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ISLAMIC MEDICAL EDUCATION RESOURCES 04

0011-MOTIVATION IN THE NURSING PROFESSION: AN ISLAMIC PERSPECTIVE

Paper presented at the 4th International Nursing Conference held in Brunei 19-22 November 2000 by Prof Dr Omar Hasan Kasule, Sr. MB ChB (MUK), MPH, DrPH (Harvard); Deputy Dean for Research and Post-graduate Affairs, Kulliyah of Medicine, International Islamic University, Kuantan, MALAYSIA EM: omarkasule@yahoo.com

1.0 CONCEPT and METHODS OF MOTIVATION IN ISLAM

A. DEFINITION OF MOTIVATION

WHAT IS MOTIVATION?

Motivation explains why individuals behave the way they do. Motivation is bringing out the best in people. Motivation is an internal drive, a conscious voluntary choice, a positive attitude to work, with purpose and high expectation of success. Motivation is inside, its outward manifestation is behavior of the worker: a strong sense of direction in the work, persistence in face of obstacles and challenges, and intensity of performance.

 

COMPONENTS OF MOTIVATION

Motivation has three components: (1) instincts: innate biological determinants of behavior (2) drive: an aroused state that occurs because of  convictions, determination, or physiological need (3) incentives: external stimuli in the form of rewards or even punishments.

 

MOTIVATION vs MANIPULATION

Motivation should not be confused with manipulation. Motivation is internal whereas manipulation is external. Motivation primarily is follower satisfaction whereas manipulation is for the sole pleasure of the leader to the detriment sometimes of the follower.

 

HIGHLY MOTIVATED INDIVIDUALS:

Highly motivated individuals manifest some common characteristics: clarity of vision and objectives, strategic and tactical plans for achieving objectives, high expectancy, energy, drive and self confidence, need for responsibility and control, strong communication skills, taking risks, accepting Correction/criticism, want for recognition, doing interesting work, high expectancy, having authority

 

TYPES OF MOTIVATION

Intrinsic and extrinsic motivation: The best motivation is self-motivation. The role of leaders is to facilitate the process. Superior performance results when the inner person is influenced positively: his thinking, his self-esteem and his commitment. Motivation is individual. What motivates one person may not motivate another one. What motivates a leader may not motivate a follower. Achievement motivation is when the basic drive is to succeed regardless of the rewards or punishments. Both intrinsic and extrinsic motivation are used. Intrinsic motivation is needed for competence and self-determination. Extrinsic motivation is from the environment especially rewards

 

Real vs reactionary motivation: Some highly motivated people in one area may be trying to cover up failures elsewhere. Reactionary motivation is temporary.

 

COMMITMENT, ikhlaas & INTENTION,  niyyat IN WORK

Commitment, ikhlaas, was described in the Qur’an (p. 80 2:139, 4:146, 6:90, 7:29, 10:72, 11:29, 11:51, 12:24, 12:4-10, 15:40, 19:51, 25:51, 26:109, 26:127, 26:145, 26:164, 26:180, 29:65, 31:32, 34:47, 36:21, 37:40-49, 37:74, 37:128, 39:160, 37:169, 38:2-3, 38:83, 38:86, 39:11, 39:14, 40:14, 40:65, 42:23, 98:5). Ikhlaas is expressed in the intention, Ikhlaas al niyyat (KS 66). Work is the consequence of the intention.

Every work is rewarded according to the intention behind it, innama al a’amaal bi al niyaat (KS 93). Every person is rewarded according to his/her niyyat, li kulli imri ma nawa (KS 552). The amount of reward is commensurate with the intention, iqaau al ajr ;ala qadr al niyyat (KS 552). On the day of resurrection people will be resurrected with their intentions, yukhsharu al naas ‘ala niyyatihim (KS 553). Any work without niyyat is not considered (KS 553).

 

The niyyat must be constant and consistent throughout the whole period of performance until completion. Start must be early and serious, baadiru bi al ‘amal (KS 93). Work is best judged by its last stages, al ‘amal bi al khawatiim (KS 93). The best of work is that which is consistent and continuous, khayr al ‘amal adwamuha (KS 94). In all performance, the human performs that which he is capable of even if the niyyat envisaged more (KS 94). Work is a test for the human, ibtilaau al insan bi al ‘amal (p 839 7:129, 10:14, 11:7, 18:7, 67:2).

 

Work is responsibility (p 849-850 2:134, 2:139, 2:141, 2:234, 2:240,  2:281, 2:286, 3:25, 3:161, 4:66, 4:111, 6:164, 7:155, 7:173, 10:41, 14:51, 21:23, 24:11, 26:112, 26:168-169, 26:216, 28:55, 34:25, 40:12, 42:15, 45:22, 52:21, 66:11, 74:38). The Qur’an emphasizes the importance of work, al hath ‘ala al ‘amal (p 840 6:135, 9:105, 11:93, 11:121, 18:110, 34:11, 34:13, 39:39, 41:5, 41:40, 67:15). There is reward for work done, jazaau al ‘amal (p 840 2:85, 3:30, 6:132, 11:15, 11:111, 16:93, 16:111, 18:49, 21:59, 23:63, 24:64, 36:54, 37:39, 39:70, 41:46, 45:15, 45:28, 46:19, 47:33, 47:35, 49:14, 52:16, 52:21, 58:6-7, 64:7, 6:135, 9:105, 11:93, 11:121, 18:110).

 

Humans have freedom to choice in the work that they do, hurriyat al insaan fi al ‘amal (p 841 4:66, 17:18-19, 17:84, 41:40, 73:19, 74:37, 76:29, 78:39, 81:28, 92:4-10). Work can be good, ‘amal hasan (p 841 9:121, 16:96-97, 24:38, 29:7, 39:35, 46:16). Work can also be bad, ‘amal sayyi (p 841 3:28, 3:30, 5:90, 7:28, 11:78, 12:10, 12:32, 12:69, 21:68, 21:74, 26:74, 85:7). Some people try to decorate bad work to make it appear good, tazyiin al ‘amal al sayyi (p 842 6:108, 6:12, 8:48, 9:37, 10:12, 16:63, 18:103-104, 27:4, 27:24, 29:38, 35:8, 40:37, 47:14). Bad work s condemned, dhammu al ‘amal al sayyi (p 843 2:282, 5:62, 5:66, 5:79, 9:9, 28:15, 29:4, 58:15, 60:1, 63:2, 63:9). The reward for bad work is a bad one, jazau al ‘amal al sayyi (p. 842 2:231, 3:30, 4:30, 4:123, 7:147, 7:180, 10:106, 16:28, 16:33-35, 25:68, 27:84, 27:90, 28:84, 29:55, 30:41, 31;23, 32:14, 34:33, 40:40, 41:50, 45:33, 53:31, 66:7, 83:36, 99:8). Humans must repent from bad work, al taubat min al ‘amal al sayyi (p 842-3 2:231, 3:30, 4:30, 4;123, 7:147, 7:180, 10:106, 16:28, 16:33-35, 25:68, 27:84, 27:90, 28:84, 29:55, 30:41, 31:23, 32:14, 34:33, 40:40, 41:27, 41:50, 4:33? 53:31, 66:7, 83:36, 99:8).

 

Good work reflects underlying faith, al ‘amal al saalih min al imaan. Goods work is a criterion of superiority among humans, al tafadhul fi al ‘amal al saalih (p 844 38:24, 38:28, 40:58, 45:21, 98:7, 103:2-3). Good work is rewarded in the hereafter, thawaab al ‘amal al saalih al ukhrawi (p 844-846 2:25, 2:62, 2:82, 2:277, 3:57, 3:136, 3:195, 4:57, 4:114, 4:122, 4:124, 4:173…. 99:7). It is also rewarded on earth, thawab al ‘amal al saalih fi al duniya (p 846-7 16:97, 18:88, 19:96, 24:55).

 

Work must be performed with the purest of intentions. Everything including the various organs of the body bear testimony to good work, shahaadat al a’adha ‘ala al ‘amal (p 843 24;24, 36:65, 41:20). Allah knows all the work done (p 847-848 2:74 … 99:6).

 

Working for the purposes of showing off, riyaa, is frowned upon (KS 93, 256). Riyaa is considered shirk asghar (KS 256).

 

MOTIVATION AND PERFORMANCE:

Leaders need motivation to be able to manage; workers need motivation to be able to perform. Motivation is infectious. Motivated leaders usually have motivated followers. Motivated peers are surrounded by motivated individuals. The leader must understand what motivates people to be able to get the best from the followers under him. This is usually not an easy task because the followers may himself not be able to tell what motivates them. Most people with average abilities can be super producers if motivated well. Motivation should not be confused with performance. A highly motivated person may not perform well because of mistakes, lack of resources, or technical skills. Turning motivation into performance is a challenge, it requires setting objectives and goals, abilities and skills, training, and resources. Performance is affected by the individual's capacity to perform, the willingness to perform, and being given an opportunity to perform. Job satisfaction is how well a worker likes the job. High job satisfaction is directly related to high motivation. The relation between level of motivation and success/achievement is not always linear. Motivation is low at the start of a difficult task when the feeling is 'why waste effort on project likely not to succeed. When the project gets under way and results begin to appear, motivation level is high because of concrete results realized. Motivation is low towards the end of the project when things are moving well. The  feeling is 'why bother when all is going so well!'

 

THEORIES OF MOTIVATION:

Many of the theories on motivation in the literature reflect the West European and American world-view and would not be applicable to Muslims. Muslims find their motivation in their religion and their cultural heritage. Any approach to motivation that ignores this will not succeed. The Prophet (PBUH) taught that every human endeavor is an act of worship and charity. Thus a Muslim while working knows she is worshipping her Lord and this is a powerful motivator in itself irrespective of any material gain. The concept of ihsaan, strife towards excellence, is a great motivator for a Muslim. A Muslim looks at the salary and other material benefits as a means to enable him feed, clothe, and house herself and her family so that she can devote her energy to the work. She does not look at them as a just return for her labor. Her labor is worship and only Allah can recompense for it. There are aspects of Muslim character that affect motivation: sharaf (dignity & honor, fear of losing face, shame for self and family), thawab (reward in the hereafter), karam (generosity), and wafa (fulfillment).

 

B. METHODS AND TECHNIQUES OF MOTIVATION

POSITIVE MOTIVATION:

Motivation (or de-motivation) can be from the leader, peers, working conditions, or the general environment. Motivated leaders are powerful motivators. The very process of leading motivates by defining a sense of direction and giving purpose to the endeavors of the group. Followers are motivated if leaders communicate positive feelings of approval. Motivated co-followers buoy up the less motivated ones. Approval and positive attitudes by co-followers are very strong motivators. The old saying that nothing succeeds like success is very relevant here. The higher the probability of success the higher the level of motivation. Followers get motivated when they see that their efforts are bearing fruit. There are measures that leaders can undertake to motivate followers positively. A motivated leader motivates. Successful leaders can motivate their followers by clarifying goals, setting challenging but attainable objectives, use of participatory management that makes the workers feel they are an important part of the work team. The way a leader deals with followers can motivate or de-motivate them. Respect, recognition, humane and kind treatment, good 2-way communication are positive motivators. Fairness and justice in an organization are strong sources of positive motivation. Fairness is based on building trust (sharing information and fulfilling commitments); consistency in decisions, behaviors and pronouncements; truthfulness; integrity; equitable treatment of all people and justice for all; respect for others; and following due process. The follower must feel secure about his job and know that as a member of a work team he will be protected and supported when he encounters difficulties. His basic physiological and psychological or social needs must be fulfilled so that he does not have to worry about them. The type of work assigned can motivate. The follower motivated by work that is challenging and meaningful; has opportunities for advancement, learning and personal growth; provides responsibility and independence; and gives job satisfaction.

 

NEGATIVE MOTIVATION:

Worries, lack of self-confidence, low self-esteem, and low self-worth are associated with low follower motivation. Negative opinions in the work place, poor working conditions, poor leadership, inequity, and injustice are negative motivators.

 

REINFORCEMENT:

reinforcement can be positive or negative. Positive reinforcement is through appreciation, reward and praise. A worker who knows that his work is useful and is appreciated will be highly motivated. Reinforcement can be continuous, or at fixed intervals, or at variable intervals. Reinforcement at variable intervals is more effective because of the expectancy it generates. Negative reinforcement is reprimand. A worker may perform well to avoid a reprimand. However this approach will fail in the long run.

 

AJR AS A MOTIVATOR

A good act is rewarded 10-fold (KS 93).

MATERIAL REWARDS AS A MOTIVATOR:

Expectation of a just reward (material or non material) for work well done is a motivator. Need-based motivators can be ranked. Respect comes first followed by security, success, and independence. Little financial compensation is not in itself a de-motivator unless it is viewed as not being equitable. The gap between the lowest and the highest paid should not be flagrantly large. Financial rewards should be directly related to the effort expended or the contribution to the organization. The use of material rewards as a motivator should be put in proper perspective. People work because they believe not because they receive. Once material rewards become the prime motivators, many workers will look for ways (and there are many) of getting the rewards without putting in the requisite effort. They may pretend to work, lie to their managers, be polite and respectful to superiors, stroke the egos of leaders to get loved, develop and nurture strategic friendships, give impressions of being team players, avoid high risk assignments that could expose weaknesses, and generally play the pretending game well. In many organizations promotions are not a result of documented performance but senior management feeling good about the employee. You cannot get away with material rewards for no work for long. You can however spend a life-time hopping from one pretense job to another with eventual loss of self-esteem. When the reality becomes known as it must be, termination is the result. Rewards can be contingent on certain follower achievements. Intrinsic rewards are task completion, achievement, autonomy, and personal growth. Extrinsic rewards are salary, benefits, and promotions.

 

MOTIVATING AN INDIVIDUAL:

motivation of an individual is different from motivation of a group. General measures needed to motivate an individual include: positive working atmosphere, emphasis on high hopes, opportunities for growth, promoting team spirit, fair rewards, and setting achievable challenges. Specific measures for motivating an individual are a step-by-step process. Determine the motivation needs of an individual. Define the desired performance. Link motivation to performance. Provide training, information, and resources. Then loosen grip and monitor performance with frequent feed-back.

 

MOTIVATING A TEAM:

a team can be motivated by providing the right working conditions, defining a clear mission, identifying a common goal and a common identity. The attitude must be positive and the leader must be motivated.

 

C. MOTIVATION IN THE NURSING PROFESSION

MOTIVATION TO CHOSE A CAREER IN NURSING:

What motivates a student to enter nursing school, will affect her commitment to practice of good nursing. Nursing is a vocation and success in it requires special aptitude and motivation. Two processes are going on. Pre-nursing school the character of the student and knowledge base are formed by the schools and society. During nursing school and after graduation, there are influences from the profession and from colleagues that affect the nurse’s motivation. The motivating factors range from the idealistic to the pragmatic material rewards. It is difficult to undertake a valid survey research of the reasons for choosing a medical career. Many students will consciously or unconsciously talk about ultruistic motivation.The real motivators may be prestige, status, family/peer pressure, and expectation of material rewards. Students are idealistic on entry into nursing school. Towards the end of their education, clinical students believe that nursing education will enable them to find a job, enjoy easy life and have a high social status.

 

MOTIVATION PRE-NURSING SCHOOL:

The formal education of a physician starts with the elementary school. In the elementary school a child should learn about morals, Islamic culture, adab and akhlaq, service and feeling for others. Good grounding in the Qur’an and sunnat is needed at this stage.  Ibn Sina started his education very early at the age of six. He started by learning the Qur’an by heart.  Knowledge, values and attitudes acquired in the elementary stage of education are the basis for later studies in medicine. Thus the future nurse has a solid base of Islamic culture. Choice of a nursing career fulfils a collective responsibility,  fardh kifayat. In some cases it may be individual responsibility, fard ‘ayn, where there is no other nurse. Families and communities should encourage children to enter the nursing profession where there is a shortage of medical manpower. The importance of medicine was underlined by Imaam al Shafie when he said: ‘I know of no discipline of knowledge after knowing halal and haram that is more noble than medicine. He also said that Muslims lost one third of all knowlege and left it to the Jews and Christians. He regretted the monopoly of medicine by people of the book. Students should be taught that study of medicine contributes to preparing the ummah’s strength, i’idaad al quwat and restoring Muslim dignity.

 

MOTIVATION DURING THE MEDICAL SCHOOL:

A question should be asked: do we offer a subject called ‘Islamic Medicine’ to orient the students or do we change the whole curriculum so that it reflects Islamic values?. The latter choice seems to be the most appropriate. The student should be taught about the Islamic heritage in methodology and medicine as a motivator for excellence. The achievements of Muslims in the science of fiqh and hadith methodology could motivate excellent research. The model of the earlier physicians is inspiring to the young ones. They were encyclopedic and all-rounded in their knowledge. They would lead prayers in the mosque, go and research on medicine, and may be return to teach Qur’an. The main lesson for the young student is that the ancient Muslim physicians were able to excel while they maintained their Islamic identity. Islam is not incompatible with excellence in science or medicine. There are several accounts of achievements by early Muslim medicine written by Muslims and non-Muslims. The Muslims may overstate while the non-Muslims may understate and in-between lies the truth. Early Muslim physicians excelled in several medical fields. A nursing course is a difficult undertaking and requires a lot of patience. The Qur’anic story about Musa (PBUH) and the righteous man is very inspiring to the student who may feel fatigue.

 

MOTIVATION AFTER MEDICAL SCHOOL:

Material motives can not be completely ignored in the name of idealism. A minimum of comfort is necessary for the practice of virtue. The nurse should be recompensed adequately for her services. Inadequate material rewards often result into frustration or even brain drain. Incentives for graduates to work in rural or depressed areas or choose unpopular but necessary specialties lies beyond the control of nursing educators. The nursing school can however maintain motivation for its graduates by means of continuing medical education programs. The following Islamic concepts are motivating for the nurse:  (a) the search for excellence, ihsaan (b) witnessing against other communities, shahadat ‘ala al naas, which implies that this ummah must lead the destiny of humanity and its members must excel in work as befits leaders who must set the example for others (c) good deeds, amal salih, is the basis for al human endeavors by a Muslim. (d) Fulfilling responsibility, amanat in work and (e) placing self-interest below others’ interests, ithaar (hashr 59:9).

 

D. MOTIVATION and RESPONSIBILITY

RESPONSIBILITY TO THE PATIENT

The responsibility of the physician, mas uliyat al tabiib (KS 339)

Delivery of excellent and affordable care

Working towards ensuring universal access

 

RESPONSIBILITY TO THE COMMUNITY

A nurse is influential in some sectors of society and can engage in general education, tarbiyyah; enjonining the good and forbidding evil,  amr bi maroof wa nahy ‘an al munkar, leadership, and advocacy for the poor

 

RESPONSIBILITY TO MEDICAL SCIENCE

Research and work on frontiers of knowledge

Medical practice based on new knowledge

Solving practical medical problems

Publication and teaching to disseminate knowledge

Professor Omar Hasan Kasule, Sr. November 2000