Indian Journal of Health Social Work
(UGC Care List Journal)
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MOTIVATIONAL DETERMINANTS OF CAREGIVERS AND THE ROLE OF
MULTIDISCIPLINARY TEAMS IN HEALTH CARE
Hiya Roy1 & Swapna Ramachandran2
1Assistant Professor, Department of Psychology, University College, Thiruvananthapuram,
2Associate Professor, Department of Psychology, University College, Thiruvananthapuram
Correspondence: Hiya Roy, E-mail: hiyaroy@gmail.com
ABSTRACT
The multidisciplinary team in health care centres need to devote their energy physically, cognitively
and emotionally in the service of others. Such investment can create mental weariness and
exhaustion. But the number of caregiving professionals and institutions are mounting up day by
day. The present study is an attempt to uncover the driving forces that help the caregivers of
terminally ill patients to continue in their profession despite their mental exhaustion and physical
fatigue. An in-depth interview was conducted among 25 care workers in Kerala. Thematic analysis
was used to explore the motivating factors. The results identified that the caregivers were
intrinsically and extrinsically motivated. The result revealed some of intrinsically motivating themes
like purpose in Life, personal growth, spiritual aspects and challenges. Reinforcement in terms
of appreciation and monetary reward were the major extrinsic factors that played an important
role in motivating them. Findings highlight the crucial role that the multidisciplinary teams,
especially social workers and psychologists can play in fostering intrinsic motivation among care
workers in order to enhance their performance and reduce stress. The collaborative work of
psychologists and social workers is significant to cater the emotional and psychological needs of
the caregivers by allocating resources efficiently and creating a supportive environment. They
should be providing holistic support and therapeutic interventions to enhance the self-esteem
and subjective wellbeing of the caregiver.
Keywords: Motivation, Multidisciplinary Team, Social workers, Psychologists, Caregivers
INTRODUCTION
Care is a fundamental aspect in human
relationships. Providing physical or emotional
support and care for people in need is the
vital role of helping professionals (Gibelman
& Margaret, 1999). Being sensitive, becoming
responsible, providing comfort & respect and
actively listening are some of the caring
behaviours (Tabers, 1993). Caregiving
professionals might have entered into a
helping profession with an idealistic goal to
serve others. The list of professions with
caring behaviours are endless.
Health care centres, especially Palliative care,
are intended to enhance the quality of life
among patients with life threatening diseases
and their immediate family members (World
Health Organization, 1997). Such centres
address psychosocial and spiritual distress
beyond the physical symptoms faced by
terminally ill patients (Saunders, 2001). The
caregivers play a foremost role in a patient’s
physical and mental wellbeing at such centres as they provide holistic care to the patients
(Choi S & Seo J, 2019). Their role is broader,
since they are involved in constant and close
proximity with the patients as well as family
members during the life- death transition
(Reigada C., Pais-Ribeiro, Novella, Gonclaves
2015). They will confront death and mourning
almost every day (Cherian M & Mathew P
(2019). The caregiver who takes up
responsibility for terminally ill patients shows
up the ‘cost of caring’ when they are
excessively involved in caretaking behaviours
(Kessler & McLeod, 1984). There is much
research that illustrates how service oriented
professionals go through hassles and become
exhausted while working with people
(Brannan, Helflinger and Bickman, 1997;
Marvardi et al, 2005; Leinonen et al, 2001).
A study among 221 caregivers of palliative
care from Kollam district, Kerala using
Achutha Menon Centre Caregiver Burden
Inventory revealed low quality of life and poor
health among caregivers Kochuvilayil A &
Varma R P, 2024). In a Norweigan study,
Thommessen et al (2002) reported caregivers
concern on their strenuous work environment
with restrictions in personal and social life,
unorganised household routines, disturbed
sleep and constrained holidays when their
patients have dementia, stroke and Parkinson’s
disease. Another study using Maslach Burnout
Inventory on 1755 care practitioners revealed
high emotional exhaustion among the health
care practioners (Goehring, Bouvier, Kunzi and
Bouvier, 2005). In a survey on community
health nurses, 50% of them were found to be
emotionally drained in their working
environment (Hannigan, Edwards and Coyole,
2000). An analysis on studies of caregiver’s
burden expressed low well-being, high stress
level and poor health conditions of caregivers
of patients with chronic disease (Pinquit &
Sorenson, 2003).Women caregivers at
palliative centres of Kerala reported higher
rates of social, physical and psychological
problems (Jose, Florence, 2018). Thus stress
of caregivers had been a burning topic for
research. Nevertheless, we can see enormous
raise in care centres (1550 care units) in
Kerala with 90% of India’s registered nurses
from Kerala (Chacko & Anooja, 2017).
A qualitative study among specialist palliative
care social workers focused on the need to
work as a multidisciplinary team to manage
the anxieties, alleviate the stress and develop
academic underpinnings among workers in
palliative care service (Sheldon F M, 2000).
The Multidisciplinary Team (MDT) approach
in Palliative care emphasised the collaborative
efforts by different health care professionals
for the optimal care and broad array of mental
health services for the patient and their
relatives (World Health Organization, 1997).
The team can include doctors, nurses,
psychologists and social workers (National
Hospice and Palliative Care Organization,
2019; Vissers, K C et al 2013; El Nawawi et
al 2012). The doctors in the MDT might include
specific specialist physicians based on the
requirements of each patient (National
Hospice and Palliative Care Organization,
2019). Psychologists and social workers are
involved in assisting the psychological and
social wellbeing of the patients (Fernando G
V M C & Hughes S, 2019). Nurses mostly take
up the role of a caregiver (Kirby et al, 2014;
Kochuvilayil A & Varma R P, 2024). Literature
on palliative care multidisciplinary teams was
evidently successful in providing quality life
for patients with life threatening disease
(Seow et al, 2014). The collaborative
approach combining skills and abilities of
diverse experts demonstrated an improved
outcome among the patients (Crawford
&Price, 2003). While the patient becomes the
primary focus, the issues and distress faced
by the healthcare professionals becomes the
least priority (Useros M V et al 2012). Some
studies have suggested that focusing on
coping strategies are more significant for psychological well-being than stress (Coyne
& Aldwin, Lazarus, 1981; Folkman & Lazarus,
1980). The existing literature reveals negative
correlation between burnout and problem/
task oriented coping and a positive correlation
with emotions oriented coping (Jaracz, Gorna
and Konieczna, 2005). Extensive attention was
given to the effective coping behaviours to
manage their stress. However, caregivers of
terminally ill patients are confronted with
multiple stress, which eventually can push
them beyond their capabilities both mentally
and physically (Tripodoro, Velso V & Llanos,
2015).
An intervention study in 153 government
employees in the UK emphasized the
importance of stress management training to
reduce work related exhaustion and
psychological distress (Lloyd J et al 2017).
This study also revealed the significance
relationship between intrinsic motivation and
stress, as the employees who were
intrinsically motivated had greater benefits
from stress management training
intervention. When we motivate someone in
accomplishing his/her purpose, he/she can
deal with stress effectively (Frankl, 1976).
Motivation can be a key predictor to manage
stress because it acts as a driving force that
can trigger and guide the behavior of an
individual (Chan I Y, Leung M & Liang Q,
2018). If the duties and goals in an
organization can eventually satisfy an
employee’s needs, the employee will be
motivated to put forth his maximum effort
towards the organization (Robbin S, 1993).
Studies on the role of motivation to manage
the stress of healthcare workers are rarely
explored specifically in the Indian scenario.
Literature on the factors that fascinates health
caregivers to choose the profession is also
limited. Since 90% of India’s registered nurses
are from Kerala (Chacko & Anooja, 2017), the
researcher felt the importance of conducting
a study among health care workers from
Kerala.
The present research is also trying to
understand the hidden benefit or strategies
that can enhance achievement orientation
among caregivers through a qualitative study.
In Kerala, many studies have been conducted
on the effect of Multidisciplinary teams on
family caregivers ( Philip R R et al, 2018;
Kochuvilayil A & Varma R P, 2024). The
researcher realized the need to identify the
vital role multidisciplinary teams can play in
helping their own team members in palliative
care centres. Through qualitative design, this
study is expected to provide a platform for
the MDT to develop specific interventions to
enhance the wellbeing and resilience of the
caregivers. The current research had thus
examined the need to analyze the motivational
determinants of caregivers at palliative care
centres.
THEORETICAL PERSPECTIVE
Jean Watson’s theory of caring
One of the well-known theories on caring is
Jean Watson’s theory of human caring (1999).
She discussed different assumptions on human
caring: Caring can be demonstrated and
practiced in an interpersonal relationship;
Caring has carative factors that can satisfy
human needs; Caring can promote physical,
personal or social growth; Caring helps the
person to be accepted as he/ she is; Caring
atmosphere offers the potential for
development and the freedom to choose the
best caring behaviour at one’s own space;
Caring is a better health practice than curing.
The major elements of Watson’s theory
revolved around carrative factors,
transpersonal caring relationship and caring
moment. She spoke about the need for
affiliation as a higher order psychosocial
needs. The fulfilment of need for affiliation
can motivate quality nursing and improvement
of one’s own optimal health. The theory
highlights how humanistic- altruistic systems of values are important in motivating and
promoting altruistic behaviours among
caregivers (Watson, 1999).
Self determination theory
Ryan and Deci (2000) believed that the need
for autonomy, competence and relatedness
were important for building one’s happiness
and wellbeing. Behaviours that were
consistent with our need for autonomy,
competence and relatedness were mostly
intrinsically rewarding. In this theory, intrinsic
motivation was considered as our inclination
towards exploring and mastery over new
skills, knowledge and experience without an
external reward. People who were intrinsically
motivated showed better performance and
creativity that could increase their subjective
well-being. The satisfaction of the need for
autonomy would enhance the performance of
the caregiver, if the individual had the
opportunity to freely choose their behaviour
that was in accordance with their selfconcept. Competence needs were satisfied
when the caregiver had confidence in one’s
own abilities and could experience a sense of
control and mastery over the environment.
Need for relatedness included the desire for
positive and close relationships. This need
would help the caregiver to fulfil their
determination to care for others and feel
satisfied when they could make a cohesive
contribution to the social world. When our
behaviour was determined by a separable
outcome, we were extrinsically motivated.
Here, we would strive to meet the demands
of the external world thus making the
behaviour controlled. Controlled behaviours
could make us feel less competent by
compromising our self-efficacy (Ryan and
Deci, 2000). When caregivers were motivated
more extrinsically they showed less interest,
excitement and persistence in their
profession.
METHODS & MATERIALS
The present research was designed to identify
the factors that helped the caregivers to
sustain in their profession. The researcher
had used qualitative research method to
understand their driving force. The qualitative
research design was best advocated in studies
that extract the subjective perspective of the
client (Grove et al 2014). Phenomenological
research paradigm was incorporated in the
study to understand the experience of
caregivers. This paradigm would allow the
investigator to analyse the world of the
participants from their own frame of
reference (Boss, Dahl & Kaplan, 1996).
The study used a purposive sampling
technique to select the sample. Purposive
sampling technique would provide the
opportunity to the researcher to choose
participants according to the criteria and
characteristics set by the investigator
(Sharma G., 2017). The researcher visited
different health care institutions in Kerala to
interview the caregivers. 25 professionally
qualified caregivers of terminally ill patients
who fulfilled the inclusion criteria were
included. There were five males and nineteen
females among the sample. The caretakers
who were relatives of the patients, who were
not professionally qualified and who had less
than 5 years of experience in palliative care
were excluded from the study. When the
researcher reached a theoretical saturation,
the sample was limited to 25.
An in-depth interview was conducted to
qualitatively explore the factors that helped
them to continue in the profession. An indepth interview provided the freedom to the
researcher to probe deeply and also an
opportunity to the participants to express their
experiences and life stories in detail (Polit,
D. F., & Beck, C. 2008). Each interview lasted
for almost 30 to 45 minutes. The data was
audiotaped, transcribed and motivating factors
were explored through Thematic Analysis. It was considered as the basic data analysing
method used in qualitative research to
identify the themes (Braun & Clarke, 2006).
RESULTS
The data collected was analyzed
systematically and comprehensively. The
demographic details of the participants were
collected during the interview. Subsequently
the themes and sub themes extracted were
also mentioned. The samples were indicated
using their initials to ensure confidentiality.
1. Theme – ‘Intrinsic motivation’: The first
theme ‘Intrinsic motivation’ was reported by
most of the participants in the study. The
quotation 1:1 indicated a clear inclination
towards intrinsic motivation in both males and
females. The sub themes under ‘Intrinsic
motivation were ‘Purpose in Life’,
‘Spirituality’, ‘Personal Growth’, ‘Challenges’
and ‘Reciprocal Altruism’. ‘Intrinsic
motivation’.
1. Theme – ‘Intrinsic motivation’: The first
theme ‘Intrinsic motivation’ was reported by
most of the participants in the study. The
quotation 1:1 indicated a clear inclination
towards intrinsic motivation in both males and
females. The sub themes under ‘Intrinsic
motivation were ‘Purpose in Life’,
‘Spirituality’, ‘Personal Growth’, ‘Challenges’
and ‘Reciprocal Altruism’. ‘Intrinsic
motivation’.
1.1 Quotation of JI –
“Sometimes…..Hmmm…. I feel really
exhausted and will think of taking a day off
……But next I will be very excited to come
here… I really don’t know what energizes me.
We will get a kind of….. a kind of……
satisfaction…. self satisfaction……U don’t have
to look for opinions from others, how you feel
that is important. I feel contented and
satisfied……..Here, we try to give life to their
days……….we can’t give days to their life”.
1:1- Subtheme- ‘Purpose in life’: Among the
participants, 80% believed that ‘Purpose in
Life’ played a crucial role in motivating them.
Both males (n=4) and females (n =16)
considered the significant impact of this sub
theme on their persistence in their profession.
1:2 Quotation is a verbatim of one of the
respondents
1:2 Quotation of RA – “This centre is part
of my life… ..I don’t need any
encouragement… This gives a lot of
satisfaction…my life looks meaningful…. you
know.. I feel I am actually doing .. doing
something for the society. I had worked in
other places but feelings are different
here…..In the beginning it was difficult for
me…. to adjust………….now…. I love my job
more than my family…………”
1:2- Subtheme – ‘Spirituality’: The subtheme
‘Spirituality’ was found in 60%. There is a
subsequent difference in this subtheme in
terms of gender. Only one male reported its
importance in their job. Nevertheless, 14
female subjects concluded its relevance. The
1:3 Quotation of PT is an indicative of the
spiritual component in motivation.
1:3 Quotation of PT – “I felt an inner call to
help people. A kind of mission….. of my life.
I feel God has called me to spread love
unconditionally.., It’s like any other- like
call……. for marriage, other professions”.
1:3 Subtheme – ‘Personal Growth’: It was
significant in the life of 3 male and 11 female
caregivers with a total percentage of 56.
Compared to other sub themes under intrinsic
motivation, personal growth was relatively the
least noted subtheme.
1:4 Quotation of SH – “A kind of order
………or punctuality….. . my character itself
changed……. I was very short tempered……
Now I have learned patience. Seeing their pain
and suffering , I understood mine is far better”
1:4 Subtheme- ‘Challenge’: It created an
impact on 60% caregivers. Among them 5
were males and 10 were females. In females,
challenge had the lowest influence. But men
considered it as the one of the highest
motivating factors.
1:5 Quotation of KA – “There are lots of
challenges in this…. That motivates me to
continue further in life. Challenges help me
to do more…..A patient who is going to die…it
is a major challenge……whatever you could
do for them…….do that….so that they will
have a peaceful death….”
1:5- Subtheme-‘Reciprocal altruism’ – The
subtheme ‘Reciprocal Altruism’ was reported
by 76% with 3 males and 16 female health
care workers. The verbatim of PR is noted in
1:6 Quotation.
1:6 Quotation of PR – “I feel that I am
helping someone in their difficulty …..There
will be someone…….who will look after me
when I am in need…that’s my hope….So if
you care for someone who has no relation to
you….. there will be someone who will take
care of me…….”
2. Theme- ‘Extrinsic motivation’: The second
theme emerged was ‘Extrinsic motivation’.
The 2:1 quotation of BI explained the
pertinence of extrinsic motivation. It had two
sub themes under that, mainly, ‘Appreciation
& Recognition’ and ‘Monetary Reward’.
2:1 Quotation BI – “From the
public………there is so much of…respect…..
it’s easy to find other field nurses…. but these
kinds are very difficult……so everyone
respects us…. the patients relatives….all…..I
was here for past 10 years…. so when people
from outside come for visit….other staff who
just came …will introduce me to them… then
everyone will recognize me……..so I feel that
is a great recognition…..”
2:1 Subtheme- ‘Appreciation and
Recognition’ – The percentage of the
subjects associated with the subtheme
‘Appreciation and Recognition’ was 60%.
Among them, 14 were female caregivers and
1 was a male caregiver. Compared to the
second subtheme under extrinsic motivation,
Appreciation & Recognition were deeply recognized by female participants. The 2:2
quotation signified this sub theme
2:2 Quotation of MV – “Appreciation from
patients…… from their bystanders…… their
family members……..my family……Praise
energizes me….. Patient’s recognition………I
think even the outside world also understands
that what we are doing is something
great……… there is recognition by
everyone……”
2:2- Subtheme-‘Monetary reward’ – The
subtheme ‘Monetary Reward’, was considered
as the least reported subtheme among all the
subthemes. It was evident in 3 males and 7
females with a total of 40%. However, we
could see half of the males pointed out its
relevance. The 2:3 Quotation could provide
an explanation for this sub theme. The
thematic map summarizing the themes and
subthemes of the study was given in figure
1:1.
2:3 Quotation of SN – “Initially I came to
this not just for service…..we need money to
live …… But I am not saying that money is
everything…. a kind of satisfaction also should
be there to continue…….”
DISCUSSION
Here, each theme and subthemes extracted
through thematic analysis were discussed in
detail. The first theme identified from the data
was ‘Intrinsic motivation’ and the second one
was ‘Extrinsic motivation’. Deci & Ryan (1985)
differentiated between two basic types of
motivation: intrinsic and extrinsic motivation.
When an individual carried out a task because
it gave them enjoyment and satisfaction
inherently, it was intrinsic motivation. If the
individual was performing something with an
expectation of a separable outcome, it could
be extrinsic motivation.
1. Theme : ‘Intrinsic motivation’
‘Intrinsic motivation’ was associated with an
activity that involves no external inducement
(Malone and Lepper, 1987). Most of the
caregivers in the study clearly reported that
their motivation comes from the contentment
they get. This happiness aided them to serve
others better. Research has reported that
when people were intrinsically motivated they
could experience a sense of satisfaction and
the performance would be greater and
persistent (Deci and Ryan ,1995). Cooperation
from their patients and family members also
reported to promote their motivation. Tauer
J M, & Harackiewicz (2004) suggested the
effect of cooperation in facilitating intrinsic
motivation and performance.
1:1- Subtheme- ‘Purpose in life’
‘Purpose in life’ was the most frequently
replicated subtheme in most of the
participants. It involved a cognitive judgement
about the happiness one could derive by
leading a meaningful and purposeful life. The
caregiver believed that they were making a
positive difference in others’ lives and thus
making their own life more meaningful. Frankl
(1976) pointed out that ‘will to meaning’ was
one of the basic motivating factors. He noted
that having a sense of purpose and meaning
‘Purpose in life’ was the most frequently
replicated subtheme in most of the
participants. It involved a cognitive judgement
about the happiness one could derive by
leading a meaningful and purposeful life. The
caregiver believed that they were making a
positive difference in others’ lives and thus
making their own life more meaningful. Frankl
(1976) pointed out that ‘will to meaning’ was
one of the basic motivating factors. He noted
that having a sense of purpose and meaning could help a person to sustain through one’s
life journey, enhancing their psychological
well-being. When the caregivers were faced
with challenges and traumatic experiences,
restoring and realising the meaning and
purpose could help them to cope better. They
expressed a sense of satisfaction when they
provided emotional support and care to a
person whose days were counted. Watson
(1999) pointed out how being sensitive to
others would make oneself more authentic
and could promote self-actualization. The
caregivers felt that they had a responsibility
towards the society. Graham & Susan (2005)
also concluded that social commitment
towards the community was an important
predictor for caregiving. The chance to
socialize and work as a team were also
considered as the motivational factors for the
caregivers to continue in this profession.
Watson’s theory (1999) and Ryan and Deci
(2000) also discussed the role of caring
behaviour in satisfying one’s higher order
need for affiliation or relatedness.
1:2- Subtheme- ‘Spirituality’ – The sub
theme ‘Spirituality’ was mostly found in female
caregivers than in males. Spirituality was
often demonstrated in a more fundamental
way through the caregiver’s intention to act
according to God’s plan. They firmly believed
that they were in this profession because it
was God’s plan. They trusted that their service
would be appreciable in the eyes of God. They
didn’t believe in the material rewards of the
world. The transpersonal caring relationship
in Watson’s theory (1999) also emphasised
the ability of a person to go far beyond one’s
ego and reach the intense spiritual
connections while providing comfort and care
for others. Thus this helping profession
enhanced their dignity and provided them a
feeling of completeness and inner harmony.
Fahri Karakas (1989) also reviewed that
spirituality improved employees’
performances and organizational
effectiveness
1:3- Subtheme- ‘Personal Growth’ –
‘Personal Growth’ was another sub theme
extracted. Caregivers recognized that they
could grow as a person since they started
working with terminally ill patients. They
understood that working with the patient had
created an order in their life and gained the
capacity to face challenges by observing the
suffering of others. Their encounters with
different patients in palliative care helped
them to be more open to new experiences.
Frankl (1999) also reported that when
circumstance could provide opportunity for
personal growth, people would commit
themselves to their goals.
1:4- Subtheme- ‘Challenge’ – Another sub
theme that could promote intrinsic motivation
was ‘Challenge’. Challenges created a major
impact on the male caregivers. Among
females, challenge was one of least reported
sub themes in comparison with other
subthemes in intrinsic motivation. The
caregivers of terminally ill patients were
involved in the challenging job of improving
the quality of life of terminally ill patients. This
profession required an optimal physical and
emotional involvement even in difficult
situations. Each day they were confronted with
different challenges, for eg., temper tantrums
of the patients, deterioration of health and
death among the patients, helping the family
members to accept and cope with the
circumstances. They expressed their stress
and hassles but at the same time pointed out
how these challenges gave them more
courage, preparedness and experiences to
deal with future issues. A few of them
reported how challenging situations at work
place enhanced their capacity to use their
skills to face personal challenges effectively.
Studies have proven how challenging jobs can increase productivity of the employees
(Radhakrishnan S & Ronen J, 1999).
Nevertheless, some of them expressed the
strain and distress that they experienced while
facing some challenges which went beyond
their control.
1:5- Subtheme-‘Reciprocal altruism’ – The
sub theme ‘Reciprocal altruism’ was also one
of the most discussed sub themes among the
caregivers. Altruism involved an act of
providing help to someone without expecting
anything in turn. In reciprocal altruism, the
individual would help others with an
expectation of potential receipt in the future
(Trivers R, 1971). The very essence of
reciprocal altruism was explained in the
principal – agent relationship. The agents
would be intrinsically motivated to perform a
behaviour even when there was no monetary
incentive (Shchetinin O., 2009). In the present
study, the principal – agent relationship was
evident in the relationship between the
patient and the caregiver. The caretaker
exhausted one’s own fitness while providing
the care and comfort for the patient, with the
expectation that someone else might help
them in a similar manner in the future.
Caregivers in the study communicated their
strong assurance of someone helping them
or their family member when they fall ill.
2: Theme : Extrinsic motivation’ – The
second major theme was ‘Extrinsic
motivation’. Extrinsic motivation was
considered when an activity was done in order
to attain some outcome (Deci, 1995). A
person who was extrinsically motivated could
carry out a task even when he had no interest
in it because of the anticipation of an external
reward (Ryan &Deci, 2000). Reinforcement
was the major extrinsic factor that played a
major role in motivating a behaviour (Skinner,
1957). The reinforcements that the caregiver
could get from patients in terms of monetary rewards, appreciation were more prominently
discussed here. The participants felt that
even though death was an inevitable truth in
palliative care, the kind of love and concern
shown by the patients and family members
always energized them to care for the next.
The themes identified under extrinsic
motivation were Appreciation and Recognition
and Monetary Reward.
2:1- Subtheme-‘Appreciation and
Recognition’ – ‘Appreciation and
Recognition’ was one of the predominant sub
themes. It was considered as one of subtypes
of extrinsic motivation called introjected
regulation (Deci & Ryan, 1995). In introjected
regulation, people were externally regulated
to carry out an action to attain ego
enhancements or pride (Ryan &Deci, 2000).
In Introjection, behaviour was regulated by
contingent self-esteem. Caregivers spoke
about how words of appreciation from the
patients and family members boost their selfconfidence and morale. Appreciation was a
fuel that powered the positive cycle in
caregivers. The caregivers who had worked
in other institutions expressed the difference
they experienced in palliative care centres. It
was also reported that the love, recognition
and respect they receive in palliative centres
was more on a personal level which energizes
them. While in other health care settings, it
was just at peripheral level. Research on
frontline employees also pointed out
recognition as a best reward to strengthen
performance (Arnolds & Venter, 2007). A
written note of appreciation or an expression
of gratitude might take a little time, but means
a lot to them because it indicates that their
work has been helpful for someone. Studies
had shown how positive feedback can in turn
strengthen their intrinsic motivation because
it highlighted their personal competence (Deci
& Ryan, 1995).
2:2- Subtheme-‘Monetary reward’ –
‘Monetary reward’ was commonly used as a
method for enhancing the motivation of
employees (Bonner &Sprinkle, 2002). Among
the samples in this study, 40% had spoken
about money as an incentive. Most of them
expected high monetary reward and high job
opportunities before joining the profession but
the scenario was different at Kerala, where
professionally qualified caretakers were not
paid accordingly. They expressed how money
was important for their livelihood but it was
not the only driving factor. We can clearly
gather from their words that the financial aid
could be a reinforcement initially but monetary
reward had lesser influence on persisting and
enhancing one’s performance. Some studies
also proved that money had a varying effect
on the motivation but did not consequently
enhance the performance (Camerer
&Hogarth, 1999; Arnolds & Venter, 2007).
The life experience, institutional backgrounds,
geographical area, socio economic status and
age would have influenced the generalisation
of the study. Nevertheless, this research
might fill the gaps in the literature on the
driving force of caregivers.
During the interview many of the caregivers
reported their concern on their own mental
health and wellbeing. The caregivers also
pointed out their heavy workload and vague
job description. They revealed that the
ambiguity in job expectation would cause
disputes among the members resulting in
decreased efficiency in the job. The result
proposed the crucial role of a multidisciplinary
team to design interventions for the
caregivers in the palliative care centres. The
capacity of the team to foster the optimal
functioning of the caretakers by providing
clear and specific job descriptions were also
highlighted in the result. The study alarmed
the other members in MDT i.e., social workers
and psychologists about their role to develop
collaborative plans. The integrated plan could facilitate emotional wellbeing and resilience
among caregivers to carry out their
responsibilities efficiently. The
multidisciplinary team can support each team
member, facilitate better communication
between the caregiver and the family
members, and provide counselling and
bereavement follow up (Monroe B, 1998).
The outcome of the study stressed the
importance to enhance the performance and
persistence among helping professional by
satisfying their need for relatedness,
autonomy and competence thereby improving
their psychological well-being. The current
study was also opening a door for further
research on how social workers and
psychologists could increase intrinsic
motivation among the members of the team
to alter their strain and anxiety.
CONCLUSION
The current article highlights how healthcare
workers of palliative care units are motivated
both intrinsically and extrinsically to pursue
their profession. Through phenomenological
paradigm, this research might help the
caregivers to understand the therapeutic
nurse- patient relationship in which nursing
is noted as ‘doing with the patients’ rather
than ‘doing for the patients’ (Peplau, 1997).
We might assume monetary reward played a
critical role in attracting helping professionals
but the present study clearly states the impact
of financial reward on motivation is
transitional. We can gather from the data that
self-generated factors like purpose in life,
spiritual aspects, personal growth, challenges
and reciprocal altruism have greater influence
on sustaining a caregiver’s motivation.
When individuals are more intrinsically
motivated, they might have higher self-esteem
and subjective wellbeing (Ryan & Deci, 2000).
The Self Determination theory highlighted the
importance of well-balanced fulfilment of all
the three needs – the need for autonomous, competence and relatedness for enhancing
one’s wellbeing (Ryan & Deci, 2000). In the
Indian scenario we can observe an
overlapping of responsibilities between
members of the team which might hamper
their need for autonomy and competence.
When a person pursues a goal with lesser
sense of choice, higher coercion and fewer
control or mastery over challenges, their
intrinsic motivation can be thwarted (Deci &
Ryan, 1995). This article points out the
probable assumption behind the stress and
mental health dilemma among caregivers
irrespective of the fact that they are more
intrinsically motivated. This rationale is still
a major concern that needs utmost research
and investigation.
The present study is also emphasising the
possibilities and role of multidisciplinary team
(MDT) members to target new research to
optimise collaborative efforts to alleviate
trauma and stress among caregivers. The
article proposes the incorporation of an
interdisciplinary approach so that members
can interact and work interdependently for the
caring of the patients along with self-care and
care for each member of the team (McCallin
A, 2001). The study thus suggests the social
workers and psychologists to develop
integrated care plans and conduct training
programs for the caregivers to help them to
face professional challenges.
Nevertheless, the significance of extrinsic
motivation is not disowned in the study. The
dynamics of both intrinsic and extrinsic
motivation should be considered to enhance
the performance and wellbeing of caretakers.
The value of appreciation and recognition is
also emphasised in this article. Also, intrinsic
motivation is expected to satisfy one’s innate
psychological or quasi needs (Deci & Ryan,
1995). Each caregiver’s psychological needs
can be different. By considering their specific
motivational determinants, the current study
recommends the multidisciplinary teams to
design specialised and individualised
interventions for the caregivers.
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Conflict of interest: None
Role of funding source: None
ISSN: 2582-1393 (Online)