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Barriers and facilitators to modeling safe sleep practices in the NICU: A qualitative study of nursing & parent perspectives

Journal of Perinatology (2025)Cite this article

Subjects

Abstract

Objective

To identify nursing and parent-perceived barriers and facilitators to adherence to safe sleep practices in a level IV NICU.

Study design

20 NICU nurses and 10 parents of infants who were hospitalized in a level IV NICU within the past year participated in this qualitative study. Themes from coded interview transcripts were identified utilizing deductive thematic analysis.

Results

Barriers and facilitators to safe sleep practices spanned across individual-, unit-, and community-levels. The significance of cultural preferences and traditions, hands-on practice and direct modeling, developmental positioning tools and reflux precautions, inter-team communication and consistency, different learning styles, and caregiver stress associated with NICU stays emerged as key themes.

Conclusion

We identified several barriers and facilitators of effective safe sleep modeling in the NICU from both nursing and parent perspectives. These insights will help to inform a collaborative, family-centered, and sustainable approach to integrating safe sleep practices in the NICU.

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Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

We wish to acknowledge the Denver Metro Family Advisory Council, the Hispanic Advisory Council, The Table platform, and the Children’s Hospital Colorado Special Care Clinic for their partnership in recruiting and gaining the valuable perspective of NICU parents.

Funding

Section of Neonatology, Department of Pediatrics, University of Colorado School of Medicine. The content is solely the responsibility of the authors and does not necessarily represent the official views of the funding organization. This study was conducted in accordance with the Declaration of Helsinki, and approved by the Colorado Multiple Institutional Review Board of the University of Colorado (study ID 20-2250, approved 3/31/2023).

Author information

Authors and Affiliations

  1. University of Colorado School of Medicine, Aurora, CO, USA

    Alice E. Burgess

  2. Department of Pediatrics, Section of Neonatology, University of Colorado School of Medicine, Aurora, CO, USA

    Stephanie L. Bourque, Christina R. Fisher, Rebecca Allen & Sunah S. Hwang

Authors
  1. Alice E. Burgess
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  2. Stephanie L. Bourque
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  3. Christina R. Fisher
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  4. Rebecca Allen
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  5. Sunah S. Hwang
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Contributions

AB was responsible for designing the study, writing the protocol and interview guide, conducting all interviews, coding all transcribed interviews, and writing the manuscript. SH was responsible for designing the study, overseeing the project, coding transcribed interviews, providing mentorship, and editing the manuscript. SB and CF were each responsible for providing direction on the project, coding transcribed interviews, and editing the manuscript. RA was responsible for helping schedule interviews and providing compensation for interviewees. All authors have read and agreed to the published version of the manuscript.

Corresponding author

Correspondence to Alice E. Burgess.

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Competing interests

The authors declare no competing interests.

Ethics approval and consent to participate

All methods were performed in accordance with the relevant guidelines and regulations. This qualitative work was formally reviewed by the Multiple Institutional Review Board; since this work is deemed non-human subjects research, we were not required to formally consent participants.

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Burgess, A.E., Bourque, S.L., Fisher, C.R. et al. Barriers and facilitators to modeling safe sleep practices in the NICU: A qualitative study of nursing & parent perspectives. J Perinatol (2025). https://doi.org/10.1038/s41372-025-02507-7

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