SARAH HEXEM HUBBARD: This is At the Core of Care. A podcast where people share their stories about nurses and their creative efforts to better meet the health AND healthcare needs of patients, families and communities.
I’m Sarah Hexem Hubbard, executive director of the Pennsylvania Action Coalition and the National Nurse-Led Care Consortium.
On this episode, we’re going to hear about how nurses play a key role in educating parents about safe sleep practices to prevent SIDS and SUID. SIDS is the abbreviation for Sudden Infant Death Syndrome— and SUID stands for Sudden Unexpected Infant Death. Over the past two decades, putting babies to sleep on their backs, instead of on their tummies, has been paramount to lowering rates of these tragic cases. But an ongoing issue is making sure that babies are actually sleeping in cribs.
DEVON GEORGE: We know that the number one way that babies die from one month to one year is from SIDS and SUIDS, which the CDC will tell you 90 percent of the time is an unsafe sleep environment. So that's in the bed with blankets. So how do we make sure that that moms and dads understand that? And how do we support nurses in having that conversation?
SARAH: That’s Devon George. She has a nursing background and is the Director of Education Outreach at Cribs for Kids, a national organization based in Pittsburgh. The non-profit has been a leader when it comes to promoting and instituting safe sleep practices, as well as creating systems for how to provide families in need with free or low-cost portable cribs.
DEVON: We need to be sure we're helping nurses develop those conversations and how to have that very therapeutic conversation. So tell me, "where baby is going to sleep?" And if they say in bed with me, then what kind of education follow-up goes with that?
SARAH: Devon is going to share with us what some of that education entails and how nurses can access training.
A range of nurses play a role in helping families develop safe sleep practices for their babies. There are home visiting nurses who provide services in the home. And nurses in various clinical settings, including hospitals where nurses have an opportunity to interact directly with parents and their newborns.
In Pennsylvania, for example, there’s actually public policy mandating that hospitals provide safe sleep education to families after a baby is born.
Cribs for Kids — the organization where Devon George works— led the push for this statewide policy, which was enacted in 2010. In doing so, the non-profit also helped create the necessary educational materials that nurses across Pennsylvania continue to use today.
Officials in other states took notice and reached out to Cribs for Kids for guidance. In response, the organization started a certification program to help train nurses and, since 2015, has nearly 400 certified hospitals around the country. Here’s Devon to tell us more about how the certification process works.
DEVON: The hospital certification program is designed to recognize hospitals for the great work they're doing to ensure infant safe sleep policy and teaching and care. So you can, as a hospital, certify at one of three levels: bronze, silver, or gold. And the bronze is based on your hospital policy. So if your hospital: has an infant safe sleep policy, if you educate your healthcare team members on that, educate your healthcare team members, educate the families on infant safe sleep, that is your bronze level activities. So by all means, let's recognize the hospital for the work that they're doing.
And as you go up each level, then adds a couple of things. So the silver level, for example, adds auditing for compliance on your unit, and then also the use of wearable blankets on the unit or providing a wearable blanket upon discharge. And then going into the gold, is the bronze and the silver, but also adding two more elements, which is assessing for safe sleep environment and ensuring that the family leaves with the safe sleep space if they're at risk for not having one. And also adds community education and outreach. So these are typically nurse-led education pieces. So whether you're participating in a health fair or giving grandparent classes that include infant safe sleep or supporting a fundraising event that is done to recognize the risk of SUID AND SIDS, that includes a safe sleep message or even social media outreach, so on a Facebook page promoting infant safe sleep for example. So those are the elements that lead to infant safe sleep, hospital certification.
And we’ve recently upgraded our webpages. So if you go to cribs for kids and click on programs and click on hospital certification over to the right, you'll see a menu for a hospital tool kit. And we give all of the elements there that you would need to certify. So we have sample policies there. We have sample audit forms there. We have a whole library of safe sleep photos that you can use on your unit. And we provide lots of tools to allow hospitals to more easily and more seamlessly certify.
SARAH: In Pennsylvania, where Cribs for Kids is based, Devon says the goal is for all eligible hospitals to eventually become certified. To do so, engaging nurses is essential.
DEVON: So to that end, we are reaching out to nurses in some new ways. We've done a couple of things. If you were going to go to our website at cribsforkids.org and click on hospital certification, we have a tool kit that makes it simpler for hospitals to certify at a system level. So we think, for example, our larger hospital systems from Wellspan to UPMC and Allegheny Health Network. And this does a couple of things. One, it allows nurses to collaborate across the hospitals within their system, which is really wonderful because nurses are great at that and thrive with that. So all of the hospitals, for example, at Allegheny Health Network are certified. So that means that the nurses are all using the same sleep policy and the same kind of safe sleep education and get to rally around that and really lift one another up and asking that mama, tell me where babies going to sleep and if the answer is in bed with me, then we know that those nurses reach out to the social worker who reaches out to us to ensure that those babies, those families leave that hospital with our cribbette so that there is not even a minute of a nap of an unsafe sleep.
It really is a nurse driven program. The hospital certification program is not only a great project for nurses to collaborate with one another on, but it's also a great project for those nurses often who need a project, for example, to move up the clinical ladder in their position at the hospital. And this creates a great opportunity for that. Or, you know, the Regional Action Coalition promoting continued education of nurses. So those nurses who are working on their master's degree or a DNP. This is, again, a wonderful project for them to wrap their arms around, both in developing policy at their hospital, developing education for the families, as well as community outreach to ensure that we have more safe sleep ambassadors in all of the communities that we work with.
The role of the nurses multifaceted. Right? We're asking those nurses, particularly on the units, to do a thousand different things. So don't forget to chart this and don't forget this piece of education. And don't forget that you know a million things that you need to do…
So there is a collaboration now among the NICHD, Cribs for Kids, and A-1 to develop a gold medal nursing education in regards to infant safe sleep. And one of the things we're finding that we need to do to support those nurses is to help them with those difficult conversations because it's really easy to say to nurses, you need to be sure you ask where babies going to sleep? Well, how do I even ask that question to get to where baby is sleeping? I can't say, ‘Is baby going to sleep someplace safe?’ We need to be sure we're helping nurses develop those conversations and how to have that very therapeutic conversation. So tell me where baby is going to sleep. And if they say in bed with me, then what kind of education follow up goes with that? So we know that the number one way that babies die from one month to one year is from SIDS and SUID, which the CDC will tell you 90 percent of the time is an unsafe sleep environment. So that's in the bed with blankets. So how do we make sure that that moms and dads understand that because and how do we support nurses in having that conversation?
Again, it's very easy to say tell them the ABCs is and that it's not safe. Well, if I'm a mom and dad who is on my third baby, and the 24 year old nurse, for example, walks in and sees baby asleep on dad's chest and dad asleep, what I'm really going to say about that? So we're working with the NICHD and A-1 to develop ways to support nurses through that critical conversation and give them comfort in addressing those concerns that they would have. So that's, you know, just another way we're working to outreach with nurses and provide them the support they need in all of the things that nurses do as being advocates and educators and caregivers.
SARAH: Besides nurses working in hospital-based settings, home visiting nurses play a critical role in promoting safe sleep practices. In Allegheny County, which is in Western Pennsylvania where Cribs for Kids is based, Devon describes some of the efforts currently underway to help home visiting nurses better support the families they care for when it comes to infant safe sleep.
DEVON: We have just now become an active presence in the Allegheny County Home Visiting Nurses meetings that occur. They’re kind enough to invite us to join in. 26:55 There are a lot of efforts here in place in Allegheny County in terms of home visiting nurses and a new program they’re launching called Hello Baby. When we talk about all the things that those visiting nurses are expected to do when they go in the home, they're often not even able to see where baby is sleeping. So we're working with home visiting nurses and Children's Hospital to one: How do we give those nurses who and the social workers at discharge to say, hey, you know what, you're eligible for this? It'll allow you to ask some questions and maybe have somebody to talk to share any concerns that you might have. So, again, to offer that home visit up as support rather than some kind of monitoring. And then helping those home visiting nurses to frame the question, hey, well, I'm here. Do you want to show me where baby sleeping? You know, to ask it as a do you want to rather than, hey, show me. So we're trying to find ways to massage that conversation that nurses have and again, provide them that support so that they can manage all of the things that they're expected to do in that home. So we do know that when the home visiting nurses are in there, that there is great feedback from the families on that. So, again, how can we as nurses harness that positive feedback of the families to let other people know in the community to create a kind of more grassroots open door for that effort.
SARAH: And finally, Devon says online education is another way parents, caregivers, nurses and other providers can start to become versed in safe sleep education. Cribs for Kids has created a free online training program called Safe Sleep Ambassador. As a result of the COVID-19 pandemic, like so many organizations, Cribs for Kids has seen growth in its online programming.
DEVON: So in April of 2019, we had 32 people complete our Safe Sleep Ambassador online education program. In this past April, it was 395. So we know that those are people taking advantage of the Cribs for Kids at home. And in May of 2019, we had 38 and in May of 2020, we had 249. But that's a web-based education piece that we hope that every nurse or every person listening to this podcast will go out and do that education module and share it with people in their own circle, in their neighborhood and baby sitters that they work with.
SARAH: Special thanks to Devon George for taking time to talk with us.
And to stay up to date with our various initiatives and current outreach efforts, visit our homepage at paactioncoalition.org And you can always follow us on social media @PaAction.
Funding for this podcast comes from the Center to Champion Nursing in America, which is a joint initiative of the Robert Wood Johnson Foundation, AARP, and the AARP Foundation...along with the Pennsylvania Action Coalition.
Stephanie Marudas of Kouvenda Media is our producer and we had production assistance from Brad Linder.
I’m Sarah Hexem Hubbard of the Pennsylvania Action Coalition. Thanks for joining us.
