MOTIVATION OF NURSES TO WORK WITH HOSPITALIZED GERIATRIC PATIENTS

Background: Motivation in the broadest sense is what affects the challenge, direction and maintenance of human behaviour. It has a leading role with healthcare professionals in carrying out their professional duties. Aim: The purpose of the study is to analyse the main reasons for choosing the nursing profession and what’s the motivation to work with hospitalized geriatric patients among nursing practitioners. Materials and methods: Design: By its nature, the conducted observation is retrospective anamnestic. Data was obtained within the period from April 2014 to January 2016. The study includes an anonymous survey of 260 healthcare professionals (nurses) working in Surgical, Internal and Emergency Units with a predominant contingent of patients over the age of 65. Results: The analysis of the nurses’ opinion about the reasons for practicing the nursing profession showed that the leading reason is the desire to care for and help the ones in need (83,1%). Conclusion: It is necessary to make immediate organizational changes and management decisions in order to create and implement an effective motivational strategy to assist medical professionals in carrying out their humane profession.


INTRODUCTION:
The importance of motivation in the medical profession is directly related to the quality of the provided nursing care.Motivation is a combination of energy stemming from internal and external to the individual preconditions that cause its behaviour and determine the shape, direction, intensity, and duration of that behaviour.
Healthcare professionals must be highly motivated to maintain this motivation [1].
In the conditions of market economy and changes in the socio-economic mentality in Bulgarian workers, the motivation for work is essential for the results achieved in the labour process.This also applies to medical staff, despite some specific features of the healthcare system, which reflects the personal motivation [1].
The specificities of medical work are manifested in terms of work motivation, where, along with the traditional factors -motivators (salary, working conditions, etc.), specific factors are also involved (emotional engagement, dynamism, stress, etc.) [2].
The role of the personal factor (healthcare professionals) in preserving the life and health of the patient, and creating an environment that maximizes their recovery, is exceptional.This includes both the level of professional qualifications and the available knowledge and skills, but also the personal qualities reflecting in the process of communication and commitment in performing official duties.
Bulgaria is the second fast-aging nation in the Eastern European region and is fifth in the world.Nearly half of the hospitalized patients are over the age of 65 [3,4].
Elderly people are the largest and progressively increasing group of people needing healthcare [5].
The purpose of the study is to analyze the main reasons for choosing the nursing profession and what's the motivation to work with hospitalized geriatric patients among nursing practitioners.

MATERIALS AND METHODS:
Design: By its nature, the conducted observation is retrospective anamnestic.Data was obtained within the period from April 2014 to January 2016.
The study includes an anonymous survey of 260 healthcare professionals (nurses) working in Surgical, Internal and Emergency Units with a predominant contingent of patients over the age of 65.The study covered all University and General Hospitals in Plovdiv.The study was conducted on the basis of the written consent of the managers of the mentioned hospitals.

STATISTICAL ANALYSIS
Statistical evaluation was performed by descriptive statistics to describe the results.The results are represented by arithmetic mean and a standard error (mean and Std Error).The data was processed through SPSS statistical software package ver.16.0.

RESULTS:
After statistical processing of data we concluded the following: 260 nurses were interviewed, of which the major- The average age of the surveyed medical personnel is 41,89 ± 0,65.The main portion of the specialists is in the age range 31-50 years -61,6%.The low percentage of young professionals working in these departments is surprising (Table 1).In regards to the nursing education, the wide variety of different levels of education is impressive, which is largely the result of constant changes in nursing training regulations.The largest relative percentage is nurses with a Bachelor's degree healthcare management (25%), followed by nurses with a college education.The lowest relative percentage is the nurses with Bachelor's degree healthcare (12,3%) (Table 1).
The analysis of the nurses' opinion about the reasons for practicing the nursing profession showed that the leading reason is the desire to care for and help the ones in need (83.1%).
Another leading reason for choosing the medical profession is the financial benefit (58,5 ± 3,06%), followed by the pursuit of "professional career" (21,9 ± 2,56%).Data show that quite a few have made the choice because of the social prestige that the nursing profession brings (12,3 ± 2,04%).Lastly as a motive, the respondents indicated "inability to get higher medical education ".These are people who have not been admitted to any of the disciplinesmedicine, dental medicine or pharmacy and reorientated to nursing (4,6 ± 1,30%) (Table 2).ity work in the Internal (49,23 ± 3,10%) and Surgical Units (41,15 ± 3,05%) of the surveyed hospitals.The smallest percentage is those work in the Emergency Unit (9,62±1,83%) (Table 1).This pattern is also confirmed by the fact that despite the lack of sufficient human resources in the care for the elderly, staff are largely able to meet and cope with the basic needs of patients (Figure 1).Fig. 1 Opinion of the surveyed medical professionals on the question "Is there enough staff to care for geriatric patients?"The interviewed nurses were given the opportunity to indicate the factors of motivation to work with geriatric patients in a stationary setting.
The surveyed data strongly demonstrates that wages, although strongly motivating (58.5%), are not the only factor that encourages the medical professionals to make more effort in order to provide better and more effective nursing care.The respondents gave a significant place to the recognition received, both by patients and their relatives, as well as by their colleagues -38.1%.
Other indications, playing the role of factors resulting from the nature and content of the professional activity of medical specialists are: excessive volume of paperwork that must be filled out; insufficient number of medical specialists on shift; number of patients to be taken care of; lack of appropriate material and technical base.
Opportunities for professional development are indicated by about 16% of respondents as a motive for increasing the quality of nursing care for hospitalized geriatric patients.Unfortunately, the organization of the health system does not support and stimulate enough nursing practitioners to grow professionally.
A minor part of the respondents responded with "I cannot say" -7.7%.

Fig. 2. Satisfaction of the nurse with their choice of profession
The majority of the surveyed nurses reported that they encountered difficulties in providing geriatric care to one degree or another -78,5% (Figure 3).

DISCUSSION:
Our study found that the average age of medical staff was 41,89 ± 0,65 years.The main share of professionals is in the age range of 31-50 years.
There was a statistically significant correlation between education and the age of medical staff.The majority in the age group of up to 30 years holds a "Bachelor" and/or "Master" degree.
The data from the conducted study prove that the financial benefit, although having a strong motivating effect, is not the factor that urges the nurses to make more efforts, to work more qualitatively and efficiently.A leading motivation for practicing the nursing profession in respondents is the desire to care for and help the sick and the ones in need.The majority of medical professionals are satisfied with their work despite the difficulty and complexity of caring for geriatric patients.Similar results were obtained in foreign studies [6,7].The reasons influencing the choice of profession are crucial for future professional activity of healthcare professionals.In a study by S. Peneva, the leading reason for choosing the nursing profession is the possibility of "ease of finding a job" [8,9].The nursing profession places high demands on those who have chosen it.It is not just a calling, compassion, craft, and livelihood [10].
The results obtained by us are confirmed by Farhetdinovna, according to whom 85,3% of the medical specialists are satisfied with their work [11].There was a significant discrepancy between our results and that of P. Balkanska and et al. from 2007 when the reported satisfaction was only 5,9% [12].
We cannot take into account the fact that a large percentage of respondents in the study report having difficulties in providing geriatric care.This is most often reflected in their psycho-emotional and physical condition and is a prerequisite for the development of Burnout syndrome in medical professionals [13,14].This is a condition that brings direct and indi-rect harm to nurses' health and that of the patient.Burnout syndrome leads to indifference, lack of sympathy, compassion and empathy, denial of cooperation, and support for a person in a health crisis.It affects the personal and professional efficiency of the nurse and leads to the inability to provide quality professional skills and perform the care functions.

CONCLUSION:
Health care for elderly patients has its own specifics related to the aging process.The different cultural and educational levels, the age of the patients -require a fast adaptation of professional behavior which, in certain situations, creates tension and even leads to stress.
In this regard, it is necessary to take immediate organizational changes and management actions for the creation and implementation of an effective "motivational strategy" to facilitate the discharge of professional duties of health care professionals and increase their competence.
In this sense, providing to the healthcare professionals caring for the elderly a modern educational gerontological training, adapted to their specific professional needs, is one of the prerequisites for reducing professional stress and achieving the necessary competence in the delivery of quality health care for this contingent of the population.In the modern conditions in Bulgaria, at higher criteria of quality of care are placed even higher requirements for healthcare professionals.

Limitations:
This article is one of my research papers on "Nursing Care for Hospitalized Patients -Basic Aspects and Problems".

Fig. 3 .
Fig. 3. Nurses' opinion on the difficulties met in geriatric care

Table 1 .
Socio-demographic characteristics of the surveyed healthcare professionals

Table 2 .
Reasons for choosing the medical profession from the polled contingent

Table 3 .
Factors for motivating the interviewed specialists to work with hospitalized geriatric patients and complementing the second part of the aim