Hospital units as social contexts: effects on maternal behavior

This paper examines the impact of different styles of nursing in maternity units on maternal behavior. These styles are found to be independent of the units' formal organizational characteristics and to vary depending on specific nursing tasks. The degree to which unit management affords opportunities for individualized patient teaching probably has the greatest impact on maternal behavior. Forty-five mothers, closely matched on ethnicity, age, marital status, socioeconomic status and parity, who delivered in three different hospital units, were observed systematically while feeding their infants. The investigators' observations, supplemented by measures of nurse task conceptions and perceptions of work structure, were used to characterize each unit. Analyses of variance, in which each hospital represented a fixed level of treatment, showed that mothers in the moderately supportive unit were significantly more affectionate and responsive towards their infants, and behaved less passively towards them, than mothers in units where nursing work was highly routinized or where zeal for innovation predominated. The moderately supportive unit also significantly diminished the effects of social class and of prior experience with children on affectionate maternal behavior. The threat to validity posed by self-selection of mothers into hospital units was accounted for by the selection of hospitals owned by one prepaid group plan, each serving socioeconomically similar populations in different catchment areas, and by data from the mothers which showed that plan membership and hospital selection were governed by financial considerations and geographical convenience. The findings provide evidence that the social context of the hospital unit--particularly the opportunity for individualized interaction between nurse and patient--may have an effect on early maternal behavior which is independent of the mother's own characteristics.