Table 2 A summary of the thematic analysis of the qualitative data

Conceptualising emotional labour

•Display rules

for example, when a patient or a relative makes you angry or may be verbally he abuses you or something, there even though displaying emotions is part of you, you are not expected to display that negative emotion. So when it comes to those negative emotions like attack and things you are expected to control yourself and not to play along these negative emotions. (A: 09)

So you are always required to show happiness, no sign of remorse, no sign of stress, tension, no-no, you are always supposed to be happy before your clients because we believe that a happy emotions promote healing so you are always supposed to show this uhm, create that atmosphere around you so that your patient get this motivation that he is getting well. (E: 06)

Emotional demands and deficits

•sadness

•Emotional exhaustion

•Abuse and bullying

•Emotional mix bag

•Poor incentivization

yeah, so many. Come to think about the conditions we go through, people losing their loved ones and you see some parents acting in quote irresponsibly, may be the child is sick, keeping the child in the house and reporting in the last minute. All these things, you know, make us to be very emotional and more especially, when you also think that because of some irresponsibility on the side of parents, they leave their children to die through accidents, drinking poison, falling into wells and those things, it also adds up. And then some parents, even though the national health insurance for children is free, they don’t take advantage of it, they come here, they don’t even have money to do registration, when you look at all those things they can make emotional about it (A: 07).

The demand is very high, sometimes is so stressful that you can’t even take it. You just go like what, a man doing this, something that, like, as a man when you do those kinds of job, you feel so down, you feel demoralize, you doing those kind of work, it’s like let me even put it in a quote you are wearing a vagina, you feel like you are a woman, you have been dejected, that’s the, it’s beyond explanation emotionally, you feel so down because even with masks, those who defecate on themselves, even with mask, you can still inhale it, it’s not easy at all and you have to clean the person to look very-very neat and pleasant (H: 03)

oh, I quite remember one time a patient poured water, bucket full of water on a staff claiming that the staff looks like “shrek”, she watched some cartoon, but I don’t know the mood of the staff but then she wept, how can you compared me to shrek (M: 09)

Yes, at times you smile, you can cry. When you see that what a client is doing is not right or something. I quite remember one time a client came in, she is very beautiful, very educated. When she came here, she was in a mess so I took her to the washroom, I bathed her, I dressed her and then she came back to normal and then I told her you are very-very beautiful but in all things remember to give thanks to God. I started crying when I was talking to her, in fact I cried, seeing such a person in this condition. Then some too, when they crack jokes, you smile with them and then you also crack jokes especially, to those who are moody, you do certain things for them to be happy, you do certain things for them (B: 04)

.So for instance, if the motivation is low I have to be looking elsewhere. When I’m talking about motivation not just salary but maybe something small-small. If you do something and you are acknowledged that ooh you are doing well, keep it up, then I will be committed in doing more. But when the situation is like you are doing something and nobody is even appreciating you then I don’t feel the motivation, it means I won’t do it (K: 12).

Coping with emotional labour

•Psychological capital

•Normalization/routinization

yeah, (laughs) no human being is the same, we are all special in our own way therefore I think I’m special that’s how I’m able to handle these demands. I’m able to stand a lot of pressure even with patients who are uh, difficult. (F: 13)

You don’t take it personal because if you do you will die early, oh yes, you don’t take it personal because somebody can just come and stand in front of you and insult you without any cause. You are consulting with doctors and because they think you are consulting with doctors, you can discharge them so after the prescribers have left, they will come to you, I want you to discharge me and you will tell them you cannot, eeii, it’s a different issue altogether. So I think we’ve grown to accept, like it’s the nature of the job so we don’t really take them personal (O:09)

•Religion/spirituality

•Social support

for me, I see this profession as a calling so I do the work wholeheartedly. My Bible teaches me to love my neighbor as myself so I try as much as possible to understand and emphatise with other people. (C: 11)

Ohh, as for family they are always encouraging us. As for my family, they are always by my side and they encourage me a lot especially my husband and my children. After all, how many years is left, you will soon go on pension and I’m always happy for that (I: 14)

•Job security

Because at the end of the day you know that at the end of the month you will receive something, it’s better than you not working at all but if there is any other chance, any moment from now, it’s just that they are just keeping me, I want to move, I want to divert totally (L: 12)