Mixed Methods Socio-cultural Study of the Process of Maternal Stress Response in the Neonatal Intensive Care Unit (NICU) in South Korea
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Despite the significant comorbidity of high-level stress and maternal postpartum psychological problems with regard to the neonatal intensive care unit (NICU), and an increasing rate of preterm births in South Korea, there is a paucity of research on the fundamental reasons why stress response occurs and how it occurs among mothers of infants in the NICU in South Korea. In particular, the influences of interpersonal and socio-cultural factors on the process of stress responses of mothers who have infants in the NICU have not been identified clearly. Hence, to explore the stress response process among mothers of infants in NICUs, relevant to their social and cultural context, three studies were conducted using a multiphase mixed methods design study, in two level IV NICUs in two tertiary hospitals in South Korea. First, a cross-sectional exploratory study (N=31) showed that the perceived stress level and stress symptoms of NICU mothers were elevated, based on the perceived stress scale (PSS 10) and ten subscales of the Symptoms of Stress (SOS) Inventory, respectively. The four most frequently reported stress symptoms were depression (especially loneliness), emotional irritability, muscle tension, and peripheral manifestations. There was a significant positive association between the stress level and the symptoms of stress. Second, a grounded theory study (N=32) sought the process of stress response among NICU mothers in South Korea. The results from the analyses of open coding, axial coding, and selective coding were used to formulate a theoretical model and to reveal a central phenomenon contributing to the process of stress response among mothers of infants in the NICUs in South Korea. The causal condition was giving birth to a child with problems, the contextual condition was leaving my baby in the NICU, and continuous comparisons and high sensitivity to hierarchy (‘Gahp-Eul’ relation) emerged as the socio-cultural intervening conditions. The NICU mothers used two strategies, seeking safe support and adapting, to manage their stress. The two categories of having mother’s role and various stress levels and symptoms were identified as the consequences of the strategies. Struggling with stigma emerged as the central phenomenon in the stress response process among the NICU mothers in South Korea. Third, a sequential qualitative descriptive study (N=30), was conducted to explain the NICU maternal stress response process relevant to the South Korean social and cultural context, in particular. Uneven/unfair power balance (‘Gahp-Eul’ relation), and ranking the roles appeared as common ideas in the maternal perceptions of different roles in the NICU, both of which seemed to hinder mothers’ capacity to relieve their stress. Despite study limitations, the results of this multiphase mixed methods research improve our understanding of maternal stress and identify remediable factors that influence this stress response process for mothers in the NICU. The findings reveal how interpersonal and socio-cultural factors, such as continuous comparisons and being sensitive to uneven/unfair power balance, widely affect the stress response process among NICU mothers in South Korea. Therefore, the findings from this dissertation support the need for more effective nursing care, the development of new nursing interventions, and new family-centered NICU policies that promote management of stress as well as the prevention of postpartum psychological problems among NICU mothers.
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