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550 UNIT V Middle Range Nursing Theories

maternal role attainment during the first year of childbearing that have an impact on the transition to
motherhood: motherhood.
1. The physical recovery phase (from birth to 1 month) Mercer’s concern for the utility and applicability of
2. The achievement phase (from 2 to 4 or 5 months) her theory is evident in her continued work toward
3. The disruptions phase (from 6 to 8 months) clarity and usefulness. Revisions of her theory in 2003,
4. The reorganization phase (from after the eighth although based on nursing research, are still being
month and still in process at 1 year) tested in other studies. Mercer’s (2004) proposal of
Additionally, adaptation to the maternal role was abandoning the term maternal role attainment for
proposed to occur at three levels (biological, psycho- the term becoming a mother is argued logically, but
logical, and social), which are interacting and interde- few studies put it to use in practice or research. Al-
pendent throughout the phases. These phases and though qualitative research to describe the phases of
levels of adaptation were described briefly and were becoming a mother uses the exact words of women
applied to her research. In 2003, Mercer proposed experiencing this transition, these phases have not
additional changes to the theory (2004), which included been confirmed among women in other cultures or
abandoning the term maternal role attainment for the in different circumstances.
term becoming a mother. Changes to the model and
adoption of the following four descriptive phases to the Critique
process of becoming a mother were also proposed:
1. Commitment and preparation (pregnancy) Clarity
2. Acquaintance, practice, and physical restoration The concepts, variables, and relationships have not
(first 2 weeks) always been defined explicitly, but they were described
3. Approaching normalization (second week to and implied in Mercer’s earlier work. However, the
4 months) concepts were defined theoretically and operational-
4. Integration of maternal identity (approximately ized consistently. Work toward improving clarity is
4 months) evident. Concepts, assumptions, and goals have been
These changes were based on the research studies organized into a logical and coherent whole, so that
by other nurses and are evidence of Mercer’s contin- understanding the interrelationships among the con-
ued scrutiny and critique of her theory to improve its cepts is relatively easy. Some interchanging of terms
utility in practice and research. and labels used to identify concepts, such as adapta-
According to Mercer and Walker (2006), research tion and attainment, social support, and support net-
into specific nursing interventions that foster be- work, is potentially confusing for the reader, and
coming a mother is needed. They encourage the maternal role attainment has not been defined consis-
involvement of nursing staff, students, and faculty in tently, which can obstruct clarity. Maternal identity,
the development and testing of assessment guide- a term that Mercer defines as the final stage of role
lines and instruments to measure outcomes of nurs- attainment (personal or role identity stage) is some-
ing interventions that support maternal role identity times substituted for maternal role attainment.
and the process of becoming a mother. Mercer and According to Mercer (1995), when the maternal role
Walker also encourage further research in dealing has been attained, the mother has achieved a maternal
with mothers who face special challenges, including identity, the internalized role of mother. However,
mothers who face childbirth complications, mothers the terms attainment and role identity are sometimes
with low social and economic resources, adolescent confusing.
mothers, and mothers with high-risk infants. Ac- Mercer has continued to work toward greater clar-
cording to Mercer and Walker, development and ity. She has proposed using terms derived from nurs-
testing of nursing interventions that support and ing researchers that would be understood more clearly
empower parents are warranted. They encourage by users of her theory. She has questioned the use of
research to determine how best to foster becoming a the term maternal role attainment, because it connotes
mother in culturally diverse groups, explaining that a static state rather than the continuously evolving role
each culture has customs and values attached to as a mother. Mercer has examined qualitative research