From the Injury Prevention Center (S.C.R., K.G., H.S., G.L.), and Pediatric Emergency Medicine (S.C.R., G.L.), Connecticut Children's Medical Center/University of Connecticut School of Medicine, Hartford, Connecticut.
J Trauma Acute Care Surg. 2013 Oct;75(4 Suppl 3):S319-23. doi: 10.1097/TA.0b013e31829cba75.
Despite national, state, and hospital policies that require newborns to be transported in correctly used child safety seats (CSSs), significant CSS misuse frequently occurs among newborn infants. The objective of this study was to evaluate a comprehensive educational CSS training program for nurses and parents in a maternal/newborn unit.
In the preintervention phase, we conducted a survey among maternal/newborn unit nurses in a large urban teaching hospital to measure CSS knowledge, attitude, and practice. We then enrolled 60 maternal-newborn dyads at discharge to survey maternal CSS knowledge and observe the CSS misuse rate. Our intervention phase included a 1-hour "mandatory" nurse CSS education classroom session, a nurse hands-on CSS demonstration and practice in a mother's room. During the postintervention phase, we enrolled 70 maternal-newborn dyads at discharge to survey maternal CSS knowledge and observe change in CSS misuse rate.
In the preintervention phase, 43 (73%) of 59 eligible nurses completed the survey, and 47 (80%) of 59 completed the CSS education and training program. In the preintervention CSS survey, 23% of the nurses reported that education is part of their routine, 44% have CSS educational materials, 32% feel comfortable providing CSS education to parents, 12% feel CSS trained, 25% have time, 84% identify that CSS misuse is a problem, and 16% received CSS training.Enrolled mothers reflect maternal/newborn unit demographics as follows: maternal mean age of 29 years (range, 16-48 years), white (54%), black (11%), Hispanic origin (28%), English as primary language (83%), high school degree (31%), college degree (30%), Medicaid (23%), and private insurance (65%).Of 70 postintervention mothers, 44% reported receiving no nurse education, 21% reported receiving a brochure only, and 31% reported receiving nurse education. CSS misuse among mothers who received registered nurse education was not reduced compared with mother's who received a brochure only and those who did not receive CSS education.Comparison of CSS misuse before (n = 60) and after (n = 70) observations revealed an increase in average misuse (1.8 vs. 3.0, p < 0.05) and a decreases or no significant change in appropriate use as follows: harness in lowest slot (95% vs. 87%), retainer clip at axilla level (63% vs. 33%, p < 0.01), harness snug (50% vs. 27%, p < 0.01), attached to the vehicle (80% vs. 80%), 45-degree angle (60% vs. 19%, p < 0.01), and CSS moves (32% vs. 27%).
Car safety seat misuse did not improve following implementation of a comprehensive nursing education and training program. CSS misuse in our study population was frequent and may increase injury risk in the event of a motor vehicle crash. Future work is needed to develop novel approaches and identify appropriate settings to reduce newborn CSS misuse.
尽管国家、州和医院的政策要求新生儿在正确使用的儿童安全座椅（CSS）中运输，但新生儿中经常出现明显的 CSS 误用。本研究的目的是评估在母婴单位中对护士和父母进行综合 CSS 培训计划的效果。
在干预前阶段，我们对一家大型城市教学医院的母婴单位护士进行了一项调查，以衡量 CSS 知识、态度和实践。然后，我们在出院时招募了 60 对母婴对，以调查母亲的 CSS 知识并观察 CSS 误用率。我们的干预阶段包括 1 小时的“强制性”护士 CSS 教育课堂会议，以及在母亲房间中进行护士现场 CSS 演示和实践。在干预后阶段，我们在出院时招募了 70 对母婴对，以调查母亲的 CSS 知识并观察 CSS 误用率的变化。
在干预前阶段，59 名符合条件的护士中有 43 名（73％）完成了调查，有 47 名（80％）完成了 CSS 教育和培训计划。在干预前的 CSS 调查中，23％的护士报告教育是他们常规工作的一部分，44％有 CSS 教育材料，32％对向父母提供 CSS 教育感到舒适，12％对 CSS 培训感到满意，25％有时间，84％认为 CSS 误用是一个问题，16％接受过 CSS 培训。入组的母亲反映了母婴单位的人口统计学特征如下：母亲的平均年龄为 29 岁（范围为 16-48 岁），白人（54％），黑人（11％），西班牙裔（28％），英语为主要语言（83％），高中学历（31％），大学学历（30％），医疗补助（23％）和私人保险（65％）。在 70 名接受干预后的母亲中，44％报告未接受护士教育，21％报告仅接受了小册子，31％报告接受了护士教育。与仅接受宣传册和未接受 CSS 教育的母亲相比，接受注册护士教育的母亲的 CSS 误用率并未降低。
与观察前（n = 60）相比，观察后（n = 70）的 CSS 误用平均增加（1.8 对 3.0，p <0.05），而以下方面的适当使用率则有所下降或无明显变化：安全带在最低插槽中（95％对 87％），安全带固定夹在腋窝水平（63％对 33％，p <0.01），安全带紧固（50％对 27％，p <0.01），安全带固定在车辆上（80％对 80％），45 度角（60％对 19％，p <0.01），和安全带移动（32％对 27％）。
实施全面的护理教育和培训计划后，CSS 误用并未得到改善。我们研究人群中的 CSS 误用很普遍，并且在发生机动车碰撞时可能会增加新生儿的受伤风险。需要进一步研究以开发新方法并确定减少新生儿 CSS 误用的适当环境。
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