A Quantitative Assessment of Knowledge Gaps and Barriers to the Standardization of Neonatal Resuscitation Among Nurses

Abstract

Background: Neonatal resuscitation is a life-saving intervention essential for reducing neonatal morbidity and mortality, particularly in low- and middle-income countries where healthcare resources and clinical skills are often limited. Despite the implementation of global training initiatives such as the Neonatal Resuscitation Program and Helping Babies Breathe, knowledge-practice gaps remain widespread among nurses, the primary providers of neonatal care in resource-constrained settings. These gaps are compounded by systemic barriers, including inadequate training opportunities, lack of equipment, insufficient supervision, and heavy workloads, all of which compromise adherence to standard protocols. Objective: This study aimed to quantitatively assess the level of knowledge among nurses regarding neonatal resuscitation and to identify the major barriers that impede the standardization and effective implementation of resuscitation practices. Methods: A descriptive cross-sectional study was conducted from February to May 2025 at Mayo Hospital, Lahore, involving 110 registered female nurses working in neonatal units. Data was collected using a structured, validated questionnaire assessing knowledge (10 items) and barriers (10 items) on a 5-point Likert scale. Statistical analysis was performed using SPSS v25, with descriptive statistics summarizing participant characteristics and inferential tests evaluating associations between demographic factors, knowledge scores, and perceived barriers. Results: The overall mean knowledge score was 3.97 ± 0.48, with high awareness of advanced steps such as oxygen administration (92.7%) and bag-mask ventilation (90.0%) but lower knowledge of basic procedures such as drying the newborn (60.0%). Recent training (p = 0.004) and frequent resuscitation exposure (p = 0.011) were significantly associated with higher knowledge. Major barriers included time constraints (78.2%), inadequate equipment (75.5%), staff shortages (72.7%), and limited simulation opportunities (68.2%), all significantly linked to lower knowledge and inconsistent practice (p < 0.05). Conclusion: Nurses demonstrated moderate-to-high knowledge of neonatal resuscitation, but critical gaps persist, particularly in foundational steps, due to systemic and environmental barriers. Addressing these gaps through regular simulation-based training, improved staffing, reliable equipment availability, and stronger institutional support can enhance adherence to standardized protocols and improve neonatal outcomes.