Endorsing safe infant sleep: a call to action

Knowledge and Self-Reported Practice of Postnatal Mothers on Sudden Infant Death Syndrome Prevention: A Cross-Sectional Study

The word “Sudden Infant Death Syndrome (SIDS)” is used for a sleeping infant, who has apparently been quite well, is found unexpectedly dead. There are varied discussions throughout the world trying to find the possible reasons and preventive measures toward these sudden deaths. However, limited studies are undertaken regarding knowledge of mothers related to SIDS. The present study aimed at identifying the knowledge gaps present among the postnatal mothers toward SIDS and assess their practices that may influence SIDS among infants. The research design was a descriptive cross-sectional design and a 107 postnatal mothers were recruited focusing on the aim of the study through purposive sampling technique. A structured knowledge questionnaire and self-reported practice checklist was prepared and validated from experts.

The findings of the study revealed that the majority of subjects 57 (53.3%) had good knowledge with a mean score of 9.34 ± 1.83 (maximum score-15). The mean practice score on prevention of SIDS among subjects was 13.76 ± 1.13 (maximum score-16). There was no significant correlation between knowledge and practice (r = −0.38, p = 0.7). However, significant association was seen between knowledge on prevention of SIDS and baseline variables such as education (p = 0.001), occupation (p = 0.001), place of residence (p = 0.001), and family income (p = 0.01). Moreover, there was a significant association between self-reported practice and age of mothers (p = 0.03).

The study findings showed good knowledge level among majority of the mothers and executed good practice toward care of the infant. However, 30.8% of the mothers had average to poor level of knowledge, which is significant and needs attention.

Exploring Lactation Consultant Views on Infant Safe Sleep

Objectives The purpose of this qualitative study was to explore the infant safe sleep beliefs and occupational practices of lactation consultants and to determine if lactation consultants give advice to clients that is consistent with the American Academy of Pediatrics' recommendations on this topic. Methods Focus groups were conducted with certified lactation consultants in two cities in Ohio. Participants discussed the role of lactation consultants, the infant sleep advice they provide to women, their views on the American Academy of Pediatrics' infant safe sleep recommendations and related policies, and perceived benefits and barriers associated with providing infant safe sleep education as part of their work. A member-checking session was held to ensure the credibility of the findings. Results Four focus groups were conducted with 22 certified lactation consultants between September and November 2015. Major themes that emerged included: lactation consultants' beliefs regarding the importance of bedsharing for supporting breastfeeding success; their disagreement with the infant safe sleep recommendations of the American Academy of Pediatrics; their frustration with policies that restrict consultants' ability to discuss bedsharing; and the impact of infant safe sleep policies on their work and the advice they provide. Conclusions for Practice Lactation consultants interact with mothers of newborns at a critical time for infant safe sleep decision-making and may influence a woman's choices related to this topic. Women may not be receiving messages from lactation consultants that are consistent with the infant safe sleep recommendations of the American Academy of Pediatrics.

Barriers to and Interventions that Increase Nurses' and Parents' Compliance With Safe Sleep Recommendations for Preterm Infants

The purpose of this integrative review was to identify interventions that increase compliance of nurses and of parents with safe sleep recommendations for premature infants. Ten studies were included in the final sample, including three studies with a prospective descriptive design, five quality improvement initiatives with an interventional research design, one secondary analysis, and one retrospective medical chart review. Study samples included neonatal nurses and parents of premature infants in NICUs and transitional care nurseries in Massachusetts, Missouri, New York, North Carolina, Ohio, Pennsylvania, and Texas. Sample sizes ranged from 5 to 259 NICU parents and 86 to 658 neonatal nurses. The categories of interventions we identified include identifying barriers to compliance, changing hospital policy, and providing safe sleep education for nurses and parents. We conclude that hospitals should have current, evidence-based safe sleep policies with clear transition guidelines for premature infants and that consistent and comprehensive nursing and parental education related to safe sleep should include current American Academy of Pediatrics recommendations and should address potential barriers to compliance.

Is it Time for a Sudden Infant Death Syndrome (SIDS) Awareness Campaign? Community Stakeholders' Perceptions of SIDS

Background

Sudden infant death syndrome (SIDS) remains a leading cause of infant death in the United States and in Virginia, the SIDS rate is higher than the national average. We sought to gauge the perceptions among community-identified stakeholders as to community resource needs to reduce SIDS.

Methods

We used snowball sampling to identify important community stakeholders to be interviewed as key informants. A semi-structured interview lasting 45 min-2 hours was delivered to determine resource needs to reduce SIDS, and whether high-risk community members were aware of SIDS risk factors among stakeholders representing a variety of disciplines. Interviews were conducted in two geographic areas with higher than average rates of infant mortality, an urban district, Winchester City, VA and a rural district, Page County, VA.

Results

A total of 74 interviews were completed with stakeholders in healthcare, health departments, social services, law enforcement, education/childcare, faith-based institutions, non-profit agencies and non-affiliated community members. The majority of respondents perceive that high-risk community members are not aware of factors that can lead to SIDS (50%). Participants suggested that more "education" is needed to further reduce the rates of SIDS in their communities (73%). Respondents detailed that more pervasive, strategic, and multi-channeled education is necessary to reduce cases of SIDS.

Conclusion

Community leaders perceive that high-risk community members are not fully aware of risk factors that can lead to SIDS. Maternal/child health stakeholders in these Virginia locales suggested more community-based education as a potential solution to SIDS.

Safe sleep for pediatric inpatients

PURPOSE

To improve sleep environment safety for inpatient infants.

DESIGN AND METHODS

This quality improvement project involved assessment of sleep environment safety for inpatient infants before and after a bundled intervention of staff education and introduction of swaddle sacks and bedside storage bins.

RESULTS

The proportion of infant cribs without loose objects in them increased (32-72%, p = .025), and safe sleep positioning remained stable (82% vs. 95%, p = .183).

PRACTICE IMPLICATIONS

Staff education, swaddle sleep sacks, and bedside storage containers were associated with improved sleep safety among pediatric inpatients at our institution and may help at other institutions.

Preventing in-hospital newborn falls: a literature review

In-hospital newborn falls are arguably one of the most underresearched and underreported issues for organizations that care for newborn patients. From the few published statistics of in-hospital fall rates, we know that perhaps 600 to 1,600 newborn falls occur annually. Many of these falls can result in injury or even death of the newborn, legal issues for the institution, and severe emotional stress to the caregiver(s) and parents. Therefore, we searched the literature to ascertain causation and associated risks associated with in-hospital newborn falls. This is an important issue for nurses to understand because not only can the newborn be harmed due to a fall, but the actual newborn fall can also elicit strong feelings of guilt and culpability in the caregiver(s). This article reviews the literature to examine what is known about the factors associated with in-hospital newborn falls, to explore prevention measures, and to present best practices for how to adopt safe-sleep policy to prevent newborn falls.

Do nurses provide a safe sleep environment for infants in the hospital setting? An integrative review

BACKGROUND

Sudden infant death syndrome (SIDS) may be the most preventable cause of death for infants 0 to 6 months of age. The American Academy of Pediatrics (AAP) first published safe sleep recommendations for parents and healthcare professionals in 1992. In 1994, new guidelines were published and they became known as the "Back to Sleep" campaign. After this, a noticeable decline occurred in infant deaths from SIDS. However, this number seems to have plateaued with no continuing significant improvements in infant deaths.

OBJECTIVES

The objective of this review was to determine whether nurses provide a safe sleep environment for infants in the hospital setting. Research studies that dealt with nursing behaviors and nursing knowledge in the hospital setting were included in the review.

DATA SOURCES

A search was conducted of Google Scholar, CINAHL, PubMed, and Cochrane, using the key words "NICU," "newborn," "SIDS," "safe sleep environment," "nurse," "education," "supine sleep," "prone sleep," "safe sleep," "special care nursery," "hospital policy for safe sleep," "research," "premature," "knowledge," "practice," "health care professionals," and "parents."

STUDY ELIGIBILITY CRITERIA

The review included research reports on nursing knowledge and behaviors as well as parental knowledge obtained through education and role modeling of nursing staff. Only research studies were included to ensure that our analysis was based on rigorous research-based findings. Several international studies were included because they mirrored findings noted in the United States. All studies were published between 1999 and 2012.

PARTICIPANTS

Healthcare professionals and parents were included in the studies. They were primarily self-report surveys, designed to determine what nurses, other healthcare professionals, and parents knew or had been taught about SIDS.

SYNTHESIS METHOD

Integrative review.

RESULTS

Thirteen of the 16 studies included in the review found that some nurses and some mothers continued to use nonsupine positioning. Four of the 16 studies discussed nursing knowledge and noncompliance with AAP safe sleep recommendations. Eleven of the 16 studies found that some nurses were recommending incorrect sleep positions to mothers. Five of the 16 studies noted that some nurses and mothers gave fear of aspiration as the reason they chose to use a nonsupine sleep position.

LIMITATIONS

In the majority of the studies, the information was self-reported, which could impact the validity of the findings. Also, the studies used convenience sampling, which makes study findings difficult to generalize.

CONCLUSIONS AND IMPLICATIONS

The research indicates that there has been a plateau in safe sleeping practices in the hospital setting. Some infants continue to be placed in positions that increase the risk for SIDS. The research also shows that some nurses are not following the 2011 AAP recommendations for a safe sleep environment. Clearly, nurses need additional education on SIDS prevention and the safe sleep environment, and additional measures need to be adopted to ensure that all nurses and all families understand the research supporting the AAP recommendation that supine sleep is best. Further work is needed to promote evidence-based practice among healthcare professionals and families.