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544 UNIT V Middle Range Nursing Theories

mother-infant dyad (Mercer, 1985b). The core self Theoretical Assertions
evolves from a cultural context and determines how Mercer’s original Theory and Model of Maternal Role
situations are defined and shaped (Mercer, 1985a). Attainment were introduced in 1991 during a sympo-
The concepts of self-esteem and self-confidence are sium at the International Research Conference spon-
important in attainment of the maternal role. The sored by the Council of Nursing Research and American
mother as a separate person interacts with her infant Nurses Association in Los Angeles, California (Mercer,
and with the father or her significant other. She is 1995). It was refined and presented more clearly in her
both influential and is influenced by both of them 1995 book, Becoming a Mother: Research on Maternal
(Mercer, 1995). Identity from Rubin to the Present (see Figure 27–1).
Mercer’s (2004) more recent revision of her theory
Health has focused on the woman’s transition in becoming a
In her theory, Mercer defines health status as the mother. Motherhood involves an extensive change in
mother’s and father’s perception of their prior a woman’s life that requires her ongoing development.
health, current health, health outlook, resistance- According to Mercer, becoming a mother is more
susceptibility to illness, health worry or concern, extensive than just assuming a role. It is unending
sickness orientation, and rejection of the sick role. and continuously evolving. Therefore, she proposed
Health status of the newborn is the extent of disease that the term maternal role attainment be retired.
present and infant health status by parental rating She based that recommendation on the published
of overall health (Mercer, 1986b). The health status research of Walker, Crain, and Thompson (1986a,
of a family is affected negatively by antepartum 1986b), Koniak-Griffin (1993), and McBride and
stress (Mercer, Ferketich, DeJoseph, May, & Sollid, Shore (2001), who had examined the process of moth-
1988; Mercer, May, Ferketich, & DeJoseph, 1986). ering and raised questions about the appropriateness
Health status is an important indirect influence of maternal role attainment as an end point in the
on satisfaction with relationships in childbearing process.
families. Health is also viewed as a desired outcome
for the child. It is influenced by both maternal and Maternal Role Attainment: Mercer’s
infant variables. Mercer (1995) stresses the impor- Original Model
tance of health care during the childbearing and Mercer’s Model of Maternal Role Attainment was
childrearing processes. placed within Bronfenbrenner’s (1979) nested circles
of the microsystem, mesosystem, and macrosystem (see
Environment Figure 27–1). The original model proposed by Mercer
Mercer conceptualized the environment from Bron- was altered in 2000, changing the term exosystem,
fenbrenner’s definition of the ecological environment originally found in the second circle, and replacing it
and based her earliest model in Figure 27–1 on it with the term mesosystem. Mercer (personal commu-
(Mercer, 1995; R. Mercer, personal communication, nication, January 4, 2003) explained that this change
June 24, 2000). This model illustrates the ecological made the model more consistent with Bronfenbrenner’s
interacting environments in which maternal role terminology, as follows:
attainment develops. During personal communication 1. The microsystem is the immediate environment in
on January 4, 2003, Mercer explained, “Development which maternal role attainment occurs. It includes
of a role/person cannot be considered apart from factors such as family functioning, mother-father
the environment; there is a mutual accommodation relationships, social support, economic status,
between the developing person and the changing family values, and stressors. The variables con-
properties of the immediate settings, relationships tained within this immediate environment interact
between the settings, and the larger contexts in which with one or more of the other variables in affecting
the settings are embedded.” Stresses and social sup- the transition to motherhood. The infant as an
port within the environment influence both maternal individual is embedded within the family system.
and paternal role attainment and the developing The family is viewed as a semi-closed system main-
child. taining boundaries and control over interchange