First Advisor

Cathy Witt

Second Advisor

Patricia Cullen


Rueckert-Hartman College for Health Professions

Degree Name

Doctor of Nursing Practice


Loretto Heights

Document Type

Thesis - Open Access

Number of Pages

105 pages


Executive Summary


According to the Synactive Theory of Newborn Behavioral Organization and Development, the adaption of preterm infant to the NICU environment is determined by his/her ability to change their behavior in response to a stimulus, to achieve a self-regulated balance, and to maintain the energy required to sustain life (Als, 1986). When positioning is not done well, it can cause damage due to immaturity that can generate body alignment complications. Preterm infants do not have the muscle tone to move themselves out of an uncomfortable position. Therefore, the NICU team is responsible for the preterm infant’s alignment, posture and movement (Santos et al., 2017).


There has been a multitude of studies investigating and discussing the benefits of developmental positioning on infants’ stability. The purpose of this study was to investigate if quality and consistency of infants’ positions in SnuggleUp™ wraps improved following education.

Evidence-based practice is constantly evolving in the NICU and has become the foundation for patient-centered care; NNPs and RNs should be working together to improve patient outcomes, (Smith et al, 2009). At the end of the day, when providing patient care, it is not what was done or how it was done, but did we make a difference? (Assi, 2015).


The goal of this study is to improve the quality and consistency of developmental positioning in infants born 25 0/7 weeks to 34 6/7. This will be achieved by evaluating the use of the positioning aid, the SnuggleUp™ wrap, develop proper education, educate the staff and re-evaluate the use of the SnuggleUp™ wraps.


The objective of this Quality Improvement Project (QI) was to improve the quality and consistency of developmental positioning utilizing the SnuggleUp™ wrap following education via the present form of education used in the unit, the Occupational Competency Index (OCI).


Pre-education and post-education were both collected in 4 week periods in a total of 7 data collection sessions; two of these data collection sessions occurred on weekend days. Observations were made up to 3 times per 12 hour shift on each baby. Education and training on both the use of this product and proper developmental positioning was provided to the nursing staff for one month via the Occupational Competency Index, the unit’s current preferred mode of education. Staff was also provided with 4 baby dolls positioned in SnuggleUp™ wraps per manufacturer guidelines to facilitate tactile learning.


Though the data showed that there was not statistically significant change in position prior to and following education, there was data that showed that there was an improvement in positioning infants correctly, with the correct size of SnuggleUp™ with no extra blanket for infants who are 33 – 34 6/7 weeks gestation at birth. There were also correlations between the increased gestational age at collection and the decrease in use of extra blankets in the SnuggleUp™ Wraps.

Date of Award

Spring 2019

Location (Creation)

Colorado (state); Denver (county); Denver (inhabited place)

Rights Statement

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