This document discusses Ramona Mercer's theories on antepartum stress and maternal role attainment. It provides details on: 1. Mercer's research on the effect of antepartum stress on the family, identifying variables like stress, social support, self-esteem, and their relationships. 2. Her theory of maternal role attainment, which views it as a developmental process over time as mothers gain competence. It outlines the 4 stages and 11 variables that influence attainment. 3. A longitudinal study Mercer conducted to understand how maternal age influences role attainment, finding age was not a predictor when controlling for other factors. The study provides a model of maternal adaptation in the first

1. Theories is knowledge that is used for practice. While
process is the method to apply theory. Theory is the contents ,
process is the way of using that content, Theory contains
concepts that are related is such a way as to describe explain ,
or predict events, While process is the method of thinking about
theory.
Definition of Theory:
(i) Theories are invented to assist in describing,
explaining, predicting and understanding phenomena of concern.
In relation to research theory helps us to interpret scientific
findings. In a meaningful and general sable way [ Moody 1990].

2. (ii) Theory is a systematic abstraction of reality that serves that some
purpose. [ Chinn and kramer 1991]
(iii) Purpose of Theory:
(a) Scientific findings meaningful and generalized.
(b) Efficient mechanizes for drawing together and summarizing
accumulated facts from separate isolated investigations.
(c) Theories help stimulate research and the extension of
knowledge by providing both direction and impetus.
(d) Theories provide a method of classifying and organizing data
in a logical and meaningful manner.
(iv) Levels of Theory:
In the preceding discussion the basic from of a theory has been
described as a means of starting relationships between concepts the
theory may be commonly described are

3. .
(A) MICRO THEORIES
(B) MIDDLE RANGE THEORIES
(C) GRAND THEORIES
(D) PARADIGMS AND META THEORY
MICRO THEORIES :
Micro theories are described by Knek (1989) as the least complex [theories] .
They contain the least complex concepts and refer to scientific, easily defined
phenomena. They are narrow in scope because they attempts to explain a small
aspect of reality. They are primarily composed of enumerative or associative
concepts.
MIDDLE RANGE THEORIES:
Middle range theories are theories at the next level of complexity [ Marrina
– Tomey 1989] Moody [1990] cities Merton’s [1968] definition of middle range
theories as those that examine a portion of reality and identify a few key
variables.

4. Moody(1990) comments that middle – range theories are often developed by
qualitative or ethnographic studies in which data is colleted about an area of
practice or experience Variables are concepts are identified in the data and
suggestions [ propositions or hypotheses] are then made about the relation ship
between the different variables.
(Iv) Meta Theory :
Which is the analysis of theory or theorizing about theory in a discipline
[Moody, 1990]
Meta –analysis is a method made families in midwifery practice through the work of
Enkin [1991] who, with their colleagues have brought together a huge amount of
research in areas pregnancy and child birth.
(iii) Grand Theory :
Grand theories are the most complex and broadest in scope. They attempt to
explain areas in a discipline . They are composed of summative concepts and
incorporate narrow range theories [ Kneck 1989]

5. TYPES OF THEORY:
Four types of theory have been described by Dickoff and James (1992).
Two philosophers who have worked closely with nurses fro many years, in their
classic paper, written in 1968. Theories may either describe , explain , predict
produces or shape realty moody (1990) summarizes these four levels of theory.
(i) Factors – Isolating theories
(ii) Factor – relating theories
(iii) Situation – relating theories
(iv) Situation – Producing theories
Factor – Isolating Theories:
Observing, describing and naming concepts the first level of theory
identifiers and describe or names concepts. Dickeff etal.(1992a) describe this as
naming theory and point out that, if concepts have not been named.
Further levels of theory developed are impossible. Much of midwifery and nursing
research in descriptive and aimed at this first level of theory.

6. (ii) Factor - relating theories :
Factor – relating theories relating named concepts to one another this
theories suggest interrelationship between concepts such theories are often
the outcome of qualitative research in which factor have been named and then
relationship between them suggested.
(iii) Situation – relating theories:
Inter- relationship among concept or propositions, this theories are
the third level of theory and are predictive theories . Theories predict that if
one factor or variable is altered there will be an change in one or more
other variables.
(iv) Situation – producing theorizes :
Prescribing activities necessary to reach defined goals
also known as prescriptive theories) the fourth level of theory is described as
situation – producing theory and is aimed at bringing about change.

7. Human Being:
She emphasized that human or individual possesses unique potential,
strives towards self direction and needy stimulation , whatever the individual
does, represent his or her best judgment at the moment. Self –awareness and
self- confidence & acceptance are essential to individuals are sense of integrity
and self- worth . These circumstances require respect from the nurse.
Health :
She does not define health, however she supports the WHO’s definition of
health. Health is a state of complete physical, mental and social , spiritual well being
and not merely an absence of distance or infirmity by world health organization
(1948) .

8. Environmental :
Incorporating the environments within the realities – a major component of
her theory . One element of the realities in frame work which is a complex of
extraneous factor and circumstances, that are present in every nursing situation .
Framework includes objects such as policies , setting atmosphere , time of day ,
human and happenings.
Nursing:
Nursing, a clinical discipline , is a practice discipline designed to produce
explicit desired results. The art of nursing is goal directed activity requiring
application of knowledge and skill towards meeting a need for helps experienced by
a patient nursing process that extends or restores the patients ability to cope with
demands implicit in the situation .

9. Theory :
Ramona T. Mercer . Theories of Antepartum Stress and Maternal Role
Attainment :
Mecer is the only theorist whose work has been exclusively concerned with
understanding the process of child bearing who is included in a collection
considering the work of the major theorist in nursing (Marrines – Theory , 1989)
Been and oetting (1989) provide a description of mercer’s distinguished academic
career which has spanned over 30 years.
During that time her work has been focused on theory building, research and
practice applications of research findings in the field of maternity care.
Her work has been greatly influenced by Pubin, who was the profffessor in
maternity nursing at the university where mercer obtained her doctoral degree.
By 1998 Mercer had published four books over 55 articles book chapters and
reports a body of work which in itself shows that there has been considerable
theory development by nurse – midwives in the case of the child bearing family.

10.  In addition, Mercer has been responsible for the development of a range of
measurement tools for use in research which have been widely, used by often
researches.
 Mercer has also been concerned to apply findings of her research and theory
build to practice.
 This concern with the utilization of the is shown in the discussion of implication
nursing intervention in, first-time Motherhood Mercer (1986) and in articles
such as ‘The Nurse and Maternal tasks of the Early Post Partum [mecer11981].
 For example , in this articles , Mercer comments on the tasks that the women
has to undertake in the early postnatal days and indicates that these tasks.
Encompass for more than “bonding” to her infant [ Mercer , 1981] one of the
tasks that has been identified theoretically and confirmed through research
observation is the task of integrating the labor and birth experiences.,
 Another interesting feature of “ Mercer’s Work which is noted by beer and
oetting (1989) and applies also to many of these nurse theorists is that it has
been utilized by a large number of graduate students who were supervised by
Mercer.

11.  Such a programmed of on going research provides further evidence of the ability of
the theory or provides information which can be lead to modification of a theory.
 Through all her work, Mercer demonstrates the integration of deductive theory
building from the literature and other theory with inductive theory building from
observation in practice.
 Her work is concerned with the testing of the models collection of data to test the
relationship suggested by the evidence on work models are based.
 Mercer has undertaken theory building and research in two main areas (i) the effect
of antepartum stress on the family and (ii) Attainment of the maternal Role.

12. THE EFFECT OF ANTEPARTUM STRESS ON THE FAMILY
1. In British literature on antenatal care there is a concern to provide support
during pregnancy to reduce the effect of poor social circumstances , lack of
social support and self- esteem among women . (Chalmess .et.al.1981)
2. Mercer’s research is concerned with or number of other measures of the
effect of antenatal stress relating to the functioning of the family unit.
3. Mercer and her colleagues have been seeking to understand the effects of
antenatal stress on family functioning , as a whole , on functioning of pairs
of individuals in a family and health status.
4. Mercer et.al (1986) Identify six variables from research and other literature
which are related to health status , dyadic relationships and family
functioning.

13. (i)Antepartum Stress
(ii) Self Support
(iii) Sense of Mastery
(iv) Anxiety
(vi) Depression
(i) Antepartum Stress:
Antepartum stress is described as resulting from a combination of negative life-
events and the level of risk associated with the pregnancy.
Antepartum Stress is defined as a complication of pregnancy or at risk
condition. [ Pregnancy and negatively perceived life events ( Mercer et.al 1986)
(ii) Social Support
The amount of help actually received satisfaction with that help, and the
persons [ network] providing that help.
(iii) Self Esteem :
An individuals perception of how others view one and self – acceptance of the
perception .

14. (iv) Sense of Mastery :
The sense of mastery as a mediator and moderator inn the associan
between economic had ship & health in late life.
(v) Anxiety :
Anxiety is a multi system response to a perceived threat or danger.
(vi) Depression :
Having a group of depressive symptoms , and in particular the affective
component of the depressed mood.
 Stress from negative life – events and pregnancy risk were predicated to have
direct negative effects on self- esteem and health status.
 Self esteem , health status , and social support were predicated to have direct
negative effects on anxiety and depression which in have direct negative effects on
family functioning.

15. Hypotheses:
(i) High- risk women experiencing antenatal hospitalization and their
partners will report less optimal family functioning than how- risk women and their
partners.
(ii) Expectant partners will report similar levels of family functioning.
 The study findings supported the first hypothesis but did not support the second
hypothesis to the partners of the low- risk women.
 Using statistical tests, the researchers are able to show the different predictive
values of the different variables for work in nthe low- risk group and the high- risk
group.
 This enabled the researchers to redraw their model of the effect of antepartum
stress on family functioning.
 Two different models emerge from the data. One which demonstrates the
relationship of the variables in the case of the low- risk women and the other which
does the same for the high risk women.
These models may now be further tested and modified
This information derived from testing a model regarding the variables which are of
particular importance in predicting the experience of an tenatal stress and the effects
of that in practice in determining , may be utilized in practice in determining priority
areas for active by mid wives.

16. MATERNAL ROLE ATTAINMENT:
• Maternal role attainment is an interact ional and developmental process occurring over
a period of time , during which the mother competence in attached to her infant ,
acquires competence in the caretaking tasks involved in the role and express pleasure
and gratification in the role.
• The expression of a role by an individual will also be affected by their past experiences
and view of themselves ( Mercer 1981 b ,1986; Punninjtion and Glazer , 1991) Mercer
(1981) describes the theoretical base of her research in role acquisition theory , which
identifies four stages to role acquisition.
(i) Anticipatory
(ii) Formal
(iii) Informal
(iv) Personal Stages

17. (i) Anticipatory :
The anticipatory stage is the period, prior to incumbency when an
individual beings social and psychological adjustment to the role by learning the
expectations of the role
(ii) Formal Stage :
The formal stage beings with actual incumbency during which role
behaviors are largely guided by formal , consensual expectations of others in the
individuals social system
(iii) Informal Stage :
The informal stage begins as the individual develops unique ways of
dealing with the role that are not conveyed by the social system.
(iv) Personal Stage :
During the final, of personal stage of role acquisition an individual imposes
an individual style on the role performer and others largely accept the enactment.
Social adjustment has occurred through role modification , and psychological
adjustment has resulted in the individuals feeling a
congruence of self and role.

18. Mercers theoretical model indicates that the majority of the role- taking
activities occur after the birth of the child, and that attainment of the maternal
role may occur between three and ten months after the birth
 Mercer has identified eleven independent variables which influence the
attainment of the maternal role ( the dependent variable) and a number of
confounding variables.
 Mercer has undertaken extensive research describing the relationship between
these variables and attainment of the role. These variables can be grouped info
maternal infant and other confounding variables.
Maternal Variables:
1. Maternal age of first birth
2. Perceptions of the birth experience
3. Early maternal – Infant separation
4. Social Stress
5. Social support
6. Self- Concept
7. Personality traits
8. Child- rearing attitudes
9. Maternal health status

19. Infant Variables :
(i) Temperament
(ii) Infant Health
Other Confounding Variables :
(i) Ethnic basic ground
(ii) Marital Status
(iii) Socio Economic Status
Each of the above variables is discussed by Mercer (1981, 1986) and the theorized
base and research evidence for each variable are presented , taking social support as
an example , Mercer refer to research with identifies four types of support ,
Emotional , Information physical and applied which she defines as follows.
Emotional Support :
Emotional support is defined as feeling loved, cared for, trusted and
understood.
Informal Support :
Informational support helps the individual to help herself by providing
information that is useful in dealing with the problem and for situation.

20. Physical Support :
Physical support is a direct type of help such as baby- sitting , lending
money.
Apprasial Support :
Apprasial support is information that fells the role – takes how she is
performing in the role. It enables the individual to evaluate herself in relationship
to other performance in the role
Mercer (1986) goes on to describe research evidence of the existence and need
for different types of support in pregnancy Post nasally by fathers and in general
 The influence of these variables has been investigated by Mercer in a
longitudinal study of 242 women aged 15 to 42 year (Mercer 1986)
 The main aim of this research was to identify whether age had any effect on
attainment of the Maternal role.
 The findings from this study are extensive and are presented in relation to
three age groups of women.

21. Aged 15-19
Aged 20-24
Aged 30-42
• One of the main conclusions that is reached is that materal age was not or
predictor of maternal role attainment when, rule, educational level and marital
status were controlled.
• The younger mothers were, however , handicapped by their low incomes and poor
self- concept but mercer makes the point that almost half of the women in this age
–group dropped out of the study.
•Relationship were found between age and other variable measured which indicates
that age is an important variable in any model constructed to understand the
attainment of the maternal role.
•The findings include a large amount of statistical information and also extensive
excerpts from the interviews with the women during the first year.
• Mercer (1986) uses the data to present a model of adaptations to the maternal
role in the first year which combines four phase of adaptation at three levels

22. The Four phases described are.
(i) Physical recovery phase
(ii) Achievement Phase
(iii) Disruption Phase
(iv) Reorganization Phase
(ii) Physical Recovery Phase:
From Birth to 1 month
(ii) Achievement Phase :
From 2 to 4 or 5 Months
(iii) Disruption Phase :
From 6 to 8 months.
(iv) Reorganization Phase
That begins after the eighth and is in process at 12 months.

27. (