EVALUATING THE KNOWLEDGE AND ATTITUDES ON PATIENT SAFETY AMONG HEALTHCARE PROFESSIONALS IN NIGERIA

CHAPTER ONE

INTRODUCTION

1.1 Background of the study

Providing exceptional health care is essential for guaranteeing that patients obtain the most effective treatment available (WHO, 2019). This encompasses compliance with established healthcare standards, commitment to patient safety protocols, and the provision of vital services that are accessible, affordable, comprehensive, and effectively coordinated (Carpenter et al., 2021). Ensuring patient safety involves reducing the likelihood of avoidable harm linked to healthcare practices to the lowest possible level. A minimum represents a compilation of concepts derived from the current information, accessible resources, and the context in which the healthcare being assessed is compared to the risks associated with forgoing treatment or opting for alternative treatments (WHO, 2019). Patients who are admitted may encounter the possibility of adverse events, and individuals on medication might be susceptible to adverse drug reactions (WHO, 2019). Current estimates indicate that nations with fewer resources experience greater harm from inadequate medical care compared to their more developed counterparts (Van Den Bos, 2017). The integration of patient safety education for health professionals within higher education curricula is currently insufficient (WHO, 2019).

A study conducted in the United States revealed that medical errors resulted in a staggering loss of $19.5 billion in revenue in the year 2008 alone (WHO, 2019). A study conducted by the Institute of Medicine indicates that a highly effective method for enhancing patient safety involves the incorporation of patient safety education into clinical training programs (Van Den Bos, 2017). The report by the WHO in 2019 indicates that the occurrence of adverse events resulting from unsafe care ranks among the top ten causes of mortality and disability worldwide. In low- and middle-income nations, approximately 134 million negative occurrences transpire within healthcare facilities due to inadequate care, resulting in 2.6 million fatalities annually. As many as 40% of patients’ experience harm in primary and outpatient health care worldwide, with approximately 80% of these incidents being preventable (Schwappach & Conen, 2016). Medical errors and adverse events pose a significant threat to patients worldwide (Kohn et al., 2019). The data indicates that approximately 98,000 individuals succumb annually due to medical errors occurring within hospital settings. This surpasses the fatalities resulting from motor vehicle accidents, workplace injuries, and breast cancer. Furthermore, the economic implications of human suffering and medical mistakes readily escalate to the highest levels of pressing and pervasive societal concerns (WHO, 2019).

The assurance of patient safety is heavily influenced by the understanding and perspectives of healthcare professionals, who are essential in recognising, documenting, and addressing risks that may result in negative patient outcomes (WHO, 2019; Makary & Daniel, 2016; Eze & Obasi, 2020; Lawal et al., 2021). Nevertheless, the understanding and perceptions regarding patient safety exhibit considerable disparities across different regions and healthcare environments, especially in low- and middle-income nations such as Nigeria. Here, the healthcare framework faces obstacles due to constrained resources, elevated patient volumes, and insufficient education on patient safety protocols (Ogunleye et al., 2021; Adeoye & Amadi, 2022). Research indicates that a deficiency in awareness and an absence of a proactive safety culture among healthcare professionals lead to preventable errors (Okeke & Musa, 2020; WHO, 2020). This highlights the necessity for a thorough assessment of their knowledge and attitudes to improve patient safety in Nigeria.

In Nigeria, healthcare practitioners operate within a framework marked by limited resources, inadequate staffing levels, and elevated patient-to-provider ratios, factors that contribute to a setting where the safety of patients could be at risk (Adejumo et al., 2021; Okafor & Lawal, 2019; Njoku & Ifeanyi, 2022; Afolabi & Dike, 2021). The systemic challenges at hand require a comprehensive examination of healthcare professionals' knowledge and attitudes regarding patient safety, as these elements significantly affect their capacity to prevent, identify, and address safety threats. Research indicates that the comprehension of essential patient safety principles among healthcare professionals, including infection control, safe medication administration, and effective communication, tends to be inadequate in low-resource environments. This limitation is associated with increased occurrences of adverse events and patient dissatisfaction (Uche & Eke, 2019; WHO, 2018; Ogbonna & Musa, 2022; Okechukwu et al., 2023). An in-depth evaluation of the awareness and perceptions of patient safety among healthcare professionals in Nigeria could thus pinpoint particular areas that necessitate enhancement, training, and policy interventions to improve safety practices and outcomes.

Worldwide, the education surrounding patient safety has garnered significant focus, with global health entities promoting organised training initiatives and safety measures aimed at minimising avoidable harm within the healthcare sector (Leape et al., 2015; Jones & Nelson, 2020; WHO, 2021; Eze & Ugochukwu, 2022). Nonetheless, in light of the World Health Organization's focus on safety education, it is evident that healthcare training institutions in Nigeria frequently fall short in providing comprehensive curricula on patient safety. This deficiency results in a significant number of healthcare professionals being insufficiently equipped to tackle safety issues within their practice (Ogundele et al., 2020; Adeyemi & Okonkwo, 2021; Udeh & Nnamdi, 2023; Ogun et al., 2022). Studies suggest that the perspectives of healthcare professionals regarding patient safety are influenced by their understanding as well as the prevailing organisational culture, policies, and support mechanisms present in their work environment (Adebayo et al., 2020; Nwosu & Anene, 2019; WHO, 2021; Njoku & Oladipo, 2023). In Nigeria, the healthcare system grapples with limited resources and persistent operational hurdles, making the cultivation of a constructive safety culture a formidable task, which frequently results in heightened risks for both patients and healthcare providers. Comprehending the current knowledge and perspectives of healthcare professionals in Nigeria is crucial for addressing these disparities and fostering a culture of safety that encourages ongoing enhancement in the quality of patient care.

Although the significance of patient safety is acknowledged, there is a scarcity of research regarding the specific knowledge levels and attitudes of healthcare professionals in Nigeria related to this matter. Research carried out in comparable low-resource environments indicates a widespread deficiency in awareness and a notable lack of adherence to safety protocols. This situation is frequently influenced by time limitations, inadequate training, and insufficient resources (Ajayi & Umeh, 2018; WHO, 2020; Odigwe et al., 2022; Lawal et al., 2023). To bridge this gap in Nigeria, it is essential to assess the comprehension of healthcare professionals regarding patient safety principles and their perspectives on the integration of these practices into routine patient care.

1.2 Statement of the problem

The issue of patient safety is of paramount importance in the healthcare sector; however, it is frequently undermined by the disparate levels of understanding and perspectives among healthcare professionals concerning safety protocols, particularly in resource-limited environments such as Nigeria. As healthcare systems worldwide prioritise the reduction of medical errors, studies have repeatedly demonstrated that the understanding and perspectives of healthcare professionals regarding patient safety are crucial in enhancing patient outcomes and decreasing avoidable harm (WHO, 2019; Makary & Daniel, 2016; Lawal et al., 2021). Notwithstanding these findings, research indicates that a significant number of healthcare professionals in Nigeria demonstrate inadequate awareness and comprehension of essential patient safety principles, such as infection control, appropriate medication administration, and precise patient identification, all of which are crucial for the prevention of adverse events (Adebayo & Musa, 2020; Njoku & Okeke, 2022; Udeh & Amadi, 2023). In the absence of sufficient understanding and a constructive mindset regarding patient safety, healthcare practitioners face an elevated likelihood of inadvertently causing avoidable patient injury. This underscores the necessity for a thorough assessment of these elements within the healthcare landscape of Nigeria.

The endeavour to enhance patient safety in Nigeria is significantly hindered by systemic challenges, including insufficient staffing in hospitals, constrained resources, and the lack of organised training programs focused on patient safety within healthcare facilities (Ogbonna & Musa, 2020; WHO, 2021). Healthcare practitioners in Nigeria frequently operate within settings devoid of uniform protocols or supportive policies regarding patient safety, resulting in variable practices and a heightened risk of medical errors (Adeyemi et al., 2021). Furthermore, research carried out in Nigerian healthcare facilities indicates that the perspectives of healthcare professionals regarding patient safety are frequently shaped by workplace stressors, insufficient backing from hospital administration, and restricted availability of safety resources. These factors collectively foster an environment in which patient safety tends to be relegated to a lower priority (Okafor & Obasi, 2020; Ogun et al., 2022; Akinola & Dike, 2023).

In light of the critical nature of patient safety, there exists a notable gap in research that thoroughly examines the understanding and perspectives of healthcare professionals in Nigeria regarding safety practices. Research carried out in comparable low-resource environments has underscored deficiencies in knowledge and negative perceptions regarding patient safety, pointing to the necessity for customised educational initiatives, training programs, and support frameworks to promote safer healthcare practices (Ajayi & Umeh, 2019; WHO, 2020; Makinde & Nnamdi, 2022). The insufficient breadth of research on this subject in Nigeria obstructs the advancement of effective strategies that could enhance the healthcare system's dedication to patient safety and diminish the occurrence of avoidable harm. This research seeks to fill the existing gap by assessing the understanding and perspectives of healthcare practitioners in Nigeria, pinpointing obstacles to patient safety, and suggesting practical measures to enhance safety protocols.

1.3 Objectives of the study

The primary objective of this study is to critically evaluate the knowledge and attitudes on patient safety among healthcare professionals in Nigeria. Specific objectives of this study are to:

1. To assess the level of knowledge on patient safety principles among healthcare professionals in Nigeria

2. To evaluate the attitudes of healthcare professionals toward patient safety practices and protocols in Nigeria.

3. To identify the barriers to knowledge acquisition and positive attitudes on patient safety among healthcare professionals in Nigeria

4. To provide recommendations to enhance patient safety knowledge and attitudes among healthcare professionals in Nigeria

1.4 Research Questions

The following research questions which are in line with the objectives of this study will be answered in this study:

1. 1. 1. What is the level of knowledge on patient safety principles among healthcare professionals in Nigeria?

      2. What is the attitudes of healthcare professionals toward patient safety practices and protocols in Nigeria?

      3. What are the barriers to knowledge acquisition and positive attitudes on patient safety among healthcare professionals in Nigeria?

1.5 Research Hypotheses

To determine the effectiveness of this study, the following research null hypotheses will be formulated to guide the study and it will be tested at 0.05% levels of significance.:

Ho: The level of knowledge on patient safety principles among healthcare professionals in Nigeria is low

Ha: The level of knowledge on patient safety principles among healthcare professionals in Nigeria is high

1.6 Significance of the study

The importance of this study is rooted in its capacity to enhance comprehension of the existing knowledge and attitudes regarding patient safety among healthcare professionals in Nigeria, a domain essential for attaining quality healthcare and mitigating preventable harm. The assurance of patient safety stands as a paramount concern worldwide; however, in Nigeria, the comprehensive execution of robust patient safety protocols encounters numerous obstacles, largely attributed to disparities in knowledge and differing perspectives among healthcare professionals. The findings derived from this research will hold significant importance for healthcare professionals, hospital administrators, policymakers, regulatory bodies, students, researchers, and the Nigerian populace, all of whom contribute essential roles in enhancing the safety of the healthcare system.

This research presents a valuable opportunity for healthcare professionals to critically assess their understanding and perspectives on patient safety, pinpoint areas needing enhancement, and foster an environment where adherence to safety protocols and practices is of utmost importance. Comprehending the influence of their existing beliefs and understanding on patient safety can motivate healthcare professionals to pursue ongoing education, follow established safety protocols, and embrace a more anticipatory stance towards avoidable harm. Enhanced understanding and perspectives among healthcare practitioners can significantly influence patient results, minimise medical mistakes, and cultivate an environment where patient safety is woven into the fabric of everyday healthcare practices.

The findings of this study will be of significant importance to hospital administrators and healthcare facility managers, as they seek to refine organisational strategies that prioritise patient safety. This research can illuminate deficiencies in current training initiatives, the necessity for more regular safety education workshops, and aspects where further resources or organisational adjustments might be required. Equipped with these insights, administrators can strive to cultivate nurturing environments that emphasise safety, including the establishment of comprehensive training programs, the encouragement of transparent communication, and the enhancement of accountability. The advancement of understanding and favourable perspectives regarding patient safety can significantly elevate an institution's standing, foster patient confidence, and enhance the quality of care, thereby highlighting the critical relevance of this research for hospital administration teams.

This study offers data grounded in evidence that can assist policymakers and healthcare regulatory bodies in crafting guidelines, policies, and standards that are specifically suited to the healthcare landscape of Nigeria. Comprehending the current knowledge and perspectives of healthcare professionals regarding patient safety allows policymakers to make well-informed decisions about areas that necessitate focused interventions, such as obligatory training or certification in patient safety practices. Furthermore, the research can assist regulatory authorities in establishing policies that promote a culture of safety, ensure accountability, and harmonise healthcare practices in Nigeria with global standards, ultimately resulting in enhanced public health outcomes and increased trust in the healthcare system.

This study offers substantial advantages for both students and researchers, establishing a robust base of knowledge regarding the perceptions and comprehension of patient safety within Nigerian healthcare environments. The findings can significantly enhance the educational journey of students, offering them valuable real-world perspectives on the challenges of patient safety and underscoring the necessity of fostering positive safety attitudes and comprehensive safety knowledge within the realm of healthcare practice. Academics, conversely, may leverage this study as a foundation for deeper inquiry, investigating particular domains such as the efficacy of training programs, determinants affecting the safety perceptions of healthcare practitioners, and contrasts among various regions or healthcare organisations. This research thus stands as an important asset that can assist in steering forthcoming enquiries and aid in the development of a more secure and efficient healthcare landscape in Nigeria.

1.7 Scope of the study

Broadly, this study focus is to critically evaluate the knowledge and attitudes on patient safety among healthcare professionals in Nigeria. Empirically, the study will explore the level of knowledge on patient safety principles among healthcare professionals in Nigeria, the attitudes of healthcare professionals toward patient safety practices and protocols in Nigeria and the barriers to knowledge acquisition and positive attitudes on patient safety among healthcare professionals in Nigeria

Geographically, the study will be carried out at the Wuse general hospital, Abuja.

1.8 Limitations of the study

During the examination, the researchers carefully examined the inherent limitations that are present in all human behaviours. One of the main challenges we faced was the lack of extensive scholarly research on the subject. A notable factor that contributed to the issue was the limited data available regarding evaluating the knowledge and attitudes on patient safety among healthcare professionals in Nigeria. Given the task at hand, it was quite demanding to find the required materials, books, or information and organise the data, requiring a significant investment of time and effort.

In addition, the study's findings may be constrained by the small number of participants and the limited scope of the research, which mainly revolves around Wuse general hospital, Abuja. Therefore, the findings of the study have limited practical implications, highlighting the need for further research.

In addition, the individual experienced significant constraints due to financial constraints. As a student with limited financial resources, they had to carefully navigate these constraints throughout their study. The exorbitant transportation fees at the research site proved to be a significant hindrance in meeting the financial obligations tied to travel expenses.

Furthermore, the person had a packed schedule due to their scholarly obligations, including attending lectures and participating in a range of educational pursuits.

1.9 Definition of terms

Patient safety: Patient safety is defined as “the absence of preventable harm to a patient and reduction of risk of unnecessary harm associated with health care. It is the prevention of harm to patients.

Medical error: Medical error is defined as the failure to complete the intended plan of action or implementation of the wrong plan to achieve an intended outcome. Other experts characterized medical errors as deviations from the standard care process that may or may not result in patient injury. 

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