Nurses' Knowledge of Deformational Plagiocephaly and Discharge Instructions for Its Prevention

Background: Deformational plagiocephaly (DP) is the most common head shape abnormality in infants, and describes flattening that is on only one side of the head. DP has become more prevalent in infants and has significantly increased, since the American Academy of Pediatrics (AAP) Task Force on Infant Positioning and Sudden Infant Death Syndrome (SIDS) recommended that infants sleep in a supine position in 1992. DP can be prevented by educating parents and caregivers about the importance of tummy time (TT). However, our previous research study on parental information, knowledge and understanding of the importance of tummy time for preventing DP, showed that most parents (74%) do not have a good understanding of the importance of TT and have not received adequate information about starting TT on the first day after they return home for preventing this condition.

Purpose: To explore and describe obstetrical, neonatal and pediatric nurses’ self-reported knowledge, practice, and provision of parental education regarding DP and discharge instructions for its prevention.

Methods: A cross-sectional descriptive study design was used to survey a convenience sample of 309 obstetrical, neonatal and pediatric nurses who work at a 801-bed tertiary-care hospital in Dallas, TX. The data were collected over a 6-week period in August 2018, using a 40-item investigator designed and Internet-based questionnaire.

Results: A total of 122 surveys were analyzed, with a response rate of 39.4% (122/309). The finding indicated that most of nurses answered the questions about DP correctly and nurses ‘self-reported general knowledge of DP seemed to be adequate. However, they had inadequate knowledge on preventive measures, and were less knowledgeable about when to start TT. They did not routinely discuss the AAP’s recommendations with parents/or caregivers during discharge teaching; only 21% of the nurses reported they always told parents or caregivers that tummy time should start on their first day home from the hospital while infants are awake and supervised.

Conclusions: More than half of the nurses (55%) had inadequate knowledge about when to start TT for prevention of DP. Only 21 % of the nurses routinely provide discharge instructions that promote TT at home to prevent DP. This study indicates that nursing discharge teaching on practices to prevent DP are inconsistent; there are gaps in practice and in conflict with the AAP’s recommendations.