Inside Ghana’s Emergency Units: Skilled Nurses Face Systemic Barriers

Emergency nurses in a Ghanaian district hospital have strong knowledge of primary assessment but struggle to apply it consistently due to limited resources, training gaps, and heavy workloads. Improving emergency care requires better equipment, targeted training, and context-specific implementation of structured assessment frameworks

Emergency rooms are where seconds can decide survival, and the first few minutes of care are often the most crucial. A new study by researchers from St. Anthony Hospital in Dzodze, the University of Ghana, Kwame Nkrumah University of Science and Technology, and Pentecost University College takes a close look at how nurses in a district hospital in Ghana handle this pressure. The focus is on “primary assessment” – the quick check of a patient’s airway, breathing, circulation, and other vital signs that helps identify life-threatening conditions immediately.

The study shows that nurses clearly understand how important this step is. They see it as the foundation of emergency care, helping them act fast to prevent death or serious complications. But while the knowledge is there, putting it into practice is not always straightforward.

Knowledge Is Strong, Practice Is Tough

The nurses interviewed in the study showed a good understanding of how primary assessment works. They described it as the first and most important action when a patient arrives. They also understood its purpose: to quickly detect danger and begin treatment without delay.

However, the real challenge lies in applying this knowledge consistently. In high-pressure situations, nurses sometimes have to act based on urgency rather than strict procedure. For example, if a patient is bleeding heavily, they may treat that first, even if standard protocol suggests checking the airway first.

This gap between what nurses know and what they can actually do highlights a key issue. In theory, emergency care follows a clear structure. In reality, it often depends on quick judgment and improvisation.

Struggling with Limited Resources

One of the biggest problems identified in the study is the lack of resources. Nurses reported shortages of essential equipment, limited space, and not enough staff to handle patient loads.

In some cases, a single device like a pulse oximeter had to be shared among several patients. At times, patients had to be assessed while sitting in chairs instead of lying on proper hospital beds. These conditions make it difficult to carry out thorough and systematic assessments.

Such challenges are not just inconvenient. They directly affect the quality of care and can delay life-saving interventions. Even highly skilled nurses cannot perform at their best without the basic tools they need.

Training and Workload Add to the Pressure

The study also found gaps in specialised training. While all nurses had formal education, many had not received focused training in emergency assessment methods. This makes it harder for them to apply structured approaches confidently and consistently.

Workload is another major factor. Emergency units often deal with many patients at once, and staff shortages make the situation even more difficult. Nurses are forced to multitask, making quick decisions under pressure.

Leadership and organisational support also play a role. Nurses pointed out the need for better guidance, more training opportunities, and stronger management support. Without these, improvements in practice are hard to sustain.

A Way Forward for Better Emergency Care

Despite the challenges, the study offers hope. All nurses reported using the ABCDE approach, a widely accepted method for emergency assessment. This shows that structured care is already part of the system, even if not always applied perfectly.

More advanced frameworks, like the HIRAID model, are largely unknown in this setting. However, nurses showed interest in learning and adopting such systems if they are supported with proper training and resources.

The key takeaway is that improving emergency care requires more than just introducing new methods. It demands better equipment, targeted training, and stronger organisational support. Solutions must also fit the local context, as models from high-income countries may not work the same way in resource-limited settings.

In the end, the study highlights both the challenges and the dedication of emergency nurses in Ghana. They work under tough conditions but remain committed to saving lives. With the right support, their ability to deliver effective emergency care can be significantly strengthened.