Nurses’ Perception of the Facilitators and Barriers to the Implementation of Safe Sleep Recommendations in the Hospital Inpatient Setting

Objective: To identify facilitators and barriers to modeling and teaching safe sleep recommendations in the hospital inpatient setting to guide development of nursing education. Design: Qualitative study. Setting: Three hospitals in Connecticut and Virginia. Sample: The total sample size was 41 nurses and staff members. Methods: We conducted five focus groups with 41 nurses and other staff. Focus groups were facilitated by a trained moderator using a script modified in an iterative process. Discussions were digitally recorded and transcribed. Using standard qualitative techniques, data were organized with qualitative software and analyzed with constant comparative methods to identify key themes and subthemes. Results: Three main themes emerged as key facilitators and barriers: Previously held beliefs of families and providers could facilitate and act as barriers to modeling and teaching safe sleep recommendations. Nurses described many families not wanting to follow recommendations based on their cultural beliefs or previous practices. Inconsistent provider messages were seen as a barrier. Nurses and other health care providers were reported to sometimes give mothers messages contrary to recommendations of the American Academy of Pediatrics. Nurses felt that messages to families would only be effective if consistent. External forces can drive the success of messaging to providers and families. Nurses cited regulations from outside accreditation bodies and protocols as drivers for delivering accurate information. Many nurses noted that media messages and infant products sold in stores (such as bumpers) were often contrary to recommendations. Conclusion/Implications for Nursing Practice: We identified key themes that are important to consider when developing a program to educate nursing staff to teach and model safe sleep messages that included overcoming families’ cultural beliefs about infant care practices, the importance of uniform messages, and the influence of external regulations and contradictory media images.