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Graduate Studies
Master of Arts in Nursing
AY 2013-2014

Theoretical Foundation of Nursing


Presented by:

Presented to:

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-the proponent of the theory
Began her nursing career, received diploma from St.
Margaret’s School of Nursing (Montgomery,

Given L.L Hill award- for Highest Scholastic Standing
Returned to school after working as a (1) staff nurse, (2)head nurse, (3) instructor in the
areas of paediatrics, obstetrics, and contagious diseases
Earned BSN degree, graduated with distinction from the
University of New Mexico, Albuquerque

Completed MSN degree in Maternal and Child Nursing from Emory University
Earned a PhD degree from the University
of Pittsburg

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Accepted position as Assistant Professor in the Department of Family Health Care
Nursing at University of California, San Francisco
Promoted to Associate Professor
Promoted to Professor
Today, she is active in writing, speaking engagements, and consultations.

Awards and Recognitions
Public Health Service Nurse Trainee Award (given by Department of Health, Education,
and Welfare) at Emory University
Inducted into Sigma Theta Tau twice – (1)Emory University, (2) Pittsburg University
The Honor Society of Nursing, Sigma Theta Tau I nternational exists to improve
the health of people by increasing the scientific base of nursing research
[citation needed]
. It is
the second-largest nursing organization in the world with approximately 125,000 active
Membership is by invitation to baccalaureate and graduate nursing students, who
demonstrate excellence in scholarship, and to nurse leaders exhibiting exceptional
achievements in nursing.

Bixler Scholarship for Nursing Education & Research (given by Southern Regional
Board for doctoral study)
Maternal Child Health Nurse of the Year Award (by National Foundation of the March of
Dimes and American Nurses Association
Annual Helen Nahm Lecturer Award (by University of California)
Lamaze National Research Award
Distinguished Research Lectureship Award
American Nurses Foundation’s Distinguished Contributions to Nursing Science Award

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Articles, editorials, commentaries, 6 books, 6 book chapters
-Nursing Care for Parent at Risk
o Received American Journal of Nursing Award (1978)
-Perspective on Adolescent Health Care
o Received American Journal of Nursing Award (1980)
-First-Time Motherhood: Experiences From Teens to Forties
-Parents at Risk
o Received American Journal of Nursing Award (1986)
-Becoming a Mother: Research on Maternal Role Identity Since Rubin (1995)

Member of seven professional organizations, including the American Nurses Association,
and American Academy of Nursing
Associate Editor, Health Care for Women International (1983-1990)
Member of the Review panel, Nursing Research
Member of the Review panel, Western Journal of Nursing Research
Executive Advisory Board, Calfornia Nursing
Executive Advisory Board, Nurseweek
Actively involved with regional, national, and international scientific and professional
meetings and workshops

Maternal Role Attainment Theory is based on Mercer’s extensive research beginning in
the late 1960’s.
Reva Rubin – professor and mentor of Mercer at University of Pittsburg
o -the stimulus for research and theory development, because of Mercer’s
admiration to her
o -well-known for her work in defining and describing maternal role attainment as a
process of binding-in or being attached to the child
Relied on both role and developmental theories
o Mead’s theory on role enactment
o Turner’s theory on the core self
o Thornton and Nardi’s role acquisition process
Other sources: Burr, Leigh, Day, and Constantine
o Werner and Erikson’s developmental process
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o Bertalanffy’sGeneral System theory
o Brofenbrenner’s nested circles – source of general system’s approach
Major sources: (1) Rubin’s theories,
 (2) Gotlieb’s research on attachment and caretaking roles and the most
current research on maternal-infant relationships.
Life Span Development Models of (1)Bates, (2)Reese, and (3) Lipsitt
Research on families by Rankin and Weekes
Gloger-Tipplet’ Process Model for the Course of Pregnancy

Mercer selected both infant and maternal variables on the basis of her review of the literature
and findings of the researchers in several different disciplines.

Maternal factors/variables Infant factors/variables
Age at first birth Temperament
Birth experience Appearance
Early separation from the infant Responsiveness
Social stress Health status
Social support Ability to give cues
Personality traits
Self concept
Child-rearing attitudes, and health

Maternal Role Attainment
an interactional and developmental process occurring over time in which the mother
becomes attached to the 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 attainment –maternal identity.
Maternal Age
chronological and development
Perception of Birth Experience
a woman’s perception of her performance during labor and birth
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Early Maternal-I nfant Separation
Separation from the mother after birth resulting from illness and/or prematurity
an individual’s perception of how others view one and self-acceptance of the perceptions.
Self-concept (Self-regard)
the overall perception of self that includes self-satisfaction, self-acceptance, self-esteem,
and congruence or discrepancy between self and ideal self
Roles are not rigidly fixed; therefore who fills the role 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.”
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.
a trait in which there is specific proneness to perceive stressful situations as dangerous or
threatening, and as situation-specific state.
Having a group of depressions, and in particular the affective component of the depressed
Role Strain
The conflict and difficulty felt by the woman in fulfilling the maternal role obligation.

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The satisfaction, enjoyment, reward, or pleasure that a woman experiences in interacting
with her infant, and in fulfilling the usual tasks inherent in mothering
A component of the parental role and identity.
It is viewed as a process in which an enduring affectional and emotional commitment to
an individual is formed.
I nfant 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
I nfant Health Status
Illness causing maternal-infant separation, interfering with the attainment process
I nfant Characteristics
Temperament, appearance, and health status
”A dynamic system which includes subsystems –
a. individuals (mother, father, fetus/infant)
b. 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 sub-
systems and broader social limits
Positively and negatively perceived life events and environmental variables

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Social support
“The amount of help actually received, satisfaction with that help, and the persons
(network) providing that help
4 Areas of Social Support
1. Emotional Support ~ feeling loved, cared for, trusted, and understood
2. Informational support ~ helps the individual help herself by providing information that
is useful in dealing with the problem and/or situation.
3. Physical support ~ a direct kind of help
4. 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
Mother-Father relationship
Perception of the mate relationship that includes intended and actual values, goals, and
agreements between the two.

1. A relatively stable core self, acquired through lifelong socialization, determines how a
mother defines and perceives events; her perceptions of infant’s and other’s responses to
her mothering, with her life situations, are the real world to which she responds.
2. In addition to the mother’s socialization, her developmental level and innate personality
characteristics also influence her behavioural responses.
3. The mother’s role partner, her infant, will reflect the mothering role through growth and
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 cannot
be duplicated by any other supportive person.
6. Maternal identity develops with maternal attachment and each depends on the other.
Does not define nursing, but refers to nursing as a science emerging from “a turbulent
adolescence to adulthood.
Have the “most sustained and intense interaction with women in the maternity cycle”
Responsible for promoting health
Pioneers in developing and sharing assessment strategies
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Nursing care (not specific) – the kind of help/care a woman receives during pregnancy
and over the first year following birth can have a long term effects for her and her child
Role in providing care and information

Does not specifically defined
Self or core self
Self is separate from role played
Through maternal individuation, a woman may regain her personhood as she extrapolates
her self from the mother-infant dyad
The concepts of self-esteem and self confidence are important in the attainment of the
maternal role
The mother as a person is seen as separate

Defined as the mother and father’s perception of their prior health, current health, health
outlook, resistance susceptibility to illness, health worry or concern, sickness orientation,
and rejection of the sick role
Newborn’s – extent of disease present and infant health status by parental rating of over-
all health
Family’s - negatively affected by antepartum stress
Also viewed as a desired outcome for the child, influenced by both maternal and infant
variables, and achieved through maternal role identity
Stressed the importance of health care in childbearing and child-rearing process

Defined according to Bronfenbrenner’s definition of ecological environment
“Development of a role/person cannot be considered apart from the environment; there is
a mutual accommodation between the developing person and the changing properties of
the immediate settings, relationships between the settings, and the larger contexts in
which the settings are embedded.
Ecological environment – may be viewed as a nested arrangement of systems within the
Microsystem, mesosystem, and macrosystem
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Stresses within influences (a)maternal role attainment, (b) paternal role attainment, (c)
developing child
Environmental factors such as social support, stress, and family functioning within the
microsystem and environmental factors like work setting, school, and daycare impact role

3 Systems of Environment
1-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
Father’s role: diffuse the tension between mother-infant dyad
This system is the most influential on maternal role attainment
Maternal role is achieved within the microsystem through the interactions of father,
mother and infant
A microsystem within the evolving model of Maternal Role Attainment

*a to d - 4 stages of of Maternal role Attainment

2-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.
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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 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
It is in the macrosystem where the health care environment and the impact of current
health care system on maternal role attainment originate.

4 Stages of Maternal Role Attainment
1- Anticipatory Stage
Begins in 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.
2- 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.
3- I nformal 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.
4- 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.
This may be achieved in a month or several months
These four stages of role acquisition overlap and are altered as the infant grows as and
develop. 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.
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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.
Proposed Model of Maternal Role Attainment


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Use of both Deductive and Inductive logic
Deductive: demonstrated in the use of works from other researchers and disciplines
Inductive: development of her theory (Maternal Attainment Theory)
*Through practice and research, she observed adaptation to motherhood from a variety of
*She noted the differences existed in adaptation to motherhood when maternal illness
complicated the post-partum period, when a child with defect was born, and when a
teenager became a mother

Highly practice-oriented
Cited in many obstetrical textbooks and have been used in practice by nurses and those in
other disciplines
The theory and model: framework for assessment, planning, implementing, and
evaluating nursing care of new mothers and their infants
Nursing Theory: Utilization and Application (by Alligood and Mariner Tomey)
o ~ described the use of the theory in practice
First-Time Motherhood: Experiences from Teens to Forties (by Mercer)
o ~linked research findings with nursing practice at each time interval from birth
through the first year, making her theory applicable in a variety of pediatric
Appeared extensively in nursing texts
Many of the current concepts in maternal child nursing texts are based on Mercer’s
Mercer’s theory and model help simplify a very complex process, enhancing
understanding and making Mercer’s contribution extremely valuable to nursing
Used as a basis for numerous theses and dissertations
Development of highly reliable, valid instrument to measure mothers’ attitudes about the
labor and delivery experience
o Numerous researchers have requested permission to use the instrument
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The theoretical framework for a correlational study exploring differences between three
age groups for first-time mothers (ages 15 to 19, 20-29, 30-42) has been tested at the
University of Texas
Used by Sank in her doctoral dissertation at the University of Texas
According to McBride, Maternal Role Attainment theory is a theoretically sound
construct that nurse researchers have been searching for in their analysis of the
experience of new mothers.

Concepts and variables are not explicitly defined, but are described and implied
Interchange in adaptation-attainment, social support-support network
Logical and coherent as a whole
Despite numerous concepts and relationships, the theoretical framework for maternal role
attainment organizes a rather complex phenomenon into an easily understood and useful
Guide practice
Specific to parent-child nursing
Can be generalized to all women during pregnancy through the first year after birth,
regardless of age, parity, or environment
Applicable to perinatal patients and their families
Can be used to a variety of pediatric settings
Study and predict parental attachment
Broadened application of previously existing theories on maternal role attainment
because her studies have spanned various developmental levels and situational contexts, a
quality that other studies do not share
Empirical precision
Derived from extensive research efforts
Empirical observations
The degree of concreteness and completeness of operational definitions further increase
the empirical precision

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Derivable consequences
Useful in research, practice and education
Differentiated the focus of nursing from other service professions by combining the
social, psychological, and biological sciences
Implications for nursing and/or nursing interventions are addressed and provide the bond
between research and practice
She believes that nursing research is the “bridge to excellence” in nursing practice

Tomey, A.M., Alligood, M.R. (2002), Nursing Theorists and Their Work. City, State:

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