678 - Understanding Gaps in Neonatal Intensive Care Orientation: Findings from a Nationwide Survey in Ghana

Publication Number: 3655.678

Nana Ama Owusua. Owusu, SUNY Downstate Health Sciences College of Medicine, Brookyln, NY, United States; Medge D.. Owen, Wake Forest School of Medicine of Wake Forest Baptist Medical Center, Winston Salem, NC, United States; Lawrence Fordjour, State University of New York Downstate Medical Center College of Medicine, Brooklyn, NY, United States

Background: Effective neonatal care in low-resource settings hinges on the competence and confidence of nursing staff. In Ghana, where nursing attrition and neonatal mortality remains high, quality orientation and ongoing training for neonatal nurses are essential. However, limited data exist on the scope and effectiveness of neonatal nurse orientation programs in regional and district hospitals.

Objective: This study assessed the current orientation practices, training gaps, and perceived preparedness among neonatal nurses in Ghana.

Design/Methods: A cross-sectional survey was conducted in April 2024 among 347 nurses and midwives working in district and regional hospital neonatal units across Ghana. Survey was distributed during stakeholder meeting in Accra, Ghana among participants and distributed within GHS system and Teaching hospitals. Data were collected via a structured online questionnaire, exploring demographic characteristics, orientation experience, training content, perceived skill confidence, and barriers to practice. Descriptive statistics and thematic analysis were used to synthesize findings

Results: Respondents were predominantly female (93%), aged 25–34 years (58%), and primarily employed in public hospitals (82%), especially district-level facilities (67%). Orientation was largely informal: 58% reported on-the-job training as their main learning method, while only 14% had completed a formal neonatal nursing course. Just over half (51%) received a neonatal-specific orientation, often lasting less than one week. Only 52% rated their orientation as effective, and 66% felt well-prepared. Despite this, most nurses felt confident in infection prevention (96%) and breastfeeding support (95%) but reported low confidence in advanced skills such as CPAP use (55%), IV infusion pump handling (53%), and cardiac monitor operation (37%). Key challenges included lack of essential equipment (71%), high workload (56%), emotional stress (50%), and limited mentorship (38%). Nurses overwhelmingly recommended enhanced practical training (85%), regular refresher courses (90%), and improved access to mentorship (72%).

Conclusion(s): Neonatal nurse orientation in Ghana is inadequate in scope, duration, and content, contributing to significant skill gaps in advanced neonatal care. A standardized, competency-based orientation program with extended hands-on training, mentorship, and institutional support is needed. Strengthening the orientation process is a critical step toward improving neonatal outcomes in Ghana. It is likely that other low-resource settings with limited neonatal specialists face the same challenges.