Abstract
Background:
Non-nutritive sucking is an evidence-based practice used to support oral feeding readiness, pain management, and neurodevelopment in preterm and sick neonates. Nurses play a critical role in identifying and implementing non-nutritive sucking methods in neonatal intensive care units. However, there is limited data on the knowledge and clinical application of non-nutritive sucking among neonatal nurses.
Research Aims:
To determine the knowledge levels and practices of neonatal intensive care nurses regarding non-nutritive sucking and associated factors.
Methods:
A descriptive, cross-sectional, comparative, and correlational study was conducted with 154 neonatal nurses. Participants completed the three-part questionnaire, consisting of (1) demographic and professional characteristics; (2) nurses' practices related to non-nutritive sucking, and (3) the 27-item knowledge questionnaire. Descriptive statistics, independent samples t-test, and one-way ANOVA were performed to analyze the data.
Results:
The mean knowledge score was 19.46 (6.144). Although 64.3% of the nurses reported applying non-nutritive sucking techniques, only 29.5% felt competent. A significant difference was found between the nurses' non-nutritive sucking knowledge score averages and their age, education level, breastfeeding training, and practices.
Conclusion:
Enhancing neonatal intensive care nurses’ understanding and clinical application of non-nutritive sucking is essential to support evidence-based infant care and optimize the transition to oral feeding. Educational initiatives focusing on awareness, appropriate implementation, and evaluation of non-nutritive sucking practices may contribute to more consistent and effective nursing care in neonatal intensive care settings.
Key Messages
In Türkiye, limited evidence exists regarding neonatal intensive care unit nurses’ knowledge, clinical practices, and influencing factors related non-nutritive sucking.
The findings indicate that Turkish neonatal intensive care unit nurses had a moderate level of knowledge about non-nutritive sucking, while their clinical practices were insufficient at the time of the study.
Factors associated with nurses’ knowledge of non-nutritive sucking included age, education level, and breastfeeding training and practices.
Background
Oral feeding is a critical developmental milestone in the neonatal period and is essential for promoting growth, neurodevelopment, and physical stability. Successful oral feeding requires the coordinated function of multiple systems, including the suck-swallow-breathe reflex, arousal regulation, and autonomic control (Kurt Sezer & Küçükoğlu, 2020). However, preterm infants, especially those born before 34 weeks of gestation, often lack the neuromuscular maturity to feed effectively (Kaynak et al., 2020). As a result, many require alternative interventions to support the transition to oral feeding.
Non-nutritive sucking (NNS) is a commonly used, non-invasive technique that provides oral-tactile stimulation and enhances the development of feeding skills. NNS involves providing sucking opportunities without nutrients, typically through a pacifier, a gloved finger, or an empty breast (Gupta, 2025). It is frequently used in neonatal intensive care units (NICUs) to promote oral feeding readiness, regulate behavioral states, and support physiological parameters such as oxygen saturation and heart rate (Lubbe & ten Ham-Baloyi, 2017).
Evidence shows that NNS has a range of benefits, including improved feeding tolerance, shortened time to full oral feeding, enhanced gastrointestinal motility, and reduced stress and pain during procedures (Kurt Sezer & Küçükoğlu, 2020; Shaki et al., 2022; Silveira et al., 2021). It also plays a key role in transitioning infants from tube to oral feeding, and can help stabilize vital signs and reduce hospital length of stay. In addition, when integrated into routine care, NNS has been associated with a lower risk of complications and better neurobehavioral outcomes (Jullien, 2021; Vu-Ngoc et al., 2020).
Nurses play a key role in implementing non-nutritive sucking in neonatal intensive care unit settings. Their ability to recognize feeding cues, assess readiness, and apply evidence-based techniques directly impacts the quality of care and neonatal outcomes. Previous studies suggest that nurses' knowledge and clinical practices relating to non-nutritive sucking may be influenced by various individual and institutional factors. Educational level and professional experience have been shown to influence neonatal nurses’ clinical decision-making and the adoption of evidence-based feeding practices (Silveira et al., 2021; Vu-Ngoc et al., 2020). In addition, training programs focused on breastfeeding and neonatal feeding are associated with improved knowledge and greater confidence in implementing NNS interventions in the NICU (Jullien, 2021; Shaki et al., 2022). Clinical experience in the NICU setting may further affect nurses' ability to integrate NNS into routine care, particularly for preterm infants with complex feeding needs (Hendy et al., 2025). Furthermore, institutional policies and accreditation frameworks, such as the Baby-Friendly Hospital Initiative, may shape nurses' perceptions of and approach to NNS by emphasizing breastfeeding promotion while requiring careful clinical judgement regarding the use of artificial teats in the NICU (Silveira et al., 2021; World Health Organization [WHO], & United Nations Children’s Fund [UNICEF], 2018).
Despite the influence of these factors and the well-established benefits of NNS, evidence suggests that nurses’ clinical implementation of NNS remains inconsistent across neonatal intensive care settings. Variability in nurses’ understanding and implementation of NNS has been reported, indicating potential gaps in training, institutional guidance, or contextual adaptation of evidence-based recommendations (Dur, 2019; Lubbe & ten Ham-Baloyi, 2017). However, limited research has comprehensively examined neonatal intensive care nurses’ knowledge, clinical practices, and the factors influencing their implementation of NNS, particularly within Baby-Friendly neonatal intensive care settings. In particular, there is insufficient evidence regarding how nurses integrate NNS methods into routine care and what variables contribute to this process. Addressing this gap is essential for improving the consistency and quality of NNS implementation in NICUs. Accordingly, the aim of this study was to determine the knowledge levels and practices of NICU nurses regarding non-nutritive sucking and associated factors.
Methods
Research Design
This study employed a descriptive, cross-sectional, comparative, and correlational design. The descriptive component enabled characterization of neonatal intensive care unit nurses’ knowledge levels and clinical practices regarding non-nutritive sucking. The cross-sectional design allowed data collection at a single point in time, which is appropriate for assessing current knowledge, practices, and associated factors within a defined population (Flanagan & Tatano, 2025). The comparative component of the design enabled the examination of differences in nurses’ knowledge levels across demographic and professional subgroups, including age, education level, and breastfeeding training. In addition, the correlational component supported the investigation of associations between nurses’ knowledge levels and selected demographic and professional characteristics, without implying causality, which is consistent with the study's aim of identifying associated factors (Creswell & Creswell, 2023). This multifaceted design was considered appropriate for addressing the study aim of determining neonatal intensive care unit nurses’ knowledge and clinical practices regarding non-nutritive sucking, as well as factors associated with their knowledge levels.
Ethical approval for the study was obtained from the Non-Interventional Clinical Research Ethics Committee of a University (29/08/2024, 61351342/020-340), and institutional permission was granted by the Istanbul Provincial Health Directorate.
Setting and Relevant Context
Data collection took place from August to October 2024 at five research and training hospitals affiliated with the Istanbul Provincial Health Directorate, which operates under the Turkish Ministry of Health. Hospitals were selected using simple random sampling. All selected hospitals were located in central Istanbul and offered Level III neonatal intensive care services.
The participating hospitals are accredited as Baby-Friendly institutions and promote exclusive breastfeeding as part of their standard care practices. Following birth, newborns are initiated into exclusive breastfeeding immediately, and rooming-in is implemented to facilitate frequent breastfeeding and enhance mother–infant bonding. In cases of preterm birth or transfer from another healthcare facility, the infant's oral feeding readiness is assessed collaboratively by physicians and nurses, and appropriate interventions are initiated accordingly in the NICU. Throughout hospitalization, nurses—some of whom are nationally certified lactation consultants—support breastfeeding by providing guidance and assistance to mothers. This support continues through discharge, ensuring continuity of breastfeeding care.
Sample
Nurses employed in neonatal intensive care units constitute the study's target population. The minimum sample size was determined using the G*Power software (Version 3.1.9.7). The calculation was based on the independent-samples t-test, with a medium effect size (d = 0.50), a significance level of 0.05 (α = 0.05), and a power of 0.80 (1-β = 0.80), resulting in a minimum required sample of 128 participants. To account for potential data loss, the sample size was increased by 20%, and a total of 154 participants were included (Cohen, 2013; Faul et al., 2007). Nurses who met the inclusion criteria—being employed in these hospitals, working full-time in the NICU, and voluntarily agreeing to participate—were included in the study. In total, 154 nurses participated.
Measurements
The data collection tool was structured into three sections, each developed by the researchers based on a comprehensive review of the relevant literature.
Section 1 – Sociodemographic and Professional Characteristics: This section consisted of nine questions, including age, gender, education, duration of professional experience, duration of NICU experience, marital status, having children, breastfeeding one’s own children, receiving breastfeeding education, and using a pacifier for one’s own child.
Section 2 – Nurses’ Practices Related to Non-Nutritive Sucking: This section assessed nurses’ self-reported clinical practices related to non-nutritive sucking and comprised 14 items developed by the researchers based on an extensive review of the relevant literature and existing clinical recommendations (Gozen & Girgin, 2017; John et al., 2019; Kurt Sezer & Küçükoğlu, 2020; Lubbe & ten Ham-Baloyi, 2017; Silveira et al., 2021; Vu-Ngoc et al., 2020). The items addressed NNS practices, including awareness of NNS, interventions to improve the infant's sucking ability, application of NNS, specific methods used in practice, and nurses’ perceptions of NNS practices. The section included dichotomous (yes/no), multiple-choice, and multiple-response questions designed to capture nurses’ awareness, use, and perceptions of non-nutritive sucking in clinical practice. The item assessing nurses’ ability to recognize an infant’s desire to suck was designed to capture nurses’ self-perceived awareness rather than to assess specific behavioral feeding cues. This section was used as a descriptive checklist to document reported practices and was not intended to generate a total practice score; therefore, no overall score was calculated. Responses were analyzed descriptively using frequencies and percentages. To ensure content relevance and clarity, the items were reviewed by six experts in neonatal nursing and revised for clarity and comprehensibility prior to data collection. As this section aimed to document current practices rather than to measure a latent construct, psychometric properties such as internal consistency reliability were not calculated.
Section 3 – Non-Nutritive Sucking Knowledge Questionnaire for Nurses: This 27-item questionnaire was created by the researchers, drawing upon evidence from the relevant literature (Gozen & Girgin, 2017; John et al., 2019; Kurt Sezer & Küçükoğlu, 2020; Lubbe & ten Ham-Baloyi, 2017; Silveira et al., 2021; Vu-Ngoc et al., 2020) to assess nurses' knowledge of NNS. The items address key topics, including signs of infant readiness for oral feeding, factors influencing sucking ability, NNS methods, and the physiologic and psychologic effects of NNS on both infants and mothers. Each item is scored dichotomously: Responses were evaluated using a binary scoring method: 1 point for correct and 0 for incorrect answers. Items 15, 16, 17, and 18 are reverse-coded. The total score ranges from 0 to 27, with higher scores reflecting greater knowledge of NNS. In this study, participants’ total scores were converted to percentages and categorized into quartiles: Very low (0%–25%), low (26%–50%), moderate (51%–75%), and high (76% and above).
The content validity of the questionnaire items was assessed through expert review by seven academicians holding PhDs in pediatric nursing. All experts had published research in neonatal nursing and had over 10 years of clinical experience. The expert panel used a 4-point Likert scale to assess item relevance, with 1 indicating not relevant and 4 indicating highly relevant. To calculate the Content Validity Index (CVI), the number of experts who selected 3 or 4 was divided by the total number of evaluators (Flanagan & Tatano, 2025). The item-level CVI (I-CVI) ranged from 0.99 to 1.00, and the scale-level CVI (S-CVI) was calculated as 0.99, indicating excellent content validity. Based on expert feedback, the final version of the questionnaire was developed. No further revisions were deemed necessary following a second review by the expert panel.
For reliability analysis, the Kuder-Richardson Formula 20 (KR-20) was used to assess internal consistency, yielding a KR-20 coefficient of 0.92 for the entire knowledge questionnaire. A reliability coefficient greater than 0.70 is considered acceptable, indicating high internal consistency.
The item discrimination of the NNS Knowledge Questionnaire was evaluated by comparing the mean scores of the top and bottom 27% of participants. The difference between these groups was found to be statistically highly significant (p = 0.000), indicating strong discriminative power of the scale. The questionnaires used in this study are provided in the online Supplementary Material 1.
Data Collection
Data were collected between August and October 2024 using both in-person and online methods. Initially, the questionnaire was administered face-to-face by the researcher to nurses at hospitals that had granted approval. Prior to completing the questionnaire, nurses participating in the in-person data collection were informed of the study's purpose and procedures, and written informed consent was obtained. However, due to high workloads, unit-based scheduling constraints, limited time availability, and fatigue among nurses, the targeted sample size could not be achieved through in-person data collection. To address this limitation, the questionnaire was subsequently converted to an online format in Google Forms and distributed to NICU head nurses via WhatsApp group messages. Nurses who participated in the online survey reviewed the study information and provided electronic informed consent before accessing the questionnaire. Of the total participants, 34 nurses completed the questionnaire in person, while 120 completed it online. Participation was voluntary, and completing the questionnaire took approximately 15–20 minutes. An amendment to the original ethical approval was obtained to permit online data collection. A standardized answer key developed by the researchers was used to assess the responses to the knowledge questionnaire.
Participants’ confidentiality was ensured by collecting data anonymously and restricting access to the research team only. Face-to-face survey data were stored securely, and online survey data were stored on password-protected, encrypted digital platforms.
Data Analysis
Data analysis included demographic variables (e.g., age, sex, educational level, years of experience in the neonatal intensive care unit, parental status, and breastfeeding training), as well as nurses’ knowledge and clinical practice variables related to non-nutritive sucking. Data were analyzed using SPSS (Version 21.0). To address the study aim, descriptive statistics (means, standard deviations, frequencies, and percentages) were used to assess nurses’ knowledge levels and clinical practices regarding non-nutritive sucking. To address the other study aim, differences in nurses’ knowledge levels according to demographic and professional characteristics were examined. The assumption of normality was verified using the Kolmogorov-Smirnov test (p ≥ 0.05) and by ensuring that skewness and kurtosis values fell within the ± 2 range (George & Mallery, 2024). Accordingly, parametric tests were applied. Independent t-tests were used for two-group comparisons, and one-way ANOVA for comparisons among three or more groups. Post-hoc analyses were performed using the Bonferroni or Games-Howell test, depending on the homogeneity of variances. The statistical significance level was accepted as p < 0.05.
Results
Characteristics of the Sample
A total of 154 nurses participated in the study, representing a response rate of 70.3%. The demographic characteristics of the participants are summarized in Table 1.
Characteristics of Participants.
Note. NICU = neonatal intensive care unit.
Knowledge Levels of the Nurses Regarding Non-Nutritive Sucking
The mean knowledge score of the nurses was 19.46 (6.144), with a mean success rate of 72% (Table 2).
Distribution of Non-Nutritive Sucking Knowledge Scores of Nurses.
Note. Min = minimum, Max = maximum, KR20 = Kuder-Richardson 20, MSP = mean success percentage, calculated by taking the percentage of the mean score (M).
Practices of the Nurses Regarding Non-Nutritive Sucking
Nurses’ self-reported practices related to non-nutritive sucking are presented in Table 3. Overall, nurses reported varying levels of awareness, practice, and perceived competence regarding NNS.
Practices of the Nurses Regarding Non-Nutritive Sucking (NNS).
Factors Influence the Knowledge Levels and Clinical Practices of NICU Nurses Related to Non-Nutritive Sucking
Differences in nurses’ non-nutritive sucking knowledge scores according to demographic, professional, and practice-related variables are presented in Tables 4 and 5.
Knowledge Scores on Non-Nutritive Sucking According to Demographic and Professional Characteristics of Neonatal Intensive Care Unit Nurses (n = 154).
Note. Independent samples t-test was used for two-group comparisons, and one-way analysis of variance (ANOVA) was used for comparisons among three or more groups. Statistical significance was set at p < 0.05. Variables with statistically significant differences are presented in bold.
Knowledge Scores on Non-Nutritive Sucking According to Clinical Practices of Neonatal Intensive Care Unit Nurses (n = 154).
Note. An independent samples t-test was used for two-group comparisons, and a one-way analysis of variance (ANOVA) was used for comparisons among three or more groups. Statistical significance was set at p < 0.05. Variables with statistically significant differences are presented in bold.
The knowledge scores of nurses aged 22–25 were significantly lower than those of nurses in older age categories (F = 12.002, p = 0.000). In terms of educational background, nurses with a Master’s degree scored significantly higher than those with a bachelor’s or high school education (F = 6.637, p = 0.002). Additionally, nurses who had received breastfeeding education had significantly higher knowledge scores than those who had not (t = 2.097, p = 0.039; Table 4).
Statistically significant differences in knowledge scores were found across several practice-related variables. Nurses who were able to recognize infants’ desire to suck (F = 4.400, p = 0.014), had heard of non-nutritive sucking (t = 5.805, p = 0.005), had previously applied NNS (t = 7.012, p = 0.000), or believed it was beneficial (F = 24.492, p = 0.000), had significantly higher knowledge scores. Similarly, higher scores were observed among nurses who used pacifiers (t = 2.642, p = 0.013) or gloved fingers (t = 3.439, p = 0.004) during care, recommended NNS to colleagues (F = 29.948, p = 0.000) or mothers (F = 33.227, p = 0.000), and rated themselves as competent (F = 20.250, p = 0.000) in applying NNS techniques (Table 5).
Discussion
Effective nutritional management by neonatal nurses is essential for supporting the growth and development of infants in NICUs, and this requires periodic assessment of feeding readiness and sufficient knowledge of non-nutritive sucking to facilitate the transition to oral feeding (Gupta, 2025; Purwandari et al., 2023). In the present study, we evaluated NICU nurses' knowledge and practices regarding NNS in Türkiye.
In this study, nurses demonstrated a moderate level of knowledge regarding NNS, which may reflect the limited inclusion of this topic in undergraduate nursing curricula and in-service training programs. While a study from Brazil reported high levels of knowledge among NICU nurses (Silva et al., 2021), a study from Türkiye found that more than half of nurses answered NNS-related questions incorrectly (Girgin & Gözen, 2020), highlighting disparities in educational exposure. In the present study, more than two-thirds of the nurses (68.8%) had heard the term NNS, mainly through university courses, academic publications, colleagues, and conferences—suggesting that informal and self-directed learning played a role. Supporting this, an intervention study found that nurses' knowledge of NNS significantly improved following structured training (Girgin et al., 2021). These findings emphasize the need to integrate standardized NNS content into both undergraduate curricula and continuing education to ensure consistent knowledge levels and effective clinical application across NICU settings.
Recognizing an infant’s desire to suck is a critical component of assessing feeding readiness in the neonatal intensive care unit, and is considered a key nursing responsibility (Kurt Sezer & Küçükoğlu, 2020). In this study, 96.1% of nurses reported being able to identify this behavioral cue, and these nurses also demonstrated significantly higher knowledge scores regarding NNS. This association suggests that the ability to identify feeding readiness may be linked to greater clinical knowledge and awareness. Supporting this, a study conducted in Türkiye assessing the impact of an evidence-based feeding training program for NICU healthcare professionals found that the majority of participants—both before and after training—correctly identified “hand or fist sucking” as a hunger signal (Çelen et al., 2022). The high rate of correct responses in both studies may be related to participants’ prior training and the observational skills they developed in clinical practice. In the present study, the fact that most nurses had received breastfeeding education may have supported their ability to recognize infant feeding cues. These findings highlight the role of both education and clinical experience in helping nurses assess feeding readiness and apply appropriate interventions in neonatal care.
Non-nutritive sucking aims to support the development of infants’ sucking skills using methods such as pacifiers, gloved fingers, or an emptied breast (Gupta, 2025). In the present study, 64.3% of NICU nurses reported using NNS in clinical practice. Specifically, 61.0% used the emptied-breast method, 84.4% provided pacifiers, and 90.3% used gloved-finger stimulation. However, a previous study in Türkiye found that only 20% of nurses used evidence-based interventions to support preterms’ oral feeding, and all of them applied NNS techniques (Girgin & Gözen, 2020). Similarly, in Brazil, 58.8% of nurses reported using NNS as part of non-pharmacological pain management (Costa et al., 2017). In a multicenter study in China, 75% of NICUs used pacifiers before tube feeding, whereas only 20.5% did so before oral feeding (Lyu et al., 2020). These findings suggest that although NNS is used in practice, its application is neither widespread nor consistent. This may be due to the lack of clinical guidelines, limited education on the topic, and low awareness of its importance. In the current study, nurses who applied NNS had significantly higher knowledge scores than those who did not, supporting the role of education in improving practice. Additionally, about one-third of the nurses considered themselves inadequate in using NNS, and this group also had lower knowledge scores. Expanding training opportunities and providing supervision could help increase both the use of NNS in clinical settings and nurses’ confidence in applying it.
Although the hospitals included in this study were designated as Baby-Friendly, the application of non-nutritive sucking practices in neonatal intensive care units requires consideration of the unique clinical needs of preterm infants. The Baby-Friendly Hospital Initiative, through the Ten Steps to Successful Breastfeeding, emphasizes avoiding artificial teats or pacifiers in healthy, term infants to support exclusive breastfeeding. However, international guidelines acknowledge that neonatal intensive care units are a specialized setting in which non-nutritive sucking may be used selectively for clinical purposes, such as supporting readiness for oral feeding, neurodevelopment, and procedural comfort in preterm infants (WHO & UNICEF, 2018). In this context, the use of non-nutritive sucking in neonatal intensive care units is generally implemented in accordance with institutional protocols and clinical indications, rather than as routine soothing practices. Such approaches aim to balance adherence to Baby-Friendly principles with the developmental and therapeutic needs of preterm infants. This distinction may explain how Baby-Friendly hospitals continue to meet accreditation criteria while allowing structured suck training practices in neonatal intensive care settings.
In the present study, approximately half of the nurses (56.5%) perceived non-nutritive sucking as beneficial, and those who did so had significantly higher knowledge scores. This association is supported by similar research in neonatal care, where greater knowledge correlates with more positive attitudes and a stronger intention to practice. For example, a recent multicenter study of NICU nurses found that those with satisfactory knowledge in areas including non-nutritive sucking were more likely to report positive attitudes toward implementing related care practices (Hendy et al., 2025). This underscores the idea that knowledge and attitude are interdependent, and that enhancing nurses’ comprehension of NNS through evidence-based education may foster more favorable perceptions and increase its application in clinical settings.
Providing families with consistent, accurate, and evidence-based guidance on transitioning to oral feeding is a critical responsibility of healthcare professionals. To do so effectively, nurses must hold positive beliefs about, and confidence in, interventions such as NNS. In the present study, approximately half of the nurses reported recommending NNS to mothers during discharge education (44.8%) and to their colleagues (54.5%). This finding may reflect limited confidence or uncertainty about the practice and could be influenced by factors such as the participants' relatively young age and limited NICU experience. Moreover, nearly one-third of the nurses had not received breastfeeding education. Studies showed that nurses who participated in institution-based breastfeeding training were more confident and supportive in promoting breastfeeding (Hennop et al., 2024; Walsh et al., 2023). High-quality nursing care relies on ongoing educational programs that strengthen clinical knowledge and practical abilities. A lack of training in this area may result in knowledge and practice gaps, potentially compromising infant safety and comfort. In this study, nurses who had received breastfeeding education and recommended NNS to both mothers and colleagues had significantly higher knowledge scores, reinforcing the importance of education in shaping professional beliefs and encouraging evidence-based practice in neonatal care.
This study evaluated several associated factors thought to influence nurses' knowledge and practices regarding non-nutritive sucking. Although professional experience and years of work in the neonatal intensive care unit might be expected to influence nurses’ knowledge and clinical practices regarding non-nutritive sucking, no significant differences were identified in the present study. Similarly, parental status, personal breastfeeding experience, and prior pacifier use with one’s own child were not significantly associated with nurses’ knowledge levels. One possible explanation is that clinical decision-making in neonatal intensive care units is primarily guided by institutional protocols and standardized care routines, which may limit the influence of individual life experiences on professional practice. In addition, personal parenting experiences may not necessarily translate into clinical expertise in the care of preterm or medically fragile infants, whose feeding needs differ substantially from those of healthy term infants. Nurses with diverse personal backgrounds may therefore rely more on formal education, clinical guidelines, and unit-based training than on personal experience when implementing NNS practices. Previous studies similarly reported no significant differences in nurses’ neonatal feeding knowledge and practices across factors such as professional experience and marital and parental status (Girgin & Gözen, 2020; Hendy et al., 2025; Rurumbi et al., 2025). Nevertheless, these personal factors may still shape nurses’ attitudes and perceptions toward NNS, underscoring the potential value of future qualitative or mixed-methods research to further explore their influence on clinical decision-making.
Limitations
A notable limitation of this study is that, due to clinical workload, data could not be collected face-to-face as originally planned and were instead collected via an online survey. Additionally, the use of self-reported data may have introduced response bias. The study’s sample was limited to nurses in public hospitals within a single urban area, which may affect the generalizability of the findings. Another limitation is that this study relied on self-reported data, and the assessment of nurses’ ability to recognize an infant’s desire to suck was based on a general self-perception item rather than specific behavioral cues. Future studies should incorporate cue-based assessments to more precisely evaluate nurses’ recognition of infants’ feeding readiness.
Conclusion
This study indicates that neonatal intensive care unit nurses demonstrate a generally moderate level of knowledge regarding non-nutritive sucking, while the integration of non-nutritive sucking techniques into routine clinical practice remains limited. Although various NNS methods are used, their application appears inconsistent across clinical settings. These findings highlight the need for strengthening educational and institutional support to promote consistent, evidence-based non-nutritive sucking practices in neonatal intensive care units. Integrating NNS content into undergraduate nursing education and continuing professional development programs may help bridge the gap between knowledge and practice. In addition, the development of standardized clinical guidelines and protocols may support nurses in confidently and appropriately implementing NNS to enhance feeding readiness and neurodevelopmental outcomes in preterm and medically vulnerable infants.
Supplemental Material
sj-docx-1-jhl-10.1177_08903344261451215 – Supplemental material for Non-Nutritive Sucking in Neonatal Intensive Care: Knowledge and Practices of NICU Nurses in Türkiye
Supplemental material, sj-docx-1-jhl-10.1177_08903344261451215 for Non-Nutritive Sucking in Neonatal Intensive Care: Knowledge and Practices of NICU Nurses in Türkiye by Ferda Özgökçe and Bahise Aydın in Journal of Human Lactation
Footnotes
Acknowledgements
The authors would like to thank to the nurses who voluntarily took part in the research.
Authors’ Note
This study was conducted as part of a Master's thesis in the Pediatric Nursing graduate program at Üsküdar University, Türkiye. Ferda Özgökçe carried out the research as a graduate student, under the academic supervision of Dr. Bahise Aydın.
Ethical Considerations
Ethical approval for the study was obtained from the Non-Interventional Clinical Research Ethics Committee of a University (29/08/2024, 61351342/020-340), and institutional permission was granted by the Istanbul Provincial Health Directorate (13/06/2024, E-15916306-604.01-247623260).
Consent to Participate
All participants provided written informed consent before participating in the research.
Author Contributions
Funding
The authors received no financial support for the research, authorship, and/or publication of this article.
Declaration of Conflicting Interests
The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Data Availability Statement
The data that support the findings of this study are available from the corresponding author upon reasonable request.
Supplemental Material
Supplementary Material may be found in the “Supplemental material” tab in the online version of this article.
References
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
