Impact of Nursing Quality Improvement and Mobile Health Interventions on Sleep Practices in Infants

Sudden infant death syndrome occurs primarily during sleep resulting from unsafe sleep practices. Implementing recommended interventions has proved to be effective in reducing the rates of sudden infant death syndrome. Safe sleep practices include appropriate sleep position (supine), soft bedding use (none), sleep location (same room but not same bed) and pacifier use. This paper evaluates a research that was done on quality improvement and mobile interventions and how they impact infant sleep practices.

Impact of Nursing Quality Improvement and Mobile Health Interventions on Sleep Practices in Infants

The article’s title is “The Effect of Nursing Quality Improvement and Mobile Interventions on Infant Sleep Practices.” The authors are five medical doctors, two registered nurses and four public health officers. Of the public health officers, three have a master’s degree in public health. The study’s aim was to assess the effectiveness of two interventions combined and separately in promoting safe practices in infants, compared to control interventions (Moon et al., 2017).

The study design was four-group cluster randomized clinical trials of mothers of healthy term newborns in sixteen US hospitals from March 2015 to May 2016. The inclusion criterion for the US hospitals was annual births exceeding a hundred. The intervention in the study was providing nursing quality improvement campaign in infant safe sleep practices while the control group had only breastfeeding and queries on infant care.

The main outcomes of measure were maternal reported adherence to the four safe sleep practices for infants: sleep position (supine), soft bedding use (none), sleep location (same room but different beds) and pacifier use (any).  For each infant, the mother collected data when the infant was between 60 and 240 days old. The results included 1263 mothers who completed the survey out of 1600 (79 % out of 100 %). The mean maternal age was 28.1 years (with standard deviation of 5.8 years).

Non-Hispanic whites constituted 33 %, Hispanics 32%, non-Hispanic black 27 % and 8 % other races and ethnicities. The mean infant age was 11.2 weeks with standard deviation of 4.4 weeks. 52 % of infants were females. Mothers who had access to safe sleep mobile health intervention had higher prevalence of placing their infants in supine positions in comparison to mothers who received the mobile health intervention (89 % vs 80% in adjusted risk difference of 9%).

Also, those who  received quality improvement information had a higher prevalence of using the same room but not the same bed (83 % vs 70% with adjusted risk difference of 12 %), while no soft bedding use (79 % vs 68%) and pacifier use (69 % vs 60 %). The stand-alone impact of nursing quality improvement intervention for all outcomes was insignificant, whereas the interactions of the two interventions were significant for the supine sleep position.

The researchers concluded that the mobile health intervention, as opposed to a nursing quality improvement intervention, significantly improved adherence to infant safe sleep practices in comparison to controlled interventions. The feasibility of widespread implementation of mobile health intervention as well as its impacts in reducing rates of sudden infant death rates remains an open topic for future studies.

Randomization in this study applied a cluster randomized approach that allowed implementation of the interventions within the hospitals. Sixteen hospitals were incorporated into the study and divided into four groups that were equalized on basis of infant care (sleep and feeding) practices and their geographic locations prior to the study. Computer-generated random numbers were applied to randomly allocate the hospitals via blocked randomization scheme to one of the following four intervention combinations: breastfeeding nursing quality improvement and breastfeeding mHealth; safe sleep nursing quality improvement and breastfeeding mHealth; breastfeeding nursing quality improvement and safe sleep mHealth or safe sleep nursing quality improvement and safe sleep mHealth (Moon et al., 2017).

The participants were enrolled after a median of eighty-six days post nursing quality improvement campaign completion. The study took place between March 2015 and May 2016. Mothers were enrolled during their admission for birth. Exclusion criteria were non-English speaking mothers, non-US residents, without custody of the infant or were unable to receive daily text messages or emails.

This study is a quality improvement since it uses data to monitor outcomes of health care processes and applies improvement models to design and test changes aiming at continuously improving the safety and quality of health care systems. In the study, the aim is to improve the safety and quality of sleep practices for infants and thus reduce the rates of sudden infant death syndromes (Moon et al., 2017). The research assesses how the interventions of nursing quality improvement and mobile health messaging affect adherence to safety sleep practices with the objective of reducing the sudden infant death syndrome rates.

The nursing quality improvement intervention focuses at the initial adherence to safe infant sleep practices. The campaign provided reliable information to the mothers who had delivered healthy at term babies. The mothers were made aware of the four safe sleep habits and advised to commence their application on the infants. After the awareness, the health personnel followed up on the mothers with mobile health messaging to reinforce adherence to the practices learnt.

The significance of nursing quality improvement and mobile health intervention in reducing rates of sudden infant death syndromes could not be ignored. The rate of SIDS was 3500 within the US in 2014. The infant deaths resulted from ill-defined causes and sudden strangulation or suffocation in bed. The deaths peaked between one to four months of the infants’ lives. Whereas majority of parents are aware of the condition and the necessary initiatives in its prevention, they hesitate to implement their knowledge owing to various concerns. Such concerns include worries that the infant may be unable to sleep well in the supine position (Moon et al., 2017).

Other parents were concerned that the supine position predisposed the infant to increased likelihood for aspiration or strangulation than other positions. Nonetheless, providing in-depth information to the parents on safe practices contributed significantly to the wider application of the practices.

Curtly, the significance of nursing quality improvement in reducing adverse health outcomes and promoting safety in healthcare practices cannot be overemphasized.  In essence, quality improvement uses data to monitor outcomes of health care processes and applies improvement models to design and test changes aiming at continuously improving the safety and quality of health care systems. In this article, the research assesses how the interventions of nursing quality improvement and mobile health messaging affect adherence to safety sleep practices with the objective of reducing the sudden infant death syndrome rates. These facts have been adequately discussed in this paper.

References

  • Moon, R; Hauck, F; Colson, E.; kellams, A.; Geller, N.; Heeren, T.; Kerr, S; Drake, E.; Tanabe, K; McClain, M & Corwin, M. (2017) The Effect of Nursing Quality Improvement and Mobile Interventions on Infant Sleep Practices. American Medical Association, pp 1-9.