Safe Sleep Survey

Consent for Research ParticipationResearch 
Study Title: Barriers and facilitators that NICU nurses experience when role-
modeling and educating safe sleep practices to parents
Researcher(s): Sarah Faith Ingell, University of Tennessee, Knoxville Katherine Newnam, PhD, University of Tennessee, Knoxville
We are asking you to be in this research study because you are employed in a nursery, postpartum unit, or level I, II, III, or IV Neonatal Intensive Care Unit. You must be age 18 or older to participate in the study. The information in this consent form is to help you decide if you want to be in this research study. Please take your time reading this form and contact the researcher(s) to ask questions if there is anything you do not understand.
Why is the research being done?
The purpose of the research study is to determine barriers and facilitators that NICU nurses experience when role modeling safe sleep practices in the NICU and teaching safe sleep discharge education to parents
What will I do in this study?
If you agree to be in this study, you will complete an online survey. The survey includes questions about your current practice and understanding of safe sleep practice guidelines according to the American Academy of Pediatrics (AAP) and should take you about 20-30 minutes to complete. You can skip questions that you do not want to answer.
Can I say “No”?
Being in this study is up to you. You can stop up until you submit the survey. After you submit the survey, we cannot remove your responses because we will not know which responses came from you.
Are there any risks to me?
Possible risks include a chance that privacy and/or confidentiality of your identity and answers might be breached. The researchers have built in several safeguards to prevent this. IP addresses will not be collected. Any report of findings will include group data only.
Are there any benefits to me?
We do not expect you to benefit from being in this study. Your participation may help us to learn more about barriers and facilitators when providing a safe sleep environment for patients in the NICU We hope the knowledge gained from this study will benefit others in the future.
What will happen with the information collected for this study?
The survey is anonymous, and no one will be able to link your responses back to you. Your responses to the survey will not be linked to your computer, email address or other electronic identifiers. Please do not include your name or other information that could be used to identify
you in your survey responses. Information provided in this survey can only be kept as secure as any other online communication.
Information collected for this study will be published and possibly presented at scientific meetings.
Who can answer my questions about this research study?
If you have questions or concerns about this study, or have experienced a research related problem or injury, contact the researchers, Dr. Katherine Newnam at 865-974-7593 or knewnam@utk.edu.
For questions or concerns about your rights or to speak with someone other than the research team about the study, please contact:
Institutional Review BoardThe University of Tennessee, Knoxville 1534 White AvenueBlount Hall, Room 408Knoxville, TN 37996-1529 Phone: 865-974-7697Email: utkirb@utk.edu
Statement of Consent
I have read this information and understand that I can contact the nurse researcher, Dr. Newnam or the Institutional Review Board if I have questions. I understand that I am agreeing to be in this study by continuing to the survey questions below. If I do not want to participate in the study, I can leave the survey and close my computer browser. I can stop the survey at any point and exit from the survey site.
My age is:
I am a practicing nurse for:
I am a:
I have been a practicing Neonatal or Perinatal nurse for:
The highest nursing degree that I have is:
I hold a certification in Neonatal or Perinatal nursing:
I am a parent:
I work at a smoke-free hospital/campus
The hospital I work in is located in:
I discharge infants from my unit:
I am a nurse in a :
I think SIDS Risk-Reduction recommendations make a difference in preventing SIDS/SUID.
Supine positioning for sleep causes infants to have a flat or misshapen head.
Supine for sleep causes infants to have developmental delays.
Supine for sleep puts infants at higher risk for aspiration.
Parents will model my SIDS Risk Reduction practices with their infants.
Regardless of my personal beliefs, I follow the SIDS Risk Reduction Policy of my unit/hospital.
The BEST time to implement SIDS Risk Reduction Recommendations is:
Which of the following are included in the 2016 American Academy of Pediatrics SIDS Risk Reduction Recommendations:
"Back to Sleep" for every sleep.
Transition preterm infants to supine for sleep by 32 weeks post-menstrual age if "medically stable."
Room-sharing with a parents without bed-sharing.
Keep soft objects (toys, quilts, etc.) out of the crib.
Pregnant women should receive regular prenatal care.
Breastfeed or provide breast milk.
Offer a pacifier at naptime and bedtime.
Immunize in accordance with recommendations.
Supervised, awake tummy time.
Healthcare providers, including those in NICUs and newborn nurseries, should endorse SIDS Risk Reduction Strategies beginning at birth.
Based on the 2016 American Academy of Pediatrics policy, which of the following are SIDS Risk Reduction Recommendations:
Avoid smoke exposure during pregnancy and after birth.
Avoid alcohol and illicit drug use during pregnancy and after birth.
Avoid overheating infant.
Avoid commercial devices marketed to reduce the risk of SIDS/SUID.
Avoid the use of home cardiorespiratory monitors.
For the purpose of the following statements, "medically stable" refers to an infant with (a) stable oxygen and respiratory support needs, (b) stable pattern of apnea and bradycardia, (c) ability to maintain body temperature in an incubator or crib, and (d) ability to tolerate advancing feedings.
I most frequently position preterm infants for supine-only sleep:
I position "transfer-ready" or "discharge-ready" preterm infants:
If I position “transfer-ready” or “discharge-ready” preterm infants in prone or side-lying positions, I do so because of: (Rank in order with 1 being the most frequent reason and 5 being the least frequent reason):
Risk of Reflux/Aspiration
Infant Comfort
Traditional Nursing Practice
Medical Indication
Family Preference
When I position a preterm infant for prone or side-lying sleep because of a medical indications, that medical indication is:
I position "clinically stable" term infants:
I use positioning aids/rolls for "medically stable" preterm infants in an open crib.
I use positioning aids/rolls for "medically stable" term infants in an open crib.
I place stuffed toys, blankets, or quilts in an infant's crib/bassinet: 
I follow a unit-specific protocol/policy/guideline for SIDS Risk Reduction Recommendations in preparation for infant discharge:
I begin SIDS/SUID teaching:
I implement the following practices to encourage sleep for "medically stable" infants:
Blanket or other covering over the head of the crib to block light and/or noise.
Rolls/positioning aids.
Darken the room with blinds or shades.
Turn lights off.
Allow for traffic or noise in the patient room/area.
A pacifier
Offer sucrose.
Hold/rock infant.
Play soothing music.
Swaddle with a blanket.
I implement the following in my clinical practice:
Tuck blankets securely around the mattress.
Remove care-giving supplies from crib/bed.
Transition the infant to supine for sleep.
Provide parents with verbal information about SIDS/SUID.
Provide parents with written information about SIDS/SUID.
Remove positioning aids from crib/bed.
Remove comforter/quilt/blanket from crib/bed.
When I provide discharge teaching, I routinely discuss:
Toys in crib.
Prevention of overheating.
Back to sleep.
Supervised tummy time.
Infant sleep location (room and bed).
Use of a sleep sack.
Use of a pacifier.
Effects of second-hand smoke.
Effects of alcohol and other drug use.
Appropriate bedding.
I feel confident in my ability to appropriately model safe sleep for parents and families:
I feel confident in my ability to accurately teach safe sleep practices to parents and families:
I have received formal or informal SIDS Risk Reduction education since the release of the 2016 recommendations from the AAP: