Nurse Perspectives on Incorporating Swaddling Into Diaper Change Procedures: A Qualitative Study.

Background: Procedural stress in neonates leads to short- and long-term alterations in their metabolic and neurologic functioning. Although positive effects of swaddling intervention on neonatal stress are reported, Neonatal Intensive Care Unit (NICU) nurses' perceptions of swaddling during care procedures have not been examined.

Purpose: To explore the clinical experiences and perceptions of nurses using a swaddled diaper change intervention for feasibility of implementation as a NICU policy.

Methods: Ten open-ended interviews were conducted with experienced NICU nurses. An inductive content analysis was conducted for data analysis.

Results: Four themes and 13 subthemes were identified. NICU nurses found that swaddling was an efficient and effective way to control stress. Nurses noticed less stress in the infant, felt less personal stress, and recognized parents were calmer when the infants were calm. Demonstrating, explaining, and providing written information for both families and NICU staff allows for education to be repetitive and multimodal.

Implications for practice and research: NICU nurses found a diaper change with an upper body swaddle (infant swaddled across the upper trunk and body with legs and lower trunk open for access) intervention to be feasible, effective for stress reduction, and efficient. Expanding this simple intervention through education to staff and families can impact stress reduction for infants and parents multiple times per day.