Can nurse education in the postpartum period reduce car seat misuse among newborns?

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.