In the delicate environment of a level IV Neonatal Intensive Care Unit (NICU), ensuring adherence to safe sleep practices is a critical component of neonatal care, directly influencing infant safety and long-term health outcomes. Recently published research from a multidisciplinary team led by Burgess, Bourque, Fisher, and colleagues offers an unprecedented qualitative exploration into the nuanced dynamics that shape adherence to safe sleep protocols, illuminating the perspectives of both nursing staff and parents. This investigation not only identifies pervasive barriers but also highlights actionable facilitators that can transform how safe sleep is modeled and maintained in the NICU setting.
Safe sleep practices have long been championed by pediatric organizations to reduce the incidence of Sudden Infant Death Syndrome (SIDS) and other sleep-related infant fatalities. However, translating these guidelines into practical applications within the high-acuity environment of a NICU—a place characterized by technological complexity, critical interventions, and parental stress—presents unique challenges. Burgess et al.’s study leverages qualitative methodologies to capture the lived experiences and perceptions of nurses and parents, who are frontline stakeholders critical to the implementation of these safety protocols.
The core of this research delves into the labyrinthine interplay between clinical priorities and parental involvement in the NICU’s sanctified space. Nurses, as primary caregivers, face the constant dual pressures of providing medically necessary interventions while also advocating for and modeling recommended sleep safe behaviors. The study revealed that nursing staff often confront competing priorities; for example, medical devices and monitoring equipment essential for infant survival can impede the ability to position babies in recommended sleep postures, such as supine positioning without loose bedding or obstructions.
Concurrently, parental perceptions were found to be highly variable, reflecting a spectrum of knowledge and emotional readiness shaped by their NICU experience. Parents frequently reported feeling overwhelmed, uncertain, or even excluded from discussions about sleep safety, which in turn influenced their adherence to recommended practices once at home. This study underscores the vital importance of clear, compassionate communication and education tailored to parental needs, enabling empowerment and fostering co-participation in safe sleep adherence.
The complexity of safe sleep adherence in the NICU is further compounded by environmental design factors. Shared spaces, inconsistent signage, and variations in staff adherence contribute to a milieu where inconsistent messaging undermines the establishment of standardized safe sleep routines. Burgess et al. advocate for environmental adjustments informed by human factors engineering principles, an approach that could help mitigate confusion and promote uniform practice.
Psychological and cultural influences emerged prominently throughout the study’s findings. Nurses described the tension between following protocol and respecting diverse cultural beliefs held by families about infant sleep practices. Navigating these differences necessitates sensitivity and a culturally competent approach, underscoring that safe sleep education cannot be one-size-fits-all but must be adaptable to individual family contexts without compromising infant safety.
The research also highlights the role of institutional policies and leadership support as pivotal facilitators in promoting adherence to safe sleep protocols. NICUs with clear, consistently enforced policies, ongoing training, and leadership modeling of best practices reported higher nursing confidence and better compliance. This institutional commitment fosters an environment where safe sleep is viewed not merely as a guideline but a foundational pillar of neonatal care.
Integral to the study’s insights is the recognition of the bidirectional influence between nurses and parents. When nursing staff actively engage parents as partners in care—inviting dialogue, providing hands-on demonstrations, and responding empathetically to concerns—parent adherence and confidence in safe sleep practices improved significantly. These relational dynamics are crucial, positioning parents not only as recipients of care but as empowered advocates for their infants’ safety.
Technological innovation also surfaces as an underexplored yet promising avenue for enhancing adherence. The use of digital applications, real-time monitoring systems that include alerts for unsafe sleep positioning, and interactive educational modules tailored for parents could revolutionize safe sleep adherence, especially post-discharge. Burgess et al. suggest that future research could evaluate the integration of such technologies within the NICU workflow.
An intriguing aspect of the findings was the emotional labor experienced by nurses. Adhering to strict protocols while managing the emotional needs of families in distress requires delicate balancing. Providing emotional support alongside safe sleep modeling demands not only clinical acumen but also psychological resilience, pointing to the need for institutional support systems to prevent caregiver burnout.
This study, employing rigorous qualitative analysis methods including thematic coding and triangulation of nurse and parent interviews, establishes a rich, layered understanding of the multifactorial barriers and facilitators to safe sleep adherence in a level IV NICU. Its implications extend beyond the confines of the NICU, shedding light on how early-life interventions and family education might be optimized for the broader continuum of infant care.
The authors advocate for multipronged interventions that encompass policy revisions, dedicated training, environmental redesign, culturally sensitive education, and technological enhancements. By approaching safe sleep adherence as a systemic issue rather than an individual shortfall, healthcare systems can foster safer infant sleep environments both within the NICU and after discharge.
In conclusion, the work of Burgess and colleagues serves as a clarion call to clinicians, administrators, and policymakers alike. It underscores that fostering adherence to safe sleep practices requires more than just disseminating guidelines; it necessitates a holistic, empathetic, and systemically supported approach that empowers both nurses and parents. As neonatal care continues to evolve towards family-centered models, integrating these insights can hasten advancements in preventing sleep-related infant harm and improving neonatal outcomes.
This groundbreaking study, published in the Journal of Perinatology, represents a vital addition to neonatal safety literature and holds promise for catalyzing positive change in NICU practices globally. By embracing the voices of those most intimately involved in infant care—the nursing professionals and parents—it charts a path toward safer, more effective, and more compassionate newborn care practices.
Subject of Research: Barriers and facilitators to adherence to safe sleep practices in a level IV Neonatal Intensive Care Unit (NICU) from the perspectives of nursing staff and parents.
Article Title: Barriers and facilitators to modeling safe sleep practices in the NICU: A qualitative study of nursing & parent perspectives.
Article References:
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
Image Credits: AI Generated
DOI: 01 December 2025
