Publication Date

Spring 2014

Degree Type

Doctoral Project

Degree Name

Doctor of Nursing Practice (DNP)



First Advisor

Terea Giannetta

Second Advisor

Donna McCloudy

Third Advisor

Krishna Rajani


neonatal feeding cues, feeding protocol, developmental-care, oral feeding, premature infant, cue-based


The project was an oral feeding practice change from traditional, gestational-age/volume-driven feeding progression to developmentally-based, infant-driven feeding progression. The infant-driven (cue-based) feeding protocol was implemented with goals to improve premature infants' feeding outcomes, and decreased the infant's length of hospitalization. The project was designed to implement a cue-based feeding protocol for oral feeding initiation and progression, within the neonatal intensive care unit (NICU) at Community Regional Medical Center (CRMC), and then retrospectively evaluate the impact of the cue-based feeding protocol on feeding outcomes. In order to realize full implementation of a NICU feeding practice change, multiple components, such as electronic charting, feeding policy, staff education and data reports, needed to be developed.

Multiple unit- and hospital-level barriers prevented timely project implementation. Given the DNP program time constraints for project implementation, and the complex nature of project review and approval by nursing leadership, final, post-protocol data collection and analysis could not be completed. Delays in project implementation did not allow for oral feeding outcome evaluation, as originally proposed, however, the project did produce valuable instruments for recording and measuring feeding outcomes in the future.

Future plans for project follow-up have been established by NICU nursing leadership. Data for 6-month and 1-year feeding outcomes will be collected and evaluated, with the intention to present results to: 1) CRMC corporate leadership, 2) CPQCC 1-year collaborative follow-up (June 2014); and 3) Central Valley Nursing Research Conference 2015.


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