医療保健学研究３号：41-48頁（2012）ISSN 2185-2227

Original article

Empowerment process of mothers rearing children with disabilities
in mother and child residential rehabilitation program
Hiroshi Fujioka1, Aya Ogasawara2, Yoshiko Okubo2, Mariko Ito2
1

Department of Nursing, Faculty of Health Science, Tsukuba International University

2

Department of Nursing, National Rehabilitation Center for Children with Disabilities────────────────────────────────────────────
Abstract
The aim of this study is to identify the process of how a mother rearing her child with disabilities becomes
empowered in Mother and Child Residential Rehabilitation Program and the role of nurses in the process. Aninterview survey was conducted for 15 mothers who had experienced that program. The interview data werethen analyzed qualitatively and inductively. The participants had difﬁculties in everyday life regarding childrearing, and suffered isolation with regard to the child rearing, both psychologically and in terms of a lack ofinformation. By participating in the program, the children improved physically and emotionally, while themothers deepened their understanding of their children, and felt solidarity with other mothers. As a result,
their motivation for child-rearing was strengthened. Throughout the program, nurses should care for bothchildren with disabilities and their mothers physically and psychologically. It is necessary that nurses
understand the needs of those mothers in their everyday life, providing appropriate information with regard
to the rearing of children with disabilities, and supporting efforts to create opportunities for the mothers tohelp each other effectively.
(Med Health Sci Res TIU 3: 41–48/ Accepted 16 February 2012)
Keyword：Children with disabilities, Empowerment, Mother, Mother and Child Residential Rehabilitation
Introduction

begins at particularly early ages (Bower et al, 2001).
In consideration of such facts, a lot of centers for

In rehabilitation medicine, intensive therapeuticchildren with disabilities in Japan provide a ‘Mothertraining has been effective for children with physicaland Child Residential Rehabilitation Program’ indisabilities such as cerebral palsy that intervention

which the mothers stay in the same facility with─────────────────────
Corresponding author: Hiroshi Fujioka
Department of Nursing, Faculty of Health Science,
Tsukuba International University, 6-8-33, Manabe
Tsuchiura, Ibaraki 300-0051, Japan.
Phone/Fax: +81-29-883-6011
Email: h-fujioka@tius-hs.jp

their pre-school age children with physical disabilities
for a ﬁxed period, and receive developmental andchild-rearing support from a multi-disciplinary
team consisting of medical doctors, nurses, physiotherapists, occupational therapists, speech therapists,
clinical psychotherapists, nursery nurses and medical

42
Hiroshi Fujioka et al／医療保健学研究

social workers.

３号：41-48頁（2012）

Summary of the programSuch residential programs have been provided byvarious facilities since about 1950. Recently,

The following is the summary of the Mother andchildren with severe disabilities requiring medical

Child Residential Rehabilitation Program that thecare are increasing (Tanabe et al, 2010), and there

participants experienced in Faculty A. In mosthave been changes in the function of the family due

cases, the children with disabilities were brought into later marriage and the nature of the nuclear

from other facilities, because they were given

family (Statistics Bureau, Ministry of Internaldiagnoses calling for intensive therapeutic training

Affairs and Communications, 2010). Additionally,at an early age. When the medical doctors in thewith the introduction of the Service and Support for

center gave the same diagnosis, the doctors

Persons with Disabilities Act, the social welfare

suggested that the children with disabilities shouldsystem surrounding children with disabilities andreceive the mother-child residential program. At thetheir families is becoming complex (Miyata, 2009).

same time, the doctors explained that the effect ofUnder such a situation, a thorough improvement of

the program varies among individual cases, and it

the Mother and Child Residential Rehabilitation

may be hard for both mothers and the children

Program is imperative.

physically and psychologically because theThe present study focused on the empowerment

residential program required living together withprocess of the mothers during the stay, since theothers. When the families agreed, an interview

empowerment facilitates the formation of thesurvey was conducted by the head nurse and themother-child attachment and the mother’s will tosocial worker. The beginning date of the program

rear her child with disabilities, which is essential for

was decided in consideration of the situations of thechild-rearing (Wakimizu et al, 2010). Empowerment

family and the ward, i.e., availability of beds,in this context expresses itself in the attitude andprevalence of communicable disease. The stay inactions of the mothers to solve problems either by

the center usually lasts 8 weeks. The ward canthemselves or in cooperation with others for theiraccommodate up to 9 mother and child pairs at anychildren. The aim of this study is to identify thetime. Table 1 shows further detail of the program.

process of how a mother rearing her child withdisabilities becomes empowered in a Mother andProcedures and analysis

Child Residential Rehabilitation Program and therole of nurses in the process.

When the stay in the center was almost completed,the mothers were given an explanation of the aim of
the present study and asked to participate. Semi-Methods

structured interviews were conducted after themothers agreed. The questions in the interviews

Participants

were as follows: ‘W hat did you think before

Participants were mothers rearing children withentering into the program?’, ‘What do you thinkdisabilities. They participated in the Mother andnow?’ and ‘How do you feel about the staff of theChild Residential Rehabilitation Program in a centercenter?’ The content of the interviews was recorded

for children with disabilities (Faculty A).

with the permission of the participants, and weretranscribed verbatim. The data were then analyzed
qualitatively and inductively using the modiﬁed

43
Hiroshi Fujioka et al／医療保健学研究

３号：41-48頁（2012）

Table 1. Summary of Mother and Child Residential Rehabilitation Program in acenter for children with disabilitiesgrounded theory approach (Kinoshita, 2003) which

Results

was developed for Japanese on the basis of thegrounded theory approach (Glaser and Strauss,

Summary of the participants1967).
Throughout the design to the data analysis in theAn interview survey was conducted for 15 of 16

present study, the author was given ongoing

mothers (acceptance rate of 93.8%) at 26 to 46 years

supervision from veteran staff members of theof age (mean age = 36.1 years). All of them were

center with regard to the program as well from as

healthy physically and mentally. The duration ofan expert of qualitative studies. Transcriptions ofinterviews varied from 15 to 57 min (mean time =the interview were conﬁrmed by the participants

38.4 min). The children of the participating mothers

later in order to ensure the accuracy of the content.

were pre-school age and physically handicapped,i.e., cerebral palsy, mental and motor retardations.

Ethical considerations

The individual condition and affected body parts
varied, while all of them were unable to walk

The participants were given assurances, verballyand in writing as follows: the participation of theunassisted. Table 2 shows the characteristics of thechildren of the participants.

present study was voluntary; they could withdraw
from the study at any time; non-cooperation withEmpowerment process

the study would not disadvantage them in terms of
their ongoing treatment and care; and their personal

Five concepts were extracted in the empowerment

information would be kept conﬁdential. The consent

process of the participants described in detail below.

to participation in writing for each participant was

The examples of the verbatim transcription are in

obtained prior to the study. We received approval

italics.

for the present study through the Institutional
Review Board of the National Rehabilitation Centera. Difﬁculties faced in everyday life rearing thefor Children with Disabilities, Tokyo, Japan.

child
The mothers were frustrated that they were notgiven enough outpatient therapy sessions and could
not feel any improvement in the child’s physical or

44
Hiroshi Fujioka et al／医療保健学研究

３号：41-48頁（2012）

Table 2. Characteristics of the participants’ children (n=15)

emotional functions.

impressive that I can cry…really, the 8 weeks (of theresidential program) was a big event for us. (ID15)We had been working on the feeding training forsome time but my child remained incapable of doingc. Understanding of the child (through the therapeuticit. Since the training session was only once a month,training)

there was no improvement even after one year. I was

The mothers were impressed with the way thatfeeling really frustrated. (ID4)the therapists work hard with the children, which
made them realize the importance of continuing theThe mothers felt isolated with regard to child-training. Through the training they have deepened

rearing both psychologically and in terms of a lacktheir understanding towards their children andof information. They did not communicate withlearned how to communicate with them.

other mothers in similar circumstances.
My child started to hand the photo cards that
I had very few friends and acquaintances throughwere made by the speech therapist to other people. I

my child. I was unaware not only of the information

think he might have at last started to ﬁnd the way toabout children with disabilities, but also of the day-communicate his own feeling. I had been so attachedservice, nursery service or the various therapies

to speaking. But seeing the training, now I learnt

offered by hospitals. I was totally in the dark. (ID13)

that the most important things in communication
are forms and attempts, but not words. I willb. Physical and emotional improvements of the child
The mothers could observe the child’s physicalcertainly communicate with him in such ways, i.e.,
using photo cards, but not using words. (ID11)and emotional improvements during the stay, andcould fe el the effect of the intensive therapy
program.

d. A sense of solidarity among mothersThe mothers have developed a sense of solidarity
with other mothers and children through theMy child can ride a tricycle now. I used to think

residential program.

that it would take years to be able to do that. So, thisfact that she is riding a tricycle alone is so

I was encouraged by seeing other mothers and45
Hiroshi Fujioka et al／医療保健学研究

３号：41-48頁（2012）

the people around them working so hard. Each case

The empower ment process of the mothersof disabilities differs, but I want to confront andparticipating in the Mother and Child Residential

overcome the difﬁculties together with them. (ID5)

Rehabilitation Program identiﬁed in the present
study is summarized in Figure 1. The participatinge. Strong motivation to rear the childmothers had difﬁculties in everyday life regarding

The mothers learned about the future of childthe nurture of their children, and suffered isolation

rearing positively with a strong motivation to keepwith regard to child rearing, both psychologicallygoing through the residential program.

and in terms of a lack of information. By participating in the program, the children improved

I am stronger than I was 8 weeks ago, and now I

physically and emotionally, while the mothers

can go home with a more positive outlook than before.

deepened their understanding of their children, and(ID10)

they felt solidarity with other mothers. As a result,
their motivation for child rearing was strengthened.

The mothers hoped that other mothers would
follow, and wished the program system to continue.
Discussion(During the stay) all of the mothers began tochange. We became like comrades that can under-Throughout such a program, nurses may help tostand each other’s pain. During the stay, everyone

facilitate the empowerment process of the mothers.

had begun to perk up. It is hard to live together underSpeciﬁc points of the program where nurses may

one roof for 8 weeks, but it is very effective byhelp are as follows.

moderate stimulation. I hope that the mothers

1) Therapeutic training. This is the core of thesuffering badly with rearing their children willresidential program (Asagai et al, 2000). Improve-

participate in the program, so that they can learn toments in the children’s condition reduce parents’live positively by being given power in the program.

stress and promote parents’ empowerment (Nachshen

Therefore, the Mother and Child Residential Reha-and Minnes, 2005). Nurses can provide physical andbilitation Program (system) should continue. (ID10)

psychological support during the training.
2) Communication with children. Most of themothers rearing children with disabilities had
difﬁculties in communicating with their children(Power et al, 2009). The residential program led theparticipating mothers to deepen their understandingof the children with disabilities, and was helpful forthem to communicate with their children in thepresent study. In another institution, support topromote the mother-child interaction by nurses wasreported (Araki and Katayama, 2003).
3) Information about child rearing from otherFig. 1. Empowerment process of mothers rearing children
with disabilities in Mothers & Child Residential
Rehabilitation Program

mothers or the staff members. This promotes theempowerment process of the mothers (Mitchell andSloper, 2002). It has identiﬁed the importance of46
Hiroshi Fujioka et al／医療保健学研究

３号：41-48頁（2012）providing information about the service resources,

trial of physiotherapy in 56 children withwhich is needed for families that have children withcerebral palsy followed for 18 months. Dev

disabilities (Burton-Smith et al, 2009). Nurses are

Med Child Neurol 43:4–15.

often asked to provide information with regard to

Burton-Smith R, McVilly KR, Yazbeck M, Parmenter

everyday care (Sen and Yurtsever, 2007). Thus,TR, Tsutsui T (2009) Service and support needs

nurses should understand the needs of the mothersof Australian carers supporting a family memberin their everyday life, and provide appropriatewith disability at home. J Intellect Dev Disabil

information throughout the residential program.

34:239–247.

4) Communication and friendship with otherGlaser BG, Strauss AL (1967) The Discovery ofmothers and children. This was found to be con-Grounded Theory: Strategies for Qualitative

tributing to empowerment in the present study. TheResearch. Aldine, Chicago.

effect of peer support in residential program has
been demonstrated in previous studies (YamamotoKinoshita Y (2003) Grounded theory approach nojissen. Koubundou, Tokyo.

et al, 2003). It is necessary that nurses help in

Mitchell W, Sloper P (2002) Information that informs

creating an environment in which the mothers canrather than alienates families with disabled

support each other effectively.

children: developing a model of good practice.
Health Soc Care Commun 10:74–81.
Miyata H (2009) Reconsideration of the support

Acknowledgement

system for the disabled children and the futureof the children's day care rehabilitation center.

We are very grateful to the mothers for partici-

Jap J Devl Disabil 31:286–295. (in Japanese)

pating in the present study. This study was supported

Nachshen JS, Minnes P (2005) Empowerment inby a grant from the Tokyo Nursing Association.

parents of school-aged children with andwithout developmental disabilities. J Intellect
Disabil Res 49:889–904.

References

Power R, McManus V, Fourie R (2009) Hardship,dedication and investment: an exploration ofAsagai Y, Ohshita S, Nakagomi T, Moriyama A

Irish mothers commitment to communicating(2000) Examinationof the Effects of Rehabilita-

with their children with cerebral palsy. Jtion in Children with Cerebral Motor Disorders

Psychiatr Ment Health Nurs 16:531–538.

when both the Patients and their Mothers areSen E, Yurtsever S (2007) Difﬁculties experienced

Admitted to Hospitals and Homes for Physicallyby families with disabled children. J Spec Pediatr

Handicapped Child. Jpn J Rehabil Med 37:711–Nurs 12:238–252.

716. (in Japanese)

Statistics Bureau, Ministry of Internal Affairs andAraki A, Katayama Y (2003) Nursing Intervention

Communications, Japan. 2010 Japan Census.

Promoting Mother-child Interaction of Young[Cited 18 Jan 2012.] Available from URL:http://Children with Disabilities in a Hospitalized

www.stat.go.jp/english/

Early Intervention Program. J Chiba Acad
Nurs Sci 9:9–15. (in Japanese)
Bower E, Michell D, Burnett M, Campbell MJ,
McLellan DL (2001) Randomized controlled

Tanabe R, Ishii M, Sato Y, Nagasawa K, Ehara M(2010) Boshi-nyuen seido no saikin go nenkanno shorei kentou to motomerareru yakuwari nosaikou. J Jpn Pediatr Soc 114:1261 (abstract).

47
Hiroshi Fujioka et al／医療保健学研究

３号：41-48頁（2012）

Wakimizu R, Fujioka H, Yoneyama A (2010) Empow-Yamamoto T, Yamada T, Settsu K (2003) Boshi-erment process for families rearing children

nyuin shita kazoku karano message. Ryoiku

with developmental disorders in Japan. Nurs

44:110–111. (abstract)

Health Sci 12:322–328.

48
Hiroshi Fujioka et al／医療保健学研究

３号：41-48頁（2012）

原著論文

母子入園における障害児を養育する母親のエンパワメントプロセス
藤岡寛1，小笠原彩2，大久保嘉子2，伊藤真理子21

つくば国際大学医療保健学部看護学科
2【要心身障害児総合医療療育センター旨】本研究の目的は、母子入園における障害児を養育する母親のエンパワメントプロセスと、そのプロセスにおける看護師の役割を明らかにすることである。母子入園を経験した母親15名に対してインタビューを実施した。インタビュー内容を質的帰納的に分析した。対象者は、児の養育に関して日常生活上の困難を抱き、情報面でも心理面でも孤立していた。しかし、母子入園によって、児の身体的・情緒的機能が向上し、児に対する理解を深め、母親同士の連帯感を得た。そして、今後の児の養育に向けて前向きに取り組む意欲が充足された。母子入園において看護師は、母子の心身管理、日常生活上のニーズを把握した上での適切な情報提供、母親同士で有意義な交流が図れるための環境調整を行う必要がある。(医療保健学研究第３号：41-48頁／2012年２月16日採択)

キーワード：障害児，エンパワメント，母親，母子入園