1. Ramona
Mercer’s
Maternal
Role
Attainment
Theory
Josephine Ann J. Necor, RN

2. 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.

3. 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

4. Maternal Role
Attainment
Theory
-Middle Range Nursing Theory

5. 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.

6. 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.

7. Major
Concepts and
Definitions

8. 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.”

9. 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

10. 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.”

11. 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.”

12. 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.

13. 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.

14. 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.

15. 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.

16. 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.

17. Major
Assumptions

18. 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.

19. 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.

20. 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.

21. 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.

22. 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.

23. 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.

24. Theoretical
Assertions

26. 1.) The microsystemis 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.

27. 2.) The mesosystemencompasses, 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.

28. 3.) The macrosystemrefers 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.

30. 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.

31. • 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.

32. • 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.

33. Acceptance by
the Nursing
Community

34. Practice and Education
• The concepts theorized by Mercer have been
used by nursing in multiple obstetrical
textbooks.
• Her theory is extremely practice-oriented.

35. 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.

36. 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.

37. • 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.

38. References
• www.currenrnursing.com
• Tomey, A.M., (1994). Nursing Theorists and Their Work.
3rd ed. Missouri: Mosby
• http://groups.yahoo.com/group/NursingTheories/message
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39. THANK YOU!