Maternal Role Attainment in Mothers with Term Neonate: A Hybrid Concept Analysis

Forough Rafii, Mona Alinejad‑Naeini, Hamid Peyrovi


Background: A review of the literature shows that there is little consensus on the practical definition  of maternal role attainment in the field of neonatal nursing care. The initial interaction between  mother and neonate most often begins in the hospital and can be influenced by neonatal nurses, so  it is necessary to clarify this concept in nursing. The purpose of this study was to show the basic  characteristics and practical definition of maternal role attainment in mothers with term neonate in a  new context.

Materials and Methods: This study used a hybrid model three‑step concept analysis:  theoretical, fieldwork, and final analysis phases. At theoretical phase, articles indexed in credential  databases were searched using keywords. Totally, 33 articles were analyzed. At fieldwork phase,  12 participants were interviewed. At final phase, the findings of the two earlier phases were analyzed.  The study lasted from August to November 2018. After determining the attributes, antecedents, and  consequences, a final definition of maternal role attainment was introduced.

Results: The concept  of maternal role attainment was defined as “a developmentally, interactive, adaptive, and committed  multi‑dimensional process based on the discovery of pregnancy, characteristics of the mother,  receiving social support, which leads to maternal identity, formation of maternal skills, resiliency,  development of newborn, improvement of mother‑newborn interactions and increased well‑being of  the mother”.

Conclusions: This study identifies the concept of maternal role attainment in nursing,  providng a good basis for evaluating and applying this concept. 


Concept formation, infant, maternal behavior, mothers, neonatal nursing


Mercer RT. Becoming a mother versus maternal role attainment. J Nurs Scholarsh 2004;36:226‑32.

Nakamura Y, Takeishi Y, Ito N, Ito M, Atogami F, Yoshizawa T. Comfort with motherhood in late pregnancy facilitates maternal role attainment in early postpartum. Tohoku J Exp Med 2015;235:53‑9.

Olza I, Leahy‑Warren P, Benyamini Y, Kazmierczak M, Karlsdottir SI, Spyridou A, et al. Women’s psychological experiences of physiological childbirth: A meta‑synthesis. BMJ Open 2018;8:e020347.

Fouquier KF. State of the science: Does the theory of maternal role attainment apply to African American motherhood? J Midwifery Womens Health 2013;58:203‑10.

Alligood MR. Nursing Theory‑E‑Book: Utilization & Application: Elsevier Health Sciences; 2013.

Sanders MR, Woolley M. The relationship between maternal self-efficacy and parenting practices: Implications for parent training. Child Care Health Dev 2005;31:65‑73.

Kinsey CB, Hupcey JE. State of the science of maternal– infant bonding: A principle‑based concept analysis. Midwifery 2013;29:1314‑20.

Nicholson JM, Berthelsen D, Abad V, Williams K, Bradley J. Impact of music therapy to promote positive parenting and child development. J Health Psychol 2008;13:226‑38.

Kordi M, Fasanghari M, Asgharipour N, Esmaily H. The effect of maternal role training program on role attainment and maternal role satisfaction in nulliparous women with unplanned pregnancy. J Educ Health Promot 2017;6:61.

Abbasi‑Shavazi MJ, Inhorn MC, Razeghi‑Nasrabad HB, Toloo G. The “Iranian ART Revolution” infertility, assisted reproductive technology, and third‑party donation in the Islamic Republic of Iran. J Middle East Women’s Stud 2008;4:1‑28.

Ahmadifaraz M, Abedi H. The experiences of employed women related to their maternal role: A phenomenological qualitative research. J Qual Res Health Sci 2014;3:137‑48.

Schwartz‑Barcott D, Kim HS. An expansion and elaboration of hybrid model of concept development. In: Rodgers BL, Knafl KA, editors. Concept Development in Nursing: Foundation, Techniques, and Application. 2nd ed. Philadelphia: W.B. Saunders; 2000. p. 129‑59.

Schwartz-Barcott D, Patterson BJ, Lusardi P, Farmer BC. From practice to theory: Tightening the link via three fieldwork strategies. J Adv Nurs 2002;39:281‑9.

Rafii F, Soleimani M, Seyed‑Fatemi N. Concept analysis of participation of patient with chronic disease: Use of hybrid model. Iran J Nurs 2010;23:35‑48.

Graneheim UH, Lundman B. Qualitative content analysis in nursing research: Concepts, procedures and measures to achieve trustworthiness. Nurse Educ Today 2004;24:105‑12.

Elo S, Kyngäs H. The qualitative content analysis process. J Adv Nurs 2008;62:107‑15.

[Internet]. OED. Available from: http://www.oxforddictionaries. com/us/definition/american_english/maternalroleattainment. [Last cited on 2018 Feb 09].

Fouquier KF. The concept of motherhood among three generations of African American women. JNurs Scholarsh 2011;43:145‑53.

Fowles ER. Relationships among prenatal maternal attachment, presence of postnatal depressive symptoms, and maternal role attainment. J Spec Pediatr Nurs 1996;1:75‑82.

Bibring GL, Dwyer TF, Huntington DS, Valenstein AF. A study of the psychological processes in pregnancy and of the earliest mother‑child relationship: I. Some propositions and comments. Psychoanalytic Stud Child 1961;16:9‑24.

Miller T. Making sense of motherhood: A narrative approach: Cambridge University Press; 2005.

Reid T. Maternal identity in preterm birth. J Child Health Care 2000;4:23‑9.

Liu CC, Chen YC, Yeh YP, Hsieh YS. Effects of maternal confidence and competence on maternal parenting stress in newborn care. J Adv Nurs 2012;68:908‑18.

Kagawa RM, Deardorff J, Dominguez Esponda R, Craig D, Fernald LC. The experience of adolescent motherhood: An exploratory mixed methods study. J Adv Nurs 2017;73:2566‑76.

Khandan S, Riazi H, Amir Ali Akbari S, Nasiri M, Montazeri A. Adaptation to maternal role and infant development: Across ectional study. J Reprod Infant Psychol 2018;36:289‑301.

Koniak-Griffin D. Maternal role attainment. Image: J Nurs Scholarsh 1993;25:257‑62.

Lee SN, Long A, Boore J. Taiwanese women’s experiences of becoming a mother to a very‑low‑birth‑weight preterm infant: A grounded theory study. Int J Nurs Stud 2009;46:326‑36.

Spinelli M, Frigerio A, Montali L, Fasolo M, Spada MS, Mangili G. ‘I still have difficulties feeling like a mother’: The transition to motherhood of preterm infants mothers. Psychol Health 2016;31:184‑204.

Kim A, Tak Y, Park H, Lee H. Psychosocial determinants of maternal role development in mothers of the premature infants, among Korean married women: The roles of attachment, identity, and marital Intimacy. J Pediatr Mother Care 2018;2:118‑24.

Iwata H, Mori E, Maekawa T, Maehara K, Sakajo A, Ozawa H, et al. Developing the Maternity Portfolio to promote maternal role attainment in women who have undergone artificial reproductive treatment. Japan J Nurs Sci 2012;9:122‑6.

Schachman KA, Lee RK, Lederma RP. Baby boot camp: Facilitating maternal role adaptation among military wives. Nurs Res 2004;53:107‑15.

Heydarpour S, Keshavarz Z, Bakhtiari M. Factors affecting adaptation to the role of motherhood in mothers of preterm infants admitted to the neonatal intensive care unit: A qualitative study. J Adv Nurs 2017;73:138‑48.

Mushta J, L. Rush K, Andersen E, editors. Failure to rescue as a nurse-sensitive indicator. Nursing forum: Wiley Online Library; 2018.

Holditch-Davis D, Miles MS, Burchinal MR, Goldman BD. Maternal role attainment with medically fragile infants: Part 2. Relationship to the quality of parenting. Res Nurs Health 2011;34:35‑48.

Özkan H, Polat S. Maternal identity development education on maternity role attainment and my baby perception of primiparas. Asian Nurs Res 2011;5:108‑17.

Black BP, Holditch-Davis D, Miles MS. Life course theory as a framework to examine becoming a mother of a medically fragile preterm infant. Res Nurs Health 2009;32:38‑49.

Tarkka MT. Predictors of maternal competence by first-time mothers when the child is 8 months old. J Adv Nurs 2003;41:233‑40.

Isaacs KB. A Grounded Theory Model of Mother Role Development While in the Neonatal Intensive Care Unit [dissertation]. [Lexington]: University of Kentucky UKnowledge: 2013. 123p.

Ngai FW, Chan SW, Ip WY. Predictors and correlates of maternal role competence and satisfaction. Nurs Res 2010;59:185‑93.

Flacking R, Ewald U, Nyqvist KH, Starrin B. Trustful bonds: Akey to “becoming a mother” and to reciprocal breastfeeding. Stories of mothers of very preterm infants at a neonatal unit. Soc Sci Med 2006;62:70‑80.

Javadifar N, Majlesi F, Nikbakht A, Nedjat S, Montazeri A. Journey to motherhood in the first year after child birth. J Family Reprod Health 2016;10:146‑53.

Parratt JA, Fahy KM. A feminist critique of foundational nursing research and theory on transition to motherhood. Midwifery 2011;27:445‑51.

Jirapaet V. Factors affecting maternal role attainment among low‑income, Thai, HIV‑positive mothers. J Transcult Nurs 2001;12:25‑33.

Fowles ER, Horowitz JA. Clinical assessment of mothering during infancy. J Obstet Gynecol Neonatal Nurs 2006;35:662‑70.

Rossman B, Greene MM, Meier PP. The role of peer support in the development of maternal identity for “NICU moms”. J Obstet Gynecol Neonatal Nurs 2015;44:3‑16.

Boyer K, Spinney J. Motherhood, mobility and materiality: Material entanglements, journey-making and the process of ‘becoming mother’. Environment and Planning D: Soc Space 2016;34:1113‑31.

Osofsky JD, Thompson MD. Adaptive and maladaptive parenting: Perspectives on risk and protective factors. Handbook of early childhood intervention. 2000;2:54‑75.

Bassey Etowa J. Becoming a mother: The meaning of childbirth for African–Canadian women. Contemp Nurse 2012;41:28‑40.

Rubin R. Maternal identity and the maternal experience. Am J Nurs 1984;84:1480.

Koniak-Griffin D, Logsdon MC, Hines-Martin V, Turner CC. Contemporary mothering in a diverse society. J Obstet Gynecol Neonatal Nurs 2006;35:671‑8.

Zraly M, Rubin SE, Mukamana D. Motherhood and resilience among rwandan genocide-rape survivors. Ethos 2013;41:411‑39.

Sexton MB, Hamilton L, McGinnis EW, Rosenblum KL, Muzik M. The roles of resilience and childhood trauma history: Main and moderating effects on postpartum maternal mental health and functioning. J Affect Disord 2015;174:562‑8.


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