American Journal of Nursing Research. 2019, 7(4), 428-436
DOI: 10.12691/AJNR-7-4-4
A Clinical Study

Effect of Implementing Learning Package of Nesting and Swaddling for Premature Infants on Nurses' Knowledge and Performance in NICU

Gehan EL Nabawy Ahmed1, and Boshra Attia Mohammed1

1Lecturers of Pediatric Nursing, Faculty of Nursing, Mansoura University, Egypt

Pub. Date: May 13, 2019

Cite this paper

Gehan EL Nabawy Ahmed and Boshra Attia Mohammed. Effect of Implementing Learning Package of Nesting and Swaddling for Premature Infants on Nurses' Knowledge and Performance in NICU. American Journal of Nursing Research. 2019; 7(4):428-436. doi: 10.12691/AJNR-7-4-4


Premature infants surviving require advanced medical interventions and professional nursing care. Despite the innovative interventions in the medical field, they remain vulnerable for long-term complications, which is the result of early disruption of their intrauterine life and sudden exposure to an entirely unfamiliar NICU environment. One strategy for helping premature grows normally in NICU is developmental care, which includes positioning, nesting, and swaddling as daily routine care. This study aims to assess the effect of learning package regarding nesting and swaddling for premature on nurses knowledge and performance in NICU. A quasi-experimental research design using one group (pre, immediately post and three months later) was used for this study. Setting: The study was conducted at NICU in Abha Maternity and Child Hospital (AMCH), Abah city, Kingdom of Saudi Arabia. Subjects: 77 nurses who work in the previously mentioned NICU as a convenience sample. Tools: two tools used to collect the study: A Structured questionnaire sheet to assess nurses' knowledge regarding nesting and swaddling and the observation sheet to assess nurses' performance of nesting and swaddling in NICU. Results: There was a statistically significant difference regarding nurses' knowledge and performance about nesting and swaddling immediately after and three months later compared with before learning package. Conclusion: There was a significant positive effect of implementing learning package in improving nurses’ knowledge and performance about nesting and swaddling in NICU for premature infants. Recommendations: Neonatal nurses must be provided with the best evidence about applying nesting and swaddling techniques for premature infants as a standard of developmentally supportive care in the NICUs.


nesting, swaddling, positioning, premature infants, nurse’s knowledge, performance, NICU, developmental care


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[1]  Heron, M., Sutton, P., Xu, J., Ventura, S., Strobino, D. & Guyer, B. (2010). Annual Summary of Vital Statistics: 2007. Pediatrics; 125: 4-15.
[2]  Blencowe, H. et al. (2012). National, regional, and worldwide estimates of preterm birth rates in the year 2010 with time trends since 1990 for selected countries: a systematic analysis and implications. Lancet, 379: 2162-2172.
[3]  Abd-Allah N., Nasr E., Hassan H. (2017). Impact of a Breast Feeding Educational Program for Mothers Having Pre-Term Infants in General Hospitals in Port Said. International Journal of Novel Research in Healthcare and Nursing, 4, (3): 215-225.
[4]  World Health Organization (WHO). Preterm birth. (November 2015): Retrieved at: n/.
[5]  Besser, L., Sabag-Shaviv, L., Yitshak-Sade, M., Mastrolia, S.A., Landau, D., Beer-Weisel, R. et al. (2018).Medically indicated late preterm delivery and its impact on perinatal morbidity and mortality: a retrospective population-based cohort study. J Matern Fetal Neonatal Med; 1:1-10.
[6]  Lipner, H.S. & Huron, R.F. (2018). Developmental and interprofessional care of the preterm infant: Neonatal intensive care unit through high-risk infant follow-up. Pediatr Clin North Am; 65(1):135-41.
[7]  Haumont, D. (2014). NIDCAP and developmental care. Journal of Pediatric and Neonatal Individualized Medicine; 3(2):e030240.
[8]  Network Lead Nurse. (2017). Wales Neonatal Network Guideline: Supportive Positioning Guideline. No. 5: 1-12.
[9]  Poulose, R., Babu, M., ShardaRastogi, S. (2015). Effect of Nesting on Posture Discomfort and Physiological Parameters of Low Birth Weight Infants. IOSR Journal of Nursing and Health Science (IOSR-JNHS) e-ISSN: 2320–1959.p- ISSN: 2320–1940. 4, (1) (Jan.- Feb.), PP 46-50
[10]  Mony, K., Selvam,V., Diwakar.,K.& Raghavan,V. (2018).Effect of nesting on sleep pattern among preterm infants admitted in NICU. Biomedical Research; 29 (10): 1994-1997
[11]  Waitzman, A. (2014). The importance of positioning the nearterm infant for sleep, play and development. Newborn and Infant Nursing Reviews 7: 76-81.
[12]  Kihara H & Nakamura T (2013. Nested and swaddled positioning support in the prone position facilitates sleep and heart rate stability in very low birth weight infants. Research and Reports in Neonatology 3: 11-14.
[13]  Madlinger-Lewisa L, Reynoldsb L, Zarema C, Crapnella T, Inderc T, et al. (2014). The Effects of Alternative Positionin on Preterm Infants in the Neonatal Intensive Care Unit: A Randomized Clinical Trial. Res Dev Disabil 35: 490-497.
[14]  Wambach, A. & Hamvas, A. (2015). Respiratory distress syndrome in the neonate. In Martin RJ, Fanaroff AA, Walsh MC, eds. Fanaroff and Martin's Neonatal-Perinatal Medicine.10th ed. Philadelphia, PA: Elsevier Saunders; chap. 72.
[15]  Abdeyazdan, Zahra, et al. (2016).Effects of nesting and swaddling on the sleep duration of premature infants hospitalized in neonatal intensive care units." Iranian journal of nursing and midwifery research 21. 5: 552.
[16]  El-Nagger, N.S.M .& Bayoumi,O.R.(2016). Effect of Applying Nesting Technique as a Developmental Care on Physiological Functioning and Neurobehavioral Organization of Premature Infants. Life Science Journal; 13(1S).
[17]  Sathish, Y, Lewis,L.E., Noronha, J.N., George, A., Snayak,B., Pai, M.S., Bhat, R., Purkayastha, J. (2017). Clinical Outcomes of Snuggle up Position Using Positioning Aids for Preterm (27-32 Weeks) Infants. Iranian Journal of Neonatology. Mar: 8(1).
[18]  Abusaad, F., E., Abd El Aziz,R.,A.,E.& Nasef. A., A. (2017). The Effectiveness of Developmentally Supportive Positioning on Preterm Infants' Pain Response at Neonatal Intensive Care Units. American Journal of Nursing Science. 6, (1): pp. 63-71.
[19]  Kim, Min-Jung, & Tae-Im Kim. (2018). “Knowledge and Performance of Developmentally Supportive Positioning for Premature Infants among Neonatal Intensive Care Unit Nurses.” Child Health Nursing Research 24 (2): 229-240.
[20]  Maher, G.& Elarousy, W. (2018). Effect of Nested and Swaddled Prone Positioning on Sleep and Physiological Parameters of Low Birth Weight Neonates. International Journal of Nursing and Health Science. 5(3), 48-55.
[21]  Potter P.A., Perry A. G., Ross-Kerr J. C., Wood, M, J. (2006). Canadian Fundamentals of Nursing; 3rd Ed. Elsevier, Canada: 600-610.
[22]  Nasr, E. & Hassan, H. (2016). Association between quality of family planning services and client’s satisfaction level in maternal and child health centers in Port Said city. Journal of Nursing Education and Practice; 6(1): 85-99.
[23]  Hassan H., Gamel W., Abd El-Gawad, Sheha E., Sayed M., Arafa A. (2019). Menstrual disorders necessitating counseling among students in Beni-Suef University. Clinical Nursing Studies; 7(2): 29-36.
[24]  Farg D. and Hassan H. (2019). Study Hyperemesis Graviderum Requiring Hospital Admission during Pregnancy: Effect of Nursing Implication on Its Progress. American Journal of Nursing Research; 7(3): 328-341.
[25]  Chen, C.M, Lin, K.H, Su, H.Y, Lin, M.H.& Hsu, C.L.(2014). Improving the provision of nesting and positioning for premature infants by nurses in neonatal intensive care units. Hu Li Za Zhi. Apr; 61(2 Suppl):S41-9.
[26]  Spilker, A., Hill, C, Rosenblum, R. (2016).The effectiveness of a standardized positioning tool and bedside education on the developmental positioning proficiency of NICU nurses. Intensive Crit Care Nurs. Aug; 35:10-5.
[27]  Godarzi, Z., Rahimi, O., Khalessi, N., Soleimani, F.,, Mohammadi, N. & Shamshiri, A. (2015). The rate of developmental care delivery in neonatal intensive care unit. Iran J Crit Care Nurs.; 8(2): 117-124.
[28]  Mohammed, R., Khamis,G.M. & Sabry,Y.Y. (2018).Effect of Preterm Neonates' Developmental Supportive Care Program on Nurses' Performance. IOSR Journal of Nursing and Health Science (IOSR-JNHS) e- ISSN: 2320–1959.p- ISSN: 2320-1940. 7, (4) (Jul.-Aug.), PP 33-45.
[29]  Abd El- Aziz,D.E., Abd El Aziz,M.A., Adly,R.M. & El Sallab,S.M. (2018). Improving Nurses' Performance towards Non- Pharmacological Pain Management among Neonates In Neonatal Intensive Care Unit. IOSR Journal of Nursing and Health Science (IOSR-JNHS) e- ISSN: 2320–1959.p- ISSN: 2320–1940. 7, (4) (Jul.-Aug.), PP 33-45.
[30]  Costa, T., Rossato, L., Bueno, M., Secco, I., Sposito, N., Harrison, D., & Freitas, J., (2017). Nurses' knowledge and practices regarding pain management in newborns. Revista da Escola de Enfermagem da USP, 51.
[31]  Hassan H, &Nasr E. (2017). Improving nurses’ knowledge and skills regarding tocolytics for inhibiting preterm labor. Clinical Nursing Studies; 5(1): 1-12.
[32]  Mehrnoush, N., Ashktorab, T., Heidarzadeh, M., & Momenzadeh, S. (2017). Knowledge and attitude of personnel, key factors in implementation of neonatal pain management in NICU: A Qualitative Study. Journal of Clinical & Diagnostic Research, 11(11). Retrieved from, http://www.
[33]  El-Sayed, S., Sabry, Y, Sharkawy, H, El-Sayed E. and Ali, T. (2013). Establishing basic standards of nursing care protocol at neonatal intensive care unit. Nature and Science 11(4). Retrieved from,
[34]  Hunter, J., Lee, A.& Altimier, L. (2015).Neonatal intensive care un occupational therapy for children and adolescents. St. Louis: Elsevier, St; pp. 595-635.
[35]  Zarem, C., Crapnell, T., Tiltges, L., Madlinger, L., Reynolds, L., Lukas, K. et al. (2013).Neonatal nurses' and therapists' perceptions of positioning for preterm infants in the neonatal intensive care unit. Neonatal Netw; 32(2):110-6.
[36]  Betts, K., Watson, G., Roy, R. (2015). Joint Trust guideline for the management of developmental care of pre-term neonates. Norfolk, UK: James Paget University Hospitals, Norfolk and Norwich University Hospitals; Pp.2-12.
[37]  Gouna, G., Rakza, T., Kuissi, E., Pennaforte, T., Mur, S. & Storme, L. (2013).Positioning effects on lung function and breathing pattern in premature newborns. J Pediatr 2013; 162(6):1133-7.
[38]  Lucas, N. (2015). Developmental care in the neonatal unit. Sri Lanka Child Health J; 44(1): 45-52.
[39]  Altimier, L., Kenner, C., Damus, K. (2015).The wee care neuroprotective NICU program (Wee Care): The effect of a comprehensive developmental care training program on seven neuroprotective core measures for family-centered developmental care of premature neonates. Newborn Infant Nurs Rev; 15(1): 6-16.
[40]  Hassan H., Mohamady Sh., & Abd El-Gawad N. (2017). Protocol for improving nursing performance towards placental examination at labor units. Clinical Nursing Studies, 5(2): 1-11.
[41]  Faheim S. , Hassan H. , Gamel W. (2019). Topical Application of Human Milk versus Alcohol and Povidine-Iodine on Clinical Outcomes of Umbilical Cord in Healthy Newborn: Impact of an Educational Program of Mothers’ Knowledge and Practice Regarding Umbilical Cord Care. International Journal of Studies in Nursing; 4(2): 35-51.
[42]  Hassan H. (2018). Effectiveness of a structured teaching program on anxiety and perception regarding toxoplasmosis among seropositive pregnant women in Northern Upper Egypt. Clinical Nursing Studies, 6(1): 1-19.
[43]  Hassanine Sh., Hassan H., Alkotb Z. (2017). Effect of Preventive Program on Progression of Osteoporosis among Female Patients over 40 years at El-Fayoum City. American Research Journal of Nursing, 3(1): 1-15.
[44]  Kumar, A. (2007). Personal, Academic and Career Development in Higher Education-SOA Ring to Success London and New York, pp. 1-33. Routledge Taylor & Francis Group.
[45]  Masri, S., Ibrahim, P., Badin, D., Khalil, S.& Charafeddine, L. (2018).Structured Educational Intervention Leads to Better Infant Positioning in the NICU. Neonatal Netw. Mar 1; 37(2):70-77.