Date of Award

Fall 10-14-2020

Degree Type

Final Project

Degree Name

DNP Doctor of Nursing Practice




Mary Ellen Roberts, DNP

Committee Member

Maureen Byrnes, DNP

Committee Member

Kathleen Livolsi, DNP


An important component of nursing assessment of feeding tolerance in the neonatal intensive care unit (NICU) for both low-risk and high-risk babies, is the quantification of emesis volumes. While some nurses attempt to weigh the items saturated in emesis in order to quantify volume loss (QEV), there is no or limited consistency in this practice across nurses in this unit. Rather, volumes are “best-guessed” or estimated (EEV) and reported to the practitioner for decision-making. Often feed advances are paused or limited due to perceived feeding intolerance connected to emesis events in neonates.

For this project, 158 NICU nurses at a large metropolitan children’s hospital in New York City were given a survey consisting of ten images of simulated emesis volumes on standard hospital linens and asked to estimate the emesis volumes (Appendix B). Nurses were also surveyed on demographics, their attitudes and beliefs related to emesis in neonates, and personal practices regarding this issue.

Compiled data results revealed that nurses were able to correctly estimate the simulated emesis volume presented to them an average of 34.5% of the time, regardless of educational level, years of experience, or presence of certification in their specialty. It is clear that visual quantification of emesis volumes is a highly inaccurate method to assess feeding tolerance and guide feed advancement in the NICU. Further research is needed on how these methods affect time to full feedings and overall NICU length of stay.