|Year : 2021 | Volume
| Issue : 3 | Page : 204-208
Factors motivating nurses to work during Hajj pilgrimage in Saudi Arabia
Ahmed Saleh AlKarani
Department of Nursing, College of Applied Medical Sciences, Taif University, Taif, Saudi Arabia
|Date of Submission||26-Mar-2021|
|Date of Decision||05-Aug-2021|
|Date of Acceptance||11-Aug-2021|
|Date of Web Publication||6-Dec-2021|
Ahmed Saleh AlKarani
Al Mathnah, P. O. Box: 2425, Taif 26521
Source of Support: None, Conflict of Interest: None
Context: Every year the Ministry of Health in Saudi Arabia announces the opening of applications to those who wish to work on Hajj. A certain number of applicants are nominated, yet many nurses continue to apply to participate during Hajj ever year. Although nurses are under great work pressure during Hajj, many nurses still apply for the approval to participate in Hajj. Aims: The aim of this study is to identify the motivations of nurses to work during Hajj. Furthermore, to explore the motivations that lead nurses to participate in the Hajj season and to explore the challenges faced during the Hajj season. Settings and Design: The study used a descriptive qualitative study design. Twelve nurses participated in this study from Mina hospitals in Makkah, Saudi Arabia. Subjects and Methods: In-depth semi-structured interview with 12 nurses. Data were collected from November 2020 to January 2021. Statistical Analysis Used: The data were analyzed using the thematic analysis. Results: This study showed four themes motivating nurses to participate in Hajj: taking part in Hajj is an honor and they are proud of it; great rewards will be received from ALLAH; team spirit; and the fact that it is a good experience. This study also showed two of challenges that nurses face in Hajj which are pilgrims' low awareness and language barriers. Conclusions: The stakeholder should consider these themes and reinforce them to show to all nurses, as this may increase the quality of the applicants asking to work as nurses in Hajj.
Keywords: Hajj, massive gathering, nurses, pilgrims
|How to cite this article:|
AlKarani AS. Factors motivating nurses to work during Hajj pilgrimage in Saudi Arabia. Saudi J Health Sci 2021;10:204-8
| Introduction|| |
It is not easy to work in an environment that contains a large number of patients of different ethnicities, cultures, and languages. In this situation, nurses require correct and rapid nursing interventions to save patients' lives, and this is considered to be a difficult work environment. For example, Makkah and Madinah hospitals receive thousands of patients in every Hajj season in certain places. Hajj is the fifth pillar of Islam and it is obligatory for every capable adult Muslim once in their lifetime. Therefore, the Ministry of Health in the Kingdom of Saudi Arabia is keen to organize the nomination of workers in Hajj healthcare sectors. However, every year, many registered nurses request to participate in the Hajj. Therefore, it is important to explore the reasons for nurses claiming annually to work as staff nurse during the Hajj season. Due to limitation of literature on this topic, this study became the first study to explore the motivations that lead nurses to participate in the Hajj season and the challenges that work nurses face during the Hajj. Therefore, the purpose of this study is to explore the motivations that led the Saudi nurses to participate in Hajj, as well as, to explore the Saudi nurses' challenges of working as nurses in Hajj. Consequently, this study could become beneficial to health managers in the future of nursing in Hajj. There are three ways for nurses to work during the Hajj season. The first one is nurses who are already working in the two holy cities, Makkah and Madinah, who often want to work in Hajj and they have the priority to apply. The second way is nurses from outside those two cities and they can apply to participate in working as a nurse in Hajj; all requests are sent to the Ministry of Health, after which the required number are nominated, and the candidates are informed of their nomination to participate in Hajj. The third category, which is the newest way for nurses to participate in Hajj, is by applying for a locum job in nursing during Hajj. This category has a system that differs from the rest, as nurses sign a temporary contract with a fixed salary and work in intensive care units or emergency departments units in hospitals, as needed.
| Subjects and Methods|| |
This study used a descriptive, qualitative study design. Nurses from Mina hospitals; Mina Emergency Hospital, Mina Al-Jisr Hospital, Mina Al-Wadi Hospital and Mina new street Hospital, were invited to participate in the study. Twelve nurses were willing to participate in a semi-structured interview. In-depth semi-structured interviews were used to explore the motivations that influence nurses to work during the Hajj season and to explore the challenges that they face with their work. The duration of the interviews was 30–45 min. Participants preferred the Arabic language during the interview. Therefore, all interviews were in Arabic and recorded, transcribed and analyzed using thematic analysis. Both researchers considered the study's credibility, confirmability, and transferability; for example, both of them reviewed the data and agreed to the analysis themes.
The study was approved by the Research Ethics Committee of. university, Saudi Arabia (Application code: 42-0055). Before each interview, the participants read an information sheet, which gave more detail about the study, and then they signed the consent form. The information sheet stated that the participant understood that their participation was voluntary and highlighted that they had the right to withdraw at any time during the study. Furthermore, the participants were told in the consent form that the study would include the publication of anonymised responses.
| Results|| |
Twelve nurses who had participated more than once in Hajj enrolled in this study. Participants had worked in Hajj two or three times during their working lives, as shown in [Table 1]. The participants focused on a number of motivations for working in Hajj, the foremost of which was the fact that participating in Hajj is an honor and nurses are proud of it. Second, nurses aim to obtain great rewards from Allah “God;” and finally, there is team spirit and experiences gained from participating in Hajj. This study also showed two of the challenges that nurses face during Hajj: low levels of pilgrim awareness and language barriers.
Taking part in Hajj is an honor and we are proud of it
All nurses participating in Hajj, whether they were nominated to work in Hajj or those who worked as locum nurses during the Hajj period, indicated that participating as a nursing worker in Hajj is a great honor and work that they were proud of. This is because of the great place of Hajj in the Islamic religion. Hajj is the fifth pillar of Islam and without it, a Muslim cannot complete their Islam faith, except for one who has an excuse acceptable to God. That is why the participants believe that Hajj and serving pilgrims is an ancient honor inherited by previous governments and people. The nurses are also proud of their participation with the Ministry of Health in transporting and receiving pilgrims who suffer from various diseases or accidents that prevent them from completing Hajj on their own. Therefore, the Ministry of Health transports sick and injured pilgrims from Madinah Al Munawwarah or from the Makkah Al Mukarramah region, by transferring them through the use of proper methods and modern technologies, so that pilgrims can finish their Hajj. This takes into account the health capabilities of the pilgrims and their continuous follow-up during the transportation process to complete Hajj, as quoted below:
“Working in Hajj is a moment of pride for every nurse, and is a great honour. Therefore, you know that for many years until now, nursing colleagues in all hospitals, God bless them in Hajj, such as Mina and Arafat hospitals, opted to receive the pilgrims who came from the Madena city for Arafat's day. They received them with flowers and gifts, which was beautiful. So, all of the nurses were participating in presenting roses to them; when you give your patient a rose, it is a positively a beautiful feeling” (Participant 1).
“I mean one of the positives to work in Hajj, frankly, is that I work in nursing during this period. This is a service for pilgrims to the house of God Almighty. I feel that God is with us, whatever the number of cases and patients, and I feel that this is noble work. So, this is one of the things that makes you finish your work on Hajj and you are very happy (Participant 3).
Great reward from god
Muslim nurses know that Islamic sharia urges people to do good deeds; they believe that whatever good you do in this life, you shall find it with God on the day of judgment. Therefore, Muslim nurses know that the obligation of Hajj is one of the greatest acts of obedience to God and one of the pillars of Islam. As there are many sick people who are unable to complete Hajj alone, so nurses participate in the transmission of patients to different places, as pilgrims do in the right ways. Moreover, because of their belief that doing good deeds in Makkah Al-Mukarramah is different from the rest of the cities, in Makkah Al-Mukarramah, Muslim nurses believe that working there doubles his wage with God, so they realise that providing assistance to pilgrims is a great job with God, as quoted below:
“Glory to God, the team with whom you work on Hajj is different from any team in your life. I mean they are more cooperative, in which you can see the spirit of volunteerism clearly. Also, the spirit of the one who is looking for a God reward” (Participant 8).
“At Hajj we don't know how duty hours pass quickly, but I think the main reason for that is because it is Hajj, which is something that we all will be rewarded for by God. Also, I noticed that if we worked with different and specialized people, we would have the pleasure of working” (Participant 2).
Hajj workers believe that the pilgrims have left their home, family, work and what they own, and come from different countries with different languages. They do not want anything but to perform Hajj peacefully and complete the rituals of their Islamic religion and return to their homes peacefully. Thus, the health team participating in Hajj has one goal, which is to do what is necessary to ensure that the pilgrims finish performing Hajj in peace. Hence, the health-care team works hard with good co-operation and in a coherent manner in the medical work that is taken to serve the pilgrims, as quoted below:
“To be honest, serving pilgrims is a great honor. The second most important thing in Hajj is also the people you see and work with. You see nurses come from the north of the country from the middle, and from Jeddah from the south. Frankly, you get to know the kindness people. So great, when you work in a good spirit as one cohesive team” (Participant 5).
“The second reason for participation in Hajj is that the general atmosphere in the participation of Hajj is beautiful. Those who do not participate in the Hajj, I hope that they will participates and see the difference in working in the team spirit” (Participant 12).
A good experience
Many participants see participating in work as a nurse during the Hajj season as an excellent career choice. Working in Hajj differs from any work elsewhere, because working during Hajj requires new knowledge and skills. Examples of this are work pressure during the Hajj season, the success of work depending on teamwork, and learning to make appropriate decisions at the right time and taking responsibility; all of this reflects the experience of Hajj participants. Moreover, as a nurse, participating in Hajj is important for your career record because it distinguishes you from others, as quoted below:
“Glory be to God, whoever works on Hajj will have priority; for example, in the future he will have experience in dealing with Makkah hospitals to provide services, affording travel from his city to Makkah or Medina, and bearing the pressure of work. For these reasons, he has priority because he has a good background with the pressure of work “ (Participant 3).
“Working during Hajj is unique. As you know, after working in Hajj you will have a great experience, just from watching and observing. So, what if you worked-surely you will gain a lot more. I have a friend who encouraged me to work in Hajj, because he had good experiences” (Participant 10).
A number of participants mentioned that the equipment in each Hajj differs from the previous Hajj because of the presence of new, advanced and modern equipment. Most of them also mentioned that the new equipment supports the medical staff to make easy and correct diagnoses so they can prescribe medicine. This will help patients to receive their medication and the speed of the procedures that take place accordingly reflects on the health of the patients. Furthermore, working with modern and advanced equipment gives the nurses good experiences and a feeling of happiness in doing the work that they are assigned to, as quoted below:
“The equipment in the Hajj is very attractive, new. I remember that a staff nurse worked with a patient who had dialysis on the ICU, and he said that the dialysis devices are new and modern devices.(Participant 1).
“By God, in terms of capabilities, devices and things, these are of course at the highest level. Very high level devices, I mean the majority of the equipment is new. Thanks to God and to the government, God bless them, they used to bring devices that are made in the same year to serve the pilgrims, but year by year they improve it” (Participant 9).
Challenges that nurses face in Hajj
Most of the participants mentioned that there are a number of challenges that they face while working on Hajj. The two major challenges are a lack of awareness of pilgrims and difficulties dealing with some of the sick pilgrims.
Low level of pilgrim awareness
Many pilgrims suffer from diseases such as diabetes and high blood pressure. However, they do not disclose this directly when they arrive at health services; rather, they wait for the medical results to come. According to the participants, there were many misconceptions with regard to doing that. One of the greatest misconceptions is that pilgrims are fearful. They fear that when they mention their disease, the government may stop them from completing their Hajj, so pilgrims prefer to remain silent. The second misconception is that they believe that health services are chargeable, and they cannot afford it. Therefore, not informing the medical team about their disease often delays the work of the nursing and medical teams, as quoted below:
“Language is a barrier as there is sometimes people who do not speak either English or Arabic, which is a problem. AAAAA. The second issue is that some pilgrims have a lack of awareness. I mean, for example, the patient comes to you saying that I want to go. His health is not as important as finishing performing the Hajj” (Participant 3).
“In Hajj, I think that we need to increase awareness among pilgrims, because we still see people who do not need to come to the hospital. I mean they are not sick, but they come to take free medicine. We need more awareness of the people who come to perform Hajj, so we need them to tell us their previous health history immediately” (Participant 11).
Nurses participating in Hajj see a large number of pilgrims who are not fluent in Arabic or the English language, which is why it is difficult to deal with this group who just speak their own language. In this regard, nurses work hard to reach patients and understand their needs. Nurses sometimes use different methods, such as drawing and using sign language. In this way, the nursing work will be hard and it will take more effort and time, as noted below:
“You know, we are dealing with pilgrims from different countries who speak different languages. The first thing is the language factor, where we have a problem with language. Therefore, we will have difficulty communicating with the patient and communicating information to them, even though the technologist created language programs” (Participant 1).
| Discussion|| |
The General Authority for Statistics in Saudi Arabia stated that around three million pilgrims come to Makkah every year. Thus, health-care providers face pressure during this time, especially through the high risk of transmission of respiratory viruses including COVID-19. Respectively, it is a difficult decision for nurses to work during this time. Therefore, this study investigated why nurses work during Hajj. It was found that when contributing to help people during a religious practice, it introduced a sense of honor and pride in the nurses. Similarly, a study has found that professional identity is essential to nurses. Consequently, they value the sense of honor and consider it as a key inspiration in their careers. Moreover, nurses in this study indicated that Islamic principles urged good deeds. The participants further explained that implementing good deeds and eventually seeking reward from God was the passion for their volunteering. Similarly, studies have highlighted the association between beliefs and values and an individual's action and attitude. Based on research, reward and punishment convert one alternative in building and increasing the motivation of nurses' behavior. However, the increase of investment in reward and the excessive effort to meet the necessity of the patients could be harmful to nurses. This is because nurses may not recognize their own needs and emotional exhaustion, which leads to several stress-related chronic diseases.
Correspondingly, participants have expressed the joy of team spirit in nursing staff during Hajj, and especially the appreciation of sharing a single purpose, which is to enable all pilgrims to fulfil the Hajj practice safely. Having a unified goal results in achievement, increased progress and productivity, as well as job satisfaction and promotion. Furthermore, it is proven that teams have a powerful impact on nurses' performance and work environment. Previous studies have explained that a counterbalance of successful teamwork decreases negative occurrences, which leads to a decrease in workload and less stress on nursing staff. Conversely, studies also argued that accepting team purpose and expected outcomes are a challenge nurses face frequently. Hence, this generates miscommunication and conflict between nursing staff and causes tension and compression in the work environment.
Nevertheless, the participants have described the experience in Hajj as being beneficial career-wise. This is due to the unique environment that requires high knowledge and skills. According to research, nurses who work during Hajj are required to work additional hours whilst operating with higher occurrences of emergencies and crisis. Furthermore, research explained that nurses with such experience are on demand due to their familiarity with the stressed work environment and are less likely to face psychological crises in the future. However, a study has shown that putting nurses under those stressors can cause physical fatigue, somatic illness, and irritability.
Furthermore, one of the challenges nurses face during Hajj include the lack of awareness between pilgrims. It has been reported that pilgrims' population often lack knowledge in hygiene, vaccination, and protection from heat stroke. It also includes travelling with many co-morbid diseases and the absence of knowledge about their management. This is very crucial as accurate self-awareness is essential for adapting behavior to actual abilities and to avoid risky performance. Therefore, this challenge creates a millstone to health carers and specifically nurses who are in the front-line during Hajj. Moreover, since the Hajj involves millions around the world, it is not unusual to face language barriers. However, the participants have justified the significance of language barrier when implementing the delivery of healthcare. This is because language barriers produce miscommunication and reduce the satisfaction of nurses and patients, the quality of health-care delivery and the patients' safety. Regardless of the hardships that follow working in Hajj, the number of nurses and other health-care providers who choose to work in Hajj increases yearly.
| Conclusions|| |
The study's objective was to investigate the motivations that lead nurses to participate in the Hajj season and to explore the challenges faced by nurses working during Hajj. Consequently, it was expressed that nurses seek motivation in the rewards from God, and the feeling of honour when working in such a religious practice. It was found that nurses gain advantages when adding the experience of working during Hajj in their careers. Furthermore, the study found that nurses experience challenges such as the overwhelming number of pilgrims every year, the low awareness of people, and the language barrier. However, the number of nurses choosing to work in Hajj increases every year.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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