Nurses’ perspectives on implementing sleep protection for premature infants in the neonatal intensive care unit: a qualitative study

The normal development of sleep-wake cycles is crucial for the long-term neurological health of preterm infants, yet sleep protection practices remain suboptimal. Given China's large population of preterm infants and its distinct cultural background and healthcare policies compared to Western countries, NICU nurses in China may face unique challenges. However, our understanding of the barriers and facilitators encountered by nurses in implementing sleep protection for preterm infants is limited. From November 2023 to February 2024, we conducted semi-structured interviews with 15 nurses at a tertiary children's hospital in China. The interview guide was based on the Capability, Opportunity, Motivation, and Behavior (COM-B) model. Data analysis employed inductive thematic analysis, aligning the findings with the COM-B model and the Theoretical Domains Framework (TDF) to identify key barriers to effective management and potential interventions. Three major themes emerged: (1) Capability: Lack of knowledge among practitioners; Limited communication with parents; Inability to understand the cues of the baby; and Developing guidelines to support decision-making; (2) Opportunity: Time constraints; Poor interdisciplinary collaboration; Lower priority for sleep; and Additional medical expenses; (3) Motivation: Positive management attitude; Organizational expectations and support; Professional sense of responsibility; and Being an example to peers. To improve sleep protection for preterm infants in NICU settings, it is imperative to address several key barriers. Firstly, elevating the priority of sleep protection is essential. Specifically, a comprehensive strategy focusing on enhancing healthcare professionals' knowledge and skills, promoting multidisciplinary collaboration, strengthening communication with parents, and optimizing human resource allocation is crucial for effectively implementing sleep protection measures. Not required.