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546 UNIT V Middle Range Nursing Theories

interact with the mother’s developing maternal iden- to retire the term maternal role attainment because
tity, depicted as a through d in Figure 27–2, include “it implies a static situation rather than fluctuating pro-
the following: cess” (p. 79). Finally, in a synthesis of nine qualitative
a. Eye contact with the mother as she talks to her or studies, Nelson (2003) described continued growth and
him, grasp reflex transformation in women as they become mothers.
b. Smile reflex and quieting behavior in response to Mercer (2004) acknowledged that new challenges in
the mother’s care motherhood require making new connections to regain
c. Consistent interactive behaviors with the mother confidence in the self and proposed replacing the term
d. Eliciting responses from the mother; increasingly maternal role attainment with becoming a mother.
more mobile Qualitative studies have identified stages of mater-
According to Mercer (1995): nal role attainment using the descriptive terms of
participants. A compilation of the results of several
The personal role identity stage is reached when of these studies has led Mercer (2004, 2006) to the
the mother has integrated the role into her self following proposed changes in the names of stages
system with a congruence of self and other roles; leading to maternal role identity:
she is secure in her identity as mother, is emo- • Commitment and preparation (pregnancy)
tionally committed to her infant, and feels a • Acquaintance, practice, and physical restoration
sense of harmony, satisfaction, and competence (first 2 weeks)
in the role (p. 14).
• Approaching normalization (second week to
Using Burke and Tully’s (1977) work, Mercer 4 months)
(1995) stated that a role identity has internal and • Integration of maternal identity (approximately
external components: the identity is the internalized 4 months)
view of self (recognized maternal identity), and role is These stages parallel the original stages in Mercer’s
the external, behavioral component. theory, but they embrace the maternal experience
more completely and use terminology derived from
Becoming a Mother: A Revised Model new mothers’ descriptions of their experiences.
Mercer has continued to use both her own research Theory building, according to Mercer (personal
and the research of others as building blocks for her communication, September 3, 2003), is a continual
theory. In 2003, she began reexamining the Theory of process as research provides evidence for clarifying
Maternal Role Attainment, proposing that the term concepts, additions, and deletions. Although many of
becoming a mother more accurately reflects the pro- the more recent studies support the findings of both
cess based on recent research. According to Mercer Rubin and Mercer, Mercer (2004) recognized the evi-
(2004), the concept of role attainment suggests an end dence for needed changes in her original theory for
point rather than an ongoing process and may not greater clarity and consistency. It is with this insight that
address the continued expansion of the self as a she proposed retiring the term maternal role attain-
mother. Mercer’s conclusions are based largely on ment. Mercer (2004) acknowledges that becoming a
current nursing research about the cognitive and mother, which connotes continued growth in mother-
behavioral dimensions of women becoming mothers. ing, is more descriptive of the process, which is much
Walker, Crain, and Thompson’s (1986a, 1986b) ques- larger than a role. Although some roles may be termi-
tions about maternal role attainment as a continuing nated, motherhood is a lifelong commitment.
process contributed to Mercer’s reexamination of her Mercer has continued to use Bronfenbrenner’s
theory. Koniak-Griffin (1993) also questioned the concept of interacting nested ecological environ-
behavioral and cognitive dimensions of maternal ments. However, she renamed them to reflect the
role attainment. Hartrick (1997) reported in her study living environments: family and friends, community,
that mothers of children from 3 to 16 years of and society at large (Figure 27–3). This model places
age undergo a continual process of self-definition. the interactions between mother, infant, and father
McBride and Shore (2001) in their research on mothers at the center of the interacting, living environments
and grandmothers suggested that there may be a need (R. Mercer, personal communication, September 3,