Managing Irate Patients And Patients’ Relatives In Nigerian Hospitals

In this article you will read on Managing Irate Patients And Patients’ Relatives In Nigerian Hospitals

Abstract: Managing Irate Patients And Patients’ Relatives In Nigerian Hospitals

Workplace violence perpetrated by irate patients and patients’ relatives is a problem that exists in every country and in every workplace. Healthcare providers are particularly prone to assaults due to the conditions in which they offer treatment.

The article identified increasing stress levels in patients and their relatives, long waiting times, financial stress, enforcement of hospital rules, perceived staff rudeness and loss of a loved one as major triggers to violence against healthcare staff.

This brings consequences to both the individuals directly affected by the violence and the hospital at large. Loss of professional self-esteem, loss of job satisfaction, trauma, disability, higher litigation expenses, and employee absenteeism were also identified as possible consequences of violence against healthcare staff.

Indicators of possible violence were also identified to include obvious possession of a weapon, nervousness, abrupt movements, extreme restlessness, pacing or obvious agitation, approaching very closely to the other person, raised voice tone, hitting walls or items, or hitting themselves in the head or chest or breaking things, inappropriate laughter and excessive sarcasm.

Staff training on recognition and management of violence, reduction of waiting times, carrying patients and their relatives along in matters relating to their healthcare, among others were also put forward as recommendations in the management of irate patients and their relatives.

Keywords: Irate patients, patient’s relatives, healthcare staff, violence

Introduction

In 2017, the Bureau of Labour and Statistics reported that healthcare workers are five times more likely to experience violence on the job than the average worker in the United States (Pitts & Schaller, 2021).

The United States’ National Institute for Occupational Safety and Health (NIOSH) introduced workplace violence as a major occupational hazard, including aggressive behaviour such as physical attacks against employees or the threat of physical invasion while at work (OSHA, 2015).

Violence against healthcare workers also include incidents where personnel are mistreated, intimidated, or assaulted in situations connected to their work, including travelling to and from work, involving an explicit or implicit challenge to their safety, well-being, or health.

Workplace violence can be classified into four categories: physical violence (punching, kicking, slapping, pushing, biting, pinching, and wounding by sharp objects), verbal violence (insulting, humiliating, scaring, mocking and abusing), racial violence (threatening due to colour and language, nationality, religion, place of birth, or any other situation), and sexual violence (any violent behaviour related to gender which is considered as an offense by a person and threatens, insults, or embarrasses people) (Moraveji, Soleymannejad, & Bazargan, 2012).Managing Irate Patients And Patients’ Relatives In Nigerian Hospitals

According to a study, verbal violence, which is the most common type of violence against healthcare staff can also be presented indirectly, such as when disgruntled patients use “a specific tone of voice” when talking to relatives and friends on the phone, implying that they hold the nurses responsible for issues with which they are unhappy (Jakobsson, Axelsson, & Örmon, 2020).

Workplace violence in healthcare settings perpetrated by irate patients and patients’ relatives is a well-known and widespread phenomenon with a variety of harmful effects for healthcare staff. According to reports, it increases the risk of illness, high employee turnover, and a decline in the quality of service (Niu SF, Kuo SF, Tsai HT, Kao CC, Traynor V, et al., 2019) Research has shown that healthcare personnel do not report occurrences because they believe that threats and violence are an unavoidable part of the job or because they believe it would result in no change (Jakobsson, Axelsson, & Örmon, 2020). Managing Irate Patients And Patients’ Relatives In Nigerian Hospital.

This could imply a significant number of unreported instances. Therefore, it is important to highlight this problem and its consequences. It is also critical to employ tactics that prevent or reduce the effects of workplace violence.

The Anatomy Of Violence Against Healthcare Staff

In Nigerian hospitals, violence perpetrated by irate patients and their relatives is a frequent and concerning issue. For example Premium Times (2020) reported a case in Ogun State where a doctor was battered for demanding a registration fee from a patient.

In a similar development, a female doctor at the Maitama District Hospital, Federal Capital Territory (FCT), was assaulted and stripped naked by relatives of a patient, following the death of their mother. The perpetrators of this act had earlier threatened to kill the doctor for refusing to transfuse the patient with blood for which the doctor explained that it was not necessary.

The doctor explained to the relatives that blood transfusion could complicate the patient’s condition. The report also went further to state that it has been estimated that not too long from the time of the incident, no fewer than six healthcare workers, especially doctors and nurses, have been assaulted by patient’s relatives in FCT hospitals (Dada, 2020).

In another incidence, nurses at the Federal Medical Centre, Owo, Ondo state withdrew their services over the assault on three of their colleagues by relatives of a patient who died in the hospital.Those beaten up according to findings are presently on admission at the hospital (Johnson, 2021). Also another case occurred in the same hospital where nurses on duty were threatened with pistol by relatives of a dead patient (Dada, 2021).Managing Irate Patients And Patients’ Relatives In Nigerian Hospitals

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The uniformed personnel also have had their share in unleashing violence on healthcare workers. For example at Nnamdi Azikiwe University Teaching Hospital (NAUTH), Nnewi, a doctor was locked up in a room and beaten up till he bled by two paramilitary officers who lost a relative (Eshemokha, 2020). In a similar account, Katsina Policemen brutalized a nurse attending to patients for disobeying their order (Saharareporters, 2021).

Also at the University of Maiduguri Teaching Hospital, irate police officers of the Joint Task Force (JTF) descended heavily on doctors and patients after they were told there was no more space for corpses (Ateboh, 2013).

The list goes on and as mentioned above, most violence against healthcare workers are not reported.Managing Irate Patients And Patients’ Relatives In Nigerian Hospitals

Why Do Patients And Relatives Become Violent?

There is always a reason for violence. Patients and patients’ relatives’ violence may be caused by a combination of factors that are intrinsic to the patient, such as personality, physical symptoms, or severe mental distress, as well as extrinsic factors, such as staff and other people’s attitudes and behaviours, the physical environment, and restrictions imposed on the patients and relatives by the hospital rules.

Any aggression should be taken as a sign of a distress or an attempt to convey unmet demands in someone whose coping capacities have been exceeded (Harwood, 2017). Healthcare workers are particularly exposed to occupational violence because of the conditions in which they offer care. There are many reasons for violence against healthcare workers but arguably the following are the most implicated in triggering violence in the Nigerian system.

Perceived Long Waiting Hours: Patients and relatives may react violently when they think that waiting time is too long or when they suspect injustice in the queuing process. This is especially true when they feel that the condition that brought them to the hospital is getting worse.

Financial Stress: Insurance coverage in Nigeria is poor, as a result most hospital payments are made out of pockets by the patients and their relatives. In some cases properties are sold to finance healthcare services. This creates financial and emotional tension which can trigger violence against the care givers especially when it appears that the patient’s condition is not improving, or even deteriorating.

Enforcement of Hospital Rules: Some patients and their relatives maybe hostile to some hospital rules that appears not to be in their favour. These rules try to maintain orderliness by stipulating visiting hours, number of relatives by patient’s bedside, parking areas, etc. Members of staff enforcing these rules can become victims of violence from patients and their relatives.

Perceived Staff Rudeness: Healthcare service in Nigeria is bedevilled by shortage of staff and other facilities. This places strain in the work environment as the healthcare workers hustle to render necessary care. This may take an emotional toll on the staff which patients and their relatives may interpret as rudeness. Also there have been some cases where patients and their relatives want the healthcare staff to endorse and implement certain treatment regimen or to jump the triaging process. When such staff decline it will be seen as staff rudeness despite medical opinions.

Loss Of A Loved One: The loss of a loved one brings no joy to anyone. Emotions are high and the healthcare staff can easily become victims of violence. This usually occur when much resources have been spent on the treatment or when the relatives feel that the relevant healthcare staff did not intervene on time or did not do their best to keep their loved one alife.

Warning Signs of Violence and Aggression

Despite the fact that there are no definite indications about the form a violent event is going to take, indeed, it is possible to recognize several warning signs of the manifestation of violent behaviours. Healthcare workers should be extra alert to the possibility of violence if a person appears to be under the influence of alcohol or drugs, appears to have been in a fight, is brought to the healthcare facility by the police or already under a restrain.

Visible indicators of potential violence include obvious possession of a weapon, nervousness, abrupt movements, extreme restlessness, pacing or obvious agitation, approaching very closely to the other person, raised voice tone, hitting walls or items, or hitting themselves in the head or chest or breaking things, inappropriate laughter, excessive sarcasm and sudden pause of activity that follows a period of agitation. Such a pause may signal that the person is planning a violent action (Stathopoulou, 2021).

Consequences Of Violence Against Healthcare Staff

Violence brings no joy to anyone. This is especially so when the perpetrators of the violence are the receivers of the healthcare service from the same healthcare staff. The consequences of violence in healthcare settings can be profound both to the direct victim and the hospital at large.

Consequences To The Victims: The victims of violence experience negative consequences which may include loss of self confidence and self esteem, loss of trust on his own professional abilities and expertise, loss of job satisfaction, elevated stress levels and post traumatic stress disorder, trauma, permanent or temporary disability, cost of litigation against the perpetrators of the violence, feelings of anger, fear, depression and guilt, negative impact on interpersonal relationships and a times death.

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Consequences To The Hospital: The hospital also bears some consequences of violence against its staff. These may include increased absenteeism and use of sickness leave, loss of employee morale and motivation, avoidance behavior, which can have an adverse impact on employee performance increased costs for installation and maintenance of security equipment (Stathopoulou, 2021).

Prevention Of Violence Against Healthcare Staff

Managers, psychologists, and criminal justice professionals are unable to reliably identify people who are likely to be violent.There are, however, measures that can be implemented to prevent violence against healthcare workers.To begin, show patients and their relatives respect and consideration at all times. Objects that could be used as weapons should be kept out of easy reach. In tense situations, hospital staff should keep out of reach of patients and relatives, and security personnel should be summoned. Threats should be taken seriously and reported via the proper channels.

When an individual or group of individuals appears to be on the edge of losing control, other staff members should be notified and the security personnel should be summoned. All employees should maintain safe distance and give an agitated person plenty of space. People nearby should not turn their backs. Under no circumstances should untrained personnel, for example students touch or treat an agitated health seeker. If violence occurs, employees should protect themselves to the extent necessary. All healthcare staff should be trained on how to handle violence in their workplaces (Fallon & McConnell 2013). Patients and patients’ relatives who unleashed violence on hospital staff should be to face the law as a deterrent to others. For example, a patient relative who assaulted nurses on duty at University of Benin Teaching Hospital were sentenced to three months imprisonment (Uwaila, 2021).

Furthermore, hospital management should establish potent channels where patients and their relatives who are in any way dissatisfied can go and lay their complains instead of venting it on the healthcare staff. The Channel should take the responsibility of orientating patients and their relatives on the need to maintain decorum while in the facility and to use appropriate channel in seeking redress. Also patients and their relatives should be carried along in matters concerning their healthcare including their prognoses and financial standings with the hospital. This will help to prevent surprises which may result to violence against the staff. Necessary measures should also be ensured while communicating unpleasant information to patients and their relatives.

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As mentioned above, long waiting times are among the major triggers of violence among patients and their relatives. Delays afflict the healthcare industry around the world. Patients waiting for beds in hallways are typical in hospitals and delays for surgery or diagnostic testing are usual. Waiting has a number of negative repercussions, including delayed care, low patient satisfaction, financial penalties, and more.The application of queuing theory is a call to action for optimizing patient flow across complicated healthcare industries. The notion of queuing deals with delays induced by a mismatch between demand for healthcare services and the capacity to supply them. A queuing model’s goal is to strike a compromise between consumer service (shorter wait times) and resource constraints (number of servers). The principle of queuing is widely employed in a variety of industries, including banking, shipping, and transportation. Queuing models in healthcare can be used to successfully manage the flow of unexpected patient arrivals in a variety of settings, including emergency departments, operating rooms, intensive care units, and diagnostic labs (Chowdhury, Riddles & Mackenzie, 2018). This will reduce the incidence of violence against healthcare staff in the hospitals.

Conclusion

Managing Irate Patients And Patients’ Relatives In Nigerian Hospitals The healthcare workers are inadvertently forced to tolerate violence because of the belief that their profession entails accepting violence and hostility. Due to under-reporting of such instances and insufficient documentation and record keeping, the precise scope of violent events directed towards healthcare providers is unknown. Fear of stigmatization, fear that involvement in a violent event will be regarded as an evidence of poor performance or negligence, and a lack of support from hospital administration are all factors that hinder healthcare providers from reporting such events. It is critical for healthcare staff to understand that any patient or patient relatives can be a potential perpetrator of violence in situations where violence is likely to escalate. As a result, they should be aware of all factors that can fuel violence and make every effort to avoid them, as well as recognize the warning signs of violence and deal with violent people in an effective and professional manner.

Recommendation

The article hereby makes the following recommendations towards managing irate patients and patients relatives in Nigeria hospitals:

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• Healthcare workers should be trained in the recognition, and management of violence in their workplaces.
• All cases of violence towards healthcare workers by irate patients and patients’ relatives should be reported and appropriate actions taken.
• Quick response teams that will rush to violent areas and prevent escalation of violent situations should be formed.
• Enforcement of hospital rules should be tactful yet firm.
• Patients and their relatives should be carried along in matters concerning their prognoses and financial standings with the hospital.
• Channels of complain for patients and their relatives should be established and be easily visible within the hospital premises.
• Waiting times and overcrowding should be reduced using the queuing theory and sufficient staff should be put in place to attend to booked healthcare seekers. Patients with deteriorating medical conditions should be attended to on time.
• Signs against staff brutality should be displayed in the hospital premises for awareness creation.
• Hospital staff should be well acquainted with exit routes in the events of violence and hospital security formation should always be on alert
• Access to staff rest rooms should be out of bounds to non staff.

Reference

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• Ateboh (2013). Nigeria JTF Goes Berserk, Attacks Doctors, Patients At Hospital Filled With Corpses. Premium Times . Available from https://www.premiumtimesng.com/news/133608-nigerian-military-jtf-goes-berserk-attacks-doctors-patients-at-hospital-filled-with-corpses.html
• Chowdhury, Riddles & Mackenzie (2018). Using Queuing Theory to Reduce Wait, Stay in Emergency Department. Physician leadership. Available from https://www.physicianleaders.org/news/queuing-theory-reducing-wait-stay
• Dada (2021). How children of patient who died beat, threatened us with pistol – Ondo nurses. Punch Newspaper. Available from https://punchng.com/how-children-of-patient-who-died-beat-threatened-us-with-pistol-ondo-nurses/
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• Jakobsson, Axelsson, & Örmon (2020), “The Face of Workplace Violence: Experiences of Healthcare Professionals in Surgical Hospital Wards”, Nursing Research and Practice, vol. 2020, Article ID 1854387, 10 pages, 2020. https://doi.org/10.1155/2020/1854387
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• Premium Times (2020). Patient’s relatives strip Abuja female doctor naked – President, Residents’ doctors. Agency Report. Available from https://punchng.com/patients-relatives-strip-abuja-female-doctor-naked-president-residents-doctors/

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• Saharareporters (2021). Katsina Policemen Brutalise Nurse Attending To Patients For ‘Disobeying’ Order. Sahara reporters. Available from http://saharareporters.com/2021/10/25/katsina-policemen-brutalise-nurse-attending-patients-‘disobeying’-order

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Uchemadu Nwachukwu BNSc, PGDE, MHPM, RN, RM
SMClinics