심신장애아 어머니의 역할획득에 영향을 미치는 요인에 관한 분석적 연구 : 정상아 어머니군과의 비교를 중심으로

Abstract

[한글]

심신장애아 어머니란 아무런 예고나 준비기간 없이 발생하게 되는 하나의 사건이다. 본 연구의 목적은 이와 같은 입자에 놓이게된 어머니들의 역할획득 과정을 관찰하여 정상아 어머니들과 어떻게 다르게 어머니의 역할획득 과정을 경험하고 있는지를 비교 연구하여

간호원으로써 그들이 예외적인 새로운 역할에서지니게 되는 혼란과 긴장 및 불신감을 제거하고 사랑과 관심을 받고 있다는 안도감을 갖게 하는 한편 그들이 장애 자녀의 성장과 발전을 위하여 최선을 다할 수 있도록 도와 줄 수 있는 방안을 모색하기 위함이다. 이러한 목적달성을 위하여 다음과 같은 연구의 목적과 가설을 설정하였다.

연구목적

1) 사회가 어머니에게 기대하는 역할을 측정하기 위한 도구를 개발한다.

2) 심신장애아 어머니와 정상아 어머니의 어머니역할기대 및 사회지지에 대한 어머니역할획득과의 상관관계를 비교한다.

3) 심신장애아 어머니와 정상아 어머니의 역할획득에 영향을 미치는 요인을 비교한다.

4) 정상아 어머니의 역할획득과정과 심신장애아 어머니의 역할획득 과정을 비교한다.

가설

1. 심신장애아 어머니에 있어서 어머니역할획득과 역할기대간에 긍정적 상관관계가 있을 것이다.

1) 심신장애아 어머니에 있어서 어머니역할기대의 정확도가 높을수록 어머니역할획득 관계개념에 대한 태도가 긍정적일 것이다.

2) 심신장애아 어머니에 있어서 어머니역할기대의 조화가 높을수록 어머니역할획득 관계개념에 대한 태도가 긍정적일 것이다.

3) 심신장애아 어머니에 있어서 어머니역할기대 원인들간의 의견일치가 높을수록 어머니역할획득 관계개념에 대한 태도가 긍정적일 것이다.

2. 사회지지가 높을수록 심신장애아 어머니들의 어머니역할획득 관계개념에 대한 태도가 긍정적일 것이다.

3. 심신장애아 어머니는 정상아 어머니에 비하여 어머니역할획득 관계개념에 대한 태도가 부정적일 것이다.

본 연구는 역할이론을 이론적 기틀로 하여 역할획득에 영향을 미치는 중요한 요인으로 역할기대를 선정하고 역할기대를 선정하고 역할기대를 주위환경의 역할기대의 정확도와 역할수행자와이 조화정도 및 기대원인들간의 의견일치정도의 세 형태로 측정하였다. 또한 어머니역할획득 과정에 의미있는 변수로써 사회지지를 선택하여 역할기대와 사회지지가 어머니역할획득과 어떠한 관계가 있는지를 확인하고저 하였다.

본 연구에서는 어머니역할에 영향을 미치는 어머니역할 기대를 특성과 행위의 두차원에 대한 정의를 내리고 이를 측정할 수 있는 도구개발을 시도하였다. 이와 같은 연구계획에 의하여 남, 여 19세부터 65세 이하의 일반시민들로부터 어머니로써 지녀야 할 특성과 행위에 대한 사항들을 수집하여 그 내용의 타당성과 신빙성을 검토한 후 Q card로 작성하였다. 또한 이들 card 사항의 중요성 정도에 따라 card별 rank가 정해졌으며 이들 Q card 사항은 어머니역할기대를 정확히 정의하여 어머니역할기대를 측정하기 위한 도구로 사용되었다.

한편 연구의 가설을 검정하기 위하여 첫아이가 심신장애아인 어머니들 48명과 정상아동의 어머니 52명을 서울과 W시 두 지역에서 연구의 대상자들을 선정하였다. 그리고 이들 연구대상자들을 병원에서 또는 가정방문으로 면접과 질문지를 사용하여 연구자료를 수집

하였으며, 어머니역할기대 정의를 위한 Q sorting, 역할기대와 조화정도 및 일치정도에 대한 질문지, 어머니역할획득 관계개념에 대한 Semantic differential, 사회지지를 측정하기 위한 Norbeck's social Support Questionnaire의 순서로 응답자와의 면접이 실시되

었다.

본 연구 가설인 어머니역할획득과 어머니역할기대 및 사회지지의 상관관계를 검정하였다. 심신장애아 어머니와 정상아 어머니역할획득에 영향을 미치는 변수들을 비교하기 위하여 단계별 다수회귀 분석을 시도하였으며 두 집단의 역할획득 과정을 비교하기 위하여 연령별 집단을 구성하여 역할획득과 역할기대의 평균 점수를 비교하였다.

본 연구의 결과는 다음과 같다.

1. 어머니역할기대 특성과 행위에 대한 사항별 등급비교에서 일반시민과 심신장애아 어머니와 정상아 어머니간에 유의한 자가 나타나지 않았다(특성; Kendall's W=0.86 p<.05).

2. 가설 검정결과로써

1) 역할기대와 어머니역할획득간의 관계에 대한 가설은 기각되었다.

① 어머니역할 정확도에 관한 가설에는 부정적 상관관계로 이에 대한 가설이 기각되었으며 (r=-.2891 p<.05) 정상아 어머니는 기대특성에서 긍정적 상관관계를 나타냈으나 (r=.3195 p<.5) 두 집단간의 평균점수에는 유의한 차이가 없었다.

② 조화정도에 관한 가설은 기각되었으며 두 집단간의 평균점수도 유의한 차이가 없었다.

③ 일치정도에 관한 가설 역시 기각되었으나 심신장애아 어머니와 정상아 어머니는 시어머니와 친정어머니에게서 어머니역할획득에 영향을 받게되는 것으로 나타났다.

2) 사회지지에 관한 가설은 기각되었으나 정상아 어머니와 심신장애아 어머니간의 평균점수에는 유의한 차이가 있었다(t=2.11 p<.05).

3) 어머니역할획득 관계개념에 대한 가설은 두 집단간에 역할획득 평균점수에서 유의한 차이 (t=3.61 p<.005)를 나타냈고 상관관계에서도 두 집단간에 유의한 차이가 있었으며

의미거리 공간내에서도 두 집단간에 유의한 차이가 있었다.

3. 심신장애아 어머니의 역할획득과정에 영향을 미치는 요인비교에서 심신장애아 어머

니는 아동의 연령과 어머니역할기대 행위의 중요한 사항 및 남편이 학력이었으며 정상아 어머니는 어머니역할 기대가 중요한 특성으로 나타났다.

4. 심신장애아 어머니와 정상아 어머니의 역할획득과정을 아동의 연령에 따라 비교해 본 결과 아동이 생후13개월 되는 시기에는 두 집단간에 유사성를 나타내고 있었으나 13개월 이후부터는 두 집단간에 유의한 차이를 나타내고 있었다. 생후 4∼6개월되는 시기에는

심신장애아 어머니의 역할획득 점수는 높고 정상아 어머니 점수는 낮았다. 그러나 그 시기이후부터 정상아 어머니는 높게 되고 일정하게 평균수준을 유지하고 있었다.

결론적으로 심신장애아 어머니와 정상아 어머니 역할획득에 영향을 미치는 요인은 다음과 같다.

1) 어머니들의 역할기대에 대한 일반시민과 어머니들의 인식정도에 차이가 있었다.

2) 어머니 역할기대는 심신장애아 어머니에게 행위면으로, 정상아 어머니에게는 특성면으로 어머니역할획득에 영향을 미치고 있었다.

3) 어머니역할획득에 영향을 미치는 가족성원의 변수중에서 대표적인 변수는 친정어머니와 시어머니로 나타났다.

4) 정상아 어머니들의 역할획득에는 사회지지가 영향을 미치는 반면 심신자애아 어머니들의 역할획득에는 관계가 없었다.

5) 심신장애아 어머니는 정상아 어머니에 비하여 어머니역할획득 관계개념에 대한 태도가 부정적이었다.

심신장애아 어머니와 정상아 어머니와의 어머니 역할획득과정의 양상을 분석한 본 연구의 결과는 어머니로써 적합한 역할 태도와 행동을 획득 및 지속하기 위하여 산전관리 및 산후관리시에 포함하여야 할 간호활동분야를 제시하며 또한 역할획득과정 기간중 전체 기록을 중심 또한 적절한 사회지지를 형성할 수 있는 간호계획을 세우는데 공헌할 수 있다.

[영문]

The study was designed to investigate the realtionship of role expectations and social support to role acquisition.

The objecties of the study were

1) to develop a tool to measure role expectations,

2) to examine the correlation of role expectation and social support with role acquisition in mothers of handicapped children and to compare findings with the same correlation in mothers of non-handicapped chidren,

3) to examine the effects of role expectations and social support on role acquisition in the two groups of mothers, and

4) to compare the role acquisition process in the two group of mothers.

The existence of positive attitudes to four role related concepts was used a s an indicator of role acquisition. Three hypotheses were tested.

1. In mothers of handicapped children there will be a direct relationship between role expectations and role acquisition, that is,

1) the clearer the role expectations are, the more positive the mother's attitude will be to the role related concepts.

2) the greater the congruence between the mother's expectations of her role and her role ability, the more positive the mother's attitude will be to the role related concepts.

3) the greater the congruence between the expectations of the significant others, the more positive the mother's attitude will be to the role related concepts.

2. In mothers of handicapped children the greater the amount of social support, the more positive the mother's attitudes will be to the role related concepts.

3. Attitudes to role related concepts will be less positive in mothers of handicapped children than in mothers of non-handicapped children.

Role theory was used as the theoretical basis for the study because it offers a conceptual explanation that is more useful in explaining the long term effects of a handicapped child on the role of his/her parents than other more commonly used theories.

In role theory, role acquisition is seen to be highly dependent on role expectations, partioularly the clarity with which the role incumbent perceives the expectations, the amount of congruence between the expectations of the role incumbent and his/her ability for the role and the degree of consensus that exists between significant others as to the role expectations.

Role acquisition is defined as the merger of the person with his/her role and is seen as being a potential time of stress. Social support was discussed as one factor that decreases stress and was included in this study as an independent variable affecting role acquisition.

Role expectations were defined as role characteristics and behaviours generally expected of the role incumbent for any particular role position. The lack, in the literature, of any such definitive statement as to expectations for those in the

maternal role suggested a need to define and measure expectations for the maternal role. (objective. 1) A three step process was used to develop this measure. It involved collecting maternal role items from the literature and from a sample of people. These items were used for a Q sort, the results of which were used to

define maternal role expectations in this study.

In order to test the hypotheses(objective 2) a sample of 48 mothers residing in Wonju or Seoul, whose first child had been diagnosed as having a congenital malformation, a developmental delay or an acquired handicapping condition was chosen along with a comparison group of 52 mothers whose oldest child was not handicapped.

The mothers were interviewed either in their home or in the clinic, whichever was more convenient. The interview consisted of items related to the demographic situation of the family, including, in the case of mothers of handicapped children,

some information about the child's handicap. This time allowed the interviewer to establish rapport with the mother and to express concern for her as a mother. Each mother was then asked to complete a Q sort of each of the 60 card sets, one for characteristics and one for behaviour. This was followed by the questionnaire items related to congruence and consensus, a semantic differential to measure attitudes to role concepts of "my mother" "my child" "my family," and "myself(as mother),"

and finally a scale to measure social support.

The data was analyzed as follows:

1. To determine the order of importance of the role characteristics and behaviours that make up the role expectations, each of the cards for each two categories was scored on a scale of 1 to 9. The means of these scores were

calculated and the cards were ranked accordong to their average scores. These lists were used to define maternal role expectations.

2. To test the hypotheses each of the independent variables was corralated with the dependent variable. To compare the two groups of mothers, differences between the ranks for role expectations and between the mean scores for all variables were tested using Spearman rho correlations and t-tests.

3. To determine which of the variables for each group of mothers accounted for most of the variance in the role acquisition scores, stepwise multiple regression analysis was done.(objective 3)

4. To determine if there was a difference in the process of role acquisition for the two groups, a comparison of the role variables for cross-sectional age groups of the sample was done.(objective 4)

The results:

1.a) spearman rho between each of the groups of mothers and the general society ranking was significant at P<.05. Kendall's W for similarity of ranks between the three groups was also significant at p<.05, indicating that there was a similarity in perception as to role expectations for each of the three groups.

b) The hypothesis, that, for mothers of handicapped children, the clearer the role expectations are, the more positive the mother's attitudes will be to the role related concepts was rejected as the correlation for important role attitudes was

negative.(r= -.2891, p<.05) In mothers of non-handicapped childern a positive relationship between role characteristics and role attitudes was found. (r=.3195, p<.05) There was no difference between the mean scores for role expectations between the two groups.

c) The hypothesis concerning congruence was also rejected as no difference was found between the mean scores for the two groups.

d) The hypothesis concerning consensus was rejected and no difference was found between the mean scores for the two groups. However, a negative correlation was found for mothers of handicapped children between the mother's role attitude and

her own mother's role expectation, and a positive one was found between the mother's role attitude and her mothers-in-law's role expectation. For mothers of non-handicapped children the opposite result was found.

e) The hypothesis concerning social support was also rejected. However a correlation was found between the social support variables and role attitudes in mothers of non-handicapped children, (r=.2451, p<.05) and a significant difference was found between the mean scores for social support for the two groups. (t=2.11, p<.05)

f) The hypothesis concerning the direction of role attitudes for the two groups of mothers was accepted, because, there was

1) a significant difference between the mean scores for the two groups, (t=3.61, p<.005)

2) a significant difference in the correlations between the attitudes,

3) and a difference in the semantic space occupied by the concepts for the two groups of mothers.

2. The variables contributing to the variance in the role attitude stores for the mothers of handicapped children were, the child's age, the role expectations(behaviour) and the husband's education. For mothers of non-handicapped children only one variable accounted for the significant part of the variance, role

expectations(characteristics).

3. The role process analysis showed no difference for the two groups at 13 months, but a steadily widening and significant difference at all age levels above that. Within the first year of the child's life the time between four to six months was the high point for role attitudes in mothers of handicapped followed by a

steady decline, whereas mothers of non-handicapped children show a drop at the four to six month period and then a leveling off.

Role expectation variables showed a more narrow range of values for mothers of handicapped children than for mothers of non-handicapped children.

The sample was too small to do statistical analysis for the under 13 month old groups.

The Conclusions:

1. Maternal role expectations as perceived by society in general and by the mothers of either handicapped or non-handicapped children are the same.

2. Behavioural role expectations are more salient for mothers of handicapped children Role acquisition is dependent on the mother accepting maternal role expectations that are different from those that general society has for the maternal role In comparison personality(characteristic) role expectations are more

salient for mothers of non-handicapped children and role acquisition is dependent on the mother holding expectations similar to the general society.

3. Neither congruence of role expectations and ability, nor consensus of role expectations between significant others was demonstrated to influence role acquisition, but the correlations between the role expectations of the mother's own mother and role acquisition and between role expectation of the mother's mother-in-law and role acquisition lead to the conclusion that these two

significant role others are important in the the role acquisition process.

4. Social support was not demonostrated as contributing to increasing positive attitudes to the role concepts in mothers of handicapped children. This along with the significant difference in the scores for the two groups leads to the conclusion that social isolation does exist for these mothers and that social support does not function the same way as it does for mothers of non-handicapped children.

5. The results concerning the role attitudes lead to the conclusion that whereas the concepts for mothers of non-handicapped children were correlated and integrated, presenting a unity, the concepts for mothers of handicapped children are differentiated and the mother sees herself and her child at a distance from the family, rather than integrated into it.

Significance

The study is seen as being significant to nursing theory in indicating a need to develop theory to explain all aspects of role acquisition in a role that is both achieved and ascribed and that has aspects of crisis and chronicity and that involves reciprocal relationships in a very close unity, the family.

The use of Q-sorts and semantic differential date collection tools for nursing studies is feasible, but there are some limitations.

The study is also seen as being important to nursing practice in emphasizing the need for nurses 1) to understand the on-going process related to role acquisition and role attitudes and the possibility of the development of increasingly negative attitudes, and to develop appropriate evaluation tools and intervention methodologies to decrease this possibility, 2) to be aware of the whole family in this process of role acquisition and in particular the relationship of the mother to both her own mother and to hermother-in-law, 3) to be aware of the need to help the mother develop a positive attitude to both her child and herself and to be aware that these are interrelated, and 4) to be aware of the possibility of social isolation for these mothers and to investigate ways to overcome this.