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Nursing workload instruments used in neonatal intensive care units (NICUs) may not represent neuroprotective and family-centered developmental care. A two-stage design was used. A scoping review (JBI; PRISMA-ScR) sought instruments designed to measure the workload of neuroprotective care; none were identified. Then, established workload measures were analyzed against four human-factors levels of workload and the neuroprotective core measures. NTISS, NAS, TISS-28, NEMS, WANNNT, NIS, staffing ratios, and subjective situation-level measures represented neuroprotective care partially, indirectly, or not at all, and none quantified the dose or quality of care the infant received. We propose a conceptual framework linking the NICU work system, nursing workload, and the delivery of neuroprotective care, and a candidate process indicator of care dose, the Developmental Care Workload Ratio (DCWR), with a preliminary definition, candidate variables, and a research agenda. Research should examine which work-system conditions make neuroprotective care difficult to deliver.
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Pereira et al. (2026) studied this question.
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