This
research study was funded by PSC-CUNY Research Grant for
2001-2002.
This
cross-cultural descriptive study compared the
childbearing concerns and experiences of Korean and
Western postnatal mothers in three areas:
physiological, psychosocial and infant care. In order
to ascertain whether there were cultural differences in
these three areas, a survey was conducted. Fifty
Western postnatal mothers who were born in America, or
who came from European countries, and fifty eight
Korean postnatal mothers who came from Korea were
surveyed. The t-test for independent samples were
computed on the scores obtained for concerns related to
three areas. Korean postnatal mothers rated
significantly higher in concerns of physiological needs
(t= -3.158, p<0.002 F= .993). Korean postnatal mothers
rated significantly higher in psychosocial concerns (
t= -2.038 p<0.045 F=12.6). Korean postnatal mothers
rated significantly higher in concerns of infant care (
t= -2.914, p<0.005 F=14.27)
Purpose and Significance of this Study
The
United States is a multicultural society in which many
peoples have retained their cultural heritage and values
concerning health care approach. In particular the
childbearing process poses many challenges for nurses
in caring for patients from different cultural
backgrounds. The trend toward a shorter length of
hospital stay for postnatal women and newborns is due in
part to efforts to reduce health care costs (Nichols,
2000). There is a need to make maximum use of postnatal
teaching in a minimal amount of time. To provide
optimum health care for the postnatal mother, nurses
must know which content is most needed by mothers to
care for themselves and their newborns, as well as the
priority of their desires for learning and concerns
according to cultural differences. The health care
providers often observe behavior in patients from other
cultures that is incomprehensible and the perceptions
received from different cultures have frequently been
misinterpreted by health care providers. To provide
optimum health care for the postnatal mothers, the
health care providers need to understand further
postnatal mothers’ cultural and personal values. Few
research study have been developed and conducted.
American society is like a salad. All immigrants who
have different values and cultures came together and
function in a unique way in American society. Every
culture contains an important meaning, value and should
be recognized.
Reviews of the Literature
According to Horn(1981), Western new mothers are
expected to become as physically active as possible,
shortly after delivery. Asians mothers (Chinese,
Korean, Japanese, South-Eastern Asians) avoided cold
foods during the postpartum recovery period and
preferred bed rest for more than couple weeks. The
Korean postnatal mother is encouraged to take seaweed
soup with rice as a main meal for about one week.
Seaweed soup contains iodine and is considered to speed
up recovery and to replace the blood which they lost
during childbearing.
According to Gruis’(1977) survey, the most common
concern of American postnatal mothers is their desire
to return to their body shape. Harrison’s (1983) study
showed that seventy percent of Canadian mothers
demonstrated a similar concern to return their body to
their pre-pregnant state. Martell et al (1989)’s study
showed that the two highest ranked postpartum
information needed for the postnatal women were “warning
signs for health threats” and “infant care”. Ruchala
(2000) compared the priorities of teaching content of
new mothers by nurses and the priorities of learning
content by new mothers. Findings revealed that nurses
gave priority to teaching about infant care, whereas new
mothers gave priority to their own care. Through
literature reviews, this investigator found quite a
number of postnatal research studies in the United
States, but discovered only a few research studies of
the Postnatal mothers who came from different cultures
and socioeconomic levels, particularly cross-cultural
studies.
The
United States is a multicultural society. Culture is
learned, varied and constantly changing. Culture
contains its’ own values and attitude.
Conceptual framework
The
conceptual framework used to guide the current research
study is the assessment model for transcultural health
care developed by Giger and Davidhizar (1999),
Leininger’s Sunrise Model designed for Nursing (Leininger,
1988) and the cognitive field theory of learning
derived from Gestalt Paychology (Babcock & Miller,
1994).
The
cognitive field theory of learning is that the
individuals’ perceptions are dissimilar and sometimes it
is difficult for a person to have other perceptions of
the same event. An individual tends to assume that
others perceive events as he or she does and may not be
aware that others have different perceptions. The
post-partum mother’s perception may be affected by her
ability to learn, given biologic, psychologic,
sociologic, and cultural factors (Ruchala, 2000).
Culture is learned, varied, and constantly changing.
Culture has a powerful influence on one’s interpretation
of and responses to health care. Clients and health
providers have the right to be understood, respected,
and treated as individuals despite their differences in
their beliefs, values and attitudes.
Transcultural nursing is focused on client centered
health care. Therefore it is very important for nurses
to keep in mind that culture does influence how clients
are viewed and the care they are given (Potter & Perry,
2001).
Research questions or hypotheses
This
study addresses three research questions.
-
Are there differences in the physiological
concerns/interests of Korean and Western postnatal
mothers?
-
Are there differences in the psychosocial
concerns/interests of Korean and Western postnatal
mothers?
-
Are there differences in the infant care of Korean and
Western postnatal mothers?
For
this research study, terms are defined as follows:
Physiological concerns/interests: Concerns or
interests about altered physical or health status due to
childbirth, which postnatal mothers may or may not have
until restored to non-pregnant normal health conditions.
Psychosocial concerns/interests: Concerns about
fulfilling roles of mother and wife and about maternal
self-image and personal esteem.
Infant care concerns/interests: Concerns about the
new born baby’s well-being.
Postpartum (Postnatal): From the day after
childbirth to the end of the second week.
NO concerns: The areas in which the postnatal
mothers already have sufficient knowledge, which require
no help from professional health care providers or in
which mothers are not interested in obtaining any
knowledge.
Minor concerns: Concerns in areas about which the
postnatal mothers already have some knowledge, which
only rarely require help from professional health care
providers or which mothers are not interested in knowing
any more about.
Moderate concerns: Concerns in areas about which
postnatal mothers know something related to concern
areas, but are willing to learn again if the opportunity
is given, in addition they think it is still a problem
but are not seriously concerned about it, or are
interested in it to some extent, but not greatly.
Major concerns: Concerns in area about which
postnatal mothers have no knowledge, need help from
professional health providers, are very interested in,
or feel very serious about the concern.
Back To Top
Design and Methodology
The
data on the physiological, psychosocial, and infant care
concerns of Korean and Western postnatal mothers were
obtained in order of their priority, and compared to
determine if a difference existed between the two
groups.
The
first group consisted of Western postnatal mothers who
were born in America or came from European countries.
The second group consisted of Korean postnatal mothers
who were born in Korea and resided in the United
States. These subjects were selected from the
Obstetrical floor of Flushing Hospital Medical Center,
Flushing, New York.
Whenever the investigator arrived in Flushing Hospital
Medical Center to collect data, the charge nurse on the
postnatal unit was consulted to determine which
postnatal mothers were considered to be at low risk and
select qualified subjects for Western postnatal mothers.
Upon
the approval, the investigator approached prospective
participants to explain the purpose of the study and the
method of participation. Upon their approval by oral
consent, they signed the consent form and filed out a
demographic and questionnaire. Assurance of
confidentiality to all subjects was given.
Instruments
Using an interval scale, each specific concern in each
area was scored as follows:
a no concern is scored 0
a minor concern is scored 1
a moderate concern is 2
a major concern is 3
Each
group score was obtained by adding all scores marked on
all concern areas. Statistical analysis was done by
computing the means of scores and compared two groups by
utilizing t-tests. Levels of significance were set as
a
= 0.05. The questionnaire was modified on the
questionnaire developed by Gruis’ (1977) postpartum
concerns of mothers.
To
determine the content validity of the postnatal
questionnaire, six nurses with clinical expertise in
maternity nursing reviewed all versions: Child-bearing
nursing instructors (native Korean and American), O.B./GYN
nurse practitioners and staff nurses.
Each
participant completed a data form that contained
demographic information and questionnaire. Completion
time for the demographic information and the
questionnaire was approximately 5-10 minutes.
“Patients
have a right to care that protects their personal
dignity and respects their cultural, psychosocial, and
spiritual values.” by JCAHO ( The Joint commission
on Accreditation of Healthcare Organization, 1996)
According to the JCAHO,
Assessment of patient educational needs should consider
the patient’s cultural and religious practices, ability
to learn and language barriers, among other factors. To
work effectively in multicultural society, nurses
must be able to provide efficient care to persons from
different cultural backgrounds.
Physiological concerns
•
1.
Return of body figure to normal
•
2.
Lochia
•
3.
Afterpain
•
4.
Postpartum exercise
•
5.
Breast Care
•
6.
Diet
•
7.
Discomfort of Episiotomy/C-section
•
8.
Constipation
•
9.
Hemorrhoids
•
10.
Return of Menses/ Ovulation
•
11.
Fatigue
Psychosocial Concerns
•
1.
Family adjustment
•
2.
Father’s interest in baby
•
3.
Family planning
•
4.
Sexual relations
•
5.
Finding time for self
•
6.
Sex preference of infant
•
7.
Postpartum blue
•
8.
Fear for labor pain
•
9.
Financial cost
•
10.
Reactions of siblings
•
11.
Emotional tension
Concerns for Infant Care
•
1.
Infant safety
•
2.
Immunization
•
3.
Growth and development
•
4.
Umbilical cord care
•
5.
Behavior
•
6.
Feeding
•
7.
Clothing for baby
•
8.
Crying
•
9.
Diapering
•
10.
Sleep and Activity
•
11.
Bathing the infant
Back To Top
Results: Physiolgical Concerns
•
Korean postnatal mothers rated significantly higher in
concerns of physiological needs
•
Korean X= 23.5 SD= 5.7) (Western X =19.5 SD= 6.8,
•
(t =
-3.158 p< 0.002 F = .993).
•
Among concerns: Korean postnatal mothers rated
significantly higher on return of body figure to
normal, lochia, postpartum exercise and breast care.
Results: Psychosocial Concerns
•
Korean postnatal mothers rated significantly higher in
psychosocial concerns.
•
(Western X= 16.7 SD= 8.0) (Korean X= 19.6 SD= 5.4)
•
( t
= - 2.038 p < 0.045 F = 12.6)
•
Among concerns, Korean mothers rates significantly
higher on father’s interest in baby, postnatal
sexual relations, finding time for self, and sex
preference of infant.
Results: Infant Care
•
Korean postnatal mothers rated significantly higher in
concerns of infant care.
•
(Western X=22.9 SD= 8.3, Korean X=26.8 SD = 4.6)
•
( t
= - 2.914 p < 0.005 F = 14.27)
•
Among concerns, Korean mothers rated significantly
higher about infant safety, behaviors, clothing for
baby, crying, diapering and sleep/activity.
Ranking Among physiological concerns (11 concerns):
•
Western mothers ranked
;
–
1.
(the highest), after pain
–
2.
(the second highest), discomfort of stitches.
–
3.
(the third highest), Breast care.
•
Korean mothers ranked;
–
1.
Return of body figure
–
2.
Breast care
–
3.
After pain.
Ranking among psycho-social concerns (11 concerns):
•
Western mothers ranked;
–
1.
Family adjustment
–
2.
Father’s interest in baby
–
3.
Family planning.
•
Korean mothers ranked;
–
1.
Father’s interest in baby
–
2.
Family adjustment
–
3.
Family planning
Ranking among Infant Care (11 concerns)
•
Western Mothers:
–
1.
Growth and Development
–
2.
Infant Safety
–
3.
Immunizaton
•
Korean Mothers:
–
1.
Growth and Development
–
2.
Infant Safety
–
3.
Immunization
Recommendations
•
Excerpt from this research study,
–
To
provide culturally competent health care, postpartum
unit needs to utilize a variety of teaching tools
written in Korean to promote physiological recovery.
–
For
infant care, Western and Korean mothers ranked equally
same in priority among concerns of infant care.
–
Psychosocial and infant care, percentages of
explained variances are low ((Psychosocial aspect, F =
12.6, Infant care, F = 14.27 ). Therefore further
research study will be recommended.
References
•
Gruis, M. (1977). Beyond maternity: Postpartum
concerns of mothers. Maternal Child Nursing,6,182-188.
•
Harrison, M.J. & Hicks, S.A. (1983). Postpartum
concerns of mothers and their sources of help.
Canadian Journal of Public Health, 74, 325-328.
•
Horn, B.M. (1981). Cultural concepts and postpartal
care. Nursing and Health Care, 30,
516-527.
•
Martell, l.K.Imle, M., Horwitz, s., & Wheeler, l.
(1989). Information priorities of new mothers in a
short stay program. Western Journal of Nursing
Research, 11, 320-327.
•
Ruchala, P. (2000). Teaching New Mothers: Priorities of
nurses and postpartum women. JOGNN,
May/June, 265-273.
