Abstract

Pensar Enfermagem / v.30 n.Sup / Jan-Dec 2026 / DOI: 10.71861/pensarenf.v30iSup.520 / e00520

Workload and quality of neuroprotective care in neonatal units:

Mixed-Design and Multi-Study Protocol

Ana Rita Pereira1*, Fátima Prior2, Luísa Barros3, Isabel Malheiro4

1 Centro de Investigação, Inovação e Desenvolvimento em Enfermagem de Lisboa (CIDNUR), Escola Superior de Enfermagem de Lisboa, Lisboa,

Portugal. Escola Superior de Enfermagem São Francisco das Misericórdias, Lisboa, Portugal; orcid.org/0000-0001-8708-4574

2 Centro de Investigação, Inovação e Desenvolvimento em Enfermagem de Lisboa (CIDNUR), Escola Superior de Enfermagem de Lisboa, Lisboa,

Portugal. Departamento de Neonatologia e Cuidados Especiais Pediátricos, Hospital de Cascais, Cascais, Portugal; orcid.org/0000-0003-2781-4314

3 Centro de Investigação em Ciência Psicológica (CICPSI), Faculdade de Psicologia, Universidade Lisboa, Lisboa, Portugal.

Faculdade de Psicologia, Universidade Lisboa, Lisboa, Portugal; orcid.org/0000-0002-5075-0104

4 Centro de Investigação, Inovação e Desenvolvimento em Enfermagem de Lisboa (CIDNUR), Escola Superior de Enfermagem de Lisboa, Lisboa,

Portugal. Departamento de Enfermagem da Criança e do Jovem, Escola Superior de Enfermagem de Lisboa, Lisboa, Portugal; orcid.org/0000-

0002-9093-4821

* Corresponding author: arpereira81@gmail.com

Abstract

Introduction

Preterm newborns are particularly vulnerable, and neuroprotective care centered on the newborn and family is

essential to improve development, reduce costs and disease burden, and promote health and well-being (SDG

3). However, such care is often omitted in Neonatal Intensive Care Units (NICU), influenced by factors such

as the high workload of nursing staff.

Objective

To assess the relationship between workload and the quality of neuroprotective care in NICUs, as well as to

explore the association between this relationship and short- and medium-term child neurodevelopmental

indicators.

Methods

PhD study with a mixed-methods, multi-study design. Preliminary studies included six focus groups with

content analysis, and a scoping review will be conducted to support the development of a measurement

instrument — Neonatal Neuroprotective Interventions Scoring (NeoNIS). The construction of the

questionnaire will be based on validated instruments, with previous psychometric studies. The main study will

be conducted in six NICUs, with prior submission to ethics committees, informed consent, and participant

anonymity ensured.

Results

It is expected to characterize the relationship between the nurses’ total workload and the workload dedicated

to neuroprotective care, and to understand how the ratio of these workloads impacts immediate

neurodevelopmental outcomes, highlighting the need for policies that ensure quality of care, equity, and health

education (SDGs 4 and 10).

Conclusion

The results will contribute to informing policy decisions regarding nursing staffing levels, with an impact on

the quality of care, the reduction of inequalities, and the promotion of healthy child development.

Keywords

Developmentally Supportive Care; Neonatal Intensive Care Unit; Infant, Newborn; Nursing; Workload.

References

1. World Health Organization. Born too soon: decade of action on preterm birth [Internet]. Geneva:

WHO; 2023 [cited 2023 Apr 22]. Available from:

https://www.who.int/publications/i/item/9789240073890