SeminarOnTheori

es,
ModelsAnd
Appr
oachesRelat
ed
ToMidwifer
yPract
ice

SUBMI
TTEDTO: SUBMI
TTEDBY:

Pr
of.Dr
.Manj
ubal
aDash Ms.Madhubal
a

Dept
.ofOBG I
stYearM.
ScNur
sing

Dept
.OfOBG

THEORI
ESMODELSAPPROACHESRELATEDTOMI
DWI
FERY
PRACTI
CE
1.
REVARUBI
N:ATTAI
NMENTOFTHEMATERNALROLE

Rubi
nisanur
se-
midwi
fewhoser
esear
chandt
heor
ydev
elopmenthashada
wi
dei
nfl
uenceont
hecar
eofchi
l
dbear
ingwomenandr
esear
chandt
heor
izi
ng
aboutt
hatcar
e.

Rol
esar
eacqui
redt
hroughapr
ocessofl
ear
ningwhi
chi
sachi
evedt
hrougha
ser
iesofact
ivi
ti
es.

Rubi
n’sAI
M:

I
dent
if
yinghow woment
akeont
her
oleofmot
her(
mat
ernalr
ole)andt
hus(
by
i
mpl
i
cat
ion)whati
nter
vent
ionsoract
ionsmi
ghtassi
storhav
eanegat
iveef
fecton
t
hispr
ocess.

Rubi
n’
sresear
chandwr
it
ingcov
ersaper
iodofmor
ethanaquar
terofcent
ury
,
dur
ingwhi
chhert
ermi
nol
ogychanged.Thef
oll
owi
ngdescr
ipt
ionoft
hef
ourt
asks
ofpr
egnancyi
stakenf
rom Rubi
n(1984)
:

Theobj
ect
ivesoft
hewoman’
sef
for
tsdur
ingpr
egnancyar
e:

a)Toensur
esaf
epassaget
oher
sel
fandt
hebabydur
ingpr
egnancyandchi
l
dbi
rt
h,

b)Toensur
esoci
alaccept
ancef
orher
sel
fandherchi
l
d,

c)Toi
ncr
easet
heaf
fi
nial
tiesi
ntheconst
ruct
ionoft
hei
mageandi
dent
it
yoft
he“
I”
and“
you”and,

d)Toexpl
orei
ndept
hthemeani
ngoft
het
ransi
ti
veactofgi
vi
ng/
recei
vi
ng.

Theset
asksorgoal
sofact
ivi
tydur
ingpr
egnancyandt
hepueper
ium ar
edescr
ibed
mor
esucci
nct
lybyJost
en(
1981)as:

1.Ensur
ingphy
sical
wel
l
bei
ngofher
sel
fandt
hebaby
:
 2.Soci
alaccept
anceofher
sel
fandherchi
l
dbypeopl
ewhoar
esi
gni
fi
cant
t
othem bot
h:

3.At
tachmentt
othebaby

4.Under
standi
ngoft
hecompl
exi
ti
esofmot
her
ing.

Fr
om t
hedat
aRubi
nident
if
iedt
hreeaspect
soft
hemat
ernal
rol
eident
it
y:

 Thei
deal
image

 Thesel
fimage

 Thebodyi
mage

TheI
dealI
magecompr
isesofal
lthei
deast
hatt
hewomanhadaboutt
heposi
ti
ve
at
tri
but
esandact
ivi
ti
esofwomenwhoar
emot
her
s.

The Sel
fImage compr
ises t
he at
tri
but
es t
hatt
he woman saw her
sel
fas
possessi
ngf
rom herexper
ience:sel
fimagewasusedast
her
epr
esent
ati
onoft
he
consi
stent“
mysel
f”
.

TheBodyI
magei
srel
atedt
ochangesi
nthebodydur
ingpr
egnancyandt
he
si
gni
fi
canceoft
hosechangesi
nter
msoft
hepr
ogr
essoft
hepr
egnancy
.

Themat
ernali
dent
it
yisachi
evedbyapr
ocessoft
aki
ng-
inact
ivi
ti
es,t
aki
ng-
on
act
ivi
ti
esandl
ett
ing-
goact
ivi
ti
es.I
n1967Rubi
ndescr
ibedf
iveoper
ati
onsormeans
bywhi
cht
hemat
ernal
ident
it
yisi
ncor
por
atedi
ntot
hewoman’
simageofher
sel
f.

Taki
ng-
onact
ivi
ti
es:mi
micr
yandr
olepl
ay

Taki
ng-
inact
ivi
ti
es:f
ant
asyandi
ntr
oject
ion-
proj
ect
ion-
rej
ect
ion

Let
ti
ng-
goact
ivi
ti
es:gr
ief
-wor
k

By1984 mi
micr
yand r
ole pl
ayar
e def
ined t
oget
herasr
epl
i
cat
ion;f
ant
asy
r
emai
nsasasepar
ateoper
ati
on,buti
ncor
por
atesgr
ief
-wor
k;andi
ntr
oject
ions-
pr
oject
ion-
rej
ect
ionbecomesdedi
ff
erent
iat
ion.

MI
MICRY:

I
ti
nvol
vest
her
epl
i
cat
ionofact
ionsandbehav
iour
scar
ri
edoutbyr
ole-
model
s(f
or
exampl
es,
otherwomenwhoar
eorhav
ebeenpr
egnant
)andl
ear
ningf
rom av
ari
ety
ofsour
cesaboutev
ent
sint
hef
utur
e:whatt
hedel
i
ver
ywi
l
lbel
i
ke,how t
hebaby
wi
l
lbei
nthef
ir
stf
ewday
s:

Theenv
ironmenti
ssear
chedf
ormodel
s.suddenl
ythewor
ldseemsf
il
ledwi
th
womenwhoar
eorhav
ebeeni
nsomesi
tuat
ionofchi
l
dbear
ing,af
act
ornotso
muchorser
endi
pit
yasofsel
ect
ivesear
chi
ng.Newspaperi
tems,
magazi
near
ti
cles,
books,
tel
evi
sionpr
ogr
ammes,
thegr
ocer
yandshoppi
ngmal
l
,thewai
ti
ngr
oom and
cof
feeshopneart
hedoct
or’
sof
fi
ce,
aswel
lasr
emi
niscentanecdot
esi
nfami
l
yand
soci
algr
oup gat
her
ingsaddt
othesamepopul
ati
on.Bot
hthef
avour
abl
eand
unf
avour
abl
e exper
iences become si
tuat
ion-
speci
fi
c model
sfor adopt
ion,i
f
f
avour
abl
e,f
orav
oidancei
funf
avour
abl
e.

ROLEPLAY:

Womenactoutr
olest
hatt
heywi
l
lbeunder
taki
ngi
nthef
utur
e.Forexampl
e,t
hey
baby
sitf
orf
ri
end’
schi
l
dren.Under
takef
eedi
ngorchi
l
dcar
eact
ivi
ti
es.Thi
srol
epl
ay
maybesomet
hingt
hatact
ual
l
ytakespl
aceorsomet
hingt
hatt
akespl
acei
nthe
i
magi
nat
ion.

REPLI
CATI
ON(
taki
ng-
onact
ivi
ti
es)
:

Assi
stst
hewoman,
accor
dingt
othemodelpr
oposedbyRubi
n,t
ounder
standhow
someonewho i
spr
egnant
,oranew mot
her
,behav
es.Fant
asyand t
heot
her
oper
ati
onsoft
het
aki
ng-
inphaseenabl
ethewomant
odev
elopanunder
standi
ngof
howshewi
l
lbehav
e.

Fant
asy
:Thewomani
magi
nest
hef
utur
eforher
sel
f.Forexampl
e,whatt
hebi
rt
h
wi
l
lbel
i
ke,
whatt
hebabywi
l
lwearandt
hef
utur
erel
ati
onshi
pswi
thot
hermember
s
oft
hef
ami
l
y.

GRI
EF-
WORK:Thewomanr
evi
ewsherpastr
olesandr
eli
nqui
shest
hoser
oles
whi
char
enol
ongerappr
opr
iat
eorpossi
ble;
let
ti
ng-
got
akespl
ace:

Gr
ief
-wor
kisar
evi
ew,
inmemor
y,oft
heat
tachment
sandassoci
atedev
ent
sofa
f
ormersel
f(r
ole)
.Theexper
iences,i
nter
per
sonalandsi
tuat
ional
,associ
atedwi
th
t
hef
ormersel
fincl
udet
heact
ualandt
hehopedf
or,t
hepl
easantandunpl
easant
.
Ther
evi
ewi
nthememor
yoft
hedet
ail
soft
hef
ormer
-sel
fser
vet
oloosent
het
ies
wi
tht
hef
ormer
-sel
f.

I
ntr
oject
ion-
Proj
ect
ion-
Rej
ect
ion:I
tisanact
ivepr
ocessi
nwhi
cht
hewoman
compar
est
heav
ail
abl
emodel
swi
thherv
iewofher
sel
fandmakesact
ivedeci
si
ons
aboutadopt
ingorr
eject
ingpar
ti
cul
armodel
s.Thi
sact
ivi
tyi
sdi
ff
erent
iat
edf
rom
mi
micr
yinwhi
chanact
ivi
ty,suchaswear
ingmat
erni
tycl
othes,i
scopi
ed.For
exampl
e,mi
micr
ymayoccurpost
nat
all
ywhenawomancopi
es(
ismadet
ofol
l
ow
i
n some i
nst
ances)t
he bat
hing ‘
procedur
e’wi
th herbaby buti
ntr
oject
ions-
pr
oject
ion-
rej
ect
ionhasoccur
redwhen,
athome,
shedev
elopsherownappr
oacht
o
bat
hingbasedonwhatshehasl
ear
nti
nhospi
tal
andel
sewher
e.

I
ntr
oject
ion-
proj
ect
ion-
rej
ect
ionwast
hesum andsubst
anceoft
hebul
koft
he
appar
ent
lycasualwoman-
tal
k.I
tincl
udedcl
othi
ng,wal
ki
ng,t
alki
ng,chi
l
dbear
ing,
chi
l
drear
ingandper
sonalr
elat
ionshi
ps.I
twast
hesubst
anceandessence,
indet
ail
,
ofwhatwasi
nvol
vedi
nbecomi
ngorbei
ngawomanandpar
ti
cul
arl
yinbecomi
ngor
bei
ngamot
her
.

Themat
ernalr
olei
dent
it
ydescr
ibedi
nthi
smodelcompr
isest
heachi
evementof
t
hef
ourt
asksofpr
egnancywhi
char
eaccompl
i
shedbyunder
taki
ngt
heoper
ati
ons
oract
ivi
ti
esofmi
micr
y,r
olepl
ayandsoon.Rubi
nsuggest
sthatt
hismodelcanbe
i
magi
nedasaspher
e,wi
tht
hemat
ernalr
olei
dent
it
yatt
hecent
re,sur
roundedby
t
heoper
ati
ons.Theoper
ati
onsoft
aki
ng-
on(
mimi
cryandr
olepl
ay)pr
ecedet
he
oper
ati
onsoft
aki
ng-
inandl
ett
ing-
goar
ethusdepi
ctedast
heout
err
ingsoft
he
model
.

Rubi
n’
smodelwi
l
lnow beconsi
der
edi
nrel
ati
ont
othekeyconcept
sof
per
son,heal
th,env
ironmentandmi
dwi
fer
ywhi
chwer
edi
scussed.Themodelput
s
gr
eat
eremphasi
sont
heper
sonandenv
ironmentt
hanonheal
thandmi
dwi
fer
y.

PERSON: Themodeldev
elopedbyRubi
nfr
om i
ntegr
ati
onoft
heor
ywi
th
v
astquant
it
iesofempi
ri
caldat
ahasasi
tsf
ocust
heper
son:t
hewomanandt
he
dev
elopmentoft
hewomanandheri
dent
it
yasawoman,mot
herandmemberof
soci
etywhoi
samot
her–t
hecent
ralconcer
noft
hemodeli
swi
tht
heachi
evement
byt
hewomanofaposi
ti
vei
dent
it
yasamot
her
.Theachi
evementoft
hisr
olecan
beassessedi
nter
msofat
tai
nmentoft
hef
ourt
asksofpr
egnancy
.Forexampl
e,
whet
her t
he woman has been abl
e t
o ensur
e saf
ety f
or her
sel
f
andherbabycanbeassessedi
nter
msofphy
sicalout
comes,t
heheal
thoft
he
babyandt
hewoman.Whet
hert
hewomanhasmanagedt
oint
egr
atet
hebabyi
nto
hersoci
alsi
tuat
ionmaybeassessedi
nter
msoft
hei
rsuppor
tsy
stems,f
inanci
al
si
tuat
ionoraccommodat
ion.

HEALTH: Oneoft
het
asksofpr
egnancyi
dent
if
iedi
sthemai
ntenanceof
saf
etyoft
hewomanandt
hebaby
,incl
udi
ngmai
ntenanceofheal
th.Themat
ernal
i
dent
it
yis descr
ibed as compr
isi
ng i
deal
,sel
fand bodyi
mages.Thr
oughout
pr
egnancyt
he bodyi
s seen as bei
ng ofcent
ralconcer
n so t
hatheal
th and
per
cept
ionsofheal
thar
epar
ti
cul
arl
yimpor
tantdur
ingat
imewhenbodychanges
maybeal
armi
ngormaynothav
ebeenexper
iencedbef
ore.

ENVI
RONMENT: Theenv
ironment
,orsoci
alsy
stem,i
sthesecondmaj
or
f
ocusoft
hismodel
.Rubi
nessent
ial
l
yvi
ewsmat
ernalbehav
iorasasoci
alact
ivi
ty
whi
chi
sdemonst
rat
edi
nint
eract
ionsandr
elat
ionshi
pswi
thot
her
sint
hewoman’
s
soci
alsy
stem.Agai
n,t
heext
entt
owhi
cht
hewomanhasachi
evedt
het
asksof
pr
egnancycanbeassessedi
nter
msofherr
elat
ionshi
pwi
tht
hebaby
,fami
l
y,
f
ri
ends,
col
l
eaguesandheal
thpr
ofessi
onal
s.

Mi
dwi
fer
y: Thi
smodeldescr
ibest
hewomanasbei
ngi
nvol
vedi
n
anact
ivepr
ocessofgr
owt
handdev
elopmentdur
ingpr
egnancy
.Dur
ingt
hist
ime
shei
sact
ivel
yseeki
ngoutr
ole-
model
sint
hef
orm ofpeopl
eandi
ndi
vi
dual
sand
i
ntegr
ati
ngt
heser
ole-
model
sint
oherpi
ctur
e,ori
mage,ofher
sel
f.Thewomani
s
t
hecent
ralact
ori
nthi
spr
ocess.Theai
m oft
hemi
dwi
fe,wi
thi
nthi
smodel
,ist
o
pr
ovi
de i
nter
vent
ions whi
ch suppor
tthe oper
ati
ons and achi
evementoft
he
mat
ernalt
asks.Forexampl
e,bypr
ovi
dingi
nfor
mat
ionaboutf
oodandexer
cise
ear
lyi
npr
egnancyt
hemi
dwi
fepr
ovi
desamodelf
ort
hewomant
omi
mic.By
pr
ovi
dingi
nfor
mat
ionaboutdi
ff
erentopt
ionsf
ordel
i
ver
y,shepr
ovi
desi
nfor
mat
ion
whi
cht
hewomancanusei
nint
roj
ect
ion-
proj
ect
ion-
rej
ect
ion,andi
nunder
taki
ng
obser
vat
ionsi
nlabourt
hemi
dwi
fehel
pst
hewomanachi
eveasaf
eout
come.
2.
THEORYOFRAMONAT.MERCER:MATERNALROLEATTAI
NMENT-Becomi
nga
Mot
her
RamonaT.Mer
ceri
swel
lknowni
nthespeci
alt
yofmat
ernal
-chi
l
dnur
sing.Mer
cer
dev
elopedt
he“
mat
ernalr
oleat
tai
nment-becomi
ngamot
her
”model
.Thi
smodel
i
simpor
tantbecausei
tpr
ovi
dest
hef
ramewor
kformot
her
-i
nfantbondi
ngt
hat
af
fect
stheheal
thanddev
elopmentofi
ndi
vi
dual
sandf
ami
l
iest
hroughoutt
he
l
i
fespan
Maj
. orf
act
orsi
nthesuccessofMer
cer
’smodelar
ehereducat
ion,
cli
nical
exper
ience,
theor
eti
cali
nfl
uencesandmosti
mpor
tant
lyhercommi
tmentt
ocur
rent
,
ev
idence-
basedpr
act
ice.Ther
ear
esomepr
act
it
ioner
swhohav
esomeexcept
ions
t
othemoder
ndayappl
i
cat
ionofMer
cer
’st
heor
y,especi
all
ywhenv
iewedf
rom a
f
emi
nistper
spect
ive.Butbyandl
arge,Mer
cer
’s“
Theor
yofBecomi
ngaMot
her
”
hasbecomewi
del
yaccept
ed,especi
all
ysi
ncei
tsr
evi
sion i
n 2004.I
tisused
ext
ensi
vel
yin educat
ional t
ext
s of mat
erni
ty and pedi
atr
ics. Thi
s model
i
ncor
por
atesgl
obal
concept
sofnur
singandi
sappl
i
cabl
etonur
singpr
act
icet
oday
.
Per
sonalBackgr
oundofRamonaT.Mer
cer
RamonaT.Mer
cerhasav
ari
edandcompr
ehensi
veeducat
ionalbackgr
ound.She
gr
aduat
edi
n1950wi
thhernur
singdi
plomaatt
heageof21i
nMont
gomer
y,
Al
abama.Fort
henext10y
ear
sshewor
kedasanur
seandi
nst
ruct
ori
npedi
atr
ic
andobst
etr
icalnur
singi
naddi
ti
ont
othef
iel
dofcont
agi
ousdi
seases.Herear
ly
nur
sing exper
ience mol
ded heri
nter
est
stowar
d pedi
atr
ic and obst
etr
ics.She
r
etur
nedt
oschooli
n1960andear
nedhermast
er’
sdegr
eespeci
ali
zi
ngi
nmat
ernal
-
chi
l
dnur
singatt
heUni
ver
sit
yofNewMexi
coi
n1964.Shecont
inuedpur
sui
ngher
passi
on f
ormat
erni
ty nur
sing and compl
eted herPh.
D.att
he Uni
ver
sit
y of
Pi
tt
sbur
ghi
n1973.
Mer
cerwor
ked
asanur
singpr
ofessoratt
heUni
ver
sit
yofCal
i
for
niaunt
ilsher
eti
redi
n1987.Ev
en
i
nherr
eti
rement
,shest
il
lcont
inuest
orev
iseandcl
ari
fyherwor
kbecauseshe
bel
i
evest
hat“
theor
ybui
l
dingi
sacont
inual
process”.
Ramona Mer
cer
’s ear
ly wor
kint
he 1970’
s was f
ocused on t
he needs of
br
east
feedi
ngmot
her
s,t
eenagemot
her
s,post
par
tum i
l
lness,andmot
her
sbear
ing
chi
l
drenwi
thdef
ect
s.Shehadadeepi
nter
esti
nthedev
elopmentoft
hemat
ernal
r
oleaswel
lassel
f-
est
eem andsel
f-
conceptofmot
her
s.Dur
ingt
hespanof
Mer
cer
’scar
eer
,herwor
kexpandedf
urt
heri
nthear
eaofmat
ernal
-chi
l
dnur
sing
and she aut ed books such as Per
hor spect
ives on Adol
escentHeal
th Car
e,
Tr
ansi
ti
onsi
naWoman’
sLi
fe,
andPar
ent
satRi
sk(
RamonaMer
cer
,2011)
.Shehas
wr
it
tenat
otalofsi
xbooks,publ
i
shedsi
xbookchapt
ersandnumer
ousj
our
nal
ar
ti
cles.Thr
oughouthercar
eerDr
.Mer
cerhasr
ecei
vedagr
eatdealofawar
dsand
i
samemberofsev
eral
prof
essi
onal
organi
zat
ionsandnat
ional
commi
tt
ees.
Theor
eti
calUnder
pinni
ngs
Mer
cer
’smi
d-r
angemat
ernal
rol
eat
tai
nmentt
heor
yisbasedonbecomi
ngamot
her
t
hroughoutawoman’
sli
fespani
nor
dert
odev
elopast
rongmat
ernali
dent
it
y.Thi
s
t
heor
ywasi
nfl
uencedbyt
hewor
kofMer
cer
’spr
ofessorandment
or,
Rev
aRubi
nat
t
heUni
ver
sit
yofPi
tt
sbur
gh.ThesuccessofMer
cer
’st
heor
ymaybeat
tri
but
edi
n
par
ttot
hewayt
hatshehasusedmanydi
ver
sesour
cesofr
esear
cht
odev
elopand
expandhert
heor
y.Mer
cer
’st
heor
eti
calsour
cesi
ncl
udeMead’
stheor
yonr
ole
enact
ment
,Tur
ner
stheor
yont
hecor
esel
f,Thor
ntonandNar
di’
srol
eacqui
sit
ion
pr
ocess,Wer
ner
’sdev
elopment
alpr
ocess,andt
hewor
kofBur
r,Lei
gh,Dayand
Const
ant
ine.Amodelofmat
ernalr
oleat
tai
nmentwasdev
elopedbyMer
cert
hati
s
basedonBr
onf
enbr
enner
’sconcept
sofnest
edci
rcl
es.NURSI
NG THEORY OF
RAMONAT.MERCER
Mer
cerbel
i
evest
hatnur
sescanpl
ayav
italr
olei
npr
omot
ingheal
thoff
ami
l
iesand
chi
l
dren.Mer
cerst
at nherbookBecomi
edi ngaMot
her
:Resear
chonMat
ernal
I
dent
it
yfr
om Rubi
ntot
hePr
esentt
hat“
nur
sesar
etheheal
thpr
ofessi
onal
shav
ing
t
hemostsust
ainedandi
ntensei
nter
act
ionwi
thwomeni
nthemat
erni
tycy
cle”.
Mer
cer
’st
heor
yispr
act
iceor
ient
edandhasconsi
stent
lyev
olv
edov
ert
imebecause
ofhercommi
tmentt
oconnectr
esear
cht
opr
act
ice.
I
naddi
ti
ont
other
enami
ngofmat
ernalr
oleat
tai
nmentst
ages,t
hemodelhas
under
goneongoi
ngr
evi
sionsi
ncei
tsor
igi
nalpubl
i
cat
ion.Thewor
kofWal
ker
,Cr
ain,
and Thompson i
ndi
cat
ed t
hata change was needed because t
he t
erm r
ole
at
tai
nmenti
ndi
cat
ed an end t
othepr
ocessasaf
inalgoal
.Mer
cerbegant
o
r
eexami
nehert
heor
yandf
eltt
heneedt
orev
iset
hemodel
’
sti
tl
eto“
Becomi
nga
Mot
her
”in or
dert
o connot
ea cont
inued gr
owt
hin mot
her
ing t
hroughoutt
he
l
i
fespan.
STAGESOFBECOMI
NGAMOTHER
Theconcept
sofMer
cer
’st
heor
ycent
eront
hebondbet
weenmot
herandchi
l
d
whi
chf
ost
erscompet
ency
,conf
idenceandj
oyi
nthemot
her
hoodr
ole.Mer
cer
’s
or
igi
nalmat
ernalr
oleat
tai
nmentt
heor
yfol
l
owsapr
ocesst
hathasf
ourst
ages.I
n
2004Mer
cerr
evi
sedt
het
ermsoft
hesest
agesal
thought
hest
agest
hemsel
ves
r
emai
nbasi
cal
l
ythesame.Fi
rsti
sthe“
commi
tment
,at
tachment
,andpr
epar
ati
on”
st
age dur
ing pr
egnancy when t
he mot
hermakes psy
chol
ogi
caladj
ust
s and
pr
epar
esf
ort
heexpect
ati
onsofhernewr
ole.Secondi
sthe“
acquai
ntance,
lear
ning,
andphy
sicalr
est
orat
ion”st
agewhi
chbegi
nswi
tht
hei
nfant
’sbi
rt
hwhent
her
oleof
mot
heri
sassumedandl
ear
nedi
nthecont
ext
sofhersoci
alsy
stem.Thi
rdi
sthe
“
mov
ingt
owar
danew nor
mal
”st
agei
nthef
ir
stf
ew mont
hsoft
hei
nfant
’sl
i
fe
wher
ethemot
hermakeshernewr
olef
itherl
i
fest
ylei
naper
sonal
wayi
nst
eadofi
n
cont
extwi
thasoci
alsy
stem.
 Last
lyi
sthe “
achi
evementofmat
ernali
dent
it
y”st
age when t
he mot
her
i
nter
nal
i
zesherr
oleand exper
iencesasenseofhar
mony
,compet
enceand
conf
idencewhi
chusual
l
yoccur
sabout4mont
hsaf
terbi
rt
h.Thesest
agescan
ov
erl
apandt
het
imi
ngi
shi
ghl
yvar
iabl
ehowev
ert
hest
agesusual
l
ypr
ogr
essi
na
sequent
ial
,pr
edi
ctabl
emanner
.
Gl
obalNur
singConcept
s
Ther
ear
efourgl
obalconcept
sthatRamonaMer
cerpor
tray
sinhermodel
.Thef
ir
st
onei
shumanbei
ng.Mer
cerdescr
ibeshumanbei
ngasseei
ngt
hemsel
vesasan
i
ndi
vi
dualandsepar
atesi
tsel
ffr
om ot
herr
oles.Mer
cerf
ocusest
hisf
ir
stconcept
ont
hemat
ernalsel
f.Hav
ingsel
fconf
idenceandsel
f-
est
eem ar
efact
orst
hatpl
ay
i
ntomot
her
hood.Val
uesandmor
alsal
sopl
ayar
olei
nthewayt
hatpr
obl
emsar
e
handl
ed.
Thenextconcepti
senv
ironment
.Mer
cerdescr
ibesenv
ironmentasi
thasan
i
mpactont
hemat
ernalr
ole.Ther
ear
eissuesout
sidet
hef
ami
l
ythatwi
l
limpact
howt
hemat
ernalr
olei
spl
ayed.Ther
ewi
l
lbeset
ti
ngsandchangest
hathappent
o
putst
ressont
hemat
ernalr
oleandt
her
ehast
obeabal
anci
ngact
.Pl
ayi
ngt
her
ole
ofa mat
ernalper
son t
heyneed t
o beabl
eto accommodat
efort
he out
side
i
nfl
uencesal
ongwi
thnoti
gnor
ingt
hei
ssuesathand.
Thet
hir
dconcepti
sheal
th.Mer
cerdef
inesheal
thasabackgr
oundoft
hemot
her
’s
andf
ather
’sheal
thhi
stor
ythenasi
trel
atest
othef
utur
echi
l
drent
heymi
ghthav
e.
Wheni
tcomest
obr
ingi
ngachi
l
dint
othewor
ldt
her
ear
eal
otoff
act
orst
hatneed
t
obeaddr
essed.Themot
herandf
atherneedt
olookatt
hei
rcur
rentheal
thal
ong
wi
thanyconcer
nst
hatt
hei
rli
fest
ylebr
ingsabouti
nregar
dst
othei
rheal
thhi
stor
y.
Whathappensdur
ingchi
l
dbear
ingcanaf
fectt
hechi
l
d’sheal
th.
 Thel
astconcepti
snur
sing.Mer
cerdescr
ibesnur
sesasav
eryi
mpor
tantpar
tof
t
hemat
erni
tycy
cle.Nur
seshav
eadut
ytopr
omot
egr
owt
handwel
l
-bei
ngi
n
ot
her
swhi
l
eeducat
ingf
ami
l
iesonwhatshoul
dbedonebef
ore,
dur
ing,
andaf
ter
t
hemat
ernalcy
cle.Nur
sespl
ayahugef
act
oront
heout
comeoft
hechi
l
dbi
rt
h
becauseoft
heeducat
ionandt
eachi
ngt
hatwasgi
vent
othef
ami
l
ies.
RamonaMer
cer
’st
heor
yofbecomi
ngamot
heri
sadequat
elydescr
ibedi
ncont
ext
oft
hef
ourgl
obalnur
singconcept
s.Eachconceptaddr
essesanaspectoft
he
mat
ernalcy
cleandt
her
efor
ehasapar
tint
hebui
l
dingbl
ocksofMer
cer
’st
heor
y.
Thegl
obalnur
singconcept
sinf
luencehowt
hemat
ernalr
olei
spl
ayedandhowi
tis
notaf
fect
edbyj
ustasi
ngl
efact
or,butr
atherbymany
.Theseconcept
stoget
her
def
ineandshapehowt
hemat
ernalcy
clewi
l
lbecar
ri
edout
.Eachoft
hef
ourgl
obal
concept
sar
eappl
i
ed t
othemat
ernalcy
cleand how eachonecont
ri
but
est
o
becomi
ngamot
herusi
ngt
het
heor
yofmat
ernal
rol
eat
tai
nment
.

Theor
yAppl
icat
ionandI
mpl
icat
ions
The or
igi
ns ofRamona Mer
cer
’st
heor
yar
e pr
imar
il
yinspi
red byhernur
sing
exper
ienceear
lynur
singeducat
orment
or,
Rev
aRubi
n,butherpassi
onf
orev
idence
basedr
esear
chcausedherwor
ktobei
nfl
uencedbyot
heri
nter
act
ioni
stsoci
al
psy
chol
ogymodel
s.Mer
cer
’st
heor
yhasaspeci
fi
c,concr
etef
ocusr
athert
hanan
abst
ract
,uni
ver
salappl
i
cat
ion.“
Middl
eranget
heor
yhasanev
enmor
especi
fi
c
f
ocusand i
smor
e concr
etet
han nur
sing t
heor
yini
tsl
evelofabst
ract
ion”.
Mat
ernalr
oleat
tai
nmentf
ocusesspeci
fi
cal
l
yint
hear
eaofpar
ent
-chi
l
dnur
singand
i
sappl
i
cabl
emai
nlyi
npedi
atr
icandmat
ernal
-chi
l
dnur
sing.Howev
erev
ent
hough
t
hef
ocusoft
hist
heor
yisnar
rowedt
omat
ernalchi
l
dnur
sing,
itcanbegener
ali
zed
t
oawi
der
angeofages,si
tuat
ionsandenv
ironment
s.Becauseoft
hespeci
ali
zed
f
ocusoft
hismodel
,i
tisnotgener
all
yappl
i
cabl
etoot
hernur
sing
ar
eas.Ot
herdi
sci
pli
nes such as soci
ology
,psy
chol
ogy and educat
ion hav
e
i
ncor
por
atedMer
cer
’sconcept
stot
hei
rmat
ernal
andpar
ent
ingphi
l
osophi
es.
Amedi
cal
l
yunst
abl
e,pr
emat
urel
ybor
ninf
anti
sanexampl
eofhowMer
cer
’st
heor
y
of“
Mat
ernalRol
eAt
tai
nment
”(MRA)canbeappl
i
edi
npr
act
ice.Thest
ressof
becomi
ngamot
heri
sincr
easedi
nthef
aceofani
nfant
’scr
it
icali
l
lness.Seei
ng
t
hei
rinf
antdi
str
essedandexposedt
opai
nfulpr
ocedur
escausesmot
her
swor
ry
andf
eel
i
ngsofi
ncompet
ence.Mer
cerf
oundt
hatnor
malmat
ernalr
oleat
tai
nment
canbedel
ayedi
nthest
agesofmat
ernali
dent
it
ywhi
chcant
henhav
eani
mpacton
i
nter
act
ionsbet
weenmot
herandchi
l
d.Mot
her
scanbeassessedwher
etheyf
alli
n
t
he MRA st
ages as wel
las an assessment of t
he mot
her and i
nfant
’s
char
act
eri
sti
csi
nor
dert
odev
elopani
ndi
vi
dual
i
zedpl
ant
ohel
ppr
omot
emat
ernal
compet
ence.Ev
ent
houghmot
her
hoodandr
elat
ionshi
pscanbeacompl
expr
ocess,
MRAt
heor
ycanpr
ovi
deaf
ramewor
ktohel
ppr
edi
ctbehav
iorandgui
depr
act
icei
n
r
eal
li
fesi
tuat
ions.
Concl
usi
on
RamonaMer
cerhasdev
otedherl
i
fe’
swor
ktomat
ernalchi
l
dnur
singandst
il
l
cont
inuest
othi
sdayt
oref
inehert
heor
yofmat
ernalr
oleat
tai
nment
-becomi
nga
mot
her
.Hert
heor
yisev
idence-
basedandi
ncor
por
atest
hef
ourgl
obalnur
sing
concept
s.The st
ages ofmot
her
hood r
ole at
tai
nmenti
nthi
stheor
y can be
pr
act
ical
l
yappl
i
edi
nmanyset
ti
ngsofmat
ernalchi
l
dnur
sing.RamonaMer
cerhas
dev
eloped a successf
ulnur
sing t
heor
ywhi
ch i
swi
del
yaccept
ed and used i
n
mat
ernalchi
l
d nur
sing educat
ion and pr
act
ice.The t
heor
y ofmat
ernalr
ole
at
tai
nmentpr
ovi
desnur
sest
hef
ramewor
kandgui
dancet
ohel
pfami
l
ieshandl
ethe
j
our
neyofpar
ent
hoodandsuppor
tthepr
ocessofbecomi
ngamot
her
.

3.
SWANSON'
STHEORYOFCARI
NG:

def
inescar
ingasanur
tur
ingwayofr
elat
ingt
oav
aluedot
hert
owar
dwhom one
f
eel
saper
sonalsenseofcommi
tmentandr
esponsi
bil
i
ty;suppor
tscl
aim t
hat
car
ingi
sacent
ralnur
singphenomenonbutnotnecessar
il
yuni
quet
onur
sing
pr
act
ice

Swanson'
sTheor
yofCar
ing-5pr
ocesses

knowi
ng,
bei
ngwi
th,
doi
ngf
or,
enabl
i
ng,
mai
ntai
ngbel
i
ef

Car
ingPr
ocess-Knowi
ng

St
ri
vi
ngt
ounder
standanev
entasi
thasmeani
ngi
nthel
i
feoft
heot
her
;av
oidi
ng
assumpt
ions;cent
eri
ngont
heonecar
edf
or;assessi
ngt
hor
oughl
y;seeki
ngcues;
engagi
ngt
hesel
forbot
h

Car
ingPr
ocess-Bei
ngWi
th

Bei
ng emot
ional
l
ypr
esentt
othe ot
her
;bei
ng t
her
e;conv
eyi
ng abi
l
ity
;shar
ing
f
eel
i
ngs;
notbur
deni
ng

Car
ingPr
ocess-Doi
ngFor

doi
ng f
ort
heot
herasheorshewoul
ddo f
orsel
fifi
twer
eatal
lpossi
ble;
comf
ort
ing;
ant
ici
pat
ing;
per
for
mingski
l
lful
l
y;pr
otect
ing;
preser
vingdi
gni
ty

Car
ingPr
ocess-Enabl
ing

Faci
l
itat
ing t
heot
her
spassage t
hrough l
i
fet
ransi
ti
ons(
ex-bi
rt
h,deat
h)and
unf
ami
l
iarev
ent
s;i
nfor
ming/
expl
aini
ng;suppor
ti
ng/
all
owi
ng;f
ocusi
ng;gener
ati
ng
al
ter
nat
ives;
val
i
dat
ing/
giv
ingf
eedback

Car
ingPr
ocess-Mai
ntai
ningBel
i
ef

Sust
aini
ngf
ait
hint
heot
her
'scapaci
tyt
ogett
hroughanev
entort
ransi
ti
onandf
ace
af
utur
ewi
thmeani
ng;bel
i
evi
ngi
n/hol
dingi
nest
eem;mai
ntai
ningahope-
fi
ll
ed
at
ti
tude;
off
eri
ngr
eal
i
sti
copt
imi
sm;
"goi
ngt
hedi
stance"

Car
ingi
nNur
singPr
act
ice

Pr
ovi
dingpr
esence;t
ouch;l
i
steni
ng;knowi
ngt
hepat
ient
;spi
ri
tualcar
ing;r
eli
evei
ng
pai
nandsuf
fer
ing;
fami
l
ycar
e.

Thepl
anofcar
eforwomeni
sadapt
edf
rom Swanson’
sTheor
yofCar
ing(
1991)
andt
hef
ivepr
ocessest
hatar
epr
oposedt
ochar
act
eri
secar
ing.Thepur
poseof
Swanson’
sst
udywast
odescr
ibet
hei
nduct
ivedev
elopmentandr
efi
nementofa
mi
ddl
eranget
heor
yofcar
ing,dev
elopedt
hrought
hecol
l
ect
ionofev
idencef
rom
pr
act
ice.Thet
heor
ywasv
ali
dat
edt
hroughphenomenol
ogi
cali
nvest
igat
ionsi
n
t
hreeper
inat
alcont
ext
s.Car
ingi
sdef
inedas:‘
anur
tur
ingwayofr
elat
ingt
oa
v
alued ot
her
,towar
d whom one f
eel
s a per
sonalsense ofcommi
tmentand
r
esponsi
bil
i
ty’
.Thef
ivepr
ocessest
hatchar
act
eri
secar
ingar
eknowi
ng,bei
ngwi
th,
doi
ng f
or,enabl
i
ng and mai
ntai
ning bel
i
ef.Swanson’
s def
ini
ti
on of car
ing
epi
tomi
sest
hephi
l
osophyofcar
efort
heMLU.Eachwomani
snur
tur
edandv
alued
asani
ndi
vi
dual
,whi
l
eeachmi
dwi
fei
scompl
etel
ycommi
tt
edt
owoman-
cent
red,
ev
idence-
basedcar
e.Thef
ivepr
ocessesofcar
ingar
edi
scussed,
thef
ir
stofwhi
ch,
‘
knowi
ng’
,incor
por
ates t
he way
s ofknowi
ng descr
ibed byCar
per
,whi
ch ar
e
di
scussedl
ater
.
Pr
ocessesofcar
ing:‘
Knowi
ng’
Swanson descr
ibes ‘
knowi
ng’as st
ri
vi
ng t
o under
stand an ev
entas i
thas
meani
ngi
nthel
i
feofanot
her
;notassumi
ngoneknowshowt
heot
heri
saf
fect
ed
orhowt
heyf
eel
,butt
ryi
ngear
nest
lyt
ounder
standandendeav
our
ingt
ocar
efor
t
hisper
sonasani
ndi
vi
dual
.Iti
sthei
rli
feexper
iencet
hati
sofi
mpor
tance,
andt
o
under
standt
hatonehast
oassesst
hei
rpastandcur
renthi
stor
ythor
oughl
y,
seeki
ngcuesast
owhenandwhennott
oactorcommuni
cat
e.When‘
knowi
ng’
occur
sther
eisabondofempat
hyandunder
standi
ngbet
weent
hecar
epr
ovi
der
andt
hecar
ereci
pient
.‘Knowi
ng’encompasseswoman-
cent
red,
i
ndi
vi
dual
i
sed
 car
e,cont
inui
tyofcar
eandamai
ntenanceofknowl
edgeandski
l
ls.‘
Knowi
ng’
i
ncor
por
atesknowl
edgebasedonobser
vat
ions,car
efulsy
stemat
icr
esear
chor
r
epeat
edcl
i
nicalexper
ience.Ref
lect
ionont
hisknowl
edgebr
ingsuscl
osert
oan
under
standi
ngofwhati
sknown,andonet
ypeofknowi
ngi
nit
sel
fwi
l
lnot
uncov
eral
ltheknowl
edger
equi
redf
orpr
act
ice.
 
Processesofcar
ing:‘
Bei
ngwi
th’
 
‘
Bei
ngwi
th’
,thesecondpr
ocess,i
mpl
i
esbei
ngt
her
efor
,or‘
wit
h’woman.Tobe
‘
wit
hwoman’i
nvol
vesaf
ract
ionmor
ethan‘
knowi
ng’
.Tobe‘
wit
hwoman’i
mpl
i
es
gi
vi
ngofonesel
f,st
eppi
ngi
ntot
heshoesoft
heot
herper
soni
nanaut
hent
icand
empat
het
icmanner,pr
ovi
dingphy
sical
,psy
chol
ogi
calandemot
ionalsuppor
tat
ev
eryst
epoft
hej
our
ney
.‘Bei
ngwi
th’r
equi
resef
fect
ivecommuni
cat
ion,i
ncl
udi
ng
t
heabi
l
ityt
oli
sten.Toact
ivel
yli
stent
hemi
dwi
feneedsnotonl
ytohear
,butal
sot
o
i
nter
pretandbesensi
ti
vet
ovocalandnon-
vocal
cues.‘
Bei
ngwi
th’i
ncor
por
ates
mor
ethanj
ustbei
ngphy
sical
l
yandemot
ional
l
ypr
esent
.Tobe‘
wit
hwoman’
,the
mi
dwi
fer
equi
rest
odi
spl
ayasser
ti
veness,compet
enceandbeanadv
ocat
efor
women—t
huspr
otect
ingt
hebesti
nter
est
sofmot
herandi
nfant
.Thi
sisachi
eved
byensur
ingt
hatmi
dwi
fer
ypr
act
icei
sev
idencebased— ev
idence-
basedpr
act
ice
bei
ngt
heconsci
ent
iousandj
udi
cioususeofcur
rentbestev
idencei
nmaki
ng
deci
sionsaboutt
hecar
eofi
ndi
vi
dual
women.
 
Processesofcar
ing:‘
Doi
ngf
or’
 
Mai
ntenanceofknowl
edgeandski
l
lsi
srequi
redal
sof
ort
het
hir
dcar
ingpr
ocess,
‘
doi
ngf
or’
.‘
Doi
ngf
or’
ent
ail
sdoi
ngf
ort
heot
herwhatt
heywoul
ddof
ort
hemsel
ves
i
fitwer
epossi
ble.I
tcoul
dbei
nter
pret
edast
hepr
act
icalsi
deorar
tofmi
dwi
fer
y.
Swansondescr
ibescar
ethati
s‘doi
ngf
or’
ascomf
ort
ing,
ant
ici
pat
ory
,pr
otect
iveof
t
heot
her
’sneedsandper
for
medcompet
ent
lyandski
l
ful
l
y.
 
Processesofcar
ing:‘
Enabl
ing’
Enabl
i
ng,t
he f
our
th pr
ocess,i
s descr
ibed as f
aci
l
itat
ing t
he ot
her
’s passage
t
hroughl
i
fe’
str
ansi
ti
onsandunf
ami
l
iarev
ent
s.I
tcoul
dal
sober
efer
redt
oas
empower
ment
.Tobeempower
ed,womenneedt
obegi
venchoi
cesf
orwhi
cht
hey
hav
ebeenf
ull
yinf
ormed,enabl
i
ngt
hem t
otakecont
roloft
hedeci
sionst
heymake
r
egar
dingt
hei
rpr
egnancy
,thusf
aci
l
itat
ingequalpar
tner
shi
pincar
e.Toenabl
e
mi
dwi
vest
ogi
veaf
ull
yinf
ormedchoi
ce,mi
dwi
vesneedt
obeawar
eofal
lthe
r
elev
antev
idence-
basedgui
del
i
nes.
Pr
ocessesofcar
ing:‘
Mai
ntai
ningbel
ief
’
‘
Mai
ntai
ningbel
i
ef’
,thef
if
thpr
ocess,i
saf
ulf
il
mentofexpect
ati
onswi
thr
eal
i
ties.
Howev
er,f
ulf
il
mentofexpect
ati
onswi
l
lonl
ybeachi
evedi
fthoseexpect
ati
onsar
e
r
eal
i
sti
c.Bymai
ntai
ningbel
i
eft
hemi
dwi
fest
ri
vest
oknow,bewi
th,dof
orand
enabl
ethemot
her
.Iti
sthest
ageoft
hecar
ingpr
ocesswhenal
lfi
vepr
ocesses
comet
oget
herandbecomeonepr
ocess.Swanson,
descr
ibesmai
ntai
ningbel
i
efas
hol
dingt
heot
heri
nest
eem andbel
i
evi
ngi
nthei
rabi
l
ityt
oachi
evet
hei
rgoal
.The
goal
,i
nthi
scase,
bei
ngt
oachi
eveanor
malbi
rt
h,aheal
thymot
herandi
nfantanda
f
ulf
il
li
ng exper
iencef
oral
lconcer
ned.Ki
tzi
ngerbel
i
evest
hatt
he emot
ionsof
ev
ery
dayl
i
fear
eint
ensi
fi
edbyt
hesi
gni
fi
canceofbi
rt
h.Theev
enti
tsel
fisnotonl
y
v
eryphy
sical
,butal
sov
eryspi
ri
tual
.Thi
ssenseofspi
ri
tual
i
tyi
sincor
por
atedi
nthe
pr
ocess of ‘
mai
ntai
ning bel
i
ef ’
.The f
ive pr
ocesses hav
e been di
scussed
i
ndi
vi
dual
l
y,butnonear
emut
ual
l
yexcl
usi
ve,i
nthesamewayt
hatonepat
ter
nof
knowi
ngi
nit
sel
fwi
l
lnotuncov
eral
lknowl
edger
equi
red.Thi
stheor
yofcar
ing,as
pr
oposedbySwanson,encapsul
atest
hephi
l
osophyoft
heMLU.I
tmov
esaway
f
rom t
he medi
calmodelt
hatdef
ines pr
egnancy as a pat
hol
ogi
calcondi
ti
on
r
equi
ri
ngmedi
cali
nter
vent
ionandt
hebel
i
eft
hatbi
rt
hisnor
malonl
yinr
etr
ospect
.
Themedi
calmodelst
ressest
hest
ruct
ureandf
unct
ionoft
hebodyr
athert
hant
he
uni
quenessoft
hei
ndi
vi
dual
.
 Assessmentofheal
thneeds
Two oft
he car
ing pr
ocesses descr
ibed by Swanson ar
e ut
il
ised dur
ing an
assessmentofneeds,namel
y‘knowi
ng’and ‘
enabl
i
ng’
.A f
urt
hersour
ce of
knowl
edgeut
il
iseddur
ingmi
dwi
fer
yassessmenti
spr
act
icalknowl
edgei
nthef
orm
ofexper
ience,whi
chhasal
sobeendescr
ibedast
hear
tofmi
dwi
fer
y.Bennerand
Tannerdi
scusst
heunconsci
ousdeci
sion-
maki
ngpr
ocesses,whi
chmi
ghtal
sobe
descr
ibed as i
ntui
ti
on orexper
ient
ialknowl
edge,as i
nit
ial
l
yfol
l
owi
ng st
ri
ct
i
nst
ruct
ionst
hengr
adual
l
ymov
ingal
ongt
hecont
inuum t
otheexper
tori
ntui
ti
ve
pr
act
it
ioner
.Theydescr
ibet
hisasbei
ngf
reedf
rom consci
oust
hought‘
wit
hout
wast
efulconsi
der
ati
onofal
arger
angeofunf
rui
tf
ul,al
ter
nat
ivedi
agnosesand
sol
uti
ons’
.Howev
er,i
tmi
ghtal
sobesuggest
edt
hati
nst
inct
ivepr
act
icet
hrough
exper
iencemayl
eadt
oassumpt
ivedi
agnosesorgener
ali
sat
ionofi
ndi
vi
dual
needs.
 
Ident
if
icat
ionofneedsbasedont
heassessment
Theassessmenti
ndi
cat
est
hatJay
nehashadaspont
aneousonsetofl
abour
.
Jay
nei
sexper
ienci
ngr
egul
ar,pai
nfulcont
ract
ionswi
thdi
l
atat
ionoft
hecer
vixand
descentoft
he pr
esent
ing par
t.Based on t
he i
nfor
mat
ion gai
ned f
rom t
he
assessment
,Jay
ne’
sneedsar
e:
  
Saf
edel
i
ver
yofmot
herandi
nfant
,mai
ntai
ningmat
ernal
andf
etal
wel
l
bei
ng
  
Moni
tor
/assesspr
ogr
ess,
recogni
singanydev
iat
ionf
rom
‘
nor
mal
’
  
Suppor
ti
veenv
ironment
  
Rel
i
efofpai
n
  
Indi
vi
dual
i
sedwoman-
cent
redcar
e
 Ensur
enut
ri
ti
onal
requi
rement
sar
emet
 Jay
net
oremai
nincont
rol
ofherexper
ienceandenabl
ed
t
omakei
nfor
medchoi
ces
 Ful
fi
ll
i
ngexper
ience
 Pr
eventr
hesusi
soi
mmuni
sat
ion
 Ear
lyi
nit
iat
ionofbr
east
feedi
ngf
oll
owi
ngdel
i
ver
y.

4.
ERNESTI
NEWI
EDENBACH
(
1900-1998)
"
Myt
hesi
sist
hatnur
singar
tisnotcompr
isedofr
ati
onal
norr
eact
ionar
yact
ions
butr
atherofdel
i
ber
ati
veact
ion.
"Wi
edenbach,
1964
Apr
act
it
ioner
,educat
or,
aut
hor
,phi
l
osopherandt
heor
ist
.Inherf
ivedecadesof
pr
oduct
ivecar
eer
,shei
sknownonher
 accompl
i
shment
sonchi
l
dbi
rt
heducat
ion,
f
ami
l
y-cent
eredmat
erni
tycar
e,nur
se-
midwi
fer
yeducat
ion,
andnur
singt
heor
y. 
She
i
sal
soconsi
der
edasoneoft
hepi
oneercont
ri
but
orst
onur
singi
nbui
l
ding
f
oundat
ionoft
hephi
l
osophyandgoal
sofnur
se-
midwi
fer
ypr
act
iceandeducat
ion.

Er
nest
ineWi
edenbachwasgr
eat
lyi
nf
  l
uencedbyI
daOr
lando 
i
nherwor
ksont
he
f
ramewor
k.

Educat
ionandCar
eerBackgr
ound:

 1900–Er
nest
ineWi
edenbackwasbor
ninHambur
g,Ger
many
 1909–Herf
ami
l
ymov
edi
nNewYor
k
 1922–Ear
nedt
heBachel
orofAr
tsf
rom Wel
l
esl
eyCol
l
ege
 1925–Gai
nedherRegi
ster
edNur
seLi
censef
rom JohnHopki
nsSchool
of
Nur
sing
 1934–GotherMast
erofAr
tsofTeacher
sCol
l
egei
nCol
umbi
aUni
ver
sit
y
 1946–Ear
nedacer
ti
fi
cat
einnur
se-
midwi
fer
yfr
om t
heMat
erni
tyCent
er
Associ
ati
on,
 
School
ofNur
se-
Midwi
vesi
nNewYor
k
 1951–TaughtatMat
erni
tyCent
erAssoci
ati
onSchool
ofNur
se-
Midwi
ves
i
nNewYor
k
 1952–Becameani
nst
ruct
orf
orMat
ernal
Nur
singatYal
eUni
ver
sit
y
 1954–Pr
omot
edasanassi
stantpr
ofessorofObst
etr
icNur
sing
 1956 
– Agai
npr
omot
edasAssoci
atePr
ofessorofObst
etr
icNur
sing
 1998–Shedi
edi
n1998

Publ
i
cat
ions:

 1958–Publ
i
shed"
Fami
l
y-Cent
eredMat
erni
tyNur
sing"book
 1964 
–Publ
i
shedbookof"
Cli
nical
Nur
sing,
AHel
pingAr
t"
  1969 
– Publ
i
shed"
Meet
ingt
heReal
i
tiesi
nCl
i
nical
Teachi
ng"
 1972-Cl
i
nical
Nur
singbookpubl
i
shed
 1977-Publ
i
shedVi
sual
of 
Int
erv
iewwi
thMi
ssEr
nest
ineWi
edenbach 
-
di
scussedaboutnur
semi
dwi
fer
ypr
act
icesi
nce1945,
fami
l
yinv
olv
ement
andt
headv
ant
agesofnat
ural
chi
l
dbi
rt
h.
 1978–Publ
i
shedher 
“Communi
cat
ion:
Keyt
oEf
fect
iveNur
sing"book
 1988-
 Er
nest
ineWi
edenbachpaper
s -consi
stedofdi
ari
es,
per
sonal
and
pr
ofessi
onal
fil
esf
rom herchi
l
dhoodt
obei
ngaf
acul
tymemberi
nYal
eto
herr
eti
rementi
n1966.
 
 ASuper
visor
'sManual
forUsei
ntheBr
onxGener
alNur
singDi
vi
sionoft
he
NewYor
kAssoci
ati
onf
orI
mpr
ovi
ngt
heCondi
ti
onoft
hePoor
 (Book)
 

Mai
nConcept
sandDef
ini
ti
ons:
Assumpt
ions:

 Nur
singi
sthepr
act
iceofi
dent
if
icat
ionofapat
ient
’sneedf
orhel
p
t
hrough:
 

1.obser
vat
ionofpr
esent
ingbehav
ior
sandsy
mpt
oms
2.expl
orat
ionoft
hemeani
ngoft
hosesy
mpt
omswi
tht
hepat
ient
3.det
ermi
ningt
hecause(
s)ofdi
scomf
ort
,and
4.det
ermi
ningt
hepat
ient
’sabi
l
ityt
oresol
vet
hedi
scomf
ortori
fthepat
ient
hasaneedf
orhel
pfr
om t
henur
seorot
herheal
thcar
epr
ofessi
onal
s.

 Nur
singpr
imar
il
yconsi
stsofi
dent
if
yingapat
ient
’sneedf
orhel
p.

PRESCRI
PTI
VETHEORY3FACTORS:

 Thenur
se’
scent
ral
pur
posei
nnur
singi
sthenur
se’
spr
ofessi
onal
commi
tment–t
henur
sesgoal
sar
egr
oundedi
nthenur
se’
sphi
l
osophy
:

1.r
ever
encef
ort
hegi
ftofl
i
fe
2.r
espectf
ort
hedi
gni
ty,
aut
onomy
,wor
thandi
ndi
vi
dual
i
tyofeachhuman
bei
ngand
3.r
esol
uti
ont
oactdy
nami
cal
l
yinr
elat
iont
oone’
sbel
i
ef

 Thepr
escr
ipt
ioni
ndi
cat
est
hebr
oadgener
alact
iont
hatt
henur
sedeems
appr
opr
iat
etof
ulf
il
lmentofhercent
ral
pur
pose–Thenur
sewi
l
lhav
e
t
houghtt
hrought
heki
ndofr
esul
tst
obesoughtandwi
l
ltakeact
iont
o
obt
aint
heser
esul
ts,
accept
ingaccount
abi
l
ityf
orwhatshedoesandf
or
t
heout
comesofheract
ion.

  
 Ther
eal
i
tiesar
etheaspect
soft
hei
mmedi
atenur
singsi
tuat
iont
hat
i
nfl
uencet
her
esul
tst
henur
seachi
evest
hroughwhatshedoes.
-wi
thi
nthe
 si
tuat
ionar
ethesecomponent
s.

1.Theagent–whoi
sthenur
sesuppl
yi
ngt
henur
singact
ion
2.Ther
eci
pient–t
hepat
ientr
ecei
vi
ngt
heact
ion
3.Thef
ramewor
k–si
tuat
ional
fact
orst
hataf
fectt
henur
se’
sabi
l
ityt
o
achi
evenur
singr
esul
ts
4. 
 TheGoal
–theendt
obeat
tai
nedt
hroughnur
singact
ivi
ty
5.TheMeans–t
heact
ionsanddev
icest
hroughwhi
cht
henur
sei
senabl
ed
t
oreacht
hegoal
.

SuccessesandTest
imoni
es-Cont
ri
but
iont
oCl
ini
calPr
act
ice:

 Subsequent
lyi
nfl
uencedt
hedev
elopmentofKol
caba'
sTheor
yofcomf
ort
 Pr
ovi
desgui
del
i
nesf
ori
mpl
ement
ingt
henur
singpr
ocessati
nter
act
ion
pr
ocess
 I
nspi
ri
ngnur
sesandmi
dwi
vesbypr
ovi
dingaf
ramewor
kthatexpl
i
cat
esa
mi
dwi
fer
yper
spect
ive
 Usedasf
ramewor
kforst
udy
ingnur
singcar
eofcancerpat
ient
s

APPLI
CATI
ONI
NNURSI
NG:
PRACTI
CE

 Hery
ear
sofexper
ienceasanur
semi
dwi
fecont
ri
but
edt
othear
eaofl
abor
anddel
i
ver
ypr
ocessbasedont
hear
ti
cl
eshepubl
i
shed"
Chi
l
dbi
rt
has
Mot
her
sSayTheyLi
keI
t"
 Shebel
i
evedst
rongl
yinpat
ientcar
e
 Pr
ovi
desa 
foundat
ionf
or 
assessi
ng,
orexpl
aini
ng,
pat
ientcondi
ti
ons
 I
nfl
uencedmany 
cor
econcept
sinnur
singt
oday
,i
ncl
udi
ngnur
sing
assessment
,nur
singpr
ocessand  
nur
sing 
diagnosi
ssuchassel
f-
car
e
def
ici
ts
 Consi
der
ednur
singa"
pract
ical
phenomenon"t
hati
nvol
vedact
ion

EDUCATI
ON

 Nur
singeducat
ionser
vest
hepr
act
iceofnur
singi
nfourmaj
orway
s,as
pr
oposedbyWei
denbach.

1.I
tisr
esponsi
blef
ort
hepr
epar
ati
onoff
utur
epr
act
it
ioner
sofnur
sing.
2.I
tar
rangesf
ornur
singst
udent
stogai
nexper
iencei
ncl
i
nical
areasoft
he
hospi
tal
ori
nthehomeofpat
ient
s
3.I
tsr
epr
esent
ati
vesmayf
unct
ioni
nthecl
i
nical
areaandwor
kcl
osel
ywi
th
t
hest
aff
.
4.I
tof
fer
seducat
ional
oppor
tuni
ti
est
othenur
sef
orspeci
aloradv
anced
st
udy
.

 Wei
denbach'
smodel
whenappl
i
edt
othecl
i
nical
set
ti
ngsr
equi
rest
he
nur
set
ohav
eabr
oadknowl
edgebot
hthenor
mal
andt
hepat
hol
ogi
cal
 si
de,
anext
ensi
veunder
standi
ngt
ohumanpsy
chol
ogy
,cl
i
nical
ski
l
ls
compet
ence,
andt
henur
ses'
abi
l
ityt
oef
fect
ivel
yini
ti
ateandmai
ntai
n
goodcommuni
cat
etobot
hpat
ientandf
ami
l
y.(
Mar
ri
ner
-Tomey
,1995)
 

Resear
ch

 Wei
denbach'
smodel
focusedonnur
singr
esear
chov
ert
hepat
ient
s
r
esponset
oheal
thcar
eexper
iencewher
einherr
esear
chdesi
gnt
o
pr
omot
efami
l
yrel
ati
onshi
ps,
tocont
rol
fact
orsr
esponsi
blef
or 
disabl
i
ng
condi
ti
ons,
andt
ofost
ersoundheal
thcar
epr
act
ices.Duet
othest
udi
es
nur
sesar
eabl
etomeett
hepat
ient
sneed-
for
-hel
p.(
Mar
ri
ner
-Tomey
,1995)

JEAN BALL– THE DECK-

CHAI
R THEORY OF MATERNALEMOTI
ONALWELL-
BEI
NG

JeanBal
l
,abr
it
ishmi
dwi
fe,hasunder
takenext
ensi
ver
esear
chi
ntot
hepost
nat
al
needs ofwomen and t
he consequences f
orwomen ofdi
ff
erentf
orms of
or
gani
zat
ion ofmat
erni
ty ser
vices .I
nreact
ions t
o mot
her
hood (
1987)she
descr
ibest
hef
oll
owi
ngai
m ofpost
nat
alcar
e.

Thepur
poseofal
lmat
erni
tycar
eist
oenabl
eawomant
obesuccessf
uli
n
becomi
ng a mot
her
,and t
his success appl
i
es notonl
ytot
he phy
siol
ogi
cal
pr
ocessesi
nvol
vedbutal
sot
othepsy
chol
ogi
calandemot
ionalpr
ocesseswhi
ch
mot
ivat
ethedesi
ref
orpar
ent
hoodandi
tsf
ulf
il
lment
.

I
npr
act
ice,i
nmanyor
gani
zat
ions,t
het
ypeofcar
epr
ovi
dedmaybecl
osert
oan
obst
etr
ic/
medi
calmodelofpr
egnancywi
thi
nwhi
chi
nter
esti
npost
nat
alcar
eis
mi
nimal(
asdel
i
ver
yhasbeenachi
eved)
,andpost
nat
alcar
econt
inuest
obet
heor
y
ofcar
eoft
hechi
l
dbear
ingwoman.

Thedescr
ipt
ionabov
eident
if
iespr
egnancyandt
hepost
nat
alper
iodasat
imeof
adopt
ionofanew r
ole.Thel
i
ter
atur
erev
iew f
orbal
l
’s(
1987)st
udyofpost
nat
al
car
eident
if
iesr
olet
heor
y,changet
heor
y,t
heor
iesofst
ress,
copi
ngandsuppor
tas
t
het
heor
eti
calbasi
sfort
hest
udy
.Theconcept
sinv
est
igat
edar
edr
awnf
rom
t
heor
iesofcopi
ngandsuppor
tsy
stemsandt
hev
ari
abl
esi
nvest
igat
edr
elat
etot
he
woman’
sper
sonal
i
ty.Li
ve-
event
sandper
sonalandf
ami
l
yci
rcumst
ances,f
act
ors
r
elat
ingt
othebi
rt
handpr
ogr
essf
oll
owi
ngt
hebi
rt
handt
hewoman’
svi
ewsofcar
e,
suppor
tandemot
ional
wel
l
-bei
ng.

Thi
stheor
yaddr
esseseachoft
heseofconcept
s:

Women–t
hef
ocusofBal
l
’swor
kisconcer
nfori
ndi
vi
dualwomenandf
ort
hei
r
successf
ulemot
ional
,soci
alandpsy
chol
ogi
caldev
elopmentdur
ingt
hechi
l
dbi
rt
h
pr
ocess.

Heal
th–heal
thi
scent
ralt
othi
smodel
,bei
ngseeni
nthedef
ini
ti
onoft
heai
m of
post
nat
alcar
e:t
oenabl
eawomant
obesuccessf
uli
nbecomi
ngamot
her.

Env
ironment–t
hesoci
alandor
gani
zat
ionalenv
ironment
sint
hef
orm ofsuppor
t
sy
stemsandpost
nat
alcar
eser
vices(aswel
last
hewi
dersoci
ety
)ar
eimpor
tant
el
ement
soft
hismodel
,suppor
thav
ingbeenshownt
obecr
uci
alf
ort
hewel
l
-bei
ng
oft
hewoman.

Mi
dwi
fer
y–i
npar
tther
esear
chonpost
nat
alcar
ewasmot
ivat
edbyaconcer
n
aboutt
hel
ackofi
nfor
mat
ionaboutt
heef
fect
sofmi
dwi
fer
ycar
eonemot
ionalwel
l
-
bei
ng.Themodelpr
ovi
desgui
danceonmanyar
easofi
nter
vent
ionbymi
dwi
ves
whi
char
edi
scussedbyBal
l
,incl
udi
ngpat
ter
nsofcar
e,suppor
tindeci
sionson
f
eedi
ngmet
hods,
hel
pwi
thf
eedi
ngandi
ndi
vi
dual
car
epl
anni
ng.

Sel
f–t
het
heor
ycl
ear
lyst
art
sfr
om t
hest
andpoi
ntt
hatt
her
oleoft
hemi
dwi
fei
sto
suppor
tandassi
stt
hewomant
obecomeconf
identi
nther
oleofmot
her
.Bal
l
(
1987)cont
endst
hatser
vesandpat
ter
nsofcar
emustchangei
nresponset
othe
needs ofwoman howev
erpai
nfult
hatmay be f
ort
he heal
th pr
ofessi
onal
s
concer
ned.
Mi
dwi
fer
ymodelofcar
e-

Mostmi
dwi
ves,
whet
herwor
kingoutofahospi
tal
orat
tendi
nghomebi
rt
hs,
pr
act
icewhati
sknownast
he“
midwi
fer
ymodel
ofcar
e.”Thebasi
cmi
dwi
fer
y
appr
oacht
obi
rt
handt
hepr
egnantwomant
endst
obemor
ehol
i
sti
c.Thi
smeans
t
hatt
heyl
ookatal
lfact
orswhi
chmaycont
ri
but
etot
heheal
thandsaf
etyoft
he
womanandherbi
rt
h.Emot
ions,
li
vi
ngsi
tuat
ions,
nut
ri
ti
on,
andeducat
ionshoul
dal
l
beaddr
essedbysomeonepr
ovi
dingt
hemi
dwi
fer
ymodel
ofcar
e.

Att
het
imeofbi
rt
h,t
hiscar
epr
ovi
derwi
l
lbeawar
eofandt
rai
nedt
ospott
hings
t
hatmaygowr
ong,
butwi
l
l,ov
eral
l
,consi
derchi
l
dbi
rt
hanat
ural
processt
hat
f
requent
lypr
oceedsnor
mal
l
yandsaf
ely
.

Thoset
rai
nedi
nthemi
dwi
fer
ymodel
ofcar
erout
inel
yref
eroutt
oanobst
etr
ici
an
whent
heyobser
vet
hatt
hepr
egnantwomanneedst
obecar
edf
orbysomeone
wi
thadeeperknowl
edgeofpat
hol
ogy
.

TheCi
ti
zensf
orMi
dwi
fer
ynot
ethat
,

“
Theappl
i
cat
ionoft
hiswoman-
cent
eredmodelofcar
ehasbeenpr
ovent
oreduce
t
hei
nci
denceofbi
rt
hinj
ury
,tr
auma,
andcesar
eansect
ion.
”

Medi
calmodelofcar
e-

Apr
act
it
ionerusi
ngt
hemedi
cal
model
ofcar
e,asi
scommonamongwest
ern
medi
cal
doct
ors,
tendst
oappr
oacht
hepat
ientf
rom apr
obl
em sol
vi
ngappr
oach,
sear
chi
ngf
ort
hedef
ectordy
sfunct
ionandt
ryi
ngt
ofi
xit
.Unl
i
ket
hemi
dwi
fer
y
model
ofcar
ethatseekst
ounder
standt
hewhol
eper
sonandpr
eventunnecessar
y
i
nter
vent
ionorsur
ger
y,t
hingsar
evi
ewedf
rom apat
hol
ogi
cal
model
sear
chi
ngf
or
t
hepr
obl
em andasol
uti
on.
Obst
etr
ici
ans,
whopr
ovi
det
hebul
kofmedi
cal
car
eforbi
rt
hingwomeni
ntheUni
ted
St
ates

Amer
ica,
frequent
lyappr
oacht
hei
rpat
ient
sandt
hei
rpr
egnancyandbi
rt
hfr
om t
his
angl
e.

 TheModel
ofCar
eMat
ter
s 

Soci
alsci
ent
ist
swhoar
eexper
tsi
nwomen’
sheal
th,
repr
oduct
ion,
andmat
erni
ty
car
ehav
eident
if
iedchar
act
eri
sti
cst
hatdef
inemodel
sofmat
erni
tycar
e.I
n1979
soci
ologi
stBar
bar
aKat
z-Rot
hmanwast
hef
ir
stt
odef
inet
hedi
ff
erencebet
ween
t
hemedi
cal
model
andmi
dwi
fer
ymodel
ofcar
e.I
n1992,
medi
cal
ant
hropol
ogi
st
Robbi
eDav
is-
Floy
ddescr
ibedt
het
echnocr
ati
candhol
i
sti
cmodel
sofbi
rt
h.
Ot
her
shav
epr
ovi
dedf
urt
hercl
ari
fi
cat
ion.Eachmodel
isdi
ff
erenti
nter
msof
sci
ent
if
ic,
humani
sti
c,economi
candout
comeef
fi
cienci
esanddef
ici
enci
es,
as
wel
lasef
fectonpr
ovi
der
sandr
eci
pient
soft
hesemodel
sofcar
e.Whati
s
i
mpor
tantt
onot
ewhenr
evi
ewi
ngmodel
sofmat
erni
tycar
eist
hateachmodel
r
eli
esondi
ff
erentski
l
ls,
tool
s,l
anguage,
under
lyi
ngbel
i
efs,
int
erv
ent
ions,
and
powerr
elat
ionshi
psbet
weenpat
ient
sandpr
ovi
der
s.

Mi
dwi
vesModelofCar
e™ 
IsWoman-
Cent
ered

TheMi
dwi
vesModel
ofCar
e™i
saf
undament
all
ydi
ff
erentappr
oacht
o
pr
egnancyandchi
l
dbi
rt
hthancont
empor
aryobst
etr
ics.Mi
dwi
fer
ycar
eis
uni
quel
ynur
tur
ing,
hands-
oncar
ebef
ore,
dur
ing,
andaf
terbi
rt
h.Mi
dwi
vesar
e
heal
thcar
epr
ofessi
onal
sspeci
ali
zi
ngi
npr
egnancyandchi
l
dbi
rt
hwhodev
elopa
t
rust
ingr
elat
ionshi
pwi
tht
hei
rcl
i
ent
s,whi
chr
esul
tsi
nconf
ident
,suppor
tedl
abor
andbi
rt
h.Whi
l
ether
ear
edi
ff
erentt
ypesofmi
dwi
vespr
act
ici
ngi
nvar
ious
set
ti
ngs,
all
midwi
vesar
etr
ainedt
opr
ovi
decompr
ehensi
vepr
enat
alcar
eand
educat
ion,
gui
del
aborandbi
rt
h,addr
esscompl
i
cat
ions,
andcar
efornewbor
ns.
TheMi
dwi
vesModel
ofCar
e™i
sbasedont
hef
actt
hatpr
egnancyandbi
rt
har
e
nor
mal
li
feev
ent
s.TheMi
dwi
vesModel
ofCar
eincl
udes:
 moni
tor
ingt
hephy
sical
,psy
chol
ogi
cal
andsoci
alwel
l
-bei
ngoft
hemot
her
t
hroughoutt
hechi
l
dbear
ingcy
cle
 pr
ovi
dingt
hemot
herwi
thi
ndi
vi
dual
i
zededucat
ion,
counsel
i
ng,
andpr
enat
alcar
e,
cont
inuoushands-
onassi
stancedur
ingl
aboranddel
i
ver
y,andpost
par
tum
suppor
t
 mi
nimi
zi
ngt
echnol
ogi
cal
int
erv
ent
ionsand
 i
dent
if
yingandr
efer
ri
ngwomenwhor
equi
reobst
etr
ical
att
ent
ion

Theappl
i
cat
ionoft
hismodel
hasbeenpr
ovent
oreducet
oinci
denceofbi
rt
h
i
njur
y,t
rauma,
andcesar
eansect
ion.
 

WomenRecei
vePer
sonal
izedCar
ewi
thaMi
dwi
fe
 Youwi
l
lseeaf
ami
l
iarf
aceateachofy
ourappoi
ntment
s,andy
ouwi
l
lbegi
ven
adequat
eti
met
oaskquest
ionsandaddr
essy
ourconcer
ns.
 Yourmi
dwi
fei
saspeci
ali
sti
npr
egnancy
,bi
rt
handpost
par
tum car
ewhohas
desi
gnedacompl
etepr
ogr
am ofcar
etonur
tur
eheal
thypr
egnancy
,joy
ful
bir
th
andconf
identpar
ent
ing.
 Youwi
l
lrecei
vei
ndi
vi
dual
i
ze,
cul
tur
all
yappr
opr
iat
e,f
ami
l
y-cent
eredf
ull
-scope
pr
enat
alser
vices,
andcont
inuouscar
eandsuppor
tdur
ingl
aborandbi
rt
h.
 Yourmi
dwi
fewi
l
lincor
por
ateshar
eddeci
sion-
maki
ngi
ntoy
ourcar
esot
haty
ou
wi
l
lfeel
inf
ormedandempower
edt
omakegoodheal
thdeci
sionsf
ory
ou,
your
i
nfantandy
ourf
ami
l
y. 
 Yourmi
dwi
fehast
heski
l
lsandknowl
edget
ofaci
l
itat
eheal
thynor
mal
chi
l
dbi
rt
h,
t
oassur
ecomf
ortandsaf
etyf
ory
ouandy
ourbaby
,andt
oaccommodat
eyour
f
ami
l
y’sneeds.
 Youmi
dwi
fehasapl
anf
orcol
l
abor
ati
onwi
thobst
etr
ici
ans,
pedi
atr
ici
ans,
and
ot
herspeci
ali
stsi
nther
arecasewher
emedi
cal
car
eformot
herory
ourbabyi
s
needed.
  Youwi
l
lrecei
venur
tur
ingpost
par
tum car
eandsuppor
tiny
ourhomeandt
he
mi
dwi
fe’
sof
fi
cei
ntheweeksandmont
hsaf
terbi
rt
hasy
ouadj
ustt
oyournew
babyandt
hechangesi
nyourf
ami
l
y.

Thesear
ejustaf
ewoft
her
easonswhywomensayt
heypr
efermat
erni
tycar
e
wi
thami
dwi
fe. 

Heal
thi
erOut
comes,
Heal
thi
erCommuni
ti
es

Thesaf
etyandbenef
it
sofmi
dwi
fer
ycar
ehav
ebeenpr
ovenagai
nandagai
nin
count
ri
esacr
osst
hewor
ld,
incl
udi
ngt
heUni
tedSt
ates.Wor
ldHeal
th
Or
gani
zat
ionst
ati
sti
csshowt
hatbi
rt
hsat
tendedbymi
dwi
veshav
elower
i
nfect
ionr
ates,
lowerCesar
eansect
ionr
ates,
fewercompl
i
cat
ionsandheal
thi
er
out
comes—t
hus,
lowerov
eral
lmedi
cal
cost
s—t
hanphy
sici
an-
att
endedhospi
tal
bi
rt
hs.I
naddi
ti
on,
ther
eisnodi
ff
erencei
ninf
antmor
tal
i
tybet
weenmi
dwi
fe-
at
tendedandphy
sici
an-
att
endedbi
rt
hsf
orl
ow-
ri
skwomen.Count
ri
essuchas
t
heNet
her
lands,
SwedenandNewZeal
and,
whi
chhav
ethebestbi
rt
hout
come
st
ati
sti
csi
nthewor
ld,
usemi
dwi
vesast
hei
rmai
nmat
erni
tycar
epr
ovi
der
s

TheMi
dwi
feModelofCar
e TheMedi
calModelofCar
e
i
d
Def Def
ini
ti
onofBi
rt
h
ompar
ing Mode
 Bi
rt
hisasoci
alev
ent
,anor
mal  Chi
l
dbi
rt
hisapot
ent
ial
l
y
Car
e
par
tofawoman'
sli
fe. pat
hol
ogi
cal
process.

 Bi
rt
hist
hewor
koft
hewomanand  Bi
rt
hist
hewor
kofdoct
ors,
nur
ses,
herf
ami
l
y. mi
dwi
vesandot
herexper
ts.

 Thewomani
saper
son  Thewomani
sapat
ient
.
exper
ienci
ngal
i
fe-
tr
ansf
ormi
ng
ev
ent
.
Bi
rt Bi
rt
hingEnv
ironment

 Homeorot
herf
ami
l
iar  Hospi
tal
,unf
ami
l
iart
err
it
oryt
othe
sur
roundi
ngs. woman.
di
anModelofMi
dwi
fer
yPr
act
ice

t
her
ear
epr
ovi
nci
al/
ter
ri
tor
ial
dif
fer
encesi
nhowmi
dwi
fer
yisl
egi
slat
ed,
organi
zed,
and
i
sed,
thebasi
cmodel
ofmi
dwi
fer
ypr
act
icei
sthesameacr
ossal
lregul
atedj
uri
sdi
cti
onsi
n
da.Mi
dwi
vespr
ovi
decar
efr
om ear
lypr
egnancyt
hrought
oatl
eastsi
x-weekspost
par
tum t
o
enandt
hei
rinf
ant
s.
t
handWel
l-
bei
ng
i
fer
ycar
einCanadai
sbasedonar
espectf
orpr
egnancyandchi
l
dbi
rt
hasnor
mal
phy
siol
ogi
c
r
ocesses.Mi
dwi
vespr
omot
ewel
l
nessi
nwomen,
babi
es,
andf
ami
l
ies,
taki
ngt
hesoci
al,
t
ional
,cul
tur
alandphy
sical
aspect
sofawoman’
srepr
oduct
iveexper
iencei
ntoconsi
der
ati
on.

medChoi
ce
di
anmi
dwi
vesr
espectt
her
ightofwoment
omakei
nfor
medchoi
cesaboutal
laspect
soft
hei
r
Mi
dwi
vesact
ivel
yencour
agei
nfor
meddeci
sion-
maki
ngbypr
ovi
dingwomenwi
thcompl
ete,
ant
,andobj
ect
ivei
nfor
mat
ioni
nanon-
aut
hor
it
ari
anmanner
.
nomousCar
ePr
ovi
der
s
di
anmi
dwi
vesar
eful
l
yresponsi
blef
ort
hepr
ovi
sionofpr
imar
yheal
thser
viceswi
thi
nthei
r
eofpr
act
ice,
maki
ngaut
onomousdeci
sionsi
ncol
l
abor
ati
onwi
tht
hei
rcl
i
ent
s.Whenmi
dwi
ves
t
if
ycondi
ti
onsr
equi
ri
ngcar
ethati
sout
sideoft
hei
rscopeofpr
act
ice,
theymaker
efer
ral
sto
rcar
epr
ovi
der
sandcont
inuet
opr
ovi
desuppor
ti
vecar
e.Mi
dwi
vescol
l
abor
atewi
thot
herheal
th
essi
onal
sinor
dert
oensur
ethatt
hei
rcl
i
ent
srecei
vet
hebestpossi
blecar
e.
i
nui
tyofCar
e
di
anmi
dwi
vesar
ecommi
tt
edt
owor
kingi
npar
tner
shi
pwi
tht
hewomeni
nthei
rcar
e.Mi
dwi
ves
dt
imewi
tht
hei
rcl
i
ent
sinor
dert
obui
l
dtr
ust
ingr
elat
ionshi
psandpr
ovi
dei
ndi
vi
dual
i
zedcar
e.
i
dual
orsmal
lgr
oupsofmi
dwi
vespr
ovi
decont
inui
tyofcar
etowoment
hroughoutpr
egnancy
,
r
,bi
rt
h,andupt
oatl
eastsi
xweekspost
par
tum.Ami
dwi
feknownt
othewomani
sav
ail
abl
e
al
lthr
oughouthercar
e.
ceofBi
rt
hSet
ti
ng
di
anmi
dwi
vesr
espectt
her
ightofeachwomant
omakeani
nfor
medchoi
ceaboutt
heset
ti
ngf
or
i
rt
h.Mi
dwi
vesmustbecompet
entandwi
l
li
ngt
opr
ovi
decar
einav
ari
etyofset
ti
ngs,
incl
udi
ng
e,
bir
thcent
res,
andhospi
tal
s.
nce-
basedPr
act
ice
di
anmi
dwi
vesar
eexpect
edt
ost
ayup-
to-
dat
ewi
thr
egar
dtor
esear
chonmat
erni
tycar
eissues,
i
ti
cal
l
yappr
aiser
esear
ch,
andt
oincor
por
ater
elev
antf
indi
ngsi
ntot
hei
rcar
e.
t
sar
ewomenwhohav
econt
ract
edt
owor
kwi
thandr
ecei
vecar
efr
om aspeci
fi
cmi
dwi
feor
i
ves.

MODELOFPRACTI
CE

Thepr
inci
plesout
li
nedbel
owar
efundament
alsofmi
dwi
fer
ypr
act
icewhi
ch,
whent
akent
oget
her
,ensur
ethatmi
dwi
fer
ymeet
stheneedsoft
hewomenwho
chooset
hisser
vice.Thesepr
inci
plesar
eappl
i
cabl
etomi
dwi
fer
ypr
act
iceacr
oss
al
lset
ti
ngsandar
etobeusedasabasi
sfort
hepl
anni
ngandi
ntegr
ati
onof
mi
dwi
fer
yser
vices.

Mi
dwi
vesar
eAut
onomousHeal
thCar
ePr
ovi
der
s

Mi
dwi
vesar
epr
imar
yheal
thcar
epr
ovi
der
swhosecl
i
ent
smaychooseast
hei
r
f
ir
stpoi
ntofent
ryt
othemat
erni
tycar
esy
stem.Aspr
imar
yheal
thcar
epr
ovi
der
s,
mi
dwi
vesmakeaut
onomousdeci
sionsi
ncol
l
abor
ati
onwi
tht
hei
rcl
i
ent
sandar
e
f
ull
yresponsi
blef
ort
hepr
ovi
sionofpr
imar
yheal
thser
viceswi
thi
nthei
rscopeof
pr
act
ice.Theycoor
dinat
eser
vicest
oensur
econt
inui
tyofcar
e,i
dent
if
y
condi
ti
onsr
equi
ri
ngmanagementout
sidet
hei
rscopeofpr
act
iceandr
efersuch
casest
oot
herpr
ovi
der
s.
Communi
tyI
nput

Communi
tyi
nputi
sfundament
alt
othedev
elopmentandev
aluat
ionofmi
dwi
fer
y
pr
act
iceacr
ossal
lset
ti
ngs.Communi
typar
ti
ci
pat
ionmustbest
ruct
uredi
ntot
he
mi
dwi
fer
ysy
stem dur
ingt
hedev
elopmentandongoi
ngpl
anni
ngofmi
dwi
fer
y
ser
vicesandeducat
ion.Thi
swoul
dbeachi
evedby
:

1.Faci
l
itat
ingongoi
ngcommuni
tyi
nput
sint
omi
dwi
fer
ypr
act
icesi
nal
lsi
tes.
(
e.g.communi
tyf
orums,
communi
tyboar
ds,
for
mal
li
aisonwi
thconsumer
or
gani
zat
ions,
consumerr
epr
esent
ati
onongov
erni
ngbody
)
2.Eachandev
erycl
i
entbei
ngabl
etogi
vei
nputatsomel
evel
.(e.
g.cl
i
ent
ev
aluat
ionofcar
e)
3.Eachmi
dwi
febei
ngr
esponsi
blef
orsol
i
cit
ingcl
i
entandcommuni
tyi
nput
(
e.g.cl
i
entev
aluat
ionofcar
e)
4.Educat
ionaboutt
her
oleofcommuni
tyi
nputatal
ll
evel
sincor
por
atedi
nto
t
heeducat
ionofmi
dwi
ves.(
e.g.publ
i
crepr
esent
ati
vesonadv
isor
y
commi
tt
ee(
s);
consumerpar
ti
cipat
ioni
nthet
eachi
ngofmi
dwi
ves)

I
nfor
medChoi
ce

Responsi
venesst
owomen'
sneedsi
sagui
dingpr
inci
pleofmi
dwi
fer
y
pr
act
ice.Mi
dwi
vesr
espectt
her
ightoft
hei
rcl
i
ent
stomakei
nfor
medchoi
ces
andact
ivel
yencour
agei
nfor
medcl
i
entdeci
sion-
maki
ng.Mi
dwi
vesf
aci
l
itat
e
deci
sion-
maki
ngbymaki
ngr
elev
ant
,obj
ect
ivei
nfor
mat
ionav
ail
abl
etot
hei
r
cl
i
ent
s.I
nfor
medchoi
cei
sadeci
sion-
maki
ngpr
ocess,
whi
chr
eli
esonaf
ull
exchangeofi
nfor
mat
ioni
nanon-
urgent
,non-
aut
hor
it
ari
an,
cooper
ati
vemanner
.
Hav
ingadequat
eti
mef
ordi
scussi
onst
art
ingi
nthepr
enat
alper
iodi
snecessar
y
t
othesuccessf
ulf
aci
l
itat
ionofi
nfor
medchoi
ce.Mi
dwi
vessuppor
tthepr
inci
ple
ofi
nfor
medchoi
ceby
:

1.Encour
agi
ngcl
i
ent
stopar
ti
cipat
eact
ivel
yint
hei
rcar
eandt
omake
 choi
cesaboutt
heser
vicest
heywi
l
lrecei
veandt
hemanneri
nwhi
cht
hey
ar
epr
ovi
ded.
2.Recogni
zi
ngandsuppor
ti
ngt
hepr
egnantwomanast
hepr
imar
ydeci
sion
makerandpr
omot
ingshar
edr
esponsi
bil
i
tybet
weent
hewoman,
herf
ami
l
y
andhercar
egi
ver
s.
3.Di
scussi
ngt
hescopeandl
i
mit
ati
onsofmi
dwi
fer
ycar
ewi
tht
hei
rcl
i
ent
s.
4.Al
l
owi
ngadequat
eti
mef
ordi
scussi
oni
nthepr
enat
alper
iod.

Cont
inui
tyofCar
e
Cont
inui
tyofcar
eisf
undament
alt
othemi
dwi
fer
ymodel
ofpr
act
ice.I
tis
bot
haphi
l
osophyandapr
ocesst
hatenabl
est
hemi
dwi
fet
opr
ovi
dehol
i
sti
ccar
e
andt
oest
abl
i
shanongoi
ngpar
tner
shi
pwi
tht
hecl
i
enti
nor
dert
obui
l
d
under
standi
ng,
suppor
tandt
rust
.Cont
inui
tyofcar
eisf
aci
l
itat
edt
hroughaone
t
ooner
elat
ionshi
pbet
weenmi
dwi
feandcl
i
ent
.Ther
emustbe24-
houron-
cal
l
av
ail
abi
l
ityoft
hepr
imar
ycar
emi
dwi
vesknownt
othewoman.Ev
erymi
dwi
fe
mustmaket
het
imecommi
tmentnecessar
ytodev
elopar
elat
ionshi
poft
rust
wi
tht
hewomandur
ingpr
egnancy
,topr
ovi
desaf
eindi
vi
dual
i
zedcar
eand
suppor
tthewomandur
ingt
hechi
l
dbear
ingy
ear
.Ingr
ouppr
act
ices,
asmal
lteam
ofmi
dwi
vescoul
dachi
evecont
inui
tyofcar
e,pr
ovi
dedt
hecl
i
enthast
he
oppor
tuni
tyt
oest
abl
i
shr
elat
ionshi
pswi
thal
lthemember
soft
het
eam.
Mi
dwi
vesi
nvol
vedi
ngr
ouppr
act
icemustshar
eacommonphi
l
osophyi
nor
dert
o
suppor
tcont
inui
tyofcar
e.Womenmusthav
einputi
ntot
hemanneri
nwhi
ch
cont
inui
tyofcar
eispr
ovi
ded.

Choi
ceofBi
rt
hSet
ti
ng

Mi
dwi
vesr
espectt
her
ightofwoment
omakei
nfor
medchoi
cesaboutt
heset
ti
ng
f
orbi
rt
h.Mi
dwi
vespr
ovi
decar
einav
ari
etyofset
ti
ngs,
incl
udi
nghospi
tal
s,
homesandbi
rt
hcent
res,
wher
eav
ail
abl
e.Theabi
l
ityt
ofol
l
owt
hecl
i
enti
san
essent
ial
aspectofcont
inui
tyofcar
eandi
nfor
medchoi
ce.Mi
dwi
vespr
ovi
de
t
hei
rcl
i
ent
swi
tht
hei
nfor
mat
ionandsuppor
trequi
redt
omakeani
nfor
med
choi
ceaboutt
heappr
opr
iat
eset
ti
ngsi
nwhi
cht
ogi
vebi
rt
hinaccor
dancewi
th
t
heSt
andar
dsofPr
act
iceoft
heSaskat
chewanCol
l
egeofMi
dwi
ves.

TwoAt
tendant
satEachBi
rt
h

TheCanadi
anst
andar
dofcar
eist
ohav
etwoat
tendant
s,ski
l
ledi
nneonat
aland
mat
ernal
emer
genci
es,
ateachbi
rt
h.
Thesecondbi
rt
hat
tendantmustunder
standandsuppor
tthemi
dwi
fer
ymodel
of
car
eandcoul
dbe:

 anot
hermi
dwi
fe
 aheal
thcar
epr
act
it
ionerwi
tht
heknowl
edgeandski
l
lrequi
redt
oassi
st
t
hemi
dwi
fe

Col
labor
ati
veCar
e

Mi
dwi
vescol
l
abor
atewi
thot
herpr
ofessi
onal
stoensur
ethei
rcl
i
ent
srecei
vet
he
bestpossi
blecar
ewhent
heneedsoft
hecl
i
entexceedt
hescopeofpr
act
iceof
t
hemi
dwi
fe.Col
l
abor
ati
vecar
einv
olv
est
hecooper
ati
onofv
ari
ouspr
ofessi
onal
s
i
nthepr
ovi
sionofcar
e.I
nsi
tuat
ionswher
etr
ansf
erofcar
etoaphy
sici
ani
s
r
equi
red,
themi
dwi
fei
sexpect
edt
ocont
inuepr
ovi
dingsuppor
ti
vecar
eaf
ter
t
ransf
erandwi
l
lresumepr
imar
ycar
eifappr
opr
iat
e.Col
l
abor
ati
onwi
thot
her
heal
thcar
epr
ovi
der
soccur
swi
thi
nfor
medcl
i
entchoi
ce.

Account
abi
li
tyandEv
aluat
ionofPr
act
ice
Mi
dwi
vesar
eaccount
abl
etot
hei
rcl
i
ent
s,t
hei
rpeer
sandt
hewi
dercommuni
ty
f
orsaf
e,compet
ent
,et
hical
pract
ice.Theyar
eal
soaccount
abl
etot
hei
rown
r
egul
ator
ybody
,thei
rempl
oyer
s,t
heheal
thcar
einst
it
uti
onsi
nwhi
cht
hey
pr
act
iceandt
othepubl
i
c.Mi
dwi
vescont
inuousl
yev
aluat
ethei
rpr
act
icet
o
i
mpr
ovet
hequal
i
tyofcar
etheypr
ovi
deandt
oensur
ethei
rcl
i
ent
s'needsar
emet
.
Ther
esul
tsoft
hisev
aluat
ionar
eincor
por
atedi
ntomi
dwi
fer
ypr
act
ice.

Accessi
bil
it
yofMi
dwi
fer
yCar
e
Mi
dwi
fer
ycar
emustbeaccessi
blet
oal
lwomen.Mechani
smsshoul
dbei
npl
ace
t
oensur
eequi
tabl
eaccesst
omi
dwi
fer
ycar
eforal
lwomenr
egar
dlessofpl
ace
ofr
esi
denceorci
rcumst
ances.Ami
dwi
fer
ypr
act
icemustconsi
dert
he
demogr
aphi
csoft
hepr
act
icear
easot
hatser
vicesar
eof
fer
edt
othev
ari
etyof
woment
her
ein.Thi
sensur
est
hatwomenwhowoul
dmostbenef
itf
rom
mi
dwi
fer
ycar
e,butwhomi
ghtnotseeksuchcar
e,hav
eanoppor
tuni
tyt
ouse
mi
dwi
fer
yser
vices.Themi
dwi
ves,
andt
hecommuni
tywhi
chsuppor
tst
hei
r
pr
act
ice,
arer
esponsi
blef
orr
emai
ningknowl
edgeabl
eaboutt
hewomenwi
thi
n
t
hei
rpr
act
icear
ea,
andf
ordev
elopi
ngandi
mpl
ement
ingout
reachpr
ogr
ams.I
fa
mi
dwi
fer
ypr
act
icef
indsi
tcannotser
veal
lwomenwhoar
erequest
ingser
vices,
t
hemi
dwi
vesar
eencour
agedt
otr
yandr
eachar
epr
esent
ati
vev
ari
etyofcl
i
ent
s
andar
eabl
etor
eferwoment
oot
hermi
dwi
fer
ypr
act
icesorr
elat
edser
vices(
e.g.
l
abourcompani
ons,
empower
ingchi
l
dbi
rt
hcl
asses)
.

Resear
chonEf
fect
ivenessofMi
dwi
fer
y
Mi
dwi
vesdev
elopandshar
emi
dwi
fer
yknowl
edgeandi
nit
iat
e,pr
omot
eand
par
ti
cipat
einr
esear
chr
egar
dingmi
dwi
fer
yout
comes.Resul
tsoft
hisr
esear
ch
shoul
dbei
ncor
por
atedi
ntomi
dwi
fer
ypr
act
ices.

ROPER,
LOGANANDTI
ERNEY:
ACTI
VITI
ESOFLI
VINGMODEL:

TheRoper
,LoganandTi
erneyact
ivi
ti
esofl
i
vingmodelofnur
singi
spr
obabl
ythe
onl
ygener
almodelofnur
singwhenhasbeendev
elopedi
nBr
it
ain.Modelof
nur
singshoul
dbebasedonamodelofl
i
ving,asi
ndi
vi
dual
sonl
yrequi
renur
sing
car
eint
ermi
tt
ent
lyi
nthei
rli
ves.Theyconsi
dert
hatnur
singshoul
dpr
ovi
deas
l
i
ttl
edi
srupt
iont
otheper
son’
sli
feaspossi
bleandt
hismaybef
aci
l
itat
esi
f
nur
sesbaset
hei
rpr
act
iceonamodelwomenconsi
der
sthei
ndi
vi
dualwi
thi
nthe
cont
extoft
hei
rev
ery
dayl
i
fe(
Roperetal
.
,1985)
:mi
dwi
fer
ycar
eissi
mil
arl
y
i
nter
mit
tentandi
sconcer
nedwi
tht
hewomanandt
hecont
extwi
thi
nwhi
chshe
l
i
ves.Mi
dwi
fer
ypr
act
icei
sconcer
nedwi
thhel
pingt
hewomanandf
ami
l
ymeet
t
hei
rneedsdur
ingt
hepr
egnancyandf
oll
owi
ngt
hebi
rt
handi
ntegr
ati
ngt
hei
rnew
r
olesi
ntot
hei
rongoi
ngl
i
ves.Amodelwhi
chi
sbasedonanawar
enessoft
he
woman’
swhol
eli
fewoul
dappeart
ohav
ethepossi
bil
i
tyt
oassi
stmi
dwi
fer
y
pr
act
ice.

Themodelcompr
isesf
iveel
ement
s:

Thel
i
fespan;

Theact
ivi
ti
esofl
i
ving;

Thedependence/
independenceoft
hei
ndi
vi
duali
nrel
ati
ont
oeachoft
he
act
ivi
ti
esofl
i
ving;

Fact
orsi
nfl
uenci
ngt
heact
ivi
ti
esofl
i
ving:
indi
vi
dual
i
zednur
sing.

Thel
i
fespanunder
pinst
hemodelasi
trest
sont
hei
deaoft
hecoar
seof
t
heper
son’
sli
fe.Theabi
l
ityofi
ndi
vi
dual
satdi
ff
erentst
agesoft
hei
rli
vest
omeet
t
hei
rneeds(
act
ivi
ti
esofl
i
ving)wi
l
lbeaf
fect
edbyt
hei
rposi
ti
oni
nthel
i
fespan.

Themodeli
dent
if
ies12ar
east
hatpeopl
eneedt
oaddr
essaspar
toft
he
pr
ocessofl
i
ving.Al
thought
heyar
eident
if
iedassepar
ateact
ivi
ti
es.Roperetal
.
(
1985)maket
hepoi
ntt
hatt
heact
ivi
ti
esar
eal
li
nter
rel
ated.Thi
sint
err
elat
ionshi
p
i
sseen.Forexampl
e,i
npr
egnancy
,wher
etheact
ivi
ti
esofeat
inganddr
inki
ng,
mobi
l
izi
ngandel
i
minat
ingar
eal
laf
fect
edbyt
heact
ivi
tyofexpr
essi
ngsexual
i
ty.
Thear
easar
ecal
l
edact
ivi
ti
esofl
i
vingbuti
ncor
por
atedwi
thi
neachar
eal
arge
numberofsepar
ateact
ivi
ti
es(
Roperetal
.,
1981)
.The12act
ivi
ti
esofl
i
vingar
e:

Mai
ntai
ningasaf
eenv
ironment
 Communi
cat
ing

Br
eat
hing

Eat
inganddr
inki
ng

El
i
minat
ing

Per
sonal
cleansi
nganddr
essi
ng

Cont
rol
l
edbodyt
emper
atur
e

Mobi
l
izi
ng

Wor
kingandpl
ayi
ng

Expr
essi
ngsexual
i
ty

Sl
eepi
ng

Dy
ing

The modelpr
ovi
des a f
ramewor
kfort
he assessmentoft
he woman
t
hroughout t
he chi
l
dbear
ing pr
ocess wi
th whi
ch she may demonst
rat
e
dependencei
nsomeact
ivi
ti
esatsomet
imes.I
ndependencei
not
heract
ivi
ti
es
andchangesi
nheri
ndependencei
not
her
sassheadapt
stohernewr
oledur
ing
t
hecour
seofpr
egnancy
,chi
l
dbi
rt
handt
hepost
nat
alper
iod.Consi
der
ati
onof
t
hismodel
inr
elat
iont
othemodel
sdev
elopedbyRubi
n(1984)andmer
cer(
1986)
suggest
sthatcombi
nat
ion ofel
ement
soft
hesemodel
smayassi
sti
nthe
assessmentoft
heneedsofwomenatdi
ff
erentst
agesi
npr
egnancyandaf
ter
t
hebi
rt
h.

I
nusi
ngt
heact
ivi
ti
esofl
i
vingmodel
,eachact
ivi
tyi
sassessedi
nrel
ati
on
t
othel
i
fe–span,i
ndependence/
dependenceandt
hef
ivei
nfl
uenci
ngf
act
ors.
Thef
ivei
nfl
uenci
ngf
act
orsar
egr
oupedi
ntot
hreecomponent
s:t
hephy
sicalor
phy
siol
ogi
cal
,soci
al– cul
tur
aland phy
siol
ogi
cal
,in descr
ipt
ions of t
he
assessmentpr
ocess.Suchanassessmentcanpr
oduceadet
ail
edpi
ctur
eoft
he
t
otalneedsoft
hechi
l
dbear
ingwoman,i
ncl
udi
ngpsy
chol
ogi
calandeducat
ional
needs,asshownbyTay
lorandCov
ent
ry(
1983)
,ami
dwi
fer
ycl
i
nicalt
eacherand
st
udentmi
dwi
fe.Theypr
ovi
deanexampl
eoft
heappl
i
cat
ionoft
hemodeli
nthe
car
eofawomani
ntheear
lypost
nat
alper
iod.Thi
sil
l
ust
rat
est
hecont
ri
but
ionof
t
hemodel
tot
hei
dent
if
icat
ionofar
angeofpot
ent
ial
andact
ualpr
obl
emsacr
oss
t
hespect
rum ofact
ivi
ti
esofl
i
ving.Tr
ial
soft
hemodell
edt
oexper
iencedbyone
woman,
causi
ngheranxi
etywhi
chhadnotbeeni
dent
if
iedpr
evi
ousl
ybyt
hewar
d
st
aff
.Thi
sexampl
eil
l
ust
rat
est
hev
alueofaf
ramewor
konwhi
cht
obasean
assessment
,rat
hert
hanpr
act
icebasedonnoappar
entf
ramewor
k,whi
chmay
l
eadt
opr
obl
emsbei
ngov
erl
ooked.

Nur
singcar
edescr
ibedbyt
heact
ivi
ti
esofl
i
vingmodeli
sbasedont
he
st
agesoft
hepr
ocessofnur
sing,assessment
,pl
anni
ng,i
mpl
ement
ati
onand
ev
aluat
ion (
Roperetal
.1981;Aggl
eton and chal
mer
s,1986)
.The model
descr
ibes t
hree t
ypes ofact
ivi
ty whi
ch ar
e under
taken by peopl
eto me:
pr
event
ingact
ivi
ti
es,comf
ort
ingact
ivi
ti
esandseeki
ngact
ivi
ti
es(
Roperetal
.
1983:Pear
sonandVaughan,1986)
.Theseact
ivi
ti
esmaybecar
ri
edoutbyt
he
i
ndi
vi
dualorbysomeoneel
se,suchasami
dwi
fe,onbehal
fofani
ndi
vi
dual
dependi
ngont
heneed,t
heper
son’
sdependencyandposi
ti
oni
nthel
i
fe–span.
Pr
event
ingact
ivi
ti
esar
eai
medatpr
event
ingi
l
lheal
th–f
orexampl
e,st
oppi
ng
smoki
ngi
npr
egnancyorhav
ingchi
l
dhoodi
mmuni
zat
ions.Comf
ort
ingact
ivi
ti
es
ar
eai
medatr
educi
ngdi
scomf
ort–f
orexampl
e,wear
ingcomf
ort
abl
ecl
othesi
n
pr
egnancy
.Seeki
ngact
ivi
ti
esar
eai
medatobt
aini
ngi
nfor
mat
ion–f
orexampl
e,
at
tendi
ngant
enat
alcl
assesorseeki
ngcar
e.Nur
singact
ivi
ti
esar
edescr
ibedby
t
hemodelascompr
isi
ngapr
event
ingcomponent
,acomf
ortcomponentanda
dependentcomponent
.Thi
slasti
sder
ivedf
rom t
heseeki
ngact
ivi
ti
esoft
he
i
ndi
vi
dualandappear
stodescr
ibet
heact
ivi
ti
esoft
henur
sewhi
char
emedi
cal
l
y
pr
escr
ibedsuchasadmi
nist
rat
ionofmedi
cines.

Appl
i
cat
ionoft
hismodelr
equi
resassessmentoft
hechi
l
dbear
ingwoman
i
nrel
ati
ont
oherposi
ti
oni
nthel
i
fe–span,herdependence/
independenceand
needsi
nrel
ati
ont
otheact
ivi
ti
esofl
i
vingi
nter
msofphy
sical
.Soci
o-cul
tur
aland
psy
chol
ogi
calaspect
s.Car
etomeett
heseneedsi
stheni
dent
if
iedi
nter
msof
t
het
ypeofact
ivi
tyr
equi
redt
omeett
heneed.Themodeli
sfocusedont
he
i
ndi
vi
dualandt
hei
rpr
esentabi
l
iti
est
omai
ntai
nthei
rheal
thwi
thi
nthecont
extof
t
hei
rphy
sical
,soci
alandpsy
chol
ogi
cal
needs.

ROSEMARY METHVEN: APPLI

CATI
ON OF OREM’
S AND HENDERSON’
S
MODELSTOMI
DWI
FERYCARE

Or
em f
ir
stdev
elopedt
hemodelofsel
f– car
edef
ici
tin1958andhas
publ
i
shedsev
eralr
evi
sionsoft
het
heor
ysi
nce(
Ebenetal
.,1989)
.Thecent
ral
modeldr
awson t
heor
yand knowl
edge i
n psy
chol
ogyand i
sbased on si
x
concept
s:sel
f–car
e;sel
f-
car
ecapabal
i
ties(
sel
f-
car
eagency
);t
her
apeut
icsel
f-
car
edemand;sel
f-
car
edef
ici
t;nur
singagency
;andnur
singsy
stem.Thecent
ral
phi
l
osophyoft
hemodeli
sbasedont
hev
iewt
hatpeopl
ear
eabl
etounder
take
sel
f-
car
efort
hemaj
ori
tyoft
het
imebutmayatt
imesr
equi
rehel
p.

Sel
f-
car
eiscompr
isedoft
hreet
ypesofsel
f-
car
erequi
sit
es:

1.Uni
ver
salsel
f-
car
erequi
sit
es.Thesear
ecommont
oal
lhumanbei
ngs
dur
ingal
lst
agesoft
hel
i
fecy
cle,andar
eadj
ust
edaccor
dingt
oage,
dev
elopment
alst
ate,
env
ironmentandot
herf
act
ors.

2.Dev
elopment
alsel
f-
car
erequi
sit
es.Thesear
eassoci
atedwi
thhuman
dev
elopment
alpr
ocessesandcondi
ti
onsandev
ent
sdur
ing v
ari
ous
st
agesoft
hel
i
fecy
cle,
forexampl
e,pr
emat
uri
tyandpr
egnancy
.

3.Heal
thdev
iat
ionsel
f-
car
erequi
sit
es.Thesear
eassoci
atedwi
thgenet
ic
andconst
it
uti
onaldef
ect
sandhumanst
ruct
ural
-f
unct
ionaldev
iat
ion,
 t
oget
herwi
tht
hei
ref
fect
s,medi
cal
diagnosi
s.

Or
em descr
ibesei
ghtuni
ver
salsel
f-
car
erequi
sit
esandMet
hven(
1986a;
1989)i
l
lust
rat
esassessmentoft
her
equi
sit
esi
ntheant
enat
albooki
ngi
nter
view:

1.Themai
ntenanceofasuf
fi
cienti
ntakeoff
ood;
forexampl
e:

Hast
her
ebeenanyal
ter
ati
oni
nyourusualeat
ingpat
ter
nsi
ncey
ou
becamepr
egnant
?

2.Themai
ntenanceofasuf
fi
cienti
ntakeofwat
er,
forexampl
e:

2.Doy
ouknow whatf
lui
drequi
rement
sar
erecommendedwheny
ouar
e
pr
egnant
?

3.The pr
ovi
sion ofcar
e associ
ated wi
th el
i
minat
ion pr
ocesses and
excr
ement
s,f
orexampl
e:

5.Doy
ouusual
l
ypassur
inewi
thoutdi
ff
icul
ty?

4.Themai
ntenanceofasuf
fi
cienti
ntakeofai
r,f
orexampl
e:

4.Doy
ouknowhowbr
eat
hingmaybeaf
fect
eddur
ingpr
egnancy
?

5.Themai
ntenanceofabal
ancebet
weenact
ivi
tyandr
est
,forexampl
e:

3b.Doy
oupur
sueanyspor
tsorunder
takeanyv
igor
ousexer
cise?

6.Thepr
event
ionofhaz
ardt
ohumanl
i
fe,humanf
unct
ioni
ngandhuman
wel
l
bei
ng,
forexampl
e:

8g.I
sther
eany
thi
ngt
hatusual
l
ymakesy
ouf
eel
str
essedoranxi
ous?

7.Themai
ntenanceofabal
ancebet
weensol
i
tudeandsoci
ali
nter
act
ion,
f
orexampl
e:

9h.Whati
syourr
eact
iont
o bei
ng car
edf
orbyhospi
talst
affand
 mi
dwi
veswhom y
oumaynothav
emetbef
ore?

8.Thepr
omot
ionofhumanf
unct
ioni
nganddev
elopmentwi
thi
nsoci
al
gr
oupsi
naccor
dwi
thhumanpot
ent
ial
,knownhumanl
i
mit
ati
onsand
t
hehumandesi
ret
obenor
mal
,forexampl
e:

6c.whathav
eyour
eadorwhatdoy
ouknowabouthav
ingababyand
becomi
ngamot
her
?

Sel
f-
car
ecapabi
l
iti
es(
agency
)ist
heabi
l
ityoft
hei
ndi
vi
dualt
omeett
hei
r
ownneedsort
heneedsofadependent
,suchasababy
.Thet
her
apeut
icsel
f-
car
edemanddescr
ibest
heneedf
orhel
ptomai
ntai
norpr
omot
eheal
th,andt
he
sel
f-
car
edef
ici
tdescr
ibest
hedef
ici
tbet
weent
het
her
apeut
icsel
f-
car
edemand
andt
heabi
l
ityoft
hei
ndi
vi
dualt
omeett
hesedemandst
hroughexer
cisi
ngsel
f-
car
ecapabi
l
iti
es.Thenur
singagencyact
stomeett
hisdef
ici
tthr
oughoneof
t
hreenur
singsy
stems:
whol
l
ycompensat
ory
,inwhi
cht
henur
se/
midwi
feact
sfor
t
heper
sonwhoi
sunabl
etomeett
hei
rownneeds(
forexampl
e,i
funconsci
ous
oronbed-
rest
,post
nat
all
yexper
ienci
ngsi
de-
eff
ect
sofepi
dur
alanaest
hesi
a).
Par
tl
ycompensat
orywhent
henur
se/
midwi
feunder
takessomeact
ivi
ti
esf
ort
he
i
ndi
vi
dual(
forexampl
e,car
e act
ivi
ti
es i
nlabour
);and suppor
ti
ve educat
ive.
Wher
ethei
ndi
vi
dual
isabl
etounder
takesel
f-
car
eact
ivi
ti
esbutneedsassi
stance
t
odoso(
forexampl
e.Awomangai
ningconf
idencei
nbr
east
-f
eedi
ng.

Wi
thi
nthenur
singsy
stem,
fiv
emet
hodsofassi
stancear
edescr
ibed:

(
i) Act
ingordoi
ngf
oranot
her
;

(
ii
) Gui
dinganot
her
;

(
ii
i) Suppor
ti
nganot
her(
phy
sical
l
yorpsy
chol
ogi
cal
l
y);

(
iv) Pr
ovi
ding an env
ironmentt
hatpr
omot
es per
sonaldev
elopmenti
n
r
elat
iont
obecomi
ngabl
etomeetpr
esentorf
utur
edemandsf
oract
ion;
 (
v) Teachi
nganot
her
.

Thephi
l
osophybehi
ndt
hisappr
oacht
opr
act
icei
sthati
ndi
vi
dual
sar
eessent
ial
l
y
sel
f-
car
ingandt
hati
tist
her
oleoft
henur
seormi
dwi
fet
oident
if
ysel
f-
car
e
def
ici
tsandacti
nway
stoei
thercompensat
efort
hei
ndi
vi
dual
’
sinabi
l
ityt
omeet
t
hei
rneeds orsuppor
tthe i
ndi
vi
duali
n meet
ing t
hei
rneeds.A mi
dwi
fer
y
assessmentwoul
dther
efor
eincl
udeassessmentandpl
anni
ngofcar
ewi
thi
nthe
si
xconceptar
eas.Met
hvenhasi
l
lust
rat
edt
heuseoft
hismodeli
nthecar
eofa
woman t
hroughoutt
he chi
l
dbear
ing pr
ocess.I
nthi
sil
l
ust
rat
ion met
hven
concent
rat
esont
heassessmentofuni
ver
salsel
f-
car
erequi
sit
es,comment
ing
t
hatdev
elopment
alsel
f-
car
erequi
sit
eshav
ebeenassessedbyt
hei
nter
view
conduct
edusi
ngt
heobst
etr
icnot
es,andt
hatassessmentofheal
th-
dev
iat
ion
sel
f-
car
erequi
sit
esi
sunnecessar
yfort
hepur
poseoft
hepr
esentst
udy
,whi
ch
concent
rat
esonawomanwhoexpect
stobei
nast
ateofnor
mal
heal
th.

Met
hven has al
so pr
ovi
ded a descr
ipt
ion of t
he use of Vi
rgi
nia
Hender
son’
sappr
oacht
onur
singi
nthecar
eofawomandur
ingt
hechi
l
dbi
rt
h
pr
ocess.I
tisnotsur
pri
singt
hatMet
hvenconsi
der
sthatbot
hHender
sonand
Or
em pr
ovi
deaf
ramewor
kormodelwhi
chcanbeusedi
nthecar
eoft
he
chi
l
dbear
ingwoman,
ast
het
woappr
oachesar
ever
ysi
mil
ar.

Hender
sonhasdef
inednur
singasf
oll
ows:

Theuni
quef
unct
ionoft
henur
sei
stoassi
stt
hei
ndi
vi
dual
,si
ckorwel
l
,int
he
per
for
manceoft
hoseact
ivi
ti
escont
ri
but
ingt
oheal
thori
tsr
ecov
ery(
ort
oa
peacef
uldeat
h)t
hathewoul
dper
for
m unai
dedi
fhehadt
henecessar
yst
rengt
h,
wi
l
lorknowl
edge.Andt
odot
hisi
nsuchawayast
ohel
phi
m gai
nindependence
asr
api
dlyaspossi
ble.

Theassi
stanceoft
henur
sei
sfocusedon14basi
cneedsoract
ivi
ti
esof
dai
l
yli
vi
ng.Ebenetal
.ident
if
yHender
sonasoneoft
hepeopl
ewhoi
nfl
uenced
Or
em i
nhert
heor
ydev
elopment
.Theassi
sti
ngr
oleoft
henur
sei
nhel
pingt
he
per
sonr
egai
nindependencei
nact
ivi
ti
esofdai
l
yli
vi
nghasmanysi
mil
ari
ti
est
o
t
hef
ocusoft
henur
singagencyonhel
pingt
heper
sont
oachi
evesel
f-
car
e
t
hroughat
tent
iont
osel
f-
car
edef
ici
ts.RunkandQui
l
li
ncommentt
hatHender
son
di
dnotdescr
ibeherdef
ini
ti
onasat
heor
y,butt
heconcept
swi
thi
nthedef
ini
ti
on
canbeanal
ysedandseent
ofor
mthebasi
sofamodel
.

Anot
heri
nter
est
ingf
eat
ureofHender
son’
sdef
ini
ti
oni
sit
sfocusonheal
th
andeducat
ion.Al
thoughi
nthewor
ldoft
hei
l
lness-
nur
set
hisaspectmaynot
hav
ebeenemphasi
zed,
ift
hedef
ini
ti
oni
ssl
i
ght
lyr
ear
rangedi
tcanbeseenmor
e
cl
ear
lyt
oappl
ytot
hewor
koft
heheal
th-
nur
sei
nthecommuni
tyandt
othe
mi
dwi
fe:

Theuni
quef
unct
ionoft
hemi
dwi
fei
stoassi
stt
hewoman,wel
lorsi
ck,i
n
t
heper
for
manceoft
hoseact
ivi
ti
escont
ri
but
ingt
oheal
thori
tsr
ecov
ery(
ort
oa
peacef
uldeat
h)t
hatshe woul
d per
for
m unai
ded i
fshe had t
he necessar
y
knowl
edge,wi
l
lorst
rengt
h.Andt
odot
hisi
nsuchawayast
ohel
phergai
n
i
ndependenceasr
api
dlyaspossi
ble.

Met
hvendi
scussest
hecont
ri
but
iont
hatHender
son’
smodelmadet
ocar
e
andal
sot
hedi
ff
icul
ti
esi
nappl
yi
ngt
hemodel
.Thr
oughherwor
kwi
thOr
em and
Hender
son’
smodel
s.Met
hvenwasoneoft
hei
nit
iat
orsoft
hepr
act
icalwor
kand
t
heor
eti
caldi
scussi
onwhi
chi
sneededt
ounder
standt
hewaymi
dwi
vest
hink
abouthowcar
einf
luencest
hecar
epr
ovi
ded.Met
hveni
sconcer
nedt
omaket
he
el
ement
sandconcept
sofmi
dwi
fer
ypr
act
iceexpl
i
citt
oenabl
emi
dwi
vest
o
i
dent
if
ythewi
deneedst
hatwomenhav
eandt
omakeexpl
i
citt
hemi
dwi
fer
ycar
e
neededt
omeett
heseneeds.Lackofami
dwi
fer
ymodell
edhert
oexpl
oret
he
r
elev
anceofnur
singmodel
sformi
dwi
fer
ybutsheconcl
udesatt
heendofher
di
scussi
onoft
heuseofHender
son’
smodel
:

Assuchhermodelmaybesai
dtobeani
mpr
ovementont
hepr
act
iceof
per
for
mingmi
dwi
fer
yassessmentwhi
chi
snotbasedonanyf
ramewor
kot
her
t
hant
radi
ti
on.Howev
er,amodelsat
isf
act
ori
l
ydesi
gnedf
ormi
dwi
fer
y,basedon
heal
thandnotoni
l
lness,
resul
ti
ngf
rom r
esear
chi
ntowhati
nfor
mat
ionmi
dwi
ves
r
eal
l
yneedi
nor
dert
opr
ovi
deef
fect
ivecar
efort
hemot
her
,andenabl
i
ngt
he
mi
dwi
fet
oexer
ciseheri
ndependentpr
act
it
ionerr
olewi
thi
ntheheal
thcar
eteam,
hasy
ett
obedev
eloped.

THEROYADAPTATI
ONMODEL

Theadapt
ati
onmodel
,i
nit
ial
l
ydev
elopedbysi
stercal
l
ist
aroyi
nthe1960s,
i
sanot
herexampl
eofagr
andnur
singmodeldev
elopedf
rom t
heknowl
edge
baseoft
heor
eti
calandexper
iment
alpsy
chol
ogy
.Thi
smodelhasbeenused
ext
ensi
vel
yinnur
singpr
act
ice,
educat
ionandr
esear
chandhasal
sobeenusedi
n
t
hecar
eofwomendur
ingchi
l
dbear
ing.Cast
ledi
neandJones(
1987)pr
ovi
dean
i
l
lust
rat
ionoft
heuseoft
hismodeli
nthecar
eoft
hechi
l
dbear
ingwoman,whi
l
e
Fawet
tand Tul
man (
1990)and Ly
nam and Mi
l
ler(
1991)hav
e under
taken
r
esear
chi
ntot
her
elev
anceoft
heconcept
sincl
udedi
nthemodelt
ocar
eof
womendur
ingpr
egnancy
.

Thebasi
soft
hemodeli
sthev
iewt
hatpeopl
ear
ebi
opsy
chosoci
albei
ngs
i
n const
anti
nter
act
ion wi
tht
hei
renv
ironment(
Rambo,1984)
.Gener
all
ythe
i
ndi
vi
duali
sabl
etomanaget
hisi
nter
act
ionandmai
ntai
nthei
rheal
thbutwhen
t
her
eisabr
eakdowni
nthei
ndi
vi
dual
’
sabi
l
ityt
omeett
hedemandsoft
his
i
nter
act
ionnur
sing,ormi
dwi
fer
y,car
ewi
l
lber
equi
red.Themodeli
ncl
udest
hree
t
ypesofst
imul
iwhi
chaf
fectt
hei
ndi
vi
dual
,thei
radapt
ati
onandt
husheal
th;
Aggl
etonandChal
tner
s1986;
Pear
sonandVaughan;

Focalst
imul
iar
efoundi
nthei
mmedi
ateenv
ironmentandar
ethemai
n
f
act
orswhi
chi
nfl
uencet
heper
son–f
orexampl
e,t
heheal
thori
l
lheal
thoft
he
newl
y-
bor
nbabywi
l
lhav
eani
mmedi
ateef
fectont
heheal
thoft
henewmot
her
.
Cont
ext
ualst
imul
iar
ethe gener
alf
act
ors whi
ch sur
round t
he woman.For
exampl
e,poorl
i
vingcondi
ti
onsandt
heext
entoff
ami
l
ysuppor
twi
l
laf
fectt
he
ext
entt
owhi
chshei
sabl
etocopewi
th(
adaptt
o)i
l
l-heal
thi
nherchi
l
d.Resi
dual
st
imul
iar
eint
ernalf
act
orswhi
char
eper
sonalt
othei
ndi
vi
dual
,thei
rbel
i
efs,
exper
iences and at
ti
tudes.Forexampl
e,i
fthe woman has had a poora
exper
ienceofmat
erni
tycar
eint
hepastshewi
l
lbr
ingt
hisexper
iencet
oher
expect
ati
onsoff
utur
ecar
e.

Thesest
imul
iar
edescr
ibedasaf
fect
ingt
hei
ndi
vi
duali
nfourar
easor
modesoft
hei
rli
ves:t
hephy
siol
ogi
calmode,t
hesel
f-
conceptmode,t
her
ole
f
unct
ion mode and t
he i
nter
dependence mode.The phy
siol
ogi
calmode i
s
concer
nedwi
tht
hef
unct
ioni
ngoft
hebody
,andneedsemer
gewhent
her
eis
di
srupt
ioni
nthephy
siol
ogi
cal
processesof
:

o Oxy
genat
ionandci
rcul
ati
on

o Fl
uidandel
ect
rol
ytebal
ance

o Nut
ri
ti
on

o El
i
minat
ion

o Restandact
ivi
ty

Theadapt
ati
onmodelt
akesahol
i
sti
cappr
oacht
oassessmentandcar
e
and,whi
l
eiti
ncl
udesat
tent
iont
ophy
siol
ogi
calf
act
ors,t
hreeoft
hemodesar
e
concer
nedwi
thwhatmi
ghtgener
all
ybet
ermedpsy
chosoci
alar
eas;
sel
f-
concept
r
olef
unct
ioni
ngandi
nter
dependenceCast
ledi
neandJones(
1987)descr
ibet
hei
r
i
nter
esti
ntheappl
i
cat
ionoft
heRoyadapt
ati
onmodeli
nmi
dwi
fer
yasar
isi
ng
f
rom ar
evi
ewofmi
dwi
fer
yrecor
dswhi
chshowedl
i
ttl
erecor
dingofpsy
chosoci
al
i
nfor
mat
ionbymi
dwi
ves.Theydescr
ibet
heuseofanassessmentschedul
ein
t
heant
enat
alper
iod,whi
chi
ncl
udedassessmentofi
ntr
aper
sonalf
act
ors(
sel
f-
conceptmode)
,int
erper
sonalf
act
ors(
rol
efunct
ion mode)
,int
erdependency
modef
act
orsandphy
sical
exami
nat
ion(
phy
siol
ogi
cal
mode)
.
 Ar
easassessedundert
hesel
f-
conceptmodei
ncl
udedmoodsandf
eel
i
ngs,
bodyi
mage,
sexual
i
ty,
met
hodsofcopi
ngandpai
nassessment
.Theassessment
oft
her
olef
unct
ionmodei
ncl
udedassessmentoft
her
oleshel
dbyt
hewoman,
andanyconf
li
ctbet
weendi
ff
erentr
olesandt
headopt
ionofnewr
oles:

Thi
sar
eacov
erst
hepat
ient
’susualr
oleandchangi
ngr
olef
unct
ionsand
r
elat
ionshi
pswi
thot
her
sei
therasapr
egnantwomanorasamot
heri
nrel
ati
on
t
oot
her
sathomeoratwor
k.I
tsur
pri
sesmanywhent
hei
rrol
eisspl
i
tint
wo,
i.
e.
ofawi
feandamot
her
.

Fact
orsassessedi
nthei
nter
dependencemodei
ncl
udet
heext
entt
owhi
ch
t
hewomani
sdependentonherf
ami
l
yandonheal
thcar
epr
act
it
ioner
ssuchas
t
he mi
dwi
fe and t
he gener
alpr
act
it
ioner
.Thi
s exampl
e pr
ovi
des an ear
ly
i
l
lust
rat
ionoft
heuseoft
heRoyAdapt
ati
onmodeli
nmi
dwi
fer
y.Asdi
scussed
abov
e,t
his modeli
s now qui
te wi
del
y used i
n mi
dwi
fer
y car
ein Br
it
ain.
Cast
ledi
neandJonescommentt
hatt
hemodelhasal
ter
edmi
dwi
fer
ypr
act
iceby
hel
pingmi
dwi
vest
o bemor
eawar
eofpsy
chosoci
alneedsandhashel
ped
womenf
eel
mor
einv
olv
edi
nthei
rcar
e.

NEUMANSYSTEMSMODEL

Spi
res ar
gues t
hatt
he Neuman sy
stems model
,dev
eloped byBet
ty
Neuman,i
susef
uli
nmi
dwi
fer
ypr
act
ice,ast
hemodelt
akesasi
tsst
art
ing-
poi
nt
t
hewel
lindi
vi
dualorwel
lcommuni
ty.Theper
sonorcommuni
ty,t
ermedt
he
cl
i
entsy
stem,i
sdepi
cted asacent
ral
,ener
gycor
esur
rounded byl
i
nesof
r
esi
stance and t
he nor
mall
i
ne of def
ence.The cent
ralcor
e compr
ises
phy
siol
ogi
cal
, pshy
chol
ogi
cal
, soci
ocul
tur
al, dev
elopment
al and spi
ri
tual
v
ari
abl
es.Thel
i
nesofr
esi
stancei
l
lust
rat
etheabi
l
ityoft
hecl
i
entsy
stem t
o
mai
ntai
nit
sst
ateofequi
l
ibr
ium.Thenor
mall
i
neofdef
encedemonst
rat
ethe
usualst
ateofheal
thoft
heper
sonand pr
ovi
desast
andar
d agai
nstwhi
ch
dev
iat
ionsi
nheal
thcanbemeasur
ed.Thenor
mall
i
neofdef
encei
sthr
eat
ened
byst
ressor
sint
heenv
ironmenti
nwhi
cht
hei
ndi
vi
duali
slocat
ed.Thr
eet
ypeof
env
ironment ar
e i
dent
if
ied: t
he ext
ernal env
ironment
, whi
ch i
ncl
udes
i
nter
per
sonal r
elat
ionshi
ps; t
he i
nter
nal env
ironment
, whi
ch consi
sts of
i
ntr
aper
sonalf
orces occur
ri
ng wi
thi
nthe cl
i
entsy
stem:and t
he cr
eat
ed-
env
ironment
,whi
ch i
s subconsci
ousl
ycr
eat
ed and whi
ch goes bey
ond t
he
i
nter
nal
andext
ernal
env
ironment
sencompassi
ngbot
h.

I
nthi
smodel
,then,chi
l
dbi
rt
hisper
cei
vedt
obeanor
malpr
ocess.The
mi
dwi
fer
olel
i
esmai
nlyi
npr
imar
ypr
event
iont
ost
rengt
hent
hemot
her
-f
etus
i
nter
nall
i
nesofr
esi
stanceandout
erl
i
nesofdef
encet
oenabl
ethem t
ocope
wi
thst
ressor
sandpr
eventt
heneedf
ormedi
cal
int
erv
ent
ion.(
Spi
res,
1991,
p.10)
.

I
nherdi
scussi
onoft
hemodel
,spi
respr
ovi
desexampl
esofi
ntr
aper
sonal
,
i
nter
per
sonalandext
raper
sonalf
act
orsandt
hesear
efur
theri
l
lust
rat
edbyDunn
andTr
epani
eri
nadi
scussi
onoft
heNeumanssy
stem modeli
nper
inat
alcar
e.
Consi
der
ingt
hewomanandt
hef
etusasoneuni
t,t
heyi
dent
if
ythef
oll
owi
ng
exampl
es ofsour
ces ofi
ntr
aper
sonalst
ress af
fect
ing t
he f
ive gr
oups of
v
ari
abl
es:

Phy
siol
ogi
cal
: Mat
ernal
-wei
ghtgai
n,i
ncompet
entcer
vix;f
etus-
hypoxi
a,
genet
icpr
obl
ems.

Psy
chol
ogi
cal
: Anxi
ety
,gr
iefpr
ocess

Soci
ocul
tur
al: Rol
econf
li
ct,
Cul
tur
albel
i
efs

Dev
elopment
al: Educat
ional
lev
el,
dev
elopment
alt
asksofpr
egnancy

Spi
ri
tual
: Bel
i
efsaf
fect
ingpr
egnancyandchi
l
dbi
rt
h

Theseexampl
esi
l
lust
rat
etheut
il
it
yoft
hemodeli
nthecar
eoft
hechi
l
dbear
ing
womanandt
hei
ncor
por
ati
oni
nthemodelofal
arger
angeofconcept
sand
v
ari
abl
eswhi
chneedt
obeconsi
der
edbyt
hemi
dwi
fei
fthewel
l
bei
ngoft
he
womanandf
etus/
inf
anti
stobeopt
imi
zed.