Tarlac State UniversityGraduate StudiesMaster of Arts in NursingAY 2013-2014

Theoretical Foundation of Nursing

ROWENA T. MERCERSMATERNAL ATTAINMENT THEORY

Presented by:SHERWIN C. MAURICIO, RN

Presented to:Prof. ANDREW SEBASTIAN G. MATIAS, RN, MaEd, MSN

MATERNAL ROLE ATTAINMENT THEORY

RAMONA T. MERCER

http://nursing.unm.edu/alumni-and-friends/awards/-the proponent of the theoryCredentials and Background of the TheoristEducation1950 Began her nursing career, received diploma from St. Margarets School of Nursing (Montgomery, Alabama)

http://www.epodunk.com/cgi-bin/genInfo.php?locIndex=12086Given L.L Hill award- for Highest Scholastic Standing1960 Returned to school after working as a (1) staff nurse, (2)head nurse, (3) instructor in the areas of paediatrics, obstetrics, and contagious diseases1962 Earned BSN degree, graduated with distinction from the University of New Mexico, Albuquerque

http://www.epodunk.com/cgi-bin/genInfo.php?locIndex=177731964 Completed MSN degree in Maternal and Child Nursing from Emory University1973 Earned a PhD degree from the University of Pittsburg

http://www.pitt.edu/~pleu/Openings/ Accepted position as Assistant Professor in the Department of Family Health Care Nursing at University of California, San Francisco1977 Promoted to Associate Professor1983 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*about The Honor Society of Nursing, Sigma Theta Tau International 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 members.

http://en.wikipedia.org/wiki/Sigma_Theta_TauMembership 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 4th Annual Helen Nahm Lecturer Award (by University of California) Lamaze National Research Award Distinguished Research Lectureship Award American Nurses Foundations Distinguished Contributions to Nursing Science Award

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

Theoretical Sources Maternal Role Attainment Theory is based on Mercers extensive research beginning in the late 1960s. Reva Rubin professor and mentor of Mercer at University of Pittsburg -the stimulus for research and theory development, because of Mercers admiration to her -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 Meads theory on role enactment Turners theory on the core self Thornton and Nardis role acquisition process Other sources: Burr, Leigh, Day, and Constantine Werner and Eriksons developmental process BertalanffysGeneral System theory Brofenbrenners nested circles source of general systems approach Major sources:(1) Rubins theories, (2) Gotliebs 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

USE OF EMPIRICAL EVIDENCEMercer 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/variablesInfant factors/variables

Age at first birthTemperament

Birth experienceAppearance

Early separation from the infantResponsiveness

Social stressHealth status

Social supportAbility to give cues

Personality traits

Self concept

Child-rearing attitudes, and health

Major Concepts and DefinitionMaternal 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 developmentPerception of Birth Experience a womans perception of her performance during labor and birthEarly Maternal-Infant Separation Separation from the mother after birth resulting from illness and/or prematuritySelf-esteem an individuals 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 selfFlexibility 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 mothers and fathers 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 perceive stressful situations as dangerous or threatening, and as situation-specific state.Depression Having a group of depressions, and in particular the affective component of the depressed mood.Role Strain The conflict and difficulty felt by the woman 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 motheringAttachment 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.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 motherInfant Health Status Illness causing maternal-infant separation, interfering with the attainment processInfant Characteristics Temperament, appearance, and health statusFamily 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 systemFamily Functioning The individuals view of the activities and relationships between the family and its sub-systems and broader social limitsStress Positively and negatively perceived life events and environmental variables

Social support The amount of help actually received, satisfaction with that help, and the persons (network) providing that help4 Areas of Social Support1. Emotional Support ~ feeling loved, cared for, trusted, and understood2. 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 help4. 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 roleMother-Father relationship Perception of the mate relationship that includes intended and actual values, goals, and agreements between the two.

Major Assumptions1. A relatively stable core self, acquired through lifelong socialization, determines how a mother defines and perceives events; her perceptions of infants and others responses to her mothering, with her life situations, are the real world to which she responds.2. In addition to the mothers socialization, her developmental level and innate personality characteristics also influence her behavioural responses.3. The mothers role partner, her infant, will reflect the mothering role through growth and development.4. The infant is considered an active partner in the maternal role-taking process, affecting and being affected by the role enactment5. The father or mothers 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.Nursing 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 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

Person 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

Health Defined as the mother and fathers 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 Newborns extent of disease present and infant health status by parental rating of over-all health Familys - 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

Environment Defined according to Bronfenbrenners 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 nextMicrosystem, mesosystem, and macrosystem 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 attainment.

THEORETICAL ASSERTIONS3 Systems of Environment1-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 Fathers 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 infantA microsystem within the evolving model of Maternal Role Attainment

http://groups.yahoo.com/group/NursingTheories/message/15*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 themesosystem may determine in part what happens to the developingmaternal 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.

4 Stages of Maternal Role Attainment1- 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- 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.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 monthsThese 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.**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

http://www.slideshare.net/azizahid1/maternal-role-attainment-theory

LOGICAL FORM 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 circumstances *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

ACCEPTANCE BY THE NURSING COMMUNITYPractice 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) ~ described the use of the theory in practice First-Time Motherhood: Experiences from Teens to Forties (by Mercer) ~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 settingEducation Appeared extensively in nursing texts Many of the current concepts in maternal child nursing texts are based on Mercers research Mercers theory and model help simplify a very complex process, enhancing understanding and making Mercers contribution extremely valuable to nursing education.Research 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 Numerous researchers have requested permission to use the instrument 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.

CRITIQUEClarity 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 wholeSimplicity Despite numerous concepts and relationships, the theoretical framework for maternal role attainment organizes a rather complex phenomenon into an easily understood and useful form. Guide practiceGenerality 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 shareEmpirical precision Derived from extensive research efforts Empirical observations The degree of concreteness and completeness of operational definitions further increase the empirical precision

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

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

Images from Internethttp://nursing.unm.edu/alumni-and-friends/awards/http://www.epodunk.com/cgi-bin/genInfo.php?locIndex=12086http://www.pitt.edu/~pleu/Openings/http://groups.yahoo.com/group/NursingTheories/message/15http://www.slideshare.net/azizahid1/maternal-role-attainment-theory

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