COLLEGE OF NURSING

MADURAI MEDICAL COLLEGE

MADURAI
ADVANCED NURSING PRACTICE
SEMINAR ON
ERIKSON, TOMLIN, MARY ANNS THEORY OF “
MODELLING AND ROLE MODELLING”,KATHRYN.E.
BARNARds “ PARENT –CHILd INTERACTION
MODEL”,RAMONA T.MERCER “MATERNAL ROLE
ATTAINMENT MODEL”

Submitted to:
Mrs. J .Alamelu mangai M.Sc.(N),MBA,(H.M)
Mrs. N. Rajalakshmi M.Sc.(N),
Nursing tutor GR II,
College of Nursing,
Madurai Medical College,
Madurai- 20 Submitted by:
Ms. S. Mahalakshmi,
M.Sc Nursing 1 st year,
College Of Nursing,
Madurai Medical College,
Madurai -20

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NAME:S.MAHALAKSHMI
PROGRAMME : M.Sc NURSING 1 YEAR
SUBJECT : ADVANCED NURSING PRACTICE
TOPIC :ERIKSON, TOMLIN, MARY ANNS THEORY
OF “ MODELLING AND ROLE MODELLING”,
KATHRYN E. BARNARds “ PARENT –CHILd
INTERACTION MODEL”, RAMONA
T.MERCER “MATERNAL ROLE
ATTAINMENT MODEL”

EVALUATOR: Mrs.J.ALAMELU MANGAI,M.Sc(N),MBA,

Mrs. N. RAJALAKSHMI M.Sc(N)
PLACE : COLLEGE OF NURSING
MADURAI MEDICAL COLLEGE
MADURAI
DATE : 28/11/2015

INDEX
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S.NO CONTENTS Pg.NO
1 Introduction
2 Objectives
3 Modelling and role modelling
a Define modelling and role modelling
b Aims of modelling and role modelling
c Self care of modelling and role modelling
d Paradigm of Modelling and role modelling
e Critique of modelling and role modelling
4 Parent child interaction model
a Evolution of parent child interaction model
b Paradigm of bernards model
c Critique of parent child interaction model
5 Maternal and role attainment model
a Evolution of maternal and role attainment model

b Concepts used by ramona mercers

C Paradigm of maternal and role attainment model
d Assertions of maternal role attainment model
e Critique of maternal and role attainment model
6 Summary

7 Conclusion

8 Bibliography

OBJECTIVES:

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 At the end of the seminar participants will be able to
 define modelling and role modelling
 list down the aims of modelling and role modelling
 explain the self care in modelling and role modelling
 describe the paradigm of modelling and role modelling
 enumerate the critique of modelling and role modelling
 explain the evolution of parent child interaction model
 enlist the paradigm of bernards model
 list down the nursing implications of bernards model
 evaluate the critique of parent child interaction model
 describe the evolution of maternal role attainment model
 list down the concepts used in maternal role attainment
model
 enlist the paradigm of maternal role attainment model
 enumerate the assertion of maternal role attainment model
 state the nursing implications of maternal role attainment
model
 explain the critique of maternal role attainment model.

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 ERIKSON, TOMLIN, MARY ANNS THEORY
OF MODELLING AND ROLE MODELLING

Helen c. erikson, evelyn m. tomlin and mary ann p. swain were

instrumental in developing the theory of “modelling and role
modelling”.then combination of talents of the three authors who
collaborates at the university of Michigan in the mid-1970s, was
advantageous for the development of nursing theory that was useful and
related to practice, education and research.all three authors have been
involved in nursing education .two are expert nursing clinicians and
remain actually involved in clinical practice and two remain active in
research.

THE THEORY OF MODELLING AND ROLE MODELLING

The theory of modelling and role modelling used
psychological,cognitive, and biological theories on the theoretical
base for the observation the theorists make regarding similarities
and differences among individuals.
 The works of Abraham maslow, helen c. erikson,militon
h.erikson, jean pigget, George engel and hans seleye are the
salient on the development of the theory.

 It is an interpersonnel and interactive theory of nursing that

requires the nurse to asses(model),plan(role model)and
intervene(five aims of intervention)on the basis of client world.the
nurse always acknowledges that uniqueness and individuality of
the client and appreciates that individuals, at some level, know
what makes them ill and which makes them well.two additional

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 concepts important in the theory are affiliated individuation and
adaptive potential.
MODELLING

Modelling is the process used by the nurse to develop and

understanding of the clients world as the client perceives at the
way and world as the client perceives at the way and
components;the way an individual thinks , communicates, feels
,believes and behaves,and the underlying motivations and rationale
for beliefs and behaviours – all these comprises the individuals
model of the world.

 Modelling is both an art and science. The art of modelling is the

empathetic development of an understanding of the present
situation with in the clients context of the world i.e. the
development of model of the situation from the clients
perspective.

 The science of modelling is the analysis of information collected

about the clients world.to truly understand the clients model of the
world , the nurse must have the strong theoretical base in the
physical and social science. the clients perspective is analysed on
the basis of knowledge and theory regarding human behavior,
development , cultural diversity, interaction, pathophysiology,
human needs and so forth.

ROLE MODELLING

 Role modelling also both an art and science. The art of role
modelling occurs when the nurse plans and implements

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 interventions that are unique for the clients. It involves the
individualization of care based on the clients model of world.

 The science of role modelling is the use of theoretical bases when

planning and implementing the nursing care.

 Role modelling is the facilitation of the individual in attaining

maintaining or promoting health through purposeful interventions
based on the individuals personal perceptions as well as the
theoretical base for the practice of nursing.

FIVE AIMS OF INTERVENTION

The aims of intervention is based on five principles:

1. The nursing process needs that a trusting and functional relationship

exist between nurse and client(BUILDING TRUST).

2. Affiliated individuation is dependent on the individuals perceiving

that he or she is an acceptable ,respectable and worthwhile human
being(PROMOTES CLIENTS POSITIVE ORIENTATION).

3. Human development is depend on the individuals perceiving that she

or he has some control over her or her life,while concurrently sensing
a state of affiliation (PROMOTES CLIENT CONTROL)

4. There is an innate drive towards holistic health that is facilitated by

constitute and synthetic nurturance(AFFIRM AND PROMOTE
CLIENTS STRENGTH).

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5. human growth is dependent on the ratification of basic needs and
facilitated by the growth need ratification.(SET MUTUAL GOALS
THAT ARE HEALTH DIRECTED)

BUILDING TRUST

 Nursing requires a trusting relationship. It involves honesty,

acceptance, respect, empathy and belief in the clients model of the
world.
 Therapeutic communication skills are essential in building trust.trust
is the basic to any interpersonal relationship and is easily threatened.

PROMOTE POSITIVE ORIENTATION

 Nursing intervention need to promote clients self worth as well as

hope for the future.
 Reforming can be used to assist clients in changing their perceptions
of a situations from one of threat to one of the challenge from one 0f
hopelessness to one of hope,and from something negative to
something positive.

PROMOTE PERCEIVED CONTROL

 Human development depends on theindividuals perceiving than they

have some control over their lives. nurses may understand that clients
have control over what happens to them and may understand that
clients are required to give informed consent for any procedure done
to them.

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 Generally patients will not perceive that they have control. The
responsibility of nurse is not enough to promote control,but also
topromote clients perception of control.

PROMOTE STRENGTHS
 Identification of strength is a means of assisting clients to mobilize
research.in the face of stressors individual may become overwhelmed
with their perceived weakness and not able to identify or use strength.

SET MUTUAL GOALS THAT ARE HEALTH DIRECTED

 Nurses must use the individuals innate drives to be as healthy as he or
she can be.
 Nurses and clients goals are the same to meet the client basic needs.
when the nurses and clients goals are appear to differ, the nurse has
not likely to fully modelled the clients world.
 Incomplete modelling can be the results of inadequate data gathering
and empathy or a lack of knowledge for the analysis and
interpretation of the data collected.

SELF CARE
THE three aspects of the self- care on the theory of modelling and role
modelling:
 Self –care knowledge
 Self- care resources
 Self-care action

SELF- CARE KNOWLEDGE:

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 self- care knowledge is one has about “what has made him or her
sick,lessened his or her growth.the person also known that will be make
him or her well,optimize his or her effectiveness or fulfillment,or
promote his or her growth.
Erikson found following four themes that relate to the
nature of self- care knowledge includes:
 An individuals perception of factors associated with his or her
personal health problems are rarely obvious to the health care
provider.
 The individuals perception of what is needed to help him or her can
best be defined by that person.
 The nurses role is to facilitate clients to articulate what they perceive
to be associated with their problem and what can be done to help
them feel better.
 Another nursing role is to assist the client to resolve the problems in
ways that meets personal needs and are health and growth directed.

SELF CARE RESOURCES

All individuals have internal and external resources(strengths and

support) that will help them gain,maintain,and promote an optimum
level of holistic health.it is important for the nurse to assess these
resources to assist the client in self – care action.

SELF CARE ACTION

Self- care action is the development and use of self -care knowledge and
self- care resources. the basis of nursing is assisting clients in self –care
actions related to health.

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 This theory focused on individual personal knowledge about what
makes him or her well or ill. all clients have self -care knowledge and
nurse facilitates the client identification and use of their knowledge.

AFFILIATED INDIVIDUATION
Individuals have an instrumental need for affiliated individuation. they
need to be able to be dependent on support system while simultaneously
maintaining independence from their support system.it occurs where a
person perceives himself or herself as simultaneously close to and
separate from significant other.

ADAPTIVE POTENTIAL
It refers to the individuals ability to mobilize resources to cope with
stressors. The adaptive potential assessment model has 3 categories.
 Equilibrium
 Arousal
 Improverishment

Equilibrium has two possibilities :

 Adaptive equilibrium
 Mal adaptive equilibrium
Arousal and impoverishment are both interstates.adaptive potentials is
dynamic, and the individuals canmove from any of the 3 states to any
other of the states.movement among the state is influenced by the
individual ability to cope.

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 The APAM identifies states of coping that can assist the nurse in
planning interventions of the client.adaptive potential has been well
documented.

ADAPTIVE POTENTIAL ASSESSMENT MODEL(APAM).

Equilibrium
stressor coping

Coping Stressor

Arousal stressor Impoverishment

Stress

PARADIGM OF THEORY
HUMAN BEINGS:

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 Human beings are holistic persons with interacting
subsystems(biophysical, psychological, social and cognitive)and
inherent genetic bases and spiritual drive.
 Body, mind ,emotion and spirit are a total unit and act together.the
intervention of the multiple subsystems,and the interest bases creates
holism.
 Holism implies that the whole is greater than the some of the grats.
 All the individuals have basic needs that motivate behavior ,including
drive called affiliated individuation.
 Although each individual is unique but they differ from one another
because of their inherited endowment , adaptation and self care.

ENVIRONMENT:
 environment is not identified in the theory as an entity of the
own.environment on both internal and external include both stressors
and resources for adopting to stressors.
 Stressors exist in life at all times and are necessary for overall growth
and life enhacement..
 All the individuals have both external and internal resources for
dealing with stressors.
 Potential resources exist and individuals may need assistance in
becoming aware of and constructively mobilizing them.

HEALTH:
 Health is a state of complete , physical, mental , and social well being
and not merely the absence of disease or infirmity.
WHO
 The author of the theory also writes that health connects a state of
dynamic equilibrium among the various subsystems.

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 This dynamic equilibrium implies on adaptive equilibrium whwre by
individuals learns to cope constructively with lif stressors by
mobilizing internal and external resources.

NURSING:
 Nursing is the holistic helping of persons with that self – care
activities in relation to health.
 Nursing is the process between the nurse and client requires an nurse
–client relationship.

 Three characteristics of nurse in this theory are:

 Facilitation
 Nurturance
 Unconditional acceptance

Facilitation :
The nurse help the individual to identify ,mobilise and
develop his or her own strength.
Nurturance :
It is the fusing and integrating of cognitive ,psychological
and affective process with the action of assisting a client towars health.
Unconditional acceptance:
It is the acceptance of each individual as unique.

DEFINITON OF NURSING BY THEORISTS:

Nursing is the holistic helping of persons with them self- care activities
in relation to their health.this is an interactive and interpersonal process

14
that nurses strength, to enable development ,release and channeling of
resources for coping with ones circumstances and environment.
Additional statements are:
 Nursing is the nurturance of self- care.
 Nursing in assisting persons holistically to use their strengths, to
attain and maintain optimum biopsycho-social-spiritual
functioning.
 Nursing in helping with self –care to gain optimum health.
 Nursing is an integrated and integrative helping of persons to take
better care for themselves.

EVALUATION OF MODELLING AND ROLE MODELLING

 There are two distinct meaning of nursing process acknowledge in the
authors of this theory.the first is the formalized, step by step problem-
solving process that includes gathering and analyzing path,planning
and implementing interventional and evaluating outcomes.

 The second is the more basic use of terms and refers an interactive
process- the exchange between nurse and patient in which the nurse
has purpose of the nurturing and supporting the clients –care.

 The theory of modelling and remodeling,emphasise the primary of the

interaction interpersonal definition.nursing involves an ongoing
exchange of information feelings, and behaviours; the nursing process
describes this exchange.

 This theory accepts the view that nursing care begins with first
encounter because the nurses immediate contribution to care include
the nurse himself ,herself. Since the theory directs the nurse to begin

15
 where the client is in modelling the clients world a comprehensive
assessment in rarely done to initiate the nursing care.

 The client will be always be asked to express his or her questions

,concerns,and needs.thus, the theory directs the priorities of care quite
simply, when using this theory the nurse provide care at the first
movement of contact,they assess while they implement ,that analyse
while evaluating.

 Theorists write”when we view the nursing process as an ongoing,

interactive , interpersonal relationship that includes use of the formal
scientific mode of thought, we can regard documentation of the
nursing process primarily as a valuable way to communicate with
others and keep records.”

 In providing care client data are gathered to model the clients

world.an evaluation of the clients sress and adaptation is essential, as
well as information on self care knowledge, resources and actions.

 Theorists of the study did not address the use of nursing diagnosis
taxonomy developed by the NANDA with modelling and
remodeling.while carrying out nursing care, the nurse must “role
model”, that is help client in attaining , maintaining,promoting
health through purposeful interventions.care is based on five aims
of interventions and is consistent with the clients adaptive
potential.

 The nurses role is to facilitate , nurture,and provide unconditional

acceptance while assisting the client to achieve health.evaluation

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 and nursing care is directed towards goals mutually determined
between patient and client.

CONCLUSION:
while carrying out nursing care, the nurse must “role model”, that is
help client in attaining , maintaining,promoting health through
purposeful interventions.care is based on five aims of interventions
and is consistent with the clients adaptive potential.The nurses role is
to facilitate , nurture,and provide unconditional acceptance while
assisting the client to achieve health.evaluation and nursing care is
directed towards goals mutually determined between patient and
client

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KATHRYN E. BARNARDS

PARENT –CHILD

INTERACTION MODEL
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INTRODUCTION
Kathryn e. barnard was born on april 6 1938,in Omaha, in 1956 she
enrolled a pre nursing programme at the university of Nebraska and
graduated with a bachelor of science in nursing in june 1960. Many
researchers findings were used as bernards work centering around the
parent child interaction .in addition to that she began her research in
1968 by studying mentally and physically handicapped children and
adults.in early 1970 s she astudied the activities of the well being and the
growth and development of child.

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 Kathryn e. barnard was born on april 6 1938,in Omaha, in 1956 she
enrolled a pre nursing programme at the university of Nebraska and
graduated with a bachelor of science in nursing in june 1960.upon,
graduation , she continued at the university Nebraska in part time
graduate studies.that summer she accepted an acting head nurse
position and in the fall become an assistant instructor in paediatric
nursing.

 After earning her master of science in nursing in 1962 and a

certificate of advanced graduate specialization in nursing education,
she accepted a position as an instructor in maternal and child health
nursing.in 1965 she was named assistant professor . shebegan
consulting in the area of mental retardation, and coordinated training
projects for nurses in child development and the care of children with
mental retardation and handicapps.after 1971 she earned ph.D in the
ecology of early child hood development from the university of
Washington.

 After that she accepted a position at the university of Washington as

aprofessor in parent-child nursing.she was appointed as aassociate
20
 dean for academic affairs at the university of Washington school of
nursing in 1987. Scince 1972 she become the principal investigator of
18 research grants.in addition to these barnard has provived
consultation presented lectures internationally.and served on multiple
advisory boards.

 She published articles in both nursing and non nursing journals scince
1966.she is the member of American nurses association,where she
has served on the executive comitte for the division of maternal and
child health nursing.she is also a active member of 10 other national
organisations,including the societybfor research in child
development.1n 1987 she was named as a nurse scientist of the year
by the council of nurse researchers of ANA .bernard credits Florence
blake for beliefs and values making up the foundation of current
nursing practice. She describes blake as agreat paediatric nurse
clinician and educator who turned our minds towards an orientation
on the patient rather than procedure.she amplified for nursing
important such as mother infant attachment,maternal care,and
separation of child from parents.many of Dr. Bernard publication
were co authorized bywriters such as d.king and a.w.pattulo .bernard
published a book entitled teacing a mentally retarded child:a family
care approach. Bernard et al states that theywerw influenced by child
development theorists such as j.piaget ,j.s. brunner,l. sander,and t.b.
brazelton, in adittion tonursing thoerists.

EVOLUTION OF THEORY

 Many researchers findings were used as bernards work centering

around the parent child interaction .in addition to that she began her
research in 1968 by studying mentally and physically handicapped

21
 children and adults.in early 1970 s she astudied the activities of the
well being and the growth and development of child.

 She also did the projects on examine the effects of stimulation on

sllep states in premature infants.today, Bernard continues to study the
mother infant relationship to examine the nurses role in relation to
high risk mother s and high risk infants.

 The national child assessment project formed the basis for this.using
various assessment scales and interviewing tools, the child and his
/her parenteral relationship werw assessed at six stages.

 Prenatally
 Postnatally
 At 1 month 4 month and 8 months and in 1
year.

 Researchers have used the national child assessment satellite training

intruments for diverse research purposes.the NCAST instruments
were used as an outcome measure to evaluate differences between
mothers and high risk infants who participated in a monitoring
programme and those who did not.it is useful for dysfunctional
interaction between high risk infants and mothers.

 Seidem et all conducted a research study using the NCAST

instruments to assisting in identifying the issues and questions related
toassessing urban American indian parenting and the whole of care
taker experience.

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CONCEPTS USED BY BARNARD
A major focus of barnards work was the development of assessment
tools to evakuate child health,growth,and development while viewing
the parent and child as an interactive system.she defines modification as
a adaptive behavior. The interaction between the parent and child is

Care giver- parent characteristics Infant characteristics

Sensitivity to cues Clarity of cues

Alleviation of distress Responsiveness to care giver

Providing growth fostering situations

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BERNARDS defined the terms in the diagram as follows:
Infants clarity of cues:
To participate in a synchronous relationship, the infant must
send cues to his /her care giver.infant send cues of many
kinds:sleepiness,fussiness,alertness,hunger,and satiation and changes in
body activity,to name a few.ambigious or confusing cues sent by an
infant can interrupt a care giver adaptive abilities.
Infants responsiveness to the care givers:
Just as infant must send cues so that the parent can modify
his/her behavior,the infant must also read cues so that he/she can modify
his/her behavior in return.
Parents sensitivity to the child cues:
Parents,like infants,must be able to accurately read the cues given
by the infant if they are to appropriately modify their behavior.
Parents ability to alleviate the infants distress:
The effectiveness of parents in alleviating the distress of their infants
depends upon several factors.first they must recognize that distress is
occurring.second they must know the appropriate action which will
alleviate distress.finally they must be available to put this knowledge to
work.
Parents social and emotional growth fostering activities:

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 It depends upon the global parent adaptation.to do this things
parents must be aware of the childs level of development and must be
able to adjust his or her behavior accordingly.this depends upon the
parents available energy as on his or her knowledge and skill.

Parents cognitive growth fostering activities:

The parents must have a good grasp of the childs present level of
understanding and the parent also have the energy available to use their
skills.
PARADIGM OF BERNARDS MODEL
NURSING:
Except for nursing ,barnard does not define her major
assumptions.in 1966 she defined nursing as a process by which the
patient is assisted in maintenance and promotion of his
independence.this process may be educational, therapeutic,or
restorative:it involves facilitation of change ,must probably a change in
environment.
PERSON:
When the bernards describes a person or human being,she speaks
of the ability to take in auditory, visual, and tactile stimuli but also to
make meaningful associations from what he takes in.the term includes
infants,children,and adults.
HEALTH:
Barnard does not define health, she describes a family “ as a basic
unit of health care”.the ultimate goal is primary prevention.
ENVIRONMENT:

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 It is the essential aspect of her theory.it includes all experiences
encountered by the child: people, objects,places,sounds,visual,and tactile
sensations.the inanimate environment refers to the objects available to
the child for exploration and manipulation.the animate environment
includes the activities of caretaker used in arousing and directing the
young child to the external world.

ASSERTIONS OF BARNARD
The 10 theoretical assertions are:
 The ultimate goals is to identify problems at a point before they
develop and when.

 The environmental factors are the important for determining child

health outcomes
 The care giver infant ineraction provides information that reflects the
nature of childs ongoing environment.

 The care giver brings a basic style and level of skills that are enduring
characteristics.

 In the adaptive parent child interaction , there is a process of mutual

modification.

 The adaptive process is more modifiable than the mothers or infants

basic characteristics

 An important quality of promoting childs learning is in permitting

child initiated behaviours and in reinforcing the childs attempts at
task.
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 A major issue for th nursing profession is support of the childs care
giver during the 1 st year of life.

 Interctive assessment is important in any comprehensive child health

care model.

 Assessment of the childs environment is important in any child health

assessment model.

CHILD HEALTH ASSESSMENT INTERACTION MODEL

27
It was illustrated to develop barnards theory. The smallest circle
represents the child his or her important characteristics.the next largest
circle represents the mother or care giver and his or her important
characteristics.the largest circle represents the environment of both the
child and mother.those proportions of the model where two circles
overlap represent interaction between the two concepts.
The dark center area represents interaction among all three
concepts.barnards theory focusses on this crucial child environment
interactive process.

NURSING IMPLICATIONS:
PRACTICE
The nursing satellite training project prepared about
4,000 nurses to use a series of standard assessment instruments.now, the
nurses uses the assessment tools and their skills throughout the nations
and in foreign countries.

EDUCATION
The nursing satellite training project initially used
satellite communications and later videotaped classes to teach nurses
how to use a series of standard assessment instruments.

RESEARCH

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One of the outcomes of the contract to accurate assessment tools was a
creation of a research project.the purpose of satellite training programme
was to quickly disseminate current research findings.
The greatest deficit of barnard theory is lack of clarity.although the
identification of major concepts is implied through the nursing child
health interaction assessment interaction model.barnards fail to clearly
define these concepts.this is an area requiring further development.
In the child health assessment interaction theory ,the mother is identified
as a major concept,and father is included in the description of
environment.in these instances barnards theory needs modification.

EVALUATION OF THEORY
 Clarity in general refers to the lucidness and consistency of
theory.an extremely important aspects of sematic clarity is that of
definition of concepts.barnard does not identify or define her
theoretical concepts.

 The child health assessment interaction model is simple way of

communicating the main focus of barnards work as it relates to the
parent child interaction and the development of accurate
assessment tools.

 Barnards work with the interactive focus between parent and child
is not genaralisable to nursing

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  Much research is included in barnards original work.

 More than 4000 nurse s have trained to use the standardized

assessment scales with 85% interrater reliability. Nurses across the
nation and in other countries utilize the observational skills in daily
practice.

CONCLUSION
Barnard emphasizes the need for strong links between nursing
research,theory,and practice.” There has been no more exciting time in
nursing than the clinical,research,scholarship,administrative,and
educational expertise so carefully developed over past years.”” In
discussing research,she states “ we simply must attempt to be in closer
alignment with practice from the beginning.”in the nursing child health
assessment satellite training project ,she identifies goal as the
dissemination of research findings and the application of these findings
to practice .the goal is a prime example of barnards effort to link
research, theory and practice.

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RAMONA T.MERCER

31
MATERNAL ROLE

ATTAINMENT MODEL

Introduction :
Ramona t.mercer began her nursing career in 1950, when she was
graduated from st.margaret school of nursing, montogomery
Alabama.Mercer received her ph.D. from the university of Pittsburgh
.Early in mercers research,she drew from mead’s interactionist theory of
self.As her developed research into attainment of the maternal role, she
also combined the work of werner and erikson with burr and associates
theory to develop a theoretical frameworkof role theory from an
interactionist approach.

32
 Ramona t.mercer began her nursing career in 1950, when she was
graduated from st.margaret school of nursing, montogomery
Alabama. She was graduated with the LL hill award for highest
scholastic standing. In the 10 years that followed, she worked as a
nurse,head nurse and instructor in the areas of
pediatrics,obstetrics,and contagious disease before returning to the
school in 1960.
 She completed a bachelor of science degree in nursing in
1962,graduating with distinction,from the university of new mexico,
Albuquerque. She went on to earn an msn in maternal child health
nursing from emory university in 1964 and PhD in maternity nursing
from the university of Pittsburgh in 1973.
 In 1974 she was awarded yhe HEW public health nurse traine award
and was inducted into sigma theta tau. From 1964 to 1971, she was an
33
 assistant professor of Maternal child health nursing to emory
university.
 Mercer moved to California in 1973 and accepted the position of
assistant professor, Department of family health care nursing at the
university of California,san Francisco.
 Mercer focused on the behaviors and needs of breastfeeding mothers,
mothers with postpartum illness,and mothers bearing infants with
defects.
 In 1986, mercers work on mothers at various ages was drawn together
in first time motherhood experinces from teens to forties.
 Others honors with awards she has received include maternal child
health nurse of the year award by the national foundation march of
dimes and American nurses association, division of maternal child
health practice in 1982.
 In 1988 the distinguished research lectureship award western institute
of nursing in 1990 the American nurse foundation distinguished
contribution to nursing science award.

EVOLUTION OF THEORY
 Mercer received her ph.D. from the university of Pittsburgh
 Early in mercers research,she drew from mead’s interactionist theory
of self.
 As her developed research into attainment of the maternal role, she
also combined the work of werner and erikson with burr and
associates theory to develop a theoretical frameworkof role theory
from an interactionist approach.
 Mercer used many measurement tools to test the variables under
investigation in her maternal role research.

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  To measure early postpartum and the first month attachment, she used
E.R.Broussard and Hartner’s prediction of neonatal outcomes and
perceptionwork.
 Gratification of the maternal role was measured by an adaptation of
russell’s[1974]gratification checklist.
 Maternal behavior was measured by disbrow and associates
(1977,1982). Ways parents handle irritating behavior scale was
originally used for discriminating between abusive and nonabusive
parents.
 Maternal behavior in mercers studies as observerd by the raters was
measured by an adaptation from Blank’s (1974)scale.
 To measure social stress, mercer used the life experience survey
constructed by sarason, Johnson, and siegel(1978).
 To measure maternal rigity,she used a 15-item scale constructed by
Larsen(1966). Maternal temperament was measured by using
Thomas.mittelelman,and chess’s(1982).
 Mercers theory is based on the evidence of her research spanning 25
yrs.many other researchers findings were also used in the formulation
of the maternal role attainment theory.
 The focus of mercers work went beyond the traditional mother to
encompass adolescents ,mothers ,ill mothers, mother with defective
children, families experiencing antepartal stress,parents at high
risk,and mothers who had cesarean deliveries.

CONCEPTS USED BY MERCER

 Mercers bases her theory for maternal role attainment on the following
factors:
Maternal role attainment:
An interactional and development process occurring over a period of
time,during which the mother becomes attached to her infant.

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 The movememt to the personal state in which the mother experinces a
sence of harmony,confidence and competence in how she performs the
role is the end point of maternal role attainment maternal identity.
Maternal age:
Choronological and developmental.
Perception of birth experience:
A woman’s perception of her performance during labor and birth.
Early maternal infant separation:
Separation from the mother after birth due to illness and or
prematurity.
Self esteem:
An individuals perception of how others view one and self acceptance of
the perception.
Self concept:
The overall perception of self that includes self satisfaction self
acceptanceself esteem and congrugence or discrepancy between self and
ideal itself.
Flexibility:
Roles are not rigity fixed therefore who fills the roles is not impotant.
Childrearing attitudes:
Maternal attitudes or beliefs about childrearing.
Health status:
The mother’s and father’s perception of their prior health,current health,
health outlook, resistance susceptibility to illness, health worry concern
sickness orientation and rejection of the sick role.

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Anxiety:
A trait in which is specific pronences to perceive stressful situations as
dangerous or threatening, and as situation specific state.
Depression:
Having a group of depressive symptoms and in particular the affective
component of the depressed mood.
Role strain:
The conflict and difficulty felt by the women 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
mothering.

Attachment:
Attachment 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 mother.
Infant health status causing maternal:
Infant separation interfering with the attachment process.
Family:
A dynamic system which includes subsystems individuals
(mother,father,fetus/infant) within the overall family system.
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Family functioning:
The individual’s view of the activites and relationship between the
family and its subsystems and broader social units.
Stress:
Positively and negatively perceived life events and environmental
variables.
Social support:
The amount of help actually received satisfaction with that help and
received satisfaction with that help and persons providing that help.
Four areas of social support are the following:
Emotional support:
Feeling loved, cared for,trusted,and understood.
Informational support:
Helps the individual help herself by providing information that is
useful in dealing with the problem and or situation.

Physical support;
A direct kind of help.
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 role.

ASSUMPTIONS

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1. A relatively stable core self acquired through life long socialization
/deyermines how a mother defines and perceives events.
2. In addition to the mothers socialization , her developmental level and
innate characteristics also influence her behavioural responses.
3. The mothers role partner,her infant ,will reflect the mothers
competence in the mothering role via growth and development.
4. The infant is considered an active partner in the maternal role taking
process,affecting and being affected by the role enhacement.
5. Maternal identity develops along with the maternal attachment and
each depends on the other.

PARADIGMS OF MERCERS THEORY

NURSING:
Mercers does not define nursing but refers to nursing as a science
emerging from a turbulent adolescence to adulthood.nurses are the
health professionals having the most sustained and intense
interaction with womwn in the maternity cycle.nurses are
responsible for “ promoting the health” of families and
children;nurses are pioneers in developing and sharing assessment
strategies for those clients.
Obstetrical nursing,according to mercer, is the diagnosis and
treatment of womens and mens responses to actual or potential
health problems during pregnancy,child birth,and the post psrtum
period.

PERSON
Mercer does not specifically define person but refers to the self or
core self.through maternal individuation a women mwy regain her
own person hood as she extrapolates her self from the mother
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 infant dyad.the core self evolves from a culture context and
determines how situstions are defined and shaped.

HEALTH
In her theory she defines health statys as the mothers and fathers
perception of their prior health,current health,helath
outlook,resistence-susceptibility to illness,health worry
concern,sickness orientation ,and rejection of the sick role.health
status is an important indirect influence on satisfaction with
relationships in child bearing families.

ENVIRONMENT
Mercer does not define environment. She does however,address
the individuals culture,mate,family and or support network, and
size of that network it relates to maternal role attainment.

ASSERTIONS OF MODEL /THEORY:

Mercers model of maternal role attainment is placed within
bronfenbrenners nested circles of the macro system, microsyatem, and
exosystem.

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Microsystem :
The immediate environment in which the maternal role attainment
occurs is the microsystem,which includes the family,and factors such as
family functioning ,mother father relationship,social support and stress.
The variables contained with in the microsystem interact with one or
more of the other variablesin affecting maternal role.the infant as an
individual is embedded with in the family system.the family is viewed as
a semiclosed system maintaining boundaries and control over
interchange between the family system and other social systems.
Exosystem:

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 It encompasses, influences and delimits the microsystem.the mother
infant unit is not contained with in the exosystem,but the exosystem may
determine in part wht happens to developing maternal role and child.
Macrosystem :
It refers to the general prototypes existing in a particular culture or
transmitted cultural consistencies.
Maternal role attainment is a process that follows four stages of role
acquisition.
 Anticipatory
 Formal
 Informal
 Person

NURSING IMPLICATIONS:
PRACTICE
When considering practice using mercers frame work, a clinical
practice was set up using part of the concepts in the research conducted
by neeson,Patterson,mercer,and may receiving prenatal care by nurses
practitioners in extended roles.
The concepts theorized by mercer have been used by nursing in
multiple obstetrical textbooks.she often cited as taking the work by rubin
and expanding its use.her theory is extremely practice oriented.

EDUCATION

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 As previously stated,mercers work has appeared extensively in
nursing texts,not just as it relates to maternal role attainment,rather,each
individual piece of research is used and valued.
RESEARCH
Mercer has tested factors that she theorized and or hypothesized have
a impact on maternal attainment.she has reviewed the maternal
attainment.she has reviewed the literature extensively and formulated
questions and models that guide future research.

EVALUATION OF THEORY
CLARITY
 The concepts variables and relationships are not explicitly defined
but rather than described and implied.they are however theoretically
defined and operationalized .the operational and theoretical
definitions are consistent.additionally, maternal role attainment is not
consistently defined and thus obstructs clarity.

SIMPLICITY
 Inspite of numerous concepts and relationships,the theoretical
framework for maternal role attainment organizes a rather complex
phenomena into an easily understood and useful form.

GENERALITY
Maternal role attainment is a theory specific to parent child nursing.the
theory can be generalized to all women during pregnancy through the
first year after birth regardless of age ,parity,or environment.
EMPIRICAL PRECISION

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The concepts ,assumptions, and relationship are grounded
predominantly in empirical observations and are congruent.

DERIVABLE CONSEQUENCES
The theoretical framework for maternal role attainment in the first year
has proven to be useful,practical,and valuable to nursing.mercers work is
repeatedly utilized in research ,practice, and education.

SUMMARY:
So far we have discussed about the erikson, tomlin, mary anns theory of
“ modelling and role modelling”, kathryn e. barnards “ child interaction
model”, ramona t.mercer “maternal role attainment model”.its evolution,
nursing implications , paradigm and critique of the model .i hope that
you will understand the above models.

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 CONCLUSION:
Mercer has consistently linked research to practice.implications
for nursing and or nursing interventions are addressed and to provide the
bond between research and practice in most of her works.she believes
that nursing research is the “bridge to excellence” in nursing practice.

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BIBLIOGRAPHY:
BOOK REFERENCE
 BT Basavanthappa, Ist edt (2007),“Text book of nursing theories”
Jaypee brother publication, New delhi,pg no 179-185, 327-336, 375-
383.
 BT Basavanthappa 6th edt “Text book of fundamentals of
nursing”jaypee publication pg.no 545-561.
 Shabeer.R.Basheer ,S.Yaseen Khan “A Text book of advanced
nursing practice”(2013) 1st edition ,Emmess Medical
Publishers,Bangalore.pg.no 344-363.
 Samta soni,”Text book of advanced nursing practice”1 st edition
(2013),jaypee publication pg.no 343-350
 Suresh k sharma”text book of nursing research and statistics”4 th
edition 2013elsevier publication pg.no 56-60.

JOURNAL REFERENCE

 Journal of nursing “Current trends in nursing theories”may 2012.

 Journal of nursing times “nursing models and contemporary
nursing” march 2013

NET REFERENCE

 www.wikipedia,the free encyclopedia:maternal and role attainment

model.
 www.wikipedia ,the free encyclopedia:parent child interaction model.

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 www.wikipedia, the free encyclopedia:modelling and remodeling
theory.
 www.slide share.com

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