Desiree Deighton

Safe Baby language-friendly booklet

Background

The Safe Baby book is a language-friendly, supportive booklet and tool for nurses to use with an interpreter to communicate the importance of sudden infant death prevention and safe sleeping guidelines, to parents who do not speak English, particularly during the discharge process from the neonatal unit and outreach team visits within the home. It is picture-based with explicit step-by-step health messages for the nurses to follow, featuring characters representing a wide range of ethnicities, and would clip into the front of the Infant Health Record (red book) for accessibility and integration with current practice.

There are currently no leaflets or guidance available that are language-friendly, with explicit ‘how-to’ images 

 

Bradford infants are at an increased risk of sudden infant death syndrome (SIDS) as the demographic has high incidence of poverty, deprivation, prematurity and low birth weight infants (The Lullaby Trust 2017, Highet et al 2017, Hakeem and Oddy 2015, Dufer and Godfrey 2016). Bradford Safeguarding Children Board found the primary modifiable cause of child death from 2008-2016 to be co-sleeping and SIDS (BSCB 2016).

 

Bradford infants are at an increased risk of sudden infant death syndrome (SIDS) as the demographic has high incidence of poverty, deprivation, prematurity and low birth weight infants 

 baby shoes

A Born in Bradford study has explicitly outlined a need for tailored advice about SIDS for Bradford parents, as mothers reported that it was ‘irrelevant’ to them and so do not follow safe sleeping guidelines (Crane and Ball 2016). Another Born in Bradford study (Ball et al 2012) found that South Asian infants are more likely to be placed on sofas, bed share with parents, have pillows and duvet, be positioned on their front or side, swaddled to sleep and breastfed in bed.


[...] South Asian infants are more likely to be placed on sofas, bed share with parents, have pillows and duvet, be positioned on their front or side, swaddled to sleep and breastfed in bed

 

The Safe Baby book aims to support the nurse in delivering the information of SIDS, empower parents to make informed decisions and prevent the devastation infant death can cause. Ultimately, it could increase parental compliance, reduce SIDS incidence and improve child health outcomes in Bradford and beyond.


Aims and objectives

  • To gain permission to use the booklet in a neonatal unit and outreach team
  • To find an illustrator to draw the book
  • To have books printed
  • To feedback data for January 2018

The Safe Baby book aims to support the nurse in delivering the information of SIDS, empower parents to make informed decisions and prevent the devastation infant death can cause

Activity to date

  • August 2017: meeting with a neonatal matron, at Bradford Royal Infirmary 
  • September 2017: meeting with an illustrator and draft booklet given to her 
  • October 2017: presentation for funding to Bradford Innovation Group for small sum of funding to print books. Although I did not gain this, the group want to copyright the Safe Baby book as a trust resource via Medical Illustrations. I was asked to consider this whilst gaining patient feedback on the images themselves, and represent in January 2018. However, I have not given consent for this yet as I do not know if this would compromise my RCN application 
  • January 2018: submission for funding from RCN for further development 

Outputs to date

  • A complete draft of the book
  • Several pages drawn by the illustrator
  • Keen interest from Bradford Innovation Group to launch ‘Safe Baby’ within the trust
  • Support from Bradford Royal Infirmary Neonatal Intensive Care Unit and Neonatal Outreach team to complete a trial/patient feedback once approved by Communication Patient Advisory Group (CPAG)
  • Rough estimate of £80 per 50 copies by the trust’s medical illustrations department
asian infant enfance

baby in bed sleeping
Bradford Safeguarding Children Board found the primary modifiable cause of child death from 2008-2016 to be co-sleeping and SIDS  

Lessons learned

I know very little about technicalities such as copyright and intellectual rights, so I sought guidance from my RCN mentor in November 2017, but we are not at all sure about this in terms of my university and the trust’s rights to the Safe Baby book. Therefore, some additional guidance and support on this would be much appreciated as I have had a lot of interest in my project, and want to ensure it is first and foremost a RCN Celebrating Nursing Practice project finalist. 

I wanted to have had a preliminary trial carried out and feedback to present at this point of the project. However, it has taken more time than anticipated to organise the different aspects of the book (agreement from neonatal unit/matron, researching guidelines/policy, designing the booklet, illustrations, funding, Communication Patient Advisory Group (CPAG), who has the copyright, possible printing companies, etc.) All whilst being in my final year at university. 

open book

A Born in Bradford study has explicitly outlined a need for tailored advice about SIDS for Bradford parents, as mothers reported that it was ‘irrelevant’ to them and so do not follow safe sleeping guidelines

Reflections on impact

It could reduce child death in Bradford district by making parents more aware of how to prevent sudden infant death syndrome. This could be measured in terms of 1) reduced statistical SIDS incidence, 2) parent feedback form at the back of the booklet for helpfulness/parent focus group, 3) perceived parental compliance by nurses at home visits, 4) interviews of nurses about their perceptions of the effectiveness of the book.

newborn hands
Additional impact it could have on service provision:

  • Make the discharge information of SIDS for nurses easier to explain to parents with no English language
  • Save time on repeated home visits to re-explain the SIDS prevention information
  • Evidence of the number of times SIDS was explained to the parents, in case of infant death
  • Educate parents, as it will stay in the Infant Care Record for them to refer to, so it is not just ticking the box after an invalid method of communication

Longitudinally, if a study was carried out for a year, the incidence of SIDS could be examined with the previous year, as a comparative measure of impact.

The neonatal outreach team are particularly keen to begin the use of the ‘Safe Baby’ book, as they feel it is a core tool that would exponentially enhance their care.

The way forward

Trials could be carried out in other areas with a similar demographic where parents are vulnerable, for example, I have interest from Manchester NICU.

SIDS can happen to any baby, therefore Bradford Teaching Hospital Foundation Trust felt there was significant potential to use this booklet on all maternity wards to be distributed in the Bounty packs given to new parents.

Other booklets, e.g. how to safely sterilize bottles, make up a feed, breastfeed, etc. have also been identified as potential booklets for a series of Safe Baby books.

Sustain momentum embed the project

The Neonatal Unit is keen to run the trial, therefore if it shows to improve parental compliance then this could become daily practice on the Neonatal Unit, and with your support, for all NICU’s across the UK.

I am being interviewed for a staff nurse role at the Neonatal Intensive Care Unit, therefore I could support the transition whilst being employed there.

I actively share ideas and innovation with other HCP via Twitter so this would be an effective method to expand the Safe Baby book idea to potential trusts, buyers, etc.

References

Crane, D. Ball, H. (2016) A qualitative study in parental perceptions and understanding of SIDS-reduction guidance in a UK bi-cultural urban community. BMC Pediatrics. 16:23.

Ball, H. L., Moya, E., Fairley, L., Westman, J., Oddie, S., & Wright, J. (2012). Infant care practices related to sudden infant death syndrome in South Asian and White British families in the UK. Paediatric and perinatal epidemiology, 26(1), 3-12. 

Bradford Safeguarding Children Board (2016) Child death overview panel annual report April 2015 – March 2016

Dufer, H. Godfrey, K. (2016) Integration of safe sleep and sudden infant death syndrome (SIDS) education among parents of preterm infants in the Neonatal Intensive Care Unit (NICU). Journal of Neonatal Nursing. Volume 23, Issue 2. Pp 103-108. 

Hakeem, G. Oddy, L. (2015) Incidence and determinants of sudden infant death syndrome: a population-based study on 37 million births. World Journal of Paediatrics. Volume 11, Issue 1. Pp 41-47. 

Highet, A. Goldwater, P. (2013) Maternal and perinatal risk factors for SIDS: a novel analysis utilizing pregnancy outcome data. European Journal of Paediatrics. Volume 172, Issue 3, pp 369–372. 

The Lullaby Trust (2017) What is sudden infant death syndrome (SIDS)?