Research Briefs Edited by Patricia H. Byers

Patricia H. Byers, PhD, RN, is Associate Chief of the Nursing Sen'ice for Research, Veterans Administration Medical Center, Bay Pines, FL 33504.

Nurses' Responses to Separation From Their Secondborn Infants

Martha S. Pitzer

M OTHERS OF YOUNG infants are going back to work in large numbers (.McBride,

1988; Woods, 1985), and many are ambivalent about separation from their children (Hock, Gnezda, & McBride, 1984). Nurses as a group comprise a large percentage of these mothers; 57% of the 1.5 million nurses in the U.S.A. have chil- dren, and 13% have one or more children under 6 years of age (American Nurses Association, 1987; Quarm, 1984).

Forty women enrolled in a longitudinal study were working mothers of secondborn infants who agreed to participate in a study on maternal sepa- ration. The original longitudinal study included a random, stratified sample of 623 first-time mothers who had delivered a firstborn infant in one of three midwestem hospitals (Hock et al., 1984).

The 40 mothers of secondborn infants were all white and married. They agreed to be interviewed in 1984 regarding concerns about their second- born infants. Analyses showed that they had sig- nificantly less guilt, sadness, and worry about sep- aration events with their secondborns than with their firstborns at the same infant age (M = 7 months), and they had fewer concerns about alter- native care. They also had more positive percep- tions about the effect of separation on the infant. However, these second-time mothers continued to have as much concern about work-related separa- tion and total maternal separation anxiety with the second child as they had with their first (Pitzer & Hock, 1989).

A serendipitous finding noted in these analyses w a s the high number of registered nurses (n = 11,

27%) within this sample of 40 mothers. Because of the significant number of employed nurse-mothers in the general population, an important new pur- pose was to compare the subset of nurses with all other subjects in the study on maternal separation anxiety. The original population of the longitudi- nal study contained 7.8% registered nurses; nurs- ing was the largest occupation represented, fol- lowed closely by teaching.

Group comparisons included the following methods: a questionnaire; taped, interview-based rating scales (IBRS); and qualitative analysis of the taped interviews. The questionnaire, the Maternal Separation Anxiety Scale (MSAS), is a 35-item Likert scale composed of 3 subscales that assess a mother's concerns about separation from her child. Subscale 1 includes items related to feelings of worry, sadness, and guilt surrounding a separation event and attitudes about exclusive maternal care. Subscale 2 measures maternal perceptions of the child's response to separation, and Subscale 3 measures maternal feelings about work-related separations (Hock et al., 1984).

The IBRS (a 9-point Likert scale) included par- allel questions and subscales on separation and questions on maternal role, career investment, pregnancy, and parenting a second child. Interrater reliability for 15 of the interviews varied from r = .84 to r = .95 for the IBRS. Strauss' constant comparative method (1987) helped identify addi- tional quantitative categories in the interview tran- scripts.

Using Student's t tests, nurses were compared with the other subjects for demographics, the MSAS and IBRS subscales scores, rating scales of maternal role and career investment, and parenting the second child. On Subscale 2, perceptions of the child's response to separation, of both MSAS and the IBRS, nurses showed a trend toward more anx- iety. Nurses also showed a trend toward being more stressed by second-time mothering than did the other subjects (p = .09). Nurses were signif-

34 Applied Nursing Research, VoL 3, No. 1 (February}, 1990: pp. 34-38

RESEARCH BRIEFS 35

icantly older than the other mothers in this study (29.36 years vs. 27.07 years) and they worked fewer hours per week than the other mothers (19.91 hours vs. 33.14 hours). Interestingly, the nurses worked longer during the second pregnancy (35.9 vs. 34.0 weeks gestation) than did the other mothers. All but one of these nurses worked in acute care settings or obstetrics; this woman worked 30 hours each week as an office manager and professional assistant for her husband's dental practice.

Qualitative analyses of the nurses' taped inter- views introduced the following categories. Child care preference: Separation was more tolerable when the infant was cared for by a family member. Work-status preference: Separation was also more tolerable if mother worked part time, preferably in the evenings, when father could provide child care. Separation by age of child: Separation was more beneficial to the firstborn child (M = 2½ years) than to a secondbom (M = 7 months) child. Most mothers felt that the infant would, however, benefit from greater contact with the father (if the father was the alternative care giver). Vulnerabil- ity: Mothers reported more problems or concerns with the second pregnancy or the second child. Mothers also reported working in areas involving sick children (emergency room, neonatal intensive care unit, pediatrics).

These qualitative categories validated the quan- titative findings on work-status preference and preference for child care. The category of vulner- ability (pregnancy/newborn complications and oc- cupational setting) may explain the higher mean separation scores on Subscale 2 in nurse-mothers when compared with the other subjects in the study.

Perhaps the professional backgrounds of nurses make them more aware of the potential hazards an infant or young child can encounter if not carefully supervised. Nurses, in contrast to the general pop- ulation, often see and care for ill or neglected chil- dren. Therefore, they may need additional reassur- ance and support in their decision to retum to work following the birth of the child.

The modest differences found in this small sam- ple of nurses are possible clues to how nursing may influence maternal separation concerns. A replica- tion study of 30 first-time nurse-mothers who have recently returned to work is now in progress. We hope that other nurses, and particularly nurse-

employers, will respond to this research and the possible implications maternal separation anxiety may have for our practice.

Possible Implications

Nurses are often working mothers. Their expe- riences in managing separation may influence how they view other employed mothers because they have frequent opportunities to assess and to coun- sel other mothers about employment separation concerns.

Attention to interventions to reduce nurse- mothers' separation concerns with leaving their in- fants while at work can help recruitment and re- tention of nurses. For instance, information on maternal separation anxiety can support innovative policies for employed parents of young infants and children (on-site day care, flex-time, more exten- sive parental leave, etc.). A more sensitive re- sponse from the health care system to the needs of employed parents is imperative because of the present nursing shortage. Finally, in order to pro- vide quality care to others, nurses must not be preoccupied with personal concerns such as mater- nal separation; these concerns need to be acknowl- edged and reduced whenever possible.

REFERENCES American Nurses' Association (ANA), Nursing Information

Bureau. (1987). Facts About Nursing. Kansas City, MO: American Nurses' Association.

Hock, E., Gnezda, M.T., & McBride, S. (1984). Mothers on infants: Attitudes toward employment and motherhood fol- lowing birth of the first child. Journal of Marriage and the Family, 46, 425-431.

McBride, A.B. (1988). The mental health effects on wom- en's multiple roles. Image, 20, 41-47.

Pitzer, M.S. & Hock, E. (1989). Maternal concerns about separation from first- and second-born infants. Research in Nursing in Health, 12, 123-128.

Quarm, D. (1984). Sexual equality: The high cost of leaving parenting to women. In K.M. Borman, D. Quarm, and S. Gide- onse (Eds.) Women in the workplace: Effects on families (pp. 187-208). Norwood, NJ" Ablex.

Strauss, A. (1987). Qualitative analysis for social scientists. Cambridge: Cambridge University Press.

Woods, N.F. (1985). Employment, family roles, and mental health in young married women. Nursing Research, 34, 4-10.

From the College of Nursing, The Ohio State University, Columbus, OH.

Martha S. Pitzer, RN, PhD: Assistant Professor, the College of Nursing, The Ohio State University, Columbus, OH.

Research supported in part by a National Research Service

36

Award, #5F31 NU-05554-02, Division of Nursing, HRSA DHHS.

Address reprint requests to Martha S. Pitzer, RN, PhD, As- sistant Professor, The Ohio State University, College of Nurs- ing, 1585 Nell Ave, Columbus, OH 43210.

© 1990 by W.B. Saunders Company. 0897-1897190/0301-0007505.00/0

Measurement of Psychophysiologic Response

Variables in Chronic Bronchitis and Emphysema

Linda E. Moody

V ALID AND RELIABLE instruments to mea- sure response variables in clinical research

trials and in the clinical area will permit assess- ment of interventions and outcome responses (Guyatt, Bombardier, & Tugwell, 1986). The Chronic Disease Assessment Tool (CDAT) is used to assess psychophysiologic variables, functional status, and quality of life in adults with chronic bronchitis and emphysema (CBE). It was devel- oped by Moody (1988), who modified scales from a number of established instruments that have been shown in previous research with CBE, cancer, ar- thritis, and other chronic diseases to have accept- able validity and reliability. The new instrument contains both'new and modified scales and is com- prehensive in the.measurement of psychophysio- logic variables. The instrument was piloted in a sample o f 21 subjects with CBE. Based on pilot data, a few items were modified to improve clar- ity. In this develoPment stage, two pulmonary nurse experts and one pulmonary epidemiologist reviewed the CDAT for content validity, yielding a total content validity index of .94 for all items (Waltz,:Strickland, & Lenz, 1984). The CDAT was then used in a cross-sectional study of 45 sub- jects with CBE at the Gerontology Research Cen- ter, National Institute on Aging (NIA). The CDAT (Pans 1 and 2) includes the following sections and scales.

Part 1

Pan 1 of the CDAT contains 106 self-report items and five sections, A through E. The ques- tionnaire is administered by pencil and paper to

RESEARCH BRIEFS

subjects who are usually able to complete it within 25 to 30 minutes.

Section A: General Health and Medical History

Questions in this section are used to measure the subject's perceived health status, degree of disabil- ity from lung disease, and length of known diag- nosis of lung disease. The subject's perceived de- gree of dyspnea, acute and chronic, is measured by a dyspnea visual analog scale (dyspnea severity) (Guyatt et al., 1986) and the American Thoracic Society Grade of Breathlessness Scale (GBS) (Brown,' 1985).

Section B: Environmental Risk (Air Quality and Active and Passive Tobacco Exposure)

This section measures the degree of past and current exposure to tobacco (active and passive), the subject's assessment of an allergic response, and the ventilation and quality of air in the home (Task Force on Health Risk Assessment, 1986).

Section C: Health Impact Measurement Survey

This section of the CDAT was modified from the Arthritis Impact Measurement Survey (AIMS) (Liang, Larson, Cullen, & Schwartz, 1985) and the Chronic Disease Respiratory Questionnaire (CDRQ) (Guyatt, Walter, & Geoff, 1987). The Health Impact Measurement Survey (HIMS) con- tains the following scales: functional status (mo- bility, physical activity, dexterity, household ac- tivity, activities of daily living), cognitive ability, anxiety, depression, social support, dyspnea in- dex, mastery, health status, and other health prob- lems. These scales are seven-point adjectival re- sponse scales that are designed to be administered at various intervals to assess responses. They were also used to cross-validate the scales in Section A that are scaled differently: visual analog scale and a six-point graded scale.

Section D: Quality of Life Index

The quality of life scale is a five-item index that has been used extensively in cancer research and has established validity and reliability within stan- dard limits, .89 or higher (Spitzer et al., 1981). A total score is assigned for the quality of life index. Scores range from 0 (poor) to 10 (high).