Date of Award


Document Type

Campus Access Dissertation

Degree Name

Doctor of Philosophy (PhD)



First Advisor

Esther Seibold

Second Advisor

Jacqueline Fawcett

Third Advisor

Jeffrey A. Burr


Objective: To assess nurses' perceptions of barriers to and facilitators of implementation of the shaken baby syndrome (SBS) public policy.

Background: A legislative Act providing for the prevention of SBS was passed in Massachusetts in November 2006. A stipulation of this Act was the provision of a program to educate parents/guardians of newborns about SBS prevention. The Conceptual Model of Nursing and Health Policy (Fawcett & Russell, 2001; Russell & Fawcett, 2005) and the Neuman Systems Model (Neuman & Fawcett, 2011) guided this study.

Methods: A cross-sectional survey of 13 Massachusetts birthing hospitals was completed using a Web-based survey (hosted by Qualtrics, Provo, Utah). Selected hospital, nurse, patient, and guideline characteristics were analyzed using descriptive, bivariate, and logistic regression analyses. Qualitative analysis was completed for responses to two open-ended survey questions.

Results: Hospital nurses' responses (N≈922, 155 responded) revealed barriers to and facilitators of SBS guideline implementation. The disadvantage of Web-based surveys as they relate to the challenges of enlisting cooperation, and a lack of direct access to the nurses may have attributed to the low response rate for this study. Themes from the qualitative analysis revealed a lack of SBS brochures, and an inability to provide SBS education for non-English speaking parents/guardians as barriers to SBS education. Nurses who agreed or strongly agreed that there were SBS brochures available in different languages were three times more likely (OR=3.04) to always implement each of the SBS guidelines (P=0.012, 95% CI=1.27-7.27) compared to those nurses who disagreed or strongly disagreed. An atmosphere of supportive leadership facilitated implementation of the SBS guidelines by nurses. This hospital characteristic had a significant effect on nurses' provision of the SBS brochure (OR=3.275, P=0.045, 95% CI=1.02-10.44), and documentation about SBS education in the medical record (OR=7.90, P=0.010, 95% CI=1.62-38.45).

Conclusion: A lack of SBS brochures in different languages and inability to provide SBS education for non-English speaking parents/guardians were perceived by nurses to be barriers to implementation of SBS education. The results of this study can be used to inform future research. A larger sample size would help to improve the generalizability of study findings.


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