初産婦における産後1週のストレス反応からみた産後4週における育児ストレスの特徴に関する研究 (第2報)

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  • Study of characteristics of childcare stress at 4 weeks postpartum based on stress reaction at 1 week postpartum among primipara women (2nd Report)
  • ショサンプ ニ オケル サンゴ 1シュウ ノ ストレス ハンノウ カラ ミタ サンゴ 4シュウ ニ オケル イクジ ストレス ノ トクチョウ ニ カンスル ケンキュウ ダイ2ホウ

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Purpose：This study was conducted to clarify childcare stressors, cognitive assessment and coping characteristics among primapara women in a state of strong stress reactions at 4 weeks postpartum． 　Method：A questionnaire survey was conducted targeted at 70 primapara women at 1 and 4 weeks postpartum．The contents of the survey consisted of the Childcare Stressor Scale, Cognitive Appraisal Rating Scale, Coping Scale and Public Health Research Foundation Stress Check List Short Form (PHRF-SCL-SF)． 　Results：A cluster analysis of the PHRF-SCL-SF was conducted at 1 week postpartum targeted at 27 women categorized as a high stress reaction group．These subjects consisted of 12 women (44.4%) of a persistent stress group who were categorized as the high stress reaction group at both 1 week and 4 weeks postpartum, and 15 women (55.6％) of a diminished stress reaction group who were categorized as the high stress reaction group at 1 week postpartum but categorized as a low stress reaction group at week 4 postpartum．The Mann-Whitney U test was performed using these two groups as independent variables and using subscale scores of the Childhood Stressor Scale, Cognitive Appraisal Rating Scale and Coping Scale as dependent variables．Among childcare stressors, the persistent stress group demonstrated high scores for "decreased sense of effectiveness as parent", "inadequate childcare knowledge and skills" and "sense of constraint due to childcare"．Those subjects who felt a high level of stress attributable to their baby crying at night or after feeding consisted of 6 subjects( 50.0％) in the persistent stress group and 2 subjects (13.3％) in the diminished stress group, and cognitive assessment scores were higher for "assessed as threatening" and lower for "controllability" among the persistent stress group．There were no significant differences observed with respect to coping． 　Discussion：The characteristics of childcare stressors and cognitive assessment among primapara women in whom high stress reactions persisted at week 4 postpartum were able to be identified．These were thought to be attributable to a sense of confusion and things not going as expected with respect to feeding and childcare they experienced for the first time as a result of being first-time mothers, as well as being forced to a lead a lifestyle in an environment that subjects them to restrictions such as a lack of recreational activities．In order to prevent this, it was suggested to be important for nursing professionals to provide specific guidance to first-time mothers in the areas of childcare knowledge and skills while focusing on the time from pregnancy to childrearing, as well as make active use of telephone visitations and two-week checkups after birth to validate their behavior and emotions as mothers while also promoting a sense of success and achievement． 　目的：産後4週間においてストレス反応が強い状態にある初産婦の育児ストレッサー，認知的評価，コーピングの特徴を明らかにする。 　方法：初産婦70名を対象に産後1週と4週に質問紙調査を実施した。調査内容は，育児ストレッサー尺度，認知的評価測定尺度，コーピング尺度，Public Health Research Foundation Stress Check List Short Form (PHRF-SCL-SF) であった。 　結果：産後1週のPHRF-SCL-SF のクラスタ分析によりストレス反応が高群に分類された27名を分析対象とした。産後1週と4週ともに高群に属した持続群12名 (44.4％)，産後1週は高群，4週は低群に属したストレス軽減群15名(55.6％)であった。この2 群を独立変数，4週の育児ストレッサー尺度，認知的評価測定尺度，コーピング尺度の下位尺度点を従属変数とし Mann-Whitney のU検定を行った。育児ストレッサーでは，「親としての効力感低下」「育児知識と技術不足」「育児による拘束感」で持続群の方が高得点であった。夜間や授乳後の児の啼泣をとてもストレスと感じる者は持続群6名(50.0％)，軽減群2名(13.3％)であり，認知的評価の得点は，持続群の方が「脅威性の評価」で高く，「コントロール可能性」では低かった。コーピングでは有意差はなかった。 　考察：産後4週間においてストレス反応が高い状態で持続する初産婦の育児ストレッサーや認知的評価の特徴が明らかにされた。これらは初産婦であるため初めて体験する授乳及び児の養育に対する戸惑いや思い通りにすすまないこと，外出の制限等限られた環境での生活を余儀なくされることに起因していると思われる。それらの予防には，看護職者は妊娠中から育児期を視野においた育児知識や技術の具体的な指導を行うこと，産後の電話訪問や2週間健診を活用し，母親の行動や感情を承認して成功体験や達成感の体感につなげることの重要性が示唆された。

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