Ramona Mercer’s Maternal

Role Attainment Theory

Josephine Ann J. Necor, RN

Ramona T. Mercer

• She was the Nahm Lecturer 1984 at the University of California.

• earned a diploma from St. Margaret’s School of Nursing in Montgomery, Alabama. She earned an undergraduate degree in nursing with distinction from the University of New Mexico in 1962, followed by a master’s degree in maternal child nursing from Emory University in 1964.

Ramona T. Mercer

• For ten years, she worked as a staff nurse, head nurse and instructor.

• a faculty member at Emory University for five years until she left to pursue doctoral studies in maternity nursing at the University of Pittsburgh.

• 1988: Distinguished Research Lectureship Award, Western Society for Research in Nursing (inaugural award)

• 2003: Living Legend, American Academy of Nursing

• 2004: Distinguished Alumni Award, University of New Mexico College of Nursing

Maternal Role Attainment Theory

-Middle Range Nursing Theory

Theoretical Sources

• Mead’s Interactionist Theory of Self• Von Bertalanffy’s General Systems Theory• As her research developed into attainment of the

maternal role, she also combined the work of Werner and Erikson with Burr and associates’ theory to develop a theoretical framework of role theory from an interactionist approach.• Reva Rubin’s research on maternal role attainment

and Mercer’s own research conducted on the different variable affecting the maternal role ere also major theoretical sources.

Empirical Evidence

• Mercer’s theory is based on the evidence of her research spanning 25 years. Many other researchers’ findings were also used in the formulation of the Maternal Role Attainment Theory.

• Rubin dealt with role attainment from the point of acceptance of the pregnancy to 1-month postpartum; Mercer looked beyond that period to 12 months postpartum.

Major Concepts and Definitions

Major Concepts and Definitions

• MATERNAL ROLE ATTAINMENT

- an interactional and developmental process occurring over a period of time, during which the mother becomes attached to her infant, acquires competence in the care-taking tasks involved in the role, and expresses pleasure and gratification in the role.

- “The movement to the personal state in which the mother experiences a sense of harmony, confidence, and competence in how she performs the role is the end point of maternal role attainment – maternal identity.”

Major Concepts and Definitions

• MATERNAL AGE - chronological and developmental

• PERCEPTION OF BIRTH EXPERIENCE – a woman’s perception of her performance during labor and birth.

• EARLY MATERNAL-INFANT SEPARATION – separation from the mother after birth due to illness and/or prematurity

Major Concepts and Definitions

• SELF-ESTEEM – an individual’s perception of how others view ones and self-acceptance of the perception

• SELF-CONCEPT (SELF-REGARD) – “The overall perception of self that includes self-satisfaction, self-acceptance, self-esteem, and congruence of discrepancy between self and ideal self.”

• FLEXIBILITY – Roles are not rigidly fixed. Therefore, who fills the roles is not important. “Flexibility of childrearing attitudes increases with increased development…older mothers have the potential to respond less rigidly to their infants and to view each situation in respect to the unique nuances.”

Major Concepts and Definitions

• CHILDREARING ATTITUDES – maternal attitudes or beliefs about childrearing.

• HEALTH STATUS – “The mother’s and father’s perception of their prior health, current health, health outlook, resistance-susceptibility to illness, health worry concern, sickness orientation and rejection of the sick role.”

• ANXIETY – a trait in which there is specific proneness to prceive stressful situations as dangerous or threatening, and as situation-specific state.

• DEPRESSION - “Having a group of depressive symptoms, and in particular, the affective component of the depressed mood.”

Major Concepts and Definitions

• ROLE STRAIN - the conflict and difficulty felt by the women in fulfilling the maternal role obligation.

• GRATIFICATION – the satisfaction, enjoyment, reward, or pleasure that a woman experiences in interacting with her infant, and in fulfilling the usual tasks inherent in mothering.

• ATTACHMENT – a component of the parental role and identity. Attachment is viewed as a process in which an enduring affectional and emotional commitment to an individual is formed.

Major Concepts and Definitions

• INFANT TEMPERAMENT – an easy versus a difficult temperament, it is related to whether the infant sends hard-to-read cues, leading to feelings of incompetence and frustration in the mother.

• INFANT HEALTH STATUS – Illness causing maternal-infant separation, interfering with the attachment process.

• INFANT CHARACTERISTICS – temperament, appearance, and health status.

Major Concepts and Definitions

• FAMILY – a dynamic system which includes subsystems – individuals (mother, father, fetus/infant) and dyads (mother-father, mother-fetus/infant, and father-fetus/infant) within the overall family system.

• FAMILY FUNCTIONING – the individual’s view of the activities and relationships between the family and its subsystems and broader social units.

• STRESS – positively and negatively perceived life events and environmental variables.

Major Concepts and Definitions

• SOCIAL SUPPORT – the amount of help actually received, satisfaction with that help, and the persons (network) providing that help.

4 AREAS:

1. Emotional – feeling loved, cared for, understood.

2. Informational - helps the individual help herself by providing information that is useful in dealing with the problem and/or situation.

3. Physical - a direct kind of help.

4. Appraisal – a support that tells the role taker how she is performing in the role; it enables the individual to evaluate herself in relationship to other’s performance in the role.

Major Concepts and Definitions

• MOTHER-FATHER RELATIONSHIP – perception of the mate relationship that includes intended and actual values, goals, and agreements between the two.

• CULTURE – the total way of life learned and passed on from generation to generation.

Major Assumptions

Major Assumptions

1.A relatively stable core self, acquired through life long socialization, determines how a mother defines and perceives events; her perceptions of her infant's and others' responses to her mothering, with her life situation, are the real world to which she responds.

2.The mother's developmental level and innate personality characteristics also  influence her behavioral responses. 

3.The mother's role partner, her infant, will reflect the mother's competence in the  mothering role through growth and development.

Major Assumptions

4.The infant is considered an active partner in the maternal role-taking process, affecting and being affected by the role enactment. 

5.The father or mother's intimate partner contributes to role attainment in a way that can't be duplicated by any other supportive persons. 

6.Maternal identity develops with maternal attachment and each depends on the other.

NURSING• Mercer does not define nursing but

refers to nursing as a science emerging from a “turbulent adolescence to adulthood”

• Nurses are the health professionals having the most “sustained and intense interaction with women in the maternity cycle.”

• Obstetric Nursing is the diagnosis and treatment of women’s and men’s responses to actual or potential health problems during pregnancy, childbirth, and the postpartum period.

PERSON• Mercer does not specifically define

person but refers to the “self” or “core-self”. She views the self as separate from the roles that are played.

• Through maternal individuation, a woman may regain her own “personhood” as she extrapolates her “self” from the mother-infant dyad.

• The core self evolves from a culture context and determines how situations are defined and shaped.

HEALTH• Mercer stresses the importance of health

care during the child bearing and child-rearing process.

• The health status is an important indirect influence on satisfaction with relationships in childbearing families. She defines health status as the mother and father's perception of their prior health, current health, health outlook, resistance-susceptibility to illness, health worry or concerns, sickness orientation and rejection to sick role

• Health status of the newborn is the extent of disease present and infant health status by parental rating of overall health.th relationships in childbearing families.

ENVIRONMENT• Mercer's definition on environment is taken from

Bronfrenbenner's definition of the ecological environment in which maternal role attainment develops.

• Development of role/person can't be considered apart from the environment: there is a mutual accommodation between the settings, relationships between settings are embedded.‘

• Mercer's model shows nesting of the mother and infant with the microsytem, mesosystem and macrosystem. The model indicates the environmental factors such a social support, stress, and family functioning within the microsystem and environmental factors such as work setting, school, and daycare impact role attainment. Stresses within the environment therefore, influence both maternal and parental role attainment and the developing child.

Theoretical Assertions

1.) The microsystem is the immediate environment where maternal role attainment occurs. This indicates the family and factors such as family functioning, mother-father relationships, social support and stress. The infant is an individual embedded within the family system. This system is the most influential on maternal role attainment and attainment is achieved within the microsystem through the interactions of father, mother and infant.

2.) The mesosystem encompasses, influences, and delimits the microsystem. The mother-infant unit is not contained within the mesosystem, but the mesosystem may determine in part what happens to the developing maternal role and the child. It includes extended family, school, work church and other entities within the mother's more immediate community. The exosystem, the previously used term, is an extension of the mesosystem. It is the interrelationships of two or more settings or subsystems that more directly influences the mother such as interactions between works setting, daycare, local laws and rules, community and church.

3.) The macrosystem refers to the general prototypes existing in a particular culture or transmitted cultural consistencies which include the social, political and cultural influences on other two systems. It is in the macrosystem where the health care environment and the impact of current health care system on maternal role attainment originate.

• Maternal role attainment is a process that follows four stages of role acquisition; these stages have been adapted from Thornton and Nardi's 1975 research. These four stages are indicated as microsystem within the evolving model of Maternal Role Attainment.

a. Anticipatory Stage: Begins ion the pregnancy and includes the initial social and psychological adjustments to pregnancy. The mother learns the expectations of the role, fantasizes about the role, related to the fetus in the uterus, and begins role play.

b. Formal Stage: Begins with the birth of the infant and includes learning and taking of the role of the mother. Role behaviors are guided by formal, consensual expectations and others in the mother's social system.

c. Informal Stage: Begins as the mother develops unique way of dealing with the role not conveyed by the social system. The woman makes her new role fit within her existing lifestyle based on past experiences and future goals.

d. Personal Stage: Role Identity Stage occurs as the woman internalizes her role. The mother experiences harmony, confidence and competence in the way she performs the role and the maternal role is achieved.

• These four stages of role acquisition overlap and are altered as the infant grows as and develops. The final stage of maternal role identity may be achieved in many period of time. The stages are influenced by social support, stress, family functioning, and the relationship between the mother and father or significant others.

• Traits and behaviors of both the mother and the infant may influence maternal role identity and child outcome.

• Maternal traits and behaviors included Mercer's model are empathy, sensitivity to infant cues, self-esteem and self-concept,

• parenting received as a child, maturity and flexibility, attitude, pregnancy and birth experience, health, depression and role conflict.

• Infant traits having an impact on maternal role identity include temperament, ability to send cues, appearance, general characteristics, responsiveness and stress.

Acceptance by the Nursing Community

Practice and Education

• The concepts theorized by Mercer have been used by nursing in multiple obstetrical

textbooks.

• Her theory is extremely practice-oriented.

Research

• Mercer has tested factors that she theorized and/or hypothesized have an impact on maternal

attainment. She has reviewed the literature extensively and formulated questions and models

that guided researches.

Critique• Clarity - the concepts, variables, and relationships are not

explicitly defined but rather are described and implied. They are, however, theoretically defined and operationalized.

• Simplicity – in spite of numerous concepts and relationships, the theory organizes a rather complex phenomenon into an easily understood and useful form.

• Generality – theory specific to parent-child nursing; can be generalized to all women during pregnancy through the first year of birth, regardless of age, parity, or environment.

• Empirical Precision – the concepts, assumptions, and relationships are predominantly in empirical observations and are congruent.

• Derivable Consequences - The theoretical framework for Maternal Role Attainment has proved to be useful,practical, and valuable to nursing. Mercer's work is repeatedly used in research, practice, and education. It is also readily applicable to any discipline that works with mothers and children in the first year of motherhood.

References

• www.currenrnursing.com

• Tomey, A.M., (1994). Nursing Theorists and Their Work. 3rd ed. Missouri: Mosby

• http://groups.yahoo.com/group/NursingTheories/message/15

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