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clinical implementation, kangaroo care, skin-to-skin holding, sleep, staff education



  1. Smith, Karen M. BSN, RNC, MEd


This article provides a review of a change in practice within a Level III neonatal intensive care unit setting. The use of skin-to-skin holding as a means to secure parents' attachment to their infant, and support their child's rest and recovery in the neonatal intensive care unit, has been recognized historically and supported by research in this practice. The importance of sleep to the infant's developmental outcome was recognized and the use of skin-to-skin holding as a means of increasing stable infant sleep and rest was implemented. The implementation was based on published research, current practice within the nursery, and staff and family discussions. Implementation of skin-to-skin holding earlier in the newborn's neonatal intensive care unit course was accomplished by increasing interactive education, support, and ongoing review of unit practices and outcomes. Education regarding sleep states and cues was a focus of the project and understanding infant sleep assisted the staff in recognizing levels of restful sleep or restless sleep in infants. The implications of sleep and infant success in achieving discharge to home allowed the staff to see not only their role in infant sleep but also the parents' role in their newborn infant's sleep and growth in the nursery.