Maternal role attainment theory

MATERNAL ROLE ATTAINMENT

THEORY

RAMONA T. MERCER, Ph.D, RN, FAAN

Born in 1929

CREDENTIALS AND BACKGROUND

Mercer began her nursing career in 1950 and she graduated from St. Margaret’s school of nursing, Montgomery, alabama.

For the next 10 years she worked as a nurse and instructor in pediatric and obstetrical nursing in addition to the field of contagious diseases (Meighan, 2010).

Her early nursing experience molded her interests toward pediatric and obstetrics. returned to school in 1960 and earned her master’s degree specializing in maternal-child nursing at the University of New Mexico in 1964 (Meighan, 2010).

She continued pursuing her passion for maternity nursing and completed her Ph.D. at the University of Pittsburgh in 1973.

Dr. Mercer then moved to California and worked as a nursing professor at the University of California until she retired in 1987. Even in her retirement, she still continues to revise and clarify her work because she believes that “theory building is a continual process” (Mercer, 2004, p.226).

Ramona Mercer’s early work in the 1970’s was focused on the

1.needs of breastfeeding mothers

2.teenage mothers3.postpartum illness4.mothers bearing

children with defects.

She had also a deep interest in the development of the

1.maternal role2.self-esteem3.self-concept of

mothers

(Meighan, 2010)

During the span of Mercer’s career, her work expanded further in the area of maternal-child nursing.

She authored books such as:

1. Perspectives on Adolescent Health Care

2. Transitions in a Woman’s Life

3. Parents at Risk

(Ramona Mercer, 2011)

She has written a total of six books, published six book chapters and numerous journal articles.

Throughout her career Dr. Mercer has received a great deal of awards and is a member of several professional organizations and national committees (Meighan, 2010).

Maternal Role Attainment

Theory

Defined as an interaction and developmental process occurring over time, in 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.

Maternal Role Attainment is also as defined a process of binding in or being attached to the child and Maternal Role Identity or seeing oneself in the role and having a sense of comfort about it.

(Rubin)

FACTORS THAT DIRECTLY OR INDIRECTLY INFLUENCE ON THE

MATERNAL ROLE

The maternal factors included:

•age at first birth•birth experience•early separation from the infant•social stress• social support personality traits,self-concept

•child-rearing attitudes•health


MATERNAL ROLE

She also included the infant variables:

•temperament•appearance•responsiveness•health status, and ability to give cues


MATERNAL ROLE

She also noted the importance of the father's role, the

mother-father relationship. She also noted the importance of the father's role and applied many of her previous findings

in studying the paternal response to parenthood.

CONCEPTS

MATERNAL IDENTITYMaternal identity is defined as

having an internalized view of the self as a mother (Mercer, 1995).

PERCEPTION OF BIRTH EXPERIENCE

A woman’s perception of her performance during labor and birth is her perception of the birth experience (Mercer, 1990)

CONCEPTS

SELF-ESTEEMMercer, May, Ferketich and DeJoseph

(1986) describe self-esteem as “an individual’s perception of how others view one and self-acceptance of the perception “.

SELF-CONCEPT (SELF-REGARD)Mercer (1986) outlines self-concept, or

self-regard, as “The overall perception of self that includes self-satisfaction, self-acceptance, self-esteem, and congruence or discrepancy between self and ideal self “.

CONCEPTS

FLEXIBILITYRoles are not rigidly fixed; therefore,

who fills the roles is not important (Mercer, 1990). “Flexibility of children attitudes increases with increased development …., Older mothers have infants and to view each situation in respect to the unique nuances”.

CHILDREARING ATTITUDES Childrearing attitudes are material

attitudes or beliefs about childrearing.

CONCEPTS

HEALTH STATUSHealth status is defined as “ The

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

CONCEPTS

ANXIETYMercer and colleagues (1986)

describe anxiety as “ a trait in which there is specific proneness to perceive stressful situation-specific state” .

DEPRESSIONAccording to Mercer and colleagues

(1986), depression is “having a group of depression symptoms and in particular the effective component of the depressed mood”.

CONCEPTS

ROLE STRAIN-ROLE CONFLICTRole strain is the conflict and

difficulty felt by the woman in fulfilling the maternal role obligation.

GRATIFICATION-SATISFACTIONMercer describes gratification as

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

CONCEPTS

ATTACHMENTAttachment versus a difficult

temperament is related to whether the infant sends hard-to-read cues, leading to feelings of incompetence and frustration in the mother.

INFANT HEALTH STATUSInfant health status is illness causing

maternal infant separation, interfering with the attachment process.

CONCEPTS

INFANT CHARACTERISTICS Characteristics include infant

temperament, appearance, and health status.

INFANT CUESInfant cues are infant behaviors

that elicit a response from the mother .

CONCEPTS

FAMILYMercer and colleagues define

family as “a dynamic system which includes subsystems-in-individuals (mother, father, fetus/infant) and dyads (mother-father, mother-fetus/infant, and father fetus/infant) within the overall family system.

CONCEPTS

FATHER OR INTIMATE PARTNERThe father or intimate partner

contributes to the process of maternal role attainment in a way that cannot be duplicated by any other person. The father’s interactions help diffuse tension and facilitate maternal role attainment

CONCEPTS

FAMILY FUNCTIONINGFamily functioning is the individual’s

view of the activities and relationships between the family and its subsystems and broader social units.

STRESSStress is made up of positively and

negatively perceived life events and environmental variables.

CONCEPTS

MOTHER-FATHER RELATIONSHIP

The mother-father relationship is the perception of the mate relationship that includes intended and actual values, goals, and agreement between the two. The maternal attachment to the infant develops within the emotional held of the parent’s relationship.

CONCEPTSSOCIAL SUPPORTAccording to Mercer and colleagues, social support is “the amount of help actually received, satisfaction with that help, and the persons (network) providing that help”.

Four areas of social support area as follows:

•Emotional support; “Feeling loved, cared for, trusted, and understood”

• Informational support: “Helps the individual help herself by providing information that is useful in dealing with the problem and/or situation”

• Physical support: A direct kind of help

• Appraisal support: “ A support that tells the role taker how she is performing in the role; it enables the individual to evaluate herself in relationship to others “ performance in the role”

ASSUMPTIONS

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

ASSUMPTIONS

•In addition to the mother’s socialization, her developmental level and innate personality characteristics also influence her behavioral responses.

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

ASSUMPTIONS

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

•The father or mother’s intimate partner contributes to role attainment in a way that cannot be duplicated by any other supportive person.

ASSUMPTIONS

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

ASSERTIONS

•Mercer’s original Theory and Model of Maternal Role Attainment were first introduced in 1991. It was refined and was presented more clearly in her 1995 book, Becoming a Mother: Research on Maternal Identity

ASSERTIONS

•From Rubin to Present. Her recent revision focuses on woman’s transition in becoming a mother. It involves an extensive change in her life space that requires her ongoing development.

.

ASSERTIONS

•According to Mercer, becoming a mother is more extensive than just assuming the role. It is unending and continuously evolving therefore she recommends that the Maternal role attainment be retired.

PARADIGMS

NURSINGMercer stated that, “Nurses are the health professionals having the most sustained and intense interaction with women in the maternity cycle. She emphasizes that the kind of help of a woman receives during pregnancy and over the first year following birth can have a lifelong term effects for her and her child.

PARADIGMS

PERSONShe refers the person as self or core self, view the self as separate from the roles that are played. The mother interacts with her infant and with the father or her significant other; influential and is influenced by both of them.

PARADIGMS

HEALTHShe defines health status as the mothers and father’s perception of their prior health, current health, health outlook, resistance, susceptibility to illness, worry or concern and rejection of sick role. Health status of newborn is the extent of disease present and infant health status by parental rating of overall health. She also stresses the importance of healthcare during childbearing and childrearing process.

PARADIGMS

ENVIRONMENTShe conceptualized the environment from Bronfenbrenner’s definition of the ecological environment. Development of a role/ person cannot be considered apart from the environment; there is a mutual accommodation between developing person and the changing properties of the immediate settings, and the larger context in which the settings are embedded.

Proposed Model of Maternal Role Attainment

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 influencial 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.


According to Mercer, the maternal role is attained when the mother feels internal harmony with the role and its expectations and described three major components of the role:

1. attachment to the infant 2. gaining competence in mothering

behaviors 3. expressing gratification in

maternal-infant interactions.

Outcome for the child includes cognitive, mental development attachment, health, and other social competence.


Refer to the given diagram.

Theoretical Underpinnings

•Mercer believes that nurses can play a vital role in promoting health of families and children. Mercer stated in her book Becoming a Mother: Research on Maternal Identity from Rubin to the Present that “nurses are the health professionals having the most sustained and intense interaction with women in the maternity cycle” (1995, p. xii).


Mercer’s theory is practice oriented and has consistently evolved over time because of her commitment to connect research to practice (Meighan, 2010).


•In addition to the renaming of maternal role attainment stages, the model has undergone ongoing revision since its original publication. The work of Walker, Crain, and Thompson indicated that a change was needed because the term role attainment indicated an end to the process as a final goal.


Mercer began to reexamine her theory and felt the need to revise the model’s title to “Becoming a Mother” in order to connote a continued growth in mothering throughout the lifespan (Mercer, 2004).

Stages of Becoming a Mother

• The concepts of Mercer’s theory center on the bond between mother and child which fosters competency, confidence and joy in the motherhood role (Role Attainment, 2005).

• Mercer’s original maternal role attainment theory follows a process that has four stages. In 2004 Mercer revised the terms of these stages although the stages themselves remain basically the same.


• “Commitment, attachment, and preparation” stage during pregnancy when the mother makes psychological adjusts and prepares for the expectations of her new role.

•“Acquaintance, learning, and physical restoration” stage which begins with the infant’s birth when the role of mother is assumed and learned in the contexts of her social system.


• “Moving toward a new normal” stage in the first few months of the infant’s life where the mother makes her new role fit her lifestyle in a personal way instead of in context with a social system.


“Achievement of maternal identity” stage when the mother internalizes her role and experiences a sense of harmony, competence and confidence which usually occurs about 4 months after birth.


These stages can overlap and the timing is highly variable however the stages usually progress in a sequential, predictable manner (Mercer, 2004).

Thank you for

listening!

ABDUL AZIZ JAJA AHID, RN

Maternal role attainment theory

Health & Medicine

Transcript of Maternal role attainment theory