Academic journal article Iranian Journal of Public Health

Development of a Transition Process Scale for High-Risk Infant's Caregiver

Academic journal article Iranian Journal of Public Health

Development of a Transition Process Scale for High-Risk Infant's Caregiver

Article excerpt


Low-birth-weight (LBW) or preterm infants with a gestational age under 37 weeks are more likely to have diseases or developmental disorders, or die due to physical immaturity as they age (1). In particular, they may experience the greatest stress during the initial transition process before and after discharge from the hospital (1) and this issue is not restricted to infanthood, but can persist throughout the growth phases. Therefore, many researchers have tried to develop and apply diverse post-discharge intervention programs for LBW infants (2-8).

Most of these intervention programs focus on the health status and nervous and cognitive development of infants 1 week to 12 months after discharge or on the improvement of the motherchild interaction.

Infanthood is the period when initial experiences in life begin to accumulate (9) and it is more important than any other developmental stage because a caregiver's insensitive nursing or lack of attachment for the first two years can have longterm effects even in childhood.

Transition is defined as a process requiring a sense of responsibility to reorganize a goal and behavior, and acquire a new self-concept (10). In particular, the transition into parenthood is "a major developmental life event" (11) and is very significant because it provides an opportunity to change family members' values and living priorities as well as to make new interpretations of and adjustments to one's own life. The transition into motherhood, adjustment process, and transition into parenthood are very complicated and difficult with many physical and psychological obstacles (12). Parents may feel helpless about childrearing and tired from the full-time work involved in caring for their baby at home one month after discharge from the hospital; they may only become confident in caring for the baby three months after discharge (13). In particular, mothers of high-risk infants, such as preterm ones, may become very worried about their child and have difficulties with parenting due to their vulnerability and the likelihood of disability (14). As such, development in infanthood is affected by the transition process of the mothers who are parenting the infant and the process can be prompted by the infant's developmental changes (15).

Research on the transition process in life for autistic children's parents (16) has found that they can accept constantly changing stress and conflict instead of being limited to a specific period. Some parents might have reached the acceptance stage while others could stay in other stages, including wandering or devotion, and return to the previous stage depending on their own situation. In other words, the transition process can be repetitive and can vary significantly according to individuals and their situations.

As a concept similar to the transition process, Thornton and Nardi (17) divided the maternal role acquisition process into four stages: 1) pregnancy, 2) feeling confident and satisfied as a mother through delivery and parenting, 3) getting attached to child, and 4) establishing identity. Sixty-four percent may acquire maternal identity around the fourth month and about 4% fail to acquire the role even in the first year. Comparative research on maternal behavior between preterm infants' mothers and those of normal children (18) shows that parenting confidence increases between the fourth and twelfth months, and maternal confidence decreases significantly between the eighth and twelfth months.

However, research on maternal role acquisition or identity is mostly restricted to twelve months or so after birth and fails to reveal the likelihood of stagnation or repetition according to situation, unlike the transition process. It is therefore necessary for nurses to understand correctly the transition into motherhood, or their necessary adjustment, in order to assist high-risk infants' parents who are having trouble with role acquisition to adjust and provide them with more comprehensive and integrative care during the transition process (12). …

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