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.
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.
A search was conducted of Google Scholar, CINAHL, PubMed, and Cochrane, using the key words “NICU
,” “safe sleep environment
,” “supine sleep
,” “prone sleep
,” “safe sleep
,” “special care nursery
,” “hospital policy for safe sleep
,” “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.
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
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.
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:
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
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.