Translating Infant Safe Sleep Evidence Into Nursing Practice Sarah J. M. Shaefer, Sandra E. Herman, Sandra J. Frank, Mary Adkins, and Mary Terhaar Correspondence Sandra J. Frank, JD, Tomorrow’s Child/Michigan SIDS, 112 E. Allegan, Suite 500, Lansing, MI 48933. sfrank@tomorrowschildmi. org Keywords back to sleep infant safe sleep sudden infant death syndrome (SIDS) sudden unexpected infant death (SUID) evidence based practice translation research research adoption ABSTRACT The authors describe a 4-year demonstration project (2004-2007) to reduce infant deaths related to sleep environ- ments by changing attitudes and practices among nurses who work with African American parents and caregivers in urban Michigan hospitals. An approach was developed for creating sustainable change in nursing practice by im- plementing nursing practice policies that could be monitored through quality improvement processes already established within the hospital organization. Following the policy change effort, nurses changed their behavior and placed infants on the back to sleep. JOGNN, 39, 618-626; 2010. DOI: 10.1111/j.1552-6909.2010.01194.x Accepted August 2010 I nfants who sleep on their backs in a safe sleep environment have a decreased risk of dying suddenly and unexpectedly (American Academy of Pediatrics [AAP], 2005; American Academy of Pediatrics, Task Force on Infant Sleep Position and Sudden Infant Death Syndrome, 2000; Moon, Horne, & Hauck, 2007; Pollack & Frohna, 2002). The infant safe sleep e¡ort began with the Back to Sleep Campaign of the 1990s, which reduced the number of babies dying from sudden infant death syndrome (SIDS) by half (AAP, 2005). The U.S. Pub- lic Health Service, the AAP, the SIDS Alliance, and the Association of SIDS and Infant Mortality Pro- grams implemented the Back to Sleep Campaign across the United States in 1994. Back sleep is supported by a substantial body of evidence (AAP, 2005; Colson et al., 2009; Dwyer & Ponsonby, 2009) and is a simple, inex- pensive intervention for parents and communities. Nevertheless, it is inconsistently adopted in com- munities and often rejected by parents with concerns about infant comfort, choking, and in- consistent advice from physicians (Colson et al.; VanKororn et al., 2010). Strategies that accelerate adoption of Back to Sleep and infant safe sleep guidelines promise to save lives and move the nation closer to attaining the goals of Healthy People 2020. Infant Safe Sleep The AAP (2005) has identi¢ed 11 recommendations regarding infant sleep environment to reduce the risk of SIDS and sudden unexpected deaths in healthy infants. The ¢rst is back sleep (supine posi- tion) for infants. Neither side nor prone sleeping positions are considered safe. The sleep environ- ment (crib) should have a ¢rm sleep surface, be free of soft material or objects (i.e., pillows, quilts, sheepskins, stu¡ed toys, etc.), should not have loose bedding or pillow-like bumper pads, and if a blanket is used, the baby’s feet are at the bottom of the crib, the blanket is no higher than the baby’s chest, and it is tucked in around the crib mattress. Mothers should not smoke during pregnancy, and infants’ exposure to secondhand smoke should be avoided. A separate but proximal sleeping environ- ment to parents is recommended as most safe. Parents should avoid overheating their infants by keeping the bedroom temperature in a range that is comfortable for lightly clothed adults. The AAP recommends the limited use of paci¢ers when the infant is put down for sleep if the child is willing to ac- cept it. Additionally, the AAP recommends avoiding Sarah J. M. Shaefer, PhD, RN, is an assistant professor, Department of Community-Public Health, Johns Hopkins University School of Nursing, Baltimore, MD. Sandra E. Herman, PhD, is an independent evaluation consultant and past associate director for the Center for Statistical Training and Consulting, Michigan State University, East Lansing, MI. Sandra J. Frank, JD, CAE, is the chief executive officer of Tomorrow’s Child/ Michigan SIDS, Lansing, MI. Mary Adkins, RN, MSW, is the program director of Tomorrow’s Child/ Michigan SIDS, Lansing, MI. (Continued) The authors report no con- flict of interest or relevant financial relationships. JOGNN P RINCIPLES &P RACTICE 618 & 2010 AWHONN, the Association of Women’s Health, Obstetric and Neonatal Nurses http://jognn.awhonn.org