e-sRC

CHAPTER ONE
INTRODUCTION
1.1 Background to the study
Understanding the intricate relationship between nurses and patients is essential. However, the
sobering reality of patients’ families acting forcefully against nurses is not lost on us, even in
the midst of tender care and diligent efforts to promote health. This issue challenges the
fundamental tenets of patient-centered care and jeopardizes the health and safety of nurses.
Recently, there has been a lot of attention focused on aggressive behavior aimed against nurses.
Numerous studies have shown how widespread this behavior is and how detrimental it is to
both individual nurses and healthcare institutions. These incidents not only make nurses feel
uncomfortable psychologically, but they also dramatically increase turnover rates and work
discontent.
According to Xu et al. (2021), the rising prevalence of violent behavior from patient
relatives poses a growing threat to the safety and wellbeing of nurses in modern healthcare
settings. In addition to endangering the physical and mental well-being of nurses, aggressive
behaviours including verbal abuse, threats, and even physical violence significantly lower the
standard of patient care and the atmosphere in the hospital.
Aggressive behavior by patients’ relatives toward nurses is still a major issue in healthcare set
tings worldwide. On a global scale, the World Health Organization (WHO) estimates that
8–38% of nurses will experience some form of violence at work during their careers (WHO,
2022). According to recent reports by smith et al (2020), aggressive behaviour against
healthcare workers especially nurses, is on the rise. While specific data on aggression from
patient relatives towards nurses may vary, the World Health Organization (2021)
acknowledges workplace violence as a significant issue affecting healthcare professionals
worldwide. Stress, poor communication and insufficient personnel levels are some of the things
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causing this phenomenon (Johnson & Brown, 2021). Across a broader sample in Africa, a
survey found that 59.2% of nurses experienced work place violence in the prior year, with
49.5% of the perpetrators being patients’ relatives or companions (Ogunlaja et al., 2021).
In Nigeria, aggressive behaviour towards nurses by patient relatives is a significant challenge
within the healthcare system. Despite the global discourse on aggression towards nurses, the
Nigerian healthcare context presents unique challenges and dynamics that warrant specific
attention. Existing studies have highlighted the widespread occurrence of aggressive behaviour
towards nurses in Nigeria, with verbal abuse, threats, and physical assaults being common
manifestations (Olatubi et al., 2020). A 2020 study in Katsina, Nigeria, reported that 100% of
nurses had endured some form of workplace violence (WPV), with 87.2% of the incidents
perpetrated by patient relatives (Isah et al., 2020). Supporting this, a narrative review on
violence against nurses reports that up to 38% of nurses are exposed to physical violence over
the course of their careers (Wang et al., 2023). However, these studies often lack
comprehensive exploration of the contextual factors contributing to such aggression, including
socio-cultural, organizational, and systemic dynamics.
Limited resources and overcrowded facilities contribute to tensions between healthcare
providers and patients’ families (Ogunsemi et al., 2021). Cultural factors, such as traditional
beliefs about illness, further complicate interactions between nurses and patient relatives
(Adebayo et al., 2020). Despite efforts to mitigate workplace violence, incidents of aggression
against nurses persist in Nigerian healthcare facilities (Adeloye et al., 2022).
In Kwara State, there are similar challenges regarding aggression towards nurses in healthcare
settings. While specific data on the incidence of such incidents in Kwara State may be limited,
anecdotal evidence suggests that aggressive behaviour from patient relatives is a prevalent
issue (Omotayo et al., 2023). Efforts to address this issue in Kwara State include training
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programs for healthcare workers and community engagement initiatives aimed at promoting
respectful behaviour in healthcare settings (Oyedunni et al., 2022).
The abuse of nurses by patients and their relatives represents a distressing phenomenon that
has gained prominence within the broader discourse of healthcare challenges. Nurses, as
frontline caregivers, play a pivotal role in delivering patient-centered care, yet they often find
themselves vulnerable to various forms of abuse, ranging from verbal and emotional
mistreatment to physical assaults.
Lamichhane & Bae, (2020) said that verbal abuse is a common form of patient aggression
towards nurses that affects their psychological well-being and job satisfaction, including a
decreased level of dedication to work and a weaker intention to stay in the field. Verbal abuse
towards nurses may have detrimental effects on their psychological health, as well as their
productivity and results at work.
The abuse of nurses by patients’ relatives is a complex issue with far-reaching implications for
both healthcare professionals and the quality of patient care. By identifying the root causes and
dynamics of aggression towards nurses, healthcare institutions can develop targeted
interventions and policies aimed at prevention and mitigation. Ultimately, it is my fervent hope
that this endeavor will serve as a catalyst for fostering positive change within the realm of
healthcare, nurturing environments where both patients and healthcare professionals can thrive
harmoniously.
1.2 Statement of the problem
As a student nurse who has undergone several clinical postings, the researcher has observed
and personally experienced aggressive behaviour from patients’ relatives on multiple
occasions. These incidents often occurred in high-pressure environments such as emergency
units and wards, where nurses are the most visible healthcare professionals and are frequently
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blamed for systemic delays or perceived inadequacies. These repeated exposures to aggression
formed the basis for the researcher’s interest in investigating the root causes and contributing
factors of such behaviours.
Research has shown that multiple factors contribute to aggressive behaviour toward nurses.
These include the high expectations of patients’ relatives regarding care delivery, emotional
distress resulting from the critical condition of loved ones, long waiting times, and limited
communication between healthcare workers and patients’ families (Arfaoui et al., 2023; Ugwu
et al., 2024). Additional factors such as cultural and language differences, overcrowded
hospitals, and inadequate staffing have been identified as significant stressors that may trigger
violence from patients’ relatives (Olaore & Olanrewaju, 2022).
Workplace violence not only affects the physical and psychological wellbeing of nurses but
also negatively impacts the quality of care delivered to patients. By identifying the underlying
causes of aggressive behaviour from patients’ relatives, this research aims to contribute to
strategies that promote a safer and more supportive healthcare environment for nurses,
ultimately improving patient outcomes and job satisfaction among healthcare providers.