Abstract

• The problem addressed by this study was to determine the effect of nurse-patient agreement on the means to achieve nursing goals in the early postpartum period of primiparous mothers. It was hypothesized that the experimental treatment would result in hegher self-confidence and satisfaction in maternal role performance. This Purpose was to contribute to the planning of nursing care to enhance self-confidence and satisfaction in maternal role performance and to the development of relevant nursing theory. Especially, the early postpartum period is crucial toward in recovery from childbirth and attainment of the maternal role. Maternal role attaintment is a complex social and cognitive process of stimulus-response accomplished by learning. Most women attain the maternal role successfully. But, some primiparous mothers experience difficulties in attainment of the maternal role due to lack of experience and knowledge. Self-confidence and satisfaction in maternal role performance are important factors in attainment and adjustment to the maternal role(Mercer, 1981a, 1981b ; Lederman, Weigarten, and Lederman, 1981 : Bobak and Jensen 1985). Nursing is defined as behaviors of nurses and patients that attain nursing goals through action, reaction, interaction, and transaction. For attainment of nursing goals, active participating transactions must occur by agreement on the means to achieve those goals through nurse-patient mutual goal setting and establishment of their active relationships(King, 1981, Ha, 1977). Based on King's theory of goal attainment(1981), this study was planned as a non-equivalent control group, non-synchronized quasi-experimental design using agreement on the means to achieve nursing goals in early postpartum as the experimental treatment. The data were collected from July 20 to Sep. 1, 1991 by questionnaires with 60 primiparous mothers planing to breast feed after normal deliveries at W hospital in Pusan, Korea. The subjects were divided into a control group(conventional group)-those admitted from July 20 to Aug. 12 and an experimental group(agreement group)-those admitted from Aug. 13 to Sep. 1. The instrument for agreement on the means to nursing goals in the early postpartum period included five steps-identification of disturbances of problems through action, reaction, and interaction with primiparous mothers ; mutual early postpartal nursing goal setting ; exploration of the means to achieve goals ; agreement on the means (self-care, early maternal-infant contact, performance of mothering behavior, and communicating about the infant's behavior and health condition) ; implementation of the means. This instrument was developed on the basis of King's elements that lead to transactions in nurse-patient interactions. Lederman et al's(1981) scale for Confidence in ability to cope with tasks of motherhood and Lederman et al's(1981) scale for Mother's satisfaction with motherhood and infant care were used to measure-confidence and satisfaction in maternal role performance with the subjects immediately after admission and on the day of discharge. Self-care performance in the experimental group was measured by self-evaluation tool developed by the investigator from the literature concerned. The tools to measure self-confidence and satisfaction in maternal role performance, and the tool to measure self-evaluation of self-care performance were tested for internal reliability. Cronbach's Alphas were 0.94, 0.94, and 0.63. The data were analysed by using in S. P. S. S. computerized program and included percentage, x2-test, t-test, ANOVA, and Pearson Correlation Coefficient. The conclusions obtained from this study are summarized as follows : 1. The degree of self-confidence in maternal role performance of the total subjects group measured before the experimental treatment was above average with a mean score of 2.77(range 2.14-3.64). Out of 14 items, those with relatively high mean scores were 'I would like to be a better mother than I am'(3.95), and 'I know that my baby wants most of the times'(2.28), 'When the baby cries, I can tell what she/he wants'(2.37), and 'I have confidence in my ability to care for the baby'(2.50). That is, the self-confidence of primiparous mothers was considerably high in mothering, but rather low in activities concerning the infant care and understanding of the infant behavior. The degree of satisfaction in maternal role performance of the total subjects group measured before the experimental treatment was high with a mean score of 3.18(range 1.92-3.92). Out of 13 items, those with relatively high mean scores were 'I an glad I had this baby now'(3.75), 'I play with the baby between feeding when s/he is awake and quiet'(3.67), and 'I enjoy being a mother'(3.27). Those with low mean scores were 'I and upset about having too many responsibilities as a mother'(2.78), 'it bothers me to get up for the baby at night'(2.82). and 'I get annoyed if the baby frequently interrupts my activities'(2.82), That is, the satisfaction of primiparous mothers was considerably high in mothering and infant care, but rather low in restraints in time or on the mother's self accomplishment and development. 2. Agreement on the means to achieve nursing goals in the early postpartum period included process of mutual goal setting, exploration of the means to achieve goals, and ahreement in concret means to achieve goals based on the mothers' condition, concerns, self-perception of the nurse-patient interactions. In the process of agreement, there was agreement that the means to achieve goals should be through trust and establishment of active relationships with the nurse through identification of problems according to planned nursing goals and active interaction, such as explanations, teaching, changing of opinions, acceptance or rejection of explanations, and proposing of questions. Therefore agreement on the means to achieve nursing goals in the early postpartum period appears to be an effective nursing intervention for primiparous mothers. 3. The degree of self-confidence in maternal role performance of the experimental group was higher than that of the control group(t=3.95, p<0.01). Out of 14 items those with higher score in the experimental group were 'I would like to be a better mother than I am'(t=1.93, p<0.05), 'I know that my baby wants most of the times'(t=2.75, p<0.01), 'When the baby, I can tell what she/he wants'(t=2.10, p<0.05), 'I have confidence in may ability to care for the baby'(t=3.72, p<0.01), 'I trust my own judgement in deciding how to care for the baby'(t=1.93, p<0.05)m 'I feel that I know my baby and what to do for him/her'(t=2.44, p<0.01), 'I am concerned about being able to meet the baby's needs(t=2.87, p<0.01), 'I know wat my baby likes and dislikes'(t=3.26, p<0.01), 'I dont's know to care for the baby as well as I should'(t=2.07, p<0.05), and 'I am unsure about whether I give enough attention to the baby'(t=3.04, p<0.01). That is, the degree of self-confidence in mothering, activities concerning infant care, and understanding of infant behavior of the experimental group was higher than that of the control group. Therefore, the first hypothesis, that the degree of self-confidence in maternal role performance of the experimental group would be higher than that of the control group, was supported(t=3.95, p<0.01). 4. The degree of satisfaction in the maternal role performance of the experimental group was higher than that of the control group(t=2.31, p<0.05). Out of 13 items, those with higher score in the experimental group were 'I am glad I had this baby now' (t=2.29, p<0.05), 'I enjoy taking care of the baby'(t=2.49, p<0.01), 'It is boring for me to care for the baby and do the same things over and over'(t=2.87, p<0.01), 'I am unhappy with the amount of time I have for activities other than childcare'(t=2.51, p<0.01), and 'When bathing and diapering the baby, I would like to be dong something else'(t=2.43, p<0.01). That is , the degree of satisfaction in mothering, infant care, and restraints in time of on the mother's self accomplishment and development in the experimental group was higher than that of the control group. Therefore, the second hypothesis, that the degree of satisfaction in maternal role performance of the experimental group would be higher than that of the control group, was supported(t=2.31, p<0.05). 5. The third hypothesis, that the higher the degree of satisfaction in maternal role performance, the higher the degree of self-confidence in maternal role performance in the experimental group, was supported(r=0.57, p<0.01).

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