Endorsing Safe Sleep: Helping Nurses Turn Recommendations Into Reality

Purpose for the program:

Sudden Infant Death Syndrome (SIDS) is now considered preventable.  Since 1992 the American Academy of Pediatrics’ (AAP) SIDS prevention or "safe sleep" recommendations have been considered “best practice”.  In 2011 the AAP published an expanded list of safe sleep recommendations.  Neonatal nurses are now being asked to endorse these strategies from the time of birth.

Multiple studies have described inconsistent safe sleep practices among hospital nurses which then leads to confusion for parents.  SIDS prevention efforts have been hindered by neonatal nurses’ failure to model safe sleep behaviors and educate parents.  Furthermore, some of the recommendations have been met with resistance, with other so-called “experts” creating controversy and skepticism.  This controversy has created significant barriers and added to the confusion for both nurses and parents, creating a difficult learning environment.  The purpose of this program was to not only teach nurses the safe sleep recommendations, but to also address the controversy and provide answers to their concerns.

Proposed change:

The safe sleep program of this maternal-newborn unit was developed to educate and convince nursing staff that SIDS can be prevented.  These nurses would then be prepared and motivated to convince parents of the need to follow the safe sleep recommendations.

Implementation, outcomes and evaluation:

This program was designed as a nursing competency that was slowly implemented over a one year period, with the content broken into four modules.  A pretest was given prior to the first module.  After the first module which was an overview of all the strategies, key unsafe sleep practices were identified and a list provided of nursing practices that needed to change.  In the months following, in-depth information on each strategy was provided, resources were created to assist with education of parents, and crib audits done to monitor progress.  At the end of the year a post test showed marked improvement of nurses’ knowledge, and crib audits showed marked improvement of safe sleep behaviors modeled by nurses.

Implications for nursing practice:

The United States is in last place (with New Zealand) for SIDS and other sleep-related deaths among developed nations.  These recommendations are considered “best practice” yet neonatal nurses have been slow to implement them.  Working to break through the barriers and controversy with evidence and dialogue will move us toward a unified endorsement of the safe sleep recommendations.

Keywords:

Safe sleep

Sudden infant death syndrome

SIDS prevention

Safe sleep recommendations