An Evidence-Based Approach to Nipple Feeding in a Level III NICU: Nurse Autonomy, Developmental Care, and Teamwork

Shaker, Catherine S. MS/CCC-SLP, BRS-S
Werner Woida, Amy Marie RN, BSN

Accepted for publication January 2006. Revised March 2006.

About the Authors

Catherine S. Shaker received her masters degree in speech-language pathology in 1977 from Marquette University, Milwaukee, Wisconsin. Since 1985, she has specialized in infant swallowing/feeding in the Level III NICU at Wheaton Franciscan Healthcare—St. Joseph, Milwaukee, Wisconsin, the regional perinatal center for southeastern Wisconsin. She is a board-recognized specialist in swallowing and swallowing disorders through the American Speech-Language Hearing Association. Ms. Shaker has published several manuscripts regarding neonatal swallowing/feeding. She lectures nationally to neonatal nurses, therapists, and consults on site.

Amy Marie Werner Woida received a bachelor of science in nursing in 1997 from Marquette University, Milwaukee, Wisconsin. Ms. Woida has been a staff nurse in Level III NICUs for nine years, including eight years with Wheaton Franciscan Healthcare—St. Joseph, where she currently practices, and one year with Memorial Health University Hospital in Savannah, Georgia. She is an NRP instructor and is active in interdisciplinary initiatives in the NICU.

For further information, please contact:

Catherine S. Shaker, MS/CCC-SLP, BRS-S

Wheaton Franciscan Healthcare—St. Joseph

5000 W. Chambers Street

Milwaukee, WI 53210

414-447-2797

E-mail: [email protected]

Neonatal Network 26(2):p 77-83, March-April 2007.

Abstract

Historically, nipple feeding in the NICU has been initiated and advanced by physician order based on nursing observation and suggestions. The growing evidence base regarding nipple feeding readiness and progression, contingent caregiving, and nurse autonomy in decision making prompted our Level III NICU to reconsider our process. A literature review and discussions resulted in new protocols for initiating and advancing nipple feedings for three distinct groups: healthy preterm infants, preterm infants with complicated medical courses, and sick term or postterm infants. Through incorporating contingent caregiving, greater autonomy for the bedside nurse, developmental support, and collaboration, we expect to improve outcomes, communication, and problem solving.