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Doctor of Philosophy (Ph.D.) Nursing




Background According to the Centers for Disease Control and Prevention (CDC), about 3,600 infants died suddenly and unexpectedly in the US in 2017 (CDC, 2020a). These deaths occurred among infants less than 1 year of age, having no immediately obvious cause. These sudden unexpected infant deaths (SUID) have three commonly reported mortality (or vital records) codes, which include Accidental Suffocation and Strangulation in Bed (ASSB), Sudden Infant Death Syndrome (SIDS), and other ill-defined deaths (CDC, 2020b; Mathews, MacDorman, & Thoma, 2015). These infant fatalities, with infant defined as a newborn through 12 months of age, collectively fall under the umbrella term SUID. Upon investigation, most SUID often happen during sleep or in the infant’s sleep area (CDC, 2020b). The American Academy of Pediatrics (AAP) issues recommendations to reduce the risk for SIDS, including infant safe sleep (ISS) strategies (AAP Task Force on Sudden Infant Death Syndrome, 2016). While healthcare professionals are urged by the AAP to model, endorse and teach SIDS risk reduction strategies such as ISS practices (AAP Task Force on Sudden Infant Death Syndrome, 2011; AAP Task Force on Sudden Infant Death Syndrome, 2016), not all are embracing this recommendation. Hospital nurses are uniquely situated to educate and model ISS practices, which directly impact infant care and influence caregiver sleep practices at home (Gelfer, Cameron, Masters, & Kennedy, 2013; McMullen, Fioravanti, Brown & Carey, 2016). Numerous studies have been done with the focus on inpatient Mother-Baby (MB) nurses’ ISS practices, yet lacking are studies on inpatient pediatric nurses, who care for infants in the acute care setting, other than the immediate post-delivery units. The pediatric nurse works with populations encompassing broad age ranges in numerous areas such as the Emergency Department, pediatric floor, Pediatric Intensive Care Unit, and adolescent unit. Inpatient pediatric nurses may work as a Go-Where-Needed (GWN) member or, for staffing reasons, may be reassigned to a different unit where infants are admitted. When inpatient pediatric nurses do care for infants in these diverse areas, they need to practice ISS. Hospitalizations of infants provide an opportunity for inpatient pediatric nurses to practice, teach, reinforce, and model ISS with the aim of reducing SUID events in the hospital setting, as well as providing a greater impact on the caregivers’ practices at home to reduce modifiable risk factors with an overall impact on SUID reduction. Purpose The purpose of this study was to examine inpatient pediatric nurses’ ISS knowledge, attitudes, beliefs, and practices who provided care for infants during hospitalization in the acute care setting. Theoretical Framework Theory of Planned Behavior (Ajzen, 1985, 1991) Methods A quantitative, descriptive study with a qualitative component to gain more depth of explanation with open-ended responses was used. Data were collected using a web-based survey comprised of multiple choice/select, yes/no, true/false, visual analog scales (VAS), and Likert-type scale questions (quantitative), and questions requiring the respondents to answer in their own words (qualitative). This survey was distributed to a sample of nurses, using the nationwide membership of Society of Pediatric Nurses (SPN) as a convenience sample. All returned surveys were then stratified to include those pediatric nurses who Registered Nurses (RN) that provided care to infants up to 12 months of age in the inpatient pediatric setting and excluded those who worked exclusively in MB units. The survey was developed within the framework of the Theory of Planned Behavior, by selecting, modifying, and combining two established instruments, as well as creating items to obtain applicable measures, pertaining to inpatient pediatric nurses’ ISS knowledge, attitudes, beliefs, and practices. Distribution of the survey occurred electronically via v email. Descriptive statistics, t-tests, one-way ANOVA, and correlation procedures were conducted using SPSS 25, and thematic analysis was performed on narrative survey responses. Results There were numerous associations identified and interesting findings with the variables of interest. The findings showed that a majority (74.6%) of inpatient pediatric nurses had full knowledge of the current 2016 AAP recommendations of ISS, with 67.8% reporting their practices were always to most of the time aligned with AAP recommendations. The findings of their colleagues’ practices were significantly less aligned (25.9%). Although most inpatient pediatric nurses reported a positive attitude toward, high belief in, and strong influence by the AAP, findings showed inpatient pediatric nurses were also highly influenced by their colleagues’ practices and parents of hospitalized infants. Only 39.5% of inpatient pediatric nurses reported full belief in a sleep-related/SIDS event occurring during a work-shift, and 27.3% fully self-recognized as a role model of ISS. Higher academic preparation and the presence of an ISS initiative/policy demonstrated many positive correlations, all of which were favorable toward higher ISS knowledge, attitude, belief, and practice scores. Conclusions and Implications While this population of inpatient pediatric nurses are highly knowledgeable on AAP recommendations, their ISS practices continue to be less than 100% aligned with AAP recommendations in the hospital setting. Knowledge is not the sole factor for improving ISS practices, as other studies in the literature show. Influence of others, outside of the AAP, have a significant impact on ISS practices of both inpatient pediatric nurses and their colleagues. The presence of an ISS initiative/policy significantly impacts ISS overall and is therefore recommended to be initiated more. Higher academic preparation of inpatient pediatric nurses is encouraged, as it leads to greater knowledge, attitudes, beliefs, and practices, yielding better patient outcomes. Greater awareness of the role-modeling responsibility of inpatient pediatric nurses needs to be instilled, as they serve as living examples, not only to parents of hospitalized infants but, also to all colleagues involved in caring for these infants.

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