Knowledge of Nurses about Communication Milestones at the Princess Marie Louise Children’s Hospital; A Qualitative Study

Abstract Background: Communication milestones are critical indicators of children's developmental health and predictors of future academic and social outcomes. As frontline healthcare providers, nurses play a vital role in monitoring these milestones routinely. However, research suggests this surveillance role is often inadequately fulfilled, particularly regarding the identification of communication disorders in children aged 0-5 years. Aim: This study aimed to assess nurses’ knowledge of communication milestones in children aged 0–5 years, examine their current practices regarding milestone surveillance, and identify training needs to enhance their capacity in monitoring communication development. Method: This descriptive qualitative study was conducted from May to June 2020 at Princess Marie Louise Children's Hospital in Accra, Ghana. Twenty-six nurses (16 for questionnaires, 10 for interviews) with experience ranging from less than one year to 20 years participated in the study. Data collection included semi-structured questionnaires and in-depth interviews. The questionnaire assessed nurses' knowledge of communication milestones and clinical practices, while audio-recorded interviews explored their experiences, perceptions, and training needs. Data were analyzed using descriptive statistics for quantitative components and inductive thematic analysis for qualitative data. Results: While 68.75% of nurses reported being able to identify changes in children's language development, most lacked detailed knowledge regarding specific communication milestones. The majority correctly identified some key milestones (75% for babbling before 6 months; 62.5% for first words between 6-12 months), but demonstrated inconsistent knowledge regarding expressive speech development. Key findings from the qualitative analysis revealed limited formal education on communication milestones, with participants noting it was insufficiently covered in their training curriculum. There was a complete absence of continuing professional development in this area, with just one participant reporting self-directed learning. While nurses demonstrated theoretical understanding of identifying communication difficulties, its application in clinical practice was inconsistent. Missed opportunities in identifying communication disorders were frequently attributed to workload constraints, time limitations, and inadequate clinical exposure. Parental education on communication milestones was minimal to non-existent due to both knowledge limitations and workplace pressures. Notably, all participants expressed a strong interest in further training, recognizing its value for improving early detection capabilities and enhancing parent education. Conclusion: This study demonstrates significant gaps between perceived and actual knowledge of communication milestones among nurses in Ghana, with implications for early identification of developmental delays. Findings suggest the need for curriculum enhancement, implementation of standardized screening protocols, and targeted professional development programs. A collaborative approach involving speech-language therapists could strengthen both educational practices and clinical surveillance, ultimately improving developmental outcomes for children in Ghana and similar resource-limited settings.