極低出生体重児の母親の愛着形成過程とその関連要因 <原著>

本研究は,極低出生体重児を出産した母親の愛着の形成過程を明らかにし,それに関連する要因を検討し,母親の愛着を促進させる看護援助を考えることを目的とした.

在胎週数26w～35w,体重886g、1484gで出生した極低出生体重児5名の母親に対して,子どもとの初回,2回目,3回目の面会,以降1週間毎に退院時までの期間で,面会場面を観察し,その後にMullerにより開発されたThe Maternal Attachment Inventory(1994)を参考にして作成した愛着感情質問票と関連要因に関する質問紙調査を行なった.加えてSTAIによる不安の調査と半構成面接を実施し,以下の結論を得た.
1.母親の愛着の情動面は初期から比較的高く.望んだ出産であったことが関連していると考えられた.さらに面会の中で子どもの反応に感動したことや,夫や看護者などから得た心理的サポートにより危機的心理状態が立ち直っていったことなどが関連して早期に上昇した.
2.母親の愛着の母親役割の認識面は情動面より低く,変動しやすかった.特に子どもの反応の認知が低かった.関連する主な要因としては,子どもの反応への感軌母乳,育児行動の実施があった.
3.早期より育児行動にかかわった母親は,不安や母子分離感が軽減し,満足して退院を迎えていた.ただし早期に育児行動を促す時は,未熟な子どもの反応の読み取り方と対応に関する教育が不可欠であった.
4.家族,特に夫からのサポートや第一子の状態が母親の精神状態の安定に影響して,愛着形成に間接的にかかわっていた.
5.以上より,子どもの反応に感動できる機会や,早期の面会と育児行動の保証,母乳への援助,家族関係の調整などを通して主に母親役割の認識面を促す看護援助が重要であることが示唆された.

The purposes of this study were: a ) to clarify the maternal attachment process in mothers of the very low birth weight infant, b) to clarify the influence factors for the process, and C) to examine the nursing interventions to promote the maternal attachment process.

The subjects were the mothers of five very low birth weight infants who were born between the 26weeks and the 35weeks of gestational age and between 886g and 1484g birth weight. The data were collected in the first, second and third visit to their babies and also every other week till the baby's discharge. The data was included the maternal Attachment questionnaire that was made from MAI (Maternal Attachment Inventory, Muller 1994), the questionnaire of relational factors, STAI (State-Trait Anxiety Inventory), and the interview.

Results were as follows;
1 . Emotional aspects of maternal attachment were high point, because a l l mothers hoped to give birth. Ascending factors were the baby's reactions and the her crisis reduction through the support from her husband and the nurses.
2 . Aspects of maternal roll cognition were lower than the emotional aspects, and easily changed. Especially the cognition of baby's reaction was low. Ascending factors were the deep impression to the baby's reaction, breastfeeding, and the caring of her baby.
3 . The mother that took care of her baby from an early stage decreased her anxiety, and she was satisfied with baby's hospitalization. But, when nurses make the mother takes care of very premature baby, the nurses have to teach the premature baby's reactions and the ways to cope with them.
4 . The support from her husband and the condition of the elder child had indirect influence on the maternal attachment.
5. Nursing interventions to promote maternal attachment were : a) the assurance of chances t h a t mothers can be impressed by her baby's reactions, b) the assurance of early visits and taking care of her baby, c) the support for the breastfeeding, d) the adjustment of the relationship in their family members. The aspects of maternal roll cognition were promoted mainly through these nursing interventions, which are very important.