Treading on an Eggshell: Nurses’ Experiences with Difficult Patients and Families in Acute Care Settings

Nurses in acute care settings frequently encounter difficult patients and families, a phenomenon that imposes emotional, communicative, and systemic challenges. These interactions are particularly complex in resource-constrained and culturally diverse environments like Nigeria. This study explored the lived experiences of nurses managing difficult patients and family members in acute care settings, aiming to understand the emotional, institutional, and interpersonal factors involved. Using a phenomenological qualitative approach, in-depth interviews were conducted with a purposive sample of acute care nurses. Thematic analysis was used to extract and interpret emerging patterns from the data. Five major themes emerged: (1) emotional labor and psychological strain, (2) communication barriers and cultural conflict, (3) institutional constraints and lack of support, (4) adaptive coping strategies, and (5) effects on professional identity and job satisfaction. Nurses reported feelings of burnout, emotional suppression, and frustration, often without institutional mechanisms for support. Nevertheless, they demonstrated resilience through various self-taught coping strategies and peer support. The findings reveal that dealing with difficult patients and families is not merely a matter of interpersonal skill, but a systemic issue embedded in broader cultural and organizational dynamics. Addressing these challenges requires integrated interventions involving emotional intelligence training, institutional policy reform, cultural competence education, and mental health support systems. Empowering nurses in this context will enhance professional satisfaction, reduce burnout, and improve patient care outcomes.