the wellbeing of the whole family. Nurses assess the quality of the behavioral characteristics of the maternal-infant interaction. This study examined the relationships between primiparas perceptions of their delivery experience and their maternal infant interaction. It compared to delivery experience of mothers having a normal vaginal delivery with those having a cesarean section. The purpose was to explore the relationships between the mother's perceptions of her delivery experience with her maternal infant interaction. The aim was to contribute to the development of theoretical understanding in which to vase care toward promoting the quality of maternal-infant interaction. Data were collected directly by the investigator and a trained associate from Dec. 1, 1987 to March 8, 1988. Subjects were a random sample of 62 mothers, 32 who had a normal vaginal delivery and 30 who had a non-elective cesarean section(but without other perinatal complications) at three general hospitals in Seoul. Instruments used were the Stainton Parent-infant Interaction Scale(1981). The first observations were made in the delivery room(for vaginally delivered mothers only), followed by day 1, day 2, day 3 and 2 weeks, 4 weeks, 6 weeks and 8 weeks after birth, for a total of 7-8 contacts(Cesarean section mothers were observed on days 4 and 5 but the data not used for analysis). Observations in the hospital were made during the hour prior to scheduled feedings. The infant was placed beside the mother. Later contacts were made at home. Data analysis was done by computer using as SPSS program and indulged X2 test, paired t-test, t-test, and Pearson Correlation coefficient ; the results were as follows. 1. Mothers who had a normal vaginal delivery tended to perceive the delivery experience more positively than cesarean section mothers(p=0.002). the finding supported the hypothesis I that perception of delivery would vary according to the method of delivery. Mothers' perceptions of birth were classified into three dimensions, labor, delivery and the baby. There was a significantly different and positive perception by the vaginally delivered mothers to the delivery experience(p=0.000) but no differences for labor or the baby according to the delivery method(p=0.096, p=0.389). 2. Mothers who had a normal vaginal delivery had higher average maternal-infant interaction scores(p=0.029) than mothers who had a cesarean section. There were similar higher scores for the 1st day(p=0.042), 2nd day(p=0.009), and the 3rd day(p=0.006) after delivery but not for later times. The findings supported the hypothesis II that there would be differences in maternal-infant interaction for mothers having vaginal and cesarean section deliveries. However these differences decreased section deliveries. However these differences decreased over time ; by eight weeks the scores for vaginal delivery mothers averaged 8.1 and for cesarean section mothers, 7.9. 3. The more highly positive the perception of the delivery experience, the higher the maternal-infant interaction score for all subjects(F=0.3206, P=0.006). The findings supported the hypothesis III that there would be correlations between perceptions of delivery and maternal-infant interaction. The maternal infant interaction was highest when the perception of the baby and delivery was positive(r=0.4363, p=0.000, r=0.2881, p=0.012). No correlations between perception of labor and maternal-infant interaction were found(p=0.062). 4. The daily maternal-infant interaction score for the initial contact after birth to 8 weeks postpartum had the lowest average score 5.20 and the highest 7.98(in a range of 0-10). This subjects group of mothers needed nursing intervention to promote their maternal-infant interaction. The daily scores for the maternal-infant over the period of eight weeks. However, there were significantly different increases in maternal-infant interaction only from the first to second day(p=0.000) and from the fourth to sixth weeks after birth(p=0.000). 5. When the eight items of maternal-infant interaction were evaluated separately, "Expresses feelings about her role as mother" had the highest average score, 1.64(in a range of 0-3) and "Speaks to baby" the lowest, 0.9. All items, with the possible exception of "Expresses feelings about her role as mother", suggested the subjects' need of nursing intervention to promote maternal-infant interaction. 6. There were positive correlations between certain general characteristics, namely, both a higher economic status(p=0.002) and breast feeding(p=0.202) and maternal-infant interaction. There were positive correlations between a mother's confidence in her role as a mother and the perception of the birth experience(p=0.004). For mothers who had a cesarean section, a positive perception of the birth experience was related to the duration of her marriage(p=0.010), a wanted pregnancy(p=0.030) and her confidence in her role as a mother(p=0.000). Perceptions of birth for mothers who had a normal vaginal delivery were positive than those for mothers who had a cesarean section. The level of maternal-infant interaction for mothers delivered vaginally was higher than for cesarean section mother. The relationship between perception of birth and maternal-infant interaction was confirmed. Cesarean section has an impact on the mother's perceived experience of birth which, in turn, is positively related to maternal-infant in turn, is positively related to maternal-infant interaction. Nursing intervention to enhance maternal-infant interaction should begin in prenatal classes with an exploration of the potential impact of cesarean section on the perceptions of the birth experience and continue throughout the perinatal and post-natal periods to promote the mother's ability to control with this crisis experience and to mobilize social support. Nursing should help transform a relatively negatively perceived experiences into accepted, positively perceived and self affirming experience which enhances the maternal-infant interaction.

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This study was conducted to investigate the present situation and problems related to the use of nursing diagnosis in practice. The data were obtained from 332 subjects (27 director of nursing service, 302 staff nurses) who worked in university hospitals in Korea from July through August 1988 using a mailed questionnaire. Data were analyzed by frequency, X2 test and t-test. The findings were as follows : 1. Clinical use of nursing diagnosis by directors of nursing service and staff nurses. 1) The majority of the nursing departments (88.9 %) conducted group education on nursing diagnosis during the last 5 years and 81.5% of them kept a record formet for nursing diagnosis ; 88 .9 % of them had had prior experience with the nursing diagnosis. 2) Most of nurses (97.0%) had received education on nursing diagnosis, 2. Factors related to the clinical use of nursing diagnosis in nursing service departments and by staff nurses. 1) The one factor related to the use of nursing diagnosis in the nursing service department was the existence: of a record. 2) Factors related to the use of nursing diagnosis by the staff nurses were the organization style of the nursing service department, group education during the last 5 years, existence of a record, the attitude of the director of nursing service, and prior experience of the use of the nursing diagnosis as characteristics of nursing service department and educational experience of nursing diagnosis as a character of nurse. 3. Problems with the use of nursing diagnosis. 1) The primary problem was the lack of time and personnel (mean : 3.757) I the second problem was the lack of knowledge and will to use nursing diagnosis in practice by the staff nurses(mean : 3.546). 2) There was no significant difference in problems expressed by the director of nursing services and the nurses. The majority of nurses who worked in the university hospitals expressed interest in and concern about the use of nursing diagnosis. Most of the nurses had had education about on nursing diagnosis but use in practice was limited. The primary problem was lack of time and manpower Strategies for improving use of the nursing diagnosis in practice: 1) Strengthening the education about nursing diagnosis and a holistic approach to understanding human beings. 2) Develop protocols for the use of nursing diagnosis. 3) Eliminate the language barrier regarding nursing diagnosis by translation into in Korean. 4) Decentralization of the nursing service to promote accountability by individual nurses for use of nursing diagnosis.

This study was conducted to measure the effects of clinical application of a Nursing Diagnosis Protocol. The dependent variables were the degree of patient's satisfaction and the degree of nurse's satisfaction with the nursing activity. Analysis of the effect of the use of the nursing diagnosis protocol was based on the nursing record. The subjects for this study were 61 nurses (experimental group 31, control group 30) and 155 patients (experimental group 55, control group 100) on four internal medicine wards in K University Hospital in Seoul. Data collection was done from August to October 12.1988. - The results obtained in this study can be summarized as follows, 1. Effect of the clinical application of the nursing diagnosis protocol. 1) The first hypothesis ; " nurses who use the nursing diagnosis protocol will have higher degrees of satisfaction than those who use traditional methods" was rejected.(t= .54, df=58, p=.59). 2) The second hypothesis ; " patients nursed by nurses using the nursing diagnosis protocol will have higher degrees of satisfaction than those nursed with traditional methods" was supported(t=1.93, df=154, p= ,05). 3) The third hypothesis: Major hypothesis ; "the nursing records of the experimental group, who used the nursing diagnosis protocol, will be more detailed than those of the control group " was supported (t=6.40, df=79.90, p=.000). (1) The first subhypothesis ; "The recorded data collection of the experimental group will be more detailed than . that of the control group" was rejected (t= 1.79, df=118, p=.07). (2) The second subhypothesis : "The recorded patient's problem statement of the experimental group will be more detailed than that of the control group" was supported. (3) The third subhypothesis : "The nursing record of the experimental group will be more convenient for implementation than that of the control group" was supported. 2. Factors related to the nurse's degree of satisfaction with protocol. 1) No general characteristics(age, religion, education level, duty career, present duty career) were related to the Burse's degree of satisfaction. 2) Variables related to the nurse's degree of satisfaction were "satisfaction as a nurse" and "consider nursing as lifelong job" (t=-2.6, df=13.2 2, p=.02, t=2,41, df=23.85, p=.02). 3. Factors related to the patient's degree of satisfaction. 1) General characteristics related to the patient's degree of satisfaction with nurses using the protocol were ass. educational level, and being married.(F=5.17, df=3/153, p=.00, t=-2.39, df=154, p=.01, f=5.91, df=2/153, p=.00) 2) The variables previous hospitalization, duration of hospitalization, the hospital unit, presence of a relative, medical insurance, or medical diagnosis were not related to the patient's degree of satisfaction. I. The experimental group's nursing record was more detailed than the control group's record with regard to the physical and psychological state of the patients. As noted above, the experimental group nurses, who use a nursing diagnosis had protocol were less satisfied than the: control group who used traditional methods of the recording, but experimental group patients had a higher degree of satisfaction than the control group patients. The nursing records of experimental group, using the nursing diagnosis protocol was more detailed than that of the control group. If the nursing diagnosis protocol is used in clinical nursing practice, the quality of nursing care may be improved.