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Findings and Discussion

Introduction
During the last forty years or so, a large number of studies on role stress and
related phenomena have been carried out in India. However a detailed study of
“Role Stress and related phenomena on Nurses” is missing in Indian context. We
all know that the job and role of Nurses has inbuilt potential for stress. The
present work is an attempt to understand the various aspects of Motivational
Behaviour, Role Stress and Coping Strategies amongst nurses in detailed
manner.
The context in the present study is the corporate hospital wherein we find
altogether a new set of challenges for the nursing staff. Erstwhile the nursing role
has been mainly charitable as if nurses have been working for “not for profit”
organization. But worldwide including India, the trend is changing. With entry of
private players in health care and management systems and corporatisation of
the hospitals, there is now greater emphasis on quality service deliverables.
Obviously the new thrust would be given to provision of ‘quality health service at
optimum cost’.
In light of these changes, there lies both; an opportunity for hospital staff to find
their employment ‘supposedly’ more enriched and their job and role more
stressful as now they shall have altogether a new set of expectations from people
around them in a highly competitive ‘health business’ environment. For better
health management and administration, new ways and techniques need to be
identified and developed to keep the motivation of health professionals on higher
ebb and stress at manageable level.
This thesis work is divided into six chapters. Chapter I provides the overall
framework of the concept of Motivational Behaviour, Role stress and Coping
Strategies as it is understood by different scholars. Chapter II deals with review
of relevant literature in which prominent studies in Indian as well as international
context is highlighted and key insights of some of the studies are presented.
Chapter III provides the methodology of research where in the objective of the
present study, hypotheses to be tested, the demographic characteristics of the
sample, measure and statistical tools that would be used is specified in detail.

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Chapter IV provides statistical results which have been generated through SPSS
v16.0. Each table and figure given in this chapter is described in detail. Chapter
V includes findings and discussion. And Chapter VI provides summary,
recommendations, limitations and suggestion for the further research. Also the
concluding remark, reference & select bibliography, list of tables, list of figures,
list of abbreviations and appendix is provided separately.

Conceptual Framework of Motivational Behaviour, Role


Stress and Coping Strategies

Motivational Behaviour
Murray (1938) developed a long list of human motives or needs and his work has
inspired further studies, which have produced different lists of significant
behavioural motives. McClelland, Atkinson, Clark and Lowell (1953) suggested
three important motive (achievement, affiliation and power) and elaborate
methods for measuring them. McClelland subsequently demonstrated the
importance of the achievement motive for entrepreneurship and marketing
(McClelland and Winter, 1971) and of power as a motivation in management
(McClelland, 1975; McClelland and Burnham, 1976). Litwin and Stringer(1968)
used the three motives of achievement, affiliation and power in their study of
organizational climates and organizational behaviour.
The various researches have identified six primary needs or motives, which are
relevant for understanding the behaviour of people in organizations. These are
as follows:

1. Achievement: Characterised by concern for excellence.


2. Affliation: Characterised by a concern for establishing and maintaining
close, personal relationships.
3. Influence: Characterised by concern to make an impact on others.
4. Control: Characterised by a concern for orderliness.

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5. Extention: Characterised by concern for others.


6. Dependence: Characterised by a desire for help from others.

However, each of these motives can have two dimensions: approach and
avoidance.
Organisational Role Stress
The concept of stress was introduced by Hans Selye in 1936. It is derived from a
latin word stringi which means to be drawn tight. Simply defined stress is an
external event or internal drive which threatens to upset the orgasmic equilibrium.
Hence by implication, stress is an adaptive response. Modern life is full of stress.
As organization become more complex, the potential for stress increases.
Urbanization, industrialization and increase in scale of operations are some of
the reasons for rising stress. Stress is an inevitable consequence of socio-
economic complexity and, to some extent, its stimulant as well. People
experience stress, as they no longer have complete control over what happen in
their lives.
A distinction has been made between productive or functional stress (stress for
creative work, entrepreneurial activities, Olympic competitions, etc.) and
dysfunctional stress (stress of boredom, unmanageable conflicts, overwork, etc.).
The former has been called eustress and the latter distress.
Role can be defined as a set of functions, which individuals performs in response
to the expectations of the significant members of social systems, and their own
expectations about the position that they occupy. The concept of role and two
role systems (role space and role set) have a built in potential for conflict or
stress.
In relation to organizational roles, the following ten stresses are worth
considering:
1. Self-role distance (SRD)
2. Inter-role distance (IRD)
3. Role stagnation (RS)
4. Role Isolation (RI)

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5. Role ambiguity (RA)


6. Role expectation conflict (REC)
7. Role overload (RO)
8. Role erosion (RE)
9. Resource inadequacy (RIn)
10. Personal inadequacy (PI)
Coping with Role Stress
When individuals experience stress, they try to adopt ways of dealing or coping,
with it, as they cannot remain in a continual state of tension. The word coping
has been used mainly with two meanings- ways of dealing with stress, and the
effort to master harmful conditions, threat or challenge. The present study will
use the term coping in the first sense (ways of dealing with stress).
Coping strategies can be coceptualised as a product of a combination of
externality, internality and mode of coping.
Externality is the feeling that external factors are responsible for role stress,
resulting in aggression towards, and blaming of, these external factors. It may
also indicate the tendency to expect and get a solution for the stress from
external sources. Externality may be high or low.
Internality is quite the opposite. The respondent may perceive himself as
responsible for the stress, and may therefore express aggression or blame
himself. Similarly, the respondent may expect a solution for the stress from
within. Internality may be high or low. Coping may take the form of avoiding the
situation (reactive strategy) or confronting and approaching the problem
(proactive strategy). This is a mode of coping.
Combining the two aspects of each of the three dimensions, there are eight
possible strategies for coping with the stress. These are briefly described below.
These concepts have been borrowed from Rosenzweig (1978).
Avoidance mode is characterised by any one of the following: (a) aggression and
blame, (b) helplessness and resignation, (c) minimizing the significance of the
stressful situation by accepting it with resignation, (d) denying the presence of
stress or finding an explanation for it. Such behaviour helps a person in not doing

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anything in relation to the stress. The present study has used the expression
‘punitive’ (borrowed from Rosenzweig), and has used capital letters to denote
avoidance responses.
Borrowing from Rosenzweig, the present study has used the term persistive for
this mode, and has used small letters for the styles in this mode. The eight styles
as given in fig. II are briefly described below:
1.Impunitive [M] – has a combination of low internality, low externality and
avoidance.
2.Intropunitive [I] – characterised by high internality, low externality and
avoidance.
3.Extrapunitive [E] – is characterised by low internality, high externality and
avoidance.
4.Defensive [D] - is characterised by high internality, high externality and
avoidance.
5.Impersistive [m] – is characterised by low internality, low externality and
approach.
6.Intropersistive [ i ] – is characterised by high internality, low externality and
approach.
7.Extrapersistive [e] - is characterised by low internality, high externality and
approach.
8.Interpersistive [n] – is characterized by high internality, high externality and
approach.

Review of Relevant Literature

Stress studies in India have been mainly in two areas: general population for
whom critical life events are seen as the source of stress and the organizational
contexts in which role is seen as a central construct. Some significant studies
dealing with role stress are being highlighted here.

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Studies on Role Stress in India were initiated by Udai Pareek (1974, 1993) and
later taken up seriously by a number of researchers. These studies can be
classified in to three categories – sectoral level, organizational level and job level.

There are some studies which besides testing a host of hypotheses, also
compare the level of role stress experienced by public and private sector
professionals (Pestonjee, 1992; Dwivedi, 1990). Employees in private sector
organisations experienced more role stress as compared to their counterparts in
public sector organizations. In other studies, the emphasis was placed on the
study of role stresses experienced by various job categories of a particular
organization (B.B.Khanna, 1985; Bhaskar, 1986). There is another group of
studies in which stress & related phenomena were explored in relation to
particular job categories (Fernandes and Murthy on school teachers, 1989;
Mishra on air traffic Controllers, 1996; Sighvi and Mathur on police professionals,
1997).

Review of literature suggests that there is one special group i.e. Nurses, on
which a detailed study on role stress and related phenomena is missing. Nurses
generally have to perform their duty under the tremendous stressful situation.
Their job and role has in built potential for stress. The present study has been
carried out to fill the void in research in the said area.

RESEARCH METHODOLOGY
Objectives of the Present Study
The objectives of the present study are as follows:

• To determine the pattern of different types motivational behaviour, role


stress and coping strategies amongst the nurses.
• To investigate the influence of age of nurses on motivational
behaviour, role stress and coping strategies.

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• To explore the effect of education of nurses on motivational behaviour,


role stress and coping strategies.
• To study the effect of work experience of nurses on motivational
behaviour, role stress and coping strategies.
• To explore the influence of marital status of nurses on motivational
behaviour, role stress and coping strategies.
• To determine the influence of total monthly income of the nurses on
motivational behaviour, role stress and coping strategies.
• To determine the influence of unit (department) in which the nurses are
working on motivational behaviour, role stress and coping strategies.
• To explore the influence of regional background of nurses on
motivational behaviour, role stress and coping strategies.
• To explore the relationship between motivational behaviour and role
stress, motivational behaviour and coping strategies, and role stress
and coping strategies.
• To find out the predictive value of motivational behaviour, role stress
and coping strategies on each other.
Hypotheses
• There will be significant differences among the groups divided on the
basis of demographic variables regarding their motivational behaviour,
role stress and coping strategies.
• There will be significant relationship between motivational behaviour and
role stress.
• There will be significant relationship between motivational behaviour and
coping strategies.
• There will be a positive and significant relationship between role stress
and avoidance coping strategies and a negative and a significant
relationship between role stress and approach coping strategies.

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• Motivational behaviour, role stress and coping strategies will emerge as


significant predictors of each other.
SPS Apollo Hospital, Ludhiana - the Organization for the present
study

SPS Apollo Hospital is situated in Ludhiana, an industrial city in the state of Punjab
(India). It is a modern state of the art 350 bedded multi specialty tertiary care hospital, set
up in collaboration with Apollo group of Hospitals which offers affordable and
comprehensive health-care services/facilities to the patients under one roof. SPS Apollo
Hospital, Ludhiana has rare frame to be the first hospital in South East Asia to be
accredited by Joint International Commission within two years of operations.

Sample Plan

A sample is any number of persons selected to represent the population according to


some rule or plan.The same for the present study consisted of 135 nurses working in
different units (departments) at SPS Apollo Hospital, Ludhiana. All the subjects of the
present study were females. Simple random sampling procedure was followed to select
the sample.

Note: The Level of Education & Regional Background is found to be insignificant


demographic variable for the present study and therefore have been excluded.

Measures
The following measures were used in the present study to collect data:

• Motivational Analysis of Organizational Behaviour (MAO-B)-instrument


developed by Udai Pareek (1986)

• Organizational Role Stress scale - instrument developed by Udai Pareek


(1983)

• Organizational Role PICS - instrument developed by Udai Pareek (1983)

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• A semi structured interview schedule was used to substantiate the


quantitative data. The respondent’s answers to the questions in interview
schedule helped in the development of more integrative and
comprehensive understanding of the phenomena in the present study.
The used interview schedule is presented in the Appendix.

Procedure for Data Collection


Before data were collected; the Executive Director, Chief Operating Officer and
Nursing Superintendent of the hospital were contacted and apprised of the
nature and the purpose of the study. With their help, the Nursing Supervisors for
each unit (departments) were contacted to facilitate the whole process of data
collection.

Statistical Treatment of the Data


The following statistical techniques will used to analyze the data:

• Means and Standard Deviations will be found out to know the nature
of distribution of the variables undertaken in the present study.
• Analysis of Variance (ANOVA) will be applied to find out the significant
differences, if any, among the groups divided on the basis of
demographic variable regarding their motivational behaviour, role
stress and coping strategies.
• Correlation Analysis will be done to find out the relationship between
motivational behaviour and role stress, motivational behaviour and
coping strategies, and role stress and coping strategies.
• Stepwise Multiple Regression Analysis will be used to find out the
predictive value of motivational behaviour, role stress and coping
strategies on each other.

NOTE: SPSS v16.0, on a personal computer was used to carry out statistical
analysis of data

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Findings and Discussion

Findings, Recommendations, Limitations & Suggestions


for Further Research

Findings
The major findings of the present study are given as below:
1. Extension (Approach) emerged as dominant motive for the total sample
followed by Dependence (Approach), Control (Approach) and
Achievement (Approach)
2. Role Erosion emerged as the highest stressor for the total sample
followed by Inter Role Distance, Personal Inadequacy, Role overload,
Role stagnation, Role Isolation & Resource Inadequacy. The lowest mean
score was found for Role Ambiguity.
3. Intropersistive emerged as the most popular strategy (style) of coping for
the total sample followed by Interpersistive & Defensive style. The least
popular style was found to be intropunitive.
4. Overall the mean score for the total sample was higher for Approach
Coping Style meaning there by that in the present study the Nurses were
found to use functional style to cope with the role stress.
5. The significant difference amongst the groups divided on the basis of age
was found in Control (Approach), Achievement (Avoidance), Dependence
(Approach) and OEQ A motive. Control (Approach) is found to be highest in the
age group 36-39. Achievement (Avoidance) is found to be highest in the age group
24-27. Dependence (Approach) is found to be highest in the age group 20-23 and
OEQ A is found to be highest in the age group 36-39.
6. The significant difference amongst the groups divided on the basis of age
was found in Inter Role Distance. Inter Role Distance is found to be higher
in the nurses of the higher age group.
7. Except for Influence (Approach) & Dependence (Avoidance), the
significant difference amongst the groups divided on the basis of unit was
found in all other motivational behaviour dimensions. The mean score for

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Achievement (Approach) is found to be highest in Surgical Ward and


lowest in ICU. The mean score for Affiliation (Avoidance) is found to be
highest in Surgical Ward and lowest in OT. The mean score for Control
(Approach) is found to be highest in MICU followed by OT. Extension
(Avoidance) motive is found to be highest in CCU and lowest in Cath lab.
Achievement (Avoidance) is found to be highest in Surgical Ward and
lowest in OT. Affiliation (Approach) is found to be highest in Surgical Ward
and lowest in Cath Lab. Influence (Avoidance) is found to be highest in
Emergency and lowest in Surgical Recovery. Dependence (Approach) is
found to be highest in General Ward and lowest in Cath Lab. Control
(Avoidance) is found to be highest in Surgical Ward and lowest in NICU.
Extension (Approach) is found to be highest in Surgical Ward and lowest
in NICU.OEQ A is highest in OT and lowest in Private Ward. OEQ B is
found to be highest in Cardiac Recovery & Lowest in NICU. OEQ C is
found to be highest in OT and lowest in Special Ward. OEQ F is found to
be highest in OT & lowest in Pvt. Ward. OEQ D is found to be highest in
HDU and lowest in special ward. OEQ E is found to be highest in the
Surgical Ward and lowest in NICU.
8. The significant difference amongst the groups divided on the basis of unit
is found in Inter Role Distance, Role Stagnation, Role expectation conflict,
Role Erosion, Role Overload and Self Role Distance. Inter Role Distance
is found to be highest in OT followed by MICU and lowest in PICU. Role
Stagnation is found to be highest in the Cath lab followed by Surgical
Ward, Private Ward and lowest in Emergency Department. Role
Expectation Conflict is found to be highest in Cath lab and lowest in
Cardiac Recovery. Role Erosion is found to be highest in Surgical Ward
and lowest in ICU. Role Overload is found to be highest in Surgical Ward
and lowest in Emergency department.
9. Except impersistive style, the significant difference amongst the groups
divided on the basis of unit was found in all other coping styles. The mean
score for Impunitive style is found to be highest in Cardiac Recovery

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department followed by general ward and lowest in OT. The mean score
for intropunitive style is highest in Pvt. Ward and lowest in ICU. The
Extrapunitive style has the highest mean score in CCU followed by Cath
lab, PICU & Others and lowest in HDU. Defensive coping style is found to
have highest mean score in General Ward and lowest mean score in
Emergency. Intropersistive Style is found to have highest mean score in
Emergency and lowest in CCU. The score for Extrapersistive is found to
be highest in the Surgical Ward and lowest in Cardiac Recovery. The
overall Approach Coping Strategy is found to have highest mean score in
Surgical Ward followed by Emergency, ICU and lowest in Cath Lab. The
Overall Avoidance Coping Strategy is found to have highest mean score in
Cath lab followed by Pvt. Ward & General Ward and lowest in Emergency.
10. The significant difference amongst the groups divided on the basis of
Income is found in OEQ A. The mean score for OEQ A has been highest
in the income group Rs 10001-11500 and lowest in the income group Rs
2500 - 4000.
11. The significant difference amongst the groups divided on the basis of
Income is found for only for one category of Role Stress i.e Personal
Inadequacy. The mean score for Personal Inadequacy is found to be
highest in the income group Rs. 2500-4000.
12. The significant difference amongst the groups divided on the basis of
marital status was found in OEQ A. In OEQ A motive, the mean score for
married category is found to be more than unmarried.
13. The significant difference amongst the groups divided on the basis of
marital status is found in Role Isolation. The mean score for Role Isolation
is found to be higher for married nurses.
14. The significant difference amongst the groups divided on the basis of
experience in Affiliation (Avoidance), OEQ A & OEQ F. The mean score
for Affiliation (Avoidance) is found to be highest for experience group 0-3
and the mean score for OEQ A & OEQ F is highest in the experience
group 12-20.

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15. The results of correlation analysis with a few exception of variables of


Motivational Behaviour, Role Stress & Coping Styles support our second
third & fourth hypothesis that there will be significant relationship between
Motivational Behaviour and Role Stress, Motivational Behaviour and
Coping Strategies and a positive and significant relationship between Role
Stress and Avoidance Coping Styles and a negative and significant
relationship between Role Stress and Approach Coping Style.
16. It is found that except Role Expectation Conflict and Resource
Inadequacy, for all the Role Stress Variable, one or the other variables of
motivational behaviour emerged as significant predictors.
17. It is found that except Intropersistive, for all the Coping Style Variables,
one or the other variables of motivational behaviour emerged as
significant predictors.
18. It is found for all the Coping Style Variables, one or the other variables of
Role Stress emerged as significant predictors.
19. It is found that except for Dependence (Avoidance), Extension
(Avoidance) & OEQ E, for all other Motivational Behaviour Dimensions,
one or the other variables of Role Stress emerged as significant
predictors.
20. It is found that except for Affiliation (Avoidance), Extension (Avoidance),
Dependence (Approach) & OEQ DEP, for all other Motivational Behaviour
Dimensions, one or the other variables of Coping Styles emerged as
significant predictors.
21. It is found that except for Personal Inadequacy, for all other Role Stress
Dimensions, one or the other variables of Coping Styles emerged as
significant predictors.
22. In interview schedule, on question pertaining to significance of nursing job in
their life, majority of nurses felt their job to be highly significant for the
society at large which is substantiated by the quantitative data which reveals
the dominant motive for nurses in the present study to be Extension
(Approach)

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23. On the question that if given a chance would you like to change your
profession, the majority of the nurses replied no for the same. They said that
they are in the nursing profession by choice rather than being forced by
someone to enter in to this profession. More so they felt proud to be working
with one of the biggest name in the corporate hospitals in India i.e Apollo
Group.
24. When asked that what are the job related factors which cause stress, the
respondents provided mixed opinion and gave varied reasons for stress
such as inter-personal conflict, conflict between organisational and familial
roles, needs of patients and their families, lack of support staff, work
overload, uncertainty about treatment plans etc. However majority of nurses
accepted these sources of stress to be normal part of their life and adopted
approach coping style to deal with it. This in fact is substantiated through
analysis of quantitative data in which approach coping style is found to be
the dominant style of coping for majority of the subjects.
25. On asked that what are those effects which you usually experience as result
of stress, the majority of nurses reported temporal physiological symptoms
such as headaches, lack of sleep, bad mood etc. which they said they are
able to overcome through rest and relaxation, physical exercise, going for
outing during holidays & spending time with their family members.
26. When asked whether your organisation has come forward with some
intervention strategy, the majority of nurses reported that in recent times
some new initiatives have been taken by the management especially with
the hiring of a consulting firm. The services of the consulting firm has been
sought to tone up the HR services mainly in terms of improved personnel
selection & job placement, training, use of realistic goal setting, redesigning
of jobs, increased employee involvement, improved organizational
communication and establishment of corporate wellness programme.
27. In the final question that would you advice your children/wards to opt for the
same job, the majority of the respondent nurses replied with no citing
reason that nursing job is not well paid in India. Almost all the respondent

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nurses felt that there is need to rethink the compensation and reward policy
for nursing staff by heath care administrators and the government. The
respondents’ nurses felt that in spite of the fact that they are working with
perhaps a best group in heath sector in India, they did not find their job to be
lucrative. The majority of the respondents felt that their wards should look
for more lucrative careers.
Recommendations
The following recommendations in terms of organizational and individual
interventions are suggested to reduce stress and develop functional coping Style
amongst nurses:
1. Role Overload problem could be overcome by ensuring that the staffing
levels is adequate. This could also be possible by including administrative
staff that could reduce the paper work burden on nurses.
2. Role Erosion problem could be tackled by giving due importance to every
role incumbent in all kinds of department as sometimes nurses working in
the most critical areas such as Emergency, ICU, MICU, CCU etc. may find
their role to be more important then nurses working in the units such as
radiology, infection control, labour room etc.
3. Improved leadership and management style can also go in long way in
reducing inter-professional & intra-professional conflict amongst nurses.
4. Nurses have to take care of the emotional needs of the patients and their
families. Such ‘emotional labour’ places considerable demand on nurses
that in fact could be tackled with constructive supervision, mentorship and
counseling.
5. As revealed by the semi-structured interview schedule, nurses find their
job to be less lucrative vis-à-vis other professional jobs. So there is need
to rethink compensation and reward policy for nurses by the heath
administrators and the popular governments. In this regard some positive
steps could be taken to develop economic parity between nursing and
other similar jobs.

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6. The overall motivational behaviour could be made more functional by


introducing rewards and incentives system on equitable principles.
7. Shift working particularly night shifts seem to be becoming more
prominent sources of distress for nurses. There has to be equity in the
allocation of shift schedules so that stress while working during night shifts
remains at manageable level.
8. The individual interventions that help in reducing stress could include
physical exercise, proper time management, rest and relaxation, yoga and
meditation, intake of balanced diet amongst other positive steps.

Limitations of the Present Study


The present study could fall of the desired ideals for the following reasons:

1. The sample size (N=135) of the present study was rather restricted. A
large sample could have provided a more stable and significant results.

2. In the present study the phenomena of motivational behavior, role stress &
coping strategies amongst nurses is investigated in the context of
Corporate Hospitals only. In fact the results would have been more
meaningful if the research design had the scope of comparative study
wherein the said phenomena was investigated in the context of other kind
of hospital set ups.

3. A consideration of personality variables amongst nurses could have


provided us with a more meaningful and comprehensive results.

4. The semi-structured interview schedule should have included in the


respondent’s lists, the family members of nurses that could have provided
the holistic view of the phenomena under investigation in the present
study.

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5. As revealed by the personal data form, the majority of the nurses were
from North India. The results of the present study should have been
impacted, had the nurses been from other regional backgrounds also.

Suggestions for Further Research

1. The phenomena under investigation in the present study could further be


investigated by increasing the sample size to give more realistic results.
2. Certain longitudinal studies could be designed on working life styles of
nurses in different kind of hospital set ups in India.
3. The phenomena under the present study could be further studied in a
comparative perspective where in comparison could be with the same
context of hospital such as between two or more corporate hospitals or it
could be inter contextual where in the same set of phenomena is
compared between two contexts such as comparison between nurses
working in private corporate hospitals and government owned hospitals.
4. Personality and family related variables should also be taken in to
consideration to have a more integrated and comprehensive results.
5. Intervention studies on how to assist nurses dealing with role stress and
related phenomena need to be developed.
6. More studies on model testing and instrumentation need to be conducted.
7. Cultural variables such as dominant values, beliefs, morals and ethics
should be taken in to consideration.
8. Corporatisation of hospitals and its positive and negative impact on
nursing staff mainly in terms of role demand and expectation should be
investigated in detail.

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CONCLUDING REMARKS

The corporate hospitals in present time are known for its facilities and services at
affordable costs to the families of ailing individuals. And the backbone for its
‘delivery systems’ undoubtedly remains the nursing staff. As reported, the
majority of the nurses in the present study have revealed their functional
strategies towards motivational Behavior and Coping with stress. This however
should not make us complacent as the study through semi-structured interview
schedule has found that nurses are aggrieved lot with respect to the
compensation that they get for their work. A time has come when the heath care
administrators and the popular governments should revisit and rethink the
compensation and reward policy for the nurses. Otherwise in future, there is
possibility that a few would like to opt for this profession as in this highly
monetized competitive world the potential candidate would prefer for other
lucrative careers than nursing. We all shall hope and wish to take positive steps
to make noble profession like nursing as lucrative and attractive as other
professional careers.

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