Running head: MERCER THEORY EVALUATION
Ramona T. Mercer Theory of Maternal Role Attainment
Margaret A. Gerulski
Ferris State University
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MERCER THEORY EVALUATION
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Abstract
This paper evaluates the theory development by Ramona T. Mercer and the impact on nursing
practice and education. A description of how to use the maternal role attainment theory as
framework for patient assessment and how it is used in clinical practice is included. An
explanation of this model will include person, environment, health and nursing. This paper also
evaluates the strengths and limitations of maternal role attainment theory method.
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Mercer’s Theory of Maternal Role Attainment
Ramona T. Mercer developed the theory of maternal role attainment in the late 1960s
based on her extensive research. Her academic achievements include a master’s degree and a
Ph.D. in maternal-child nursing, with advancement from an associate professor to current
Professor Emeritus in Family Health Nursing at the University of California, San Francisco, CA.
As the author of many books, Professor Mercer also writes for both nursing and non-nursing
journals and magazines. Professor Mercer’s theory process was guided by her mentor and past
professor, Dr. Rubin, which is reflected in the theory of maternal role attainment. In 1991, the
original theory and model of maternal role attainment was introduced and was presented more
clearly in 1996 in a book titled: Becoming a Mother: Research on Maternal Identity From Rubin
to Present (Tomey & Alligood, 2008).
In addition to Rubin’s work, Mercer based her research on both role and developmental
theories. She relied heavily on an interactionist approach to role theory, using Mead’s
(1934) theory on role enactment and Turner’s (1978) theory on the core self. In addition,
Thornton and Nardi’s (1975) role acquisition process also helped shape Mercer’s theory,
as did the work of Burr, Leigh, Day, and Constantine (1979), Werner’s (1957)
developmental process theories also contributed. In addition, Mercer’s work was
influenced by von Bertalanffy’s (1968) general system theory. (Tomey & Alligood,
2008, p. 607)
Major Concepts of Maternal Role Attainment Theory
There are many concepts used in the development of this theory. Maternal role
attainment theory involves the attachment of the mother to the newborn, competence in the
ability to care for the newborn, and an expression of acceptance of this new role. Associated
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concepts include acceptance of the role of mother, how they perceived the birth experience, and
a woman’s self-esteem and self-concept. The woman’s support system, relationship with the
baby’s father, and other external stressors may also influence how the new mother reaches the
attainment of the maternal role. Nursing care during the woman’s pregnancy, and in the first
year of the newborn’s life, will effect long-term their adjustment (Tomey & Alligood, 2008).
Mercer’s theory can be useful in the assessment and intervention needed to help high-risk
families who need to deal with problems for years after the birth.
Analysis of Theory Model
Nursing
The maternal role attainment theory states that, “Nurses are the health professionals
having the most sustained and intense interaction with women in the maternity cycle” (Tomey &
Alligood, 2008, p. 610). This theory is cited in numerous textbooks and practiced by most
obstetric nurses and other caregivers in this area. This theory lays the framework for assessing,
planning, implementing, and evaluation of maternal and newborn care.
Practice. “Mercer’s theory is highly practice oriented” (Tomey & Alligood, 2008, p.
614). This theory is cited in numerous textbooks and practiced by most obstetric nurses and
other caregivers in this area. This theory lays the framework for assessing, planning,
implementing, and evaluation of maternal and newborn care.
Education. Professor Mercer’s name is highly recognized among any healthcare worker
that has studied maternity nursing. The research and nursing care presented by this model of
care is used and valued by the obstetrical disciplines. The use of this theory provides a valuable
framework for students and nurses. An educational program was established for substance
abusing women in a residential treatment center based on this theory (Tomey & Alligood, 2008).
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Research. Students are actively involved in the faculty research of the maternal role
attainment theory model. Graduate student theses and research projects have used Mercer’s
theory. Mercer’s theoretical framework has been used by many in correlation studies and
doctoral research dissertations (Tomey & Alligood, 2008).
The maternal-child relationship has been studied extensively in both full-term and
premature infants. The association between maternal-child interaction and attachment has
been well established for many years. Research has also concluded that mothers of
premature infants demonstrate fewer positive interactions and less social interaction than
mothers of full-term infants, and that developmental disability and illness severity is
related to the quality and quantity of interaction and to the developmental outcomes of
children. (Pridham, Saxe, & Limbo, 2004, p. 161)
Person
“Mercer does not specifically define person, but refers to the self or core self” (Tomey &
Alligood, 2008, p. 611). Associated concepts include acceptance of the role of mother, how they
perceived the birth experience, and a woman’s self-esteem and self-concept.
Health
A new family is affected by their past, current, and future health concerns. Stressors in
the area of health status can adversely impact the attainment of the desired outcome. The
environment can interfere with the development of maternal role attainment. (Tomey &
Alligood, 2008, p. 611).
Environment
The maternal and paternal role attainment, and the developing child is influenced by both
the stresses and social support within the environment. The environmental factors can include
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the “immediate settings, relationships between settings, and the larger contexts in which the
settings are embedded” (Tomey & Alligood, 2008, p. 611).
Need for Further Development
The utility and applicability limitations of Mercer’s theory are noted in the ongoing work
to improve clarity and usefulness. “Her revisions to her theory in 2003, although based on
nursing research, have not been tested in other studies” (Tomey & Alligood, 2008, p. 617). The
lack of confirmation in this research among women in other cultures or in different
circumstances has not been investigated, and thus is another limitation to this model (Tomey &
Alligood).
As the decades have passed and more nurse scientists have studied this theory, questions
have arisen, according to Dr. Mercer, about some of the constructs involved in maternal
role attainment as originally conceptualized. A large number of studies are reviewed in
this article that lends credence to Dr. Mercer’s argument. Many of these studies have
shown that there are additional processes not originally considered in the development of
the term “maternal role attainment” that should now be a part of the role. In addition,
renaming the process would recognize that women continue to grow as mothers
throughout their children’s lives; “attaining” the role is not “becoming” the role.
Therefore, Dr. Mercer says, the former term “maternal role attainment” is no longer
sufficient to describe the larger “life-transforming experience” women go through when
they “become a mother.” (Mercer, 2004, p. 226)
Impact on Nursing Practice
The maternal role attainment theory model directly impacts nursing practice and helps to
develop guidelines for the obstetric nurse. The addition of support systems into the maternal role
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development will allow the transition to continue after discharge from the hospital. Nursing care
plans and educational plans that embrace the support system are beneficial to the maternal role
attainment. During hospital stays, the inclusion of support systems in patient care increases
patient satisfaction scores, improves consistency in instruction and education, and leads to better
patient outcomes.
The amount of time a nurse spends at the bedside listening to the new mothers concerns,
and confirming the mother’s abilities to care for her newborn greatly impacts this outcome.
(Mercer, 2006, p. 650). The nurse needs to identify a mother’s unique concerns and available
resources to address these concerns. It will take reinforcement of caretaking skills to foster the
mother’s sense of competence as she works at gaining a maternal identity.
Conclusion
The value of Mercer’s maternal-role model attainment is evident in every aspect of the
nursing process. As an obstetric nurse this theory model, allows simplification of the
transitioning at birth and over the first year to the role of mother. Mercer believes that there is a
strong bond between nursing practice and research, and “is the ‘bridge to excellence’ in nursing
practice (Tomey & Alligood, 2008, p. 618). Theory guided practice elevates the work of nurses
leading to fulfillment and satisfaction and providing a satisfying professional model of practice
(Smith & Liehr, 2008). The dedication of Professor Mercer in her continued pursuit of theory
research and formulation and her articles that increase our nursing knowledge is highly
commended.
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References
Kearney-Nunnery, R. (2008). Advancing your career: Concepts of professional nursing (4th ed.).
Philadelphia: F. A. Davis Company.
Mercer, R. T. (2004). Becoming a mother versus maternal role attainment. Journal of nursing
scholarship, 36(3), 226-232.
Mercer, R. T. (2006). Nursing support of the process of becoming a mother [Electronic Version].
JOGNN, 35(5), 649-651. doi: 10.1111/j.1552-6909.2006.00086.x
Pridham, K., Saxe, R., & Limbo, R. (2004). Feeding issues for mothers of very low-birth-weight,
premature infants through the first year. Journal of perinatal and neonatal nursing, 18(2),
161-170.
Smith, M. J., & Liehr, P. R. (2008). Middle range theory for nurses (2nd ed.). NY: Springfield.
Retrieved from: http://www.springerpub.com/samples/19166_chapter.pdf
Tomey, A. M., & Alligood, M. R. (2006). Nursing theorists and their work (6th ed.). St. Louis,
MO: Mosby Elsevier.
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Appendix A
Possible
points
Points
Earned
5
5
5
5
10
10
10
10
10
10
10
10
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a. Development of a clear, logical, well-supported paper; demonstrating
original thought and content.
b. Evidence of research with a minimum of 2 research articles in addition to
the course required texts. Correct acknowledgement of sources using APA
style referencing. Attaches APA checklist
c. Overall presentation; grammar, spelling, punctuation, clean and legible.
5
5
5
5
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d. Stays within page limit which includes: one cover page, one reference
page, body of paper is to have a maximum of 5 pages and a minimum of 3 full
pages.
Total Possible Points Very well done. Excellent use of resources!!
Total Points Earned
5
5
100
100
Grading Rubric for Theory Paper
1. Introduction of theory/model
a. Introduction clear and well focused
b. History and significance of model
2. Analysis of Model
a. Explain the model in terms of: Person, Environment, Health, and
Nursing.
b. Explain other concepts that are unique to the model.
c. Demonstrate how the model can be used in clinical practice.
d. Explain how the model can be used as a Framework for patient
assessment.
e. Explain the model within the context of nursing education.
f. Identify strengths and limitations of the model.
g. Analyze the model overall, demonstrating new insights about the model.
3. Evidence of Academic Writing