Certified Nurse-Midwives' Knowledge, Attitudes, and Behaviors About Infant Safe Sleep

Factors influencing pregnant women's intention toward bed-sharing with infant in China: a cross-sectional study

Bed-sharing can have a negative impact on infant sleep safety. In order to reduce the occurrence of bed-sharing with infants, it's necessary to shift the research lens from newborn parents to the antenatal stage before infant birth. Our study aimed to assess the attitudes, subjective norms, perceived behavioral control, and intentions of pregnant women about bed-sharing based on the theory of planned behavior (TPB). This cross-sectional study was conducted with 512 pregnant women in the obstetrics clinic of a tertiary hospital in China using convenience sampling. Data were collected through self-reported questionnaires, consisting of demographic characteristics and a questionnaire for pregnant women on infant sleep safety based on TPB (12 items). Data were analyzed with SPSS 22.0 and AMOS 24.0. Structural equation modeling was carried out to verify the hypothetical model based on TPB. The results showed the average behavior intention score was 9.90 ± 5.14, indicating low intent for bed-sharing among pregnant women post-delivery. The Theory of Planned Behavior model explained 38.7% of the variance in bed-sharing intention, with attitude as the strongest predictor (β = 0.343, p < 0.001), followed by subjective norm (β = 0.232, p < 0.001) and perceived behavioral control (β = -0.210, p < 0.001). This study highlights the importance of antenatal health education and behavioral intervention early in pregnancy based on TPB theory to enhance infant sleep safety and encourage changes in bed-sharing behavior.

Physicians-in-training and advanced practice providers perceptions in managing perioperative obstructive sleep apnea: a multi-institutional survey

STUDY OBJECTIVES

Physicians-in-training (residents, fellows) and advanced practice providers (APPs) receive limited education on sleep disorders, including obstructive sleep apnea (OSA). They often assess patients first. We aimed to understand their views on OSA and screening for OSA in the perioperative period.

METHODS

Electronic-mail surveys were sent to physicians-in-training and APPs, in 5 categories of practice (anesthesiology, internal medicine, family medicine, obstetrics/gynecology/gynecologic oncology, and surgery) at 9 major institutions. Cochran-Mantel-Haenszel tests evaluated associations between participant characteristics (clinical role, physician years of training, APP years of practice, categories of practice) and survey responses (perception of OSA, perioperative risk factor, screening/managing of perioperative OSA) stratified by institution. False discovery rate (FDR) adjustment accounted for multiple comparisons (FDR-adjusted-P values) of associations between multiple characteristics and a given response. Breslow-Day tests evaluated the homogeneity of odds ratios from Cochran-Mantel-Haenszel tests.

RESULTS

We received 2,236/6,724 (33.3%) responses. Almost all (97%) agreed OSA represents a risk factor for perioperative complications. Many (37.9%) were unaware which screening tool was used at their institution, with differences by clinical role (FDR-adjusted-P < .001), with APPs reporting not knowing more than residents and fellows, and across category of practice (FDR-adjusted-P < .001). While 66.5% routinely asked perioperative patients about signs/symptoms of OSA, 33.5% did not. There were differences by clinical role (FDR-adjusted-P < .001), as APPs reported asking about OSA more frequently than residents/fellows; and, by category of practice (FDR-adjusted-P < .001) as anesthesia and medical specialties reported asking about OSA more than surgical services. Importantly, approximately half of the respondents in surgery (48%) and obstetrics/gynecology/gynecologic oncology (46%) reported not routinely asking. Differences also existed by physician postgraduate year clinical training (FDR-adjusted-P = .005) with those with higher postgraduate year reporting they asked about OSA more often.

CONCLUSIONS

Significant differences exist in screening by clinical roles and categories of care. This highlights the importance of improving provider education on the role of OSA in perioperative risk assessment and patient care.

CITATION

Lyons MM, Auckley DH, Mokhlesi B, et al. Physicians-in-training and advanced practice providers perceptions in managing perioperative obstructive sleep apnea: a multi-institutional survey. J Clin Sleep Med. 2025;21(5):765-773.

What are the barriers to sustaining a safe sleep program for infants within hospital settings: An integrative review of the literature

PROBLEM

Safe sleep programs have been existing since the concept was first defined in 1969. The need for health care providers to model safe sleep practices is essential for successful adherence; however, barriers to promoting safe sleep practices hinder healthcare providers' ability to implement safe sleep in hospital settings.

AIM

To determine the barriers to promoting safe sleep practices amongst healthcare workers in the hospital setting.

METHODS

Whittemore & Knafl's framework (2005) guided this integrative review. CINAHL, PubMed, and Academic Search Complete databases were used as a search strategy. Inclusion criteria was limited to studies between 2010 and 2021, were peer-reviewed, in English, and quality improvement projects consisting of barriers to implementing safe sleep practices within hospitals. To assess quality of the included studies, the Mixed Methods Appraisal Tool and Standards for Quality Improvement Reporting Excellence were used. The studies were analyzed by two of the authors with data further categorized using the Social Ecological Model (SEM) to develop themes.

RESULTS

Findings of the 10 included studies were presented in the form of a data display matrix. The authors used the SEM to categorize the findings under three main categories at the organizational, individual, and cultural levels.

CONCLUSIONS

Barriers need to be addressed in hospital settings to reduce the risk of sudden infant death syndrome. Therefore, it is vital to consider those barriers while providing teaching programs in hospital settings.

IMPLICATIONS

Findings from this review provide the core elements to consider for the development of safe sleep programs in the hospital setting.

Midwives' and Other Perinatal Health Workers' Perceptions of the Black Maternal Mortality Crisis in the United States

INTRODUCTION

This study aimed to identify how perinatal health workers, especially midwives, explained US Black maternal mortality and morbidity and what ameliorative measures they suggested across categories of primary social determinants, health care access, and provider practices.

METHODS

Using a mixed closed-ended and open-ended researcher-designed exploratory survey, 227 perinatal health workers responded to a series of questions probing views of causation and strategies for improvement. The closed-ended responses were summarized. Open-ended responses were analyzed using basic categorical and thematic coding.

RESULTS

Perinatal health workers' responses prominently identified racism as a cause of Black maternal morbidity and mortality, and their recommendations ranged across levels of social determination of health.

DISCUSSION

Results suggest that the views of perinatal health workers, the majority of whom were midwives, are complex and correspond to the problems and solutions identified in the research literature. Midwives and other perinatal health workers are well positioned to help center health equity in perinatal care, through both clinical practice and policy advocacy.

Survey of Korean daycare personnel on safe sleep practices related to sudden unexplained infant death: a cross-sectional exploratory study

PURPOSE

Safe sleep practices (SSP) are among the main strategies to reduce sleep-related sudden unexplained infant death (SUID). Daycare personnel must be knowledgeable and trained in SSP related to SUID. This study explored the experience, knowledge, and confidence regarding SSP associated with SUID of daycare personnel.

METHODS

A cross-sectional survey was conducted with 395 staff members at 61 daycare centers to measure their experience related to SSP (10 items), related to sleep position and location, bedding materials, and other topics; knowledge of SSP (18 items); and confidence in SSP (1 item) related to SUID.

RESULTS

A substantial proportion (23.6%) of respondents used the lateral or prone positions for infant sleep. On average, 4.5 bedding materials were used for infant sleep. Participants showed a lack of knowledge about SSP as indicated by a 56.6% knowledge of SSP related to SUID correct answer rate. Personnel who received SUID education were more knowledgeable and had more confidence regarding SSP than those who did not. More knowledge and confidence related to SSP were associated with better adherence to SSP.

CONCLUSION

Standard SSP guidelines should be developed based on South Korea's culture of childcare for educating both childcare professionals and parents at home.

Knowledge on sudden unexplained infant death-related safe sleep practices and infant cardiopulmonary resuscitation in pediatric nurses

PURPOSE

Sudden unexplained infant death (SUID) is a major contributor to infant mortality, and pediatric nurses have the responsibility to educate parents on SUID-reducing strategies. This study was conducted to measure pediatric nurses' knowledge of SUID-related safe sleep practices (K-SSSP) and infant cardiopulmonary resuscitation (K-ICPR).

METHODS

In total, 136 pediatric nurses were administered a survey including K-SSSP (13 items), K-ICPR (5 items), confidence in K-SSSP education (1 item; 5 points), and other factors relating to SUID experiences or education.

RESULTS

The correct answer rates of the K-SSSP and K-ICPR were 62.6% and 62.5%, retrospectively. The mean score for confidence in K-SSSP education was 2.6±0.9. Only 18 nurses (13.2%) responded that they educated parents on the content of the K-SSSP, while 76 nurses had received education on SUID. Positive relationships were observed between K-SSSP scores and higher education, between K-ICPR scores and having own child(ren) and clinical experience, and between confidence in K-SSSP education and higher education or having one's own child(ren). Nurses caring for newborns performed more SUID education than nurses working in other units.

CONCLUSION

There is a profound need to implement a systemic educational program on SUID and strategies to reduce SUID for pediatric nurses.