Background
The global population of older adults is rapidly growing, and China is experiencing one of the fastest rates of population aging, surpassing that of many other Asian countries, as well as European and North American countries [1]. By the end of 2019, the proportion of Chinese older adults aged 60 and above had reached 18.1% of the total population [2]. As a middle-income country with a large and aging population,. Due to the scarcity of institutions providing daycare or long-term care, the majority of older adults must rely on care provided by their families [3].
However, despite the reliance on family care, many older adults do not live with or receive care from their relatives for various reasons. This situation complicates their lives and often adversely affects their well-being [4]. Additionally, the rapid development of modern society-encompassing technological advancements, changes in social structures, and shifts in cultural values-has made the needs of older adults increasingly diverse and complex, necessitating additional family or social support [5]. These developments have broadened the spectrum of needs among older adults to include not only basic care but also emotional support, health management, social participation, and personalized services. Furthermore, the interconnection and interdependence of these needs add to the complexity of addressing them effectively. Given that existing family support is often limited, supplementary assistance services such as volunteer services, hospital-based continuity of care, and online appointments with nurses have emerged [6]. In particular, voluntary services offer significant social benefits and developmental potential, effectively complementing paid care services and family support.
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Voluntary service is defined as a public service in which individuals or groups provide their time and energy to help others or society without seeking economic returns [7]. In recent years, the Chinese government has increased policy support for community-based volunteer services for older adults. General Secretary Xi Jinping emphasized the importance of improving social participation, empowering social organizations, and promoting volunteer services to address population aging [8]. In response, more young people in China are actively participating, either through organized efforts or by forming volunteer groups independently. While volunteers may not provide the same level of care as family caregivers, they play a vital role in offering essential support and assistance to a broader group of older adults [9, 10]. For instance, volunteers can help with daily activities such as grocery shopping or medication reminders. Additionally, they can support family caregivers by offering temporary respite or assisting with specific tasks, such as accompanying older adults to medical appointments, thereby reducing the caregivers’ burden and enabling volunteers to support more older adults within a limited amount of time. Many studies have shown that volunteers play an increasingly important role in the assistance of older adults with special needs to improve their physical functions and provide psychological support [5, 11, 12].
Unfortunately, compared with high-income countries, Chinese volunteer teams serving community-based older adults tend to be small and lack strategic scientific support due to the relatively late introduction of public welfare services [5, 13]. This has created significant challenges in developing robust community-based volunteer programs for older adults. Previous research indicate that studies on volunteer services for community-based older adult assistance rarely address the recruitment processes of young volunteers or explore the motivations and strategies of those with specialized service skills, such as nurses [14‐16]. This gap highlights the need to focus on improving volunteer recruitment and developing effective service strategies. Individuals with nursing background are particularly well-positioned to meet the diverse needs of urban home-based older adults, given their expertise in health management and service delivery. Their involvement is essential for improving the quality of life and well-being of older adults within these communities. Therefore, investigating the motivations and strategies of these volunteers is essential for optimizing recruitment efforts and improving the efficacy of these services. Furthermore, older adults living in urban communities often experience greater social isolation and have a higher demand for voluntary services [17, 18], a need that continues to grow alongside the rising number of older adults in urban China. Recent data indicates that the urban population aged 60 and above in China has reached 143 million, comprising 54.0% of the nation’s total older adult population [19]. This significant demographic shift underscores the importance of addressing the unique challenges faced by urban-dwelling older adults, including their care needs and overall well-being. Given these circumstances, this study aims to explore the motivations and strategies of volunteers with nursing background in delivering services to urban home-based older adults. By focusing on this specialized group of volunteers, the research seeks to expand volunteer teams and enhance service quality to better meet the needs of this growing population.
Theoretical framework
This study adopts the Self-Determination Theory and Swanson’s Caring Theory as its theoretical framework. The Self-Determination Theory, proposed by American psychologists Edward L. Deci and Richard M. Ryan, posits that human motivation consists of both extrinsic and intrinsic motivation [20]. It emphasizes that motivation can range from complete external control to highly autonomous internalization, forming a continuum. Swanson’s Caring Theory highlights the caring qualities that service providers should possess in order to deliver care more effectively and without burden, while also emphasizing the necessity of fostering self-care in the care recipients to achieve, maintain, or restore their optimal quality of life without reliance on external forces [21]. Swanson also proposed a middle-range theory encompassing five caring processes: “Maintaining Belief”, “Knowing”, “Being With”, “Doing For”, and “Enabling”, and established a theoretical framework based on these processes. Since the essence of volunteer service is caring, the application of Swanson’s Caring Theory in this study is highly appropriate.
Methods
Design
A qualitative descriptive approach was used for this study, following the principles of a naturalistic paradigm [22]. This method aimed to summarize the information content of the data using low inferential interpretation and provide a detailed description of the described experience in easy-to-understand language [23]. The author considered and followed the Guidance on Standards for Reporting Qualitative Research to report the study results explicitly and comprehensively (COREQ) [24]. The research protocol was approved by the Medical Ethics Committee of Tongji Medical College, Huazhong University of Science and Technology (Ethical review No. S053).
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Participants
The inclusion criteria comprised individuals with a professional nursing background, aged 18 years and over, with at least one experience in providing formal or informal volunteer service for urban community-living older adults. All participants were informed of the details of the study and the necessity of recording and obtained written or oral consent before the interview. Twenty-three participants were recruited using purposive sampling, following criterion and maximum variation sampling. The participants differed in age, gender, occupation, education, subordinate institution, and research field, factors that are related to the service experiences of the volunteers and which may influence the challenges they face and the strategies they develop.
Data collection
All interviews were conducted between September 13 and October 23, 2022. Participants were recruited from hospitals or universities in Wuhan. Data were collected through face-to-face interviews or by telephone. Face-to-face interviews were arranged in quiet places such as idle classrooms and corridors outside the ward. As some participants were busy at work or had difficulties traveling, especially during the pandemic, interviews were also conducted by telephone. Interviews were conducted individually, consisting of only one volunteer and a researcher, to allow the volunteers to freely express themselves. The investigators remained anonymous to both institutions and participants and assured the participants that all interview data or materials were confidential and would only be used for scientific research. A semi-structured interview outline was used to guide the collection of data (see Table 1). Socio-demographic details such as age, education, occupation, and work seniority were also collected (see Table 2). To confirm the understanding of the participants and avoid misunderstanding, the researchers were asked to provide timely feedback to the interviewees during the interview to clarify the information. If the interviewees deviated from the theme during the interview, the researchers would redirect them to the theme. All interviews were audio-recorded, with the consent of the interviewee. Interviews with volunteers lasted from 24 to 56 min (M = 33.2 min; median = 32.0 min).
Table 1
Interview outline
1. How did you initially learn about these volunteer service opportunities? |
2. What motivated you to decide to participate in these volunteer services? |
3. What do you believe is the important significance of participating in volunteer services for you? |
4. What suggestions do you have for improving volunteer services to better attract and support individuals with a nursing background? |
5. What strategies do you think should be used before and after the service to promote the better implementation of voluntary service? |
6. What strategies do you think should be used in providing volunteer services for home-based older adults? |
7. What details do you think should be paid attention to in providing volunteer services for home-based older adults? |
8. Do you want to add something? |
Table 2
Participant characteristics (n = 23)
Interview method | Participant no. | Age | Gender | Occupation | Affiliated institutions | Education | Position | Work seniority | Research field | Service life |
|---|---|---|---|---|---|---|---|---|---|---|
Telephone | N1 | 51 | Female | Nurse | Large-sized hospital | MBBS | / | 30 years | Surgical Nursing | >10 years |
Telephone | N2 | 33 | Female | Nurse | Large-sized hospital | MBBS | / | 12 years | Wound care | 3 years |
Telephone | N3 | 42 | Female | Nurse | Large-sized hospital | MBBS | Head nurse | 23 years | Cancer Nursing | 1 years |
Telephone | N4 | 58 | Female | Nurse | Large-sized hospital | JC | / | 38 years | Surgical Nursing | 6 years |
Telephone | N5 | 29 | Female | Nurse | Large-sized hospital | MSN | Officer | 5 years | Psychological care | 1 years |
Telephone | N6 | 40 | Female | Nurse | Medium-sized hospital | MBBS | Head nurse | 20 years | Geriatric Nursing | 6 years |
Telephone | N7 | 39 | Female | Nurse | Medium-sized hospital | MBBS | Head nurse | 15 years | Surgical Nursing | 3 years |
Telephone | N8 | 50 | Female | Nurse | Small-sized hospital | JC | Head nurse | 31 years | Geriatric Nursing | 4 years |
Telephone | N9 | 52 | Female | Nurse | Small-sized hospital | MBBS | Head nurse | 34 years | TCM Nursing | >10 years |
Telephone | N10 | 60 | Female | Nurse | Small-sized hospital | JC | / | 10 years | Clinical nursing | 2 years |
Face-to-face | N11 | 35 | Female | Nurse | Community Hospital | MBBS | / | 14 years | Community nursing | 2 years |
Face-to-face | N12 | 50 | Female | Nurse | Community Hospital | JC | / | 30 years | Clinical nursing | 5 years |
Face-to-face | N13 | 22 | Female | Nurse | Community Hospital | MBBS | Group leader | 9 years | Geriatric Nursing | 5 years |
Telephone | N14 | 39 | Female | Nurse | Community Hospital | MBBS | / | 19 years | Psychological care | 3 years |
Telephone | S1 | 21 | Female | Student | University | MBBSc | / | / | TCM Nursing | 2 years |
Telephone | S2 | 21 | Female | Student | University | MBBSc | / | / | TCM Nursing | 3 years |
Telephone | S3 | 20 | Female | Student | University | MBBSc | / | / | Geriatric Nursing | 3 years |
Face-to-face | S4 | 29 | Male | Student | University | MDc | / | / | Nursing management | 5 years |
Face-to-face | S5 | 20 | Female | Student | University | JCc | / | / | Clinical nursing | 3 years |
Telephone | T1 | 30 | Female | Teacher | University | MDc | / | 2 years | Community nursing | 5 years |
Face-to-face | T2 | 59 | Female | Teacher | University | MSN | Director | 41 years | Clinical nursing | 6 years |
Face-to-face | T3 | 39 | Female | Teacher | University | MSN | Director | 14 years | Nursing management | 6 years |
Face-to-face | T4 | 32 | Male | Teacher | University | MSN | / | 6 years | Chronic disease care | 5 years |
All interviews were conducted between September 13 and October 23, 2022. Participants were recruited from hospitals or universities in Wuhan. Data were collected by the researchers through face-to-face interviews (n = 8) or telephone interviews (n = 15). Face-to-face interviews were arranged in quiet locations, such as idle classrooms in universities and corridors outside hospital wards. As some participants were busy with work or faced difficulties traveling, especially during the pandemic, interviews were also conducted by phone, as detailed in Table 2. The interviews were conducted one-on-one, with only one volunteer and one researcher present, allowing the volunteers to freely express themselves. The researchers remained anonymous to both the institutions and participants and assured the participants that all interview data or materials were confidential and would only be used for scientific research. A semi-structured interview guide was used to collect data (see Table 1). Socio-demographic information such as age, education, occupation, and work experience was also collected (see Table 2). To ensure participants’ understanding and avoid misunderstandings, researchers provided timely feedback during the interview to clarify information. If participants deviated from the topic, the researchers redirected them back to the theme. All interviews were audio-recorded with the consent of the participants. The length of interviews with volunteers ranged from 24 to 56 min (M = 33.2 min; median = 32.0 min).
Data analysis
All interview materials were transcribed into Chinese using IFLYTEK listening transcription software. The transcribed texts were then imported into NVivo 11.0 plus software for data management and coding. Two researchers employed directed content analysis to extract and manage data, identifying and classifying relevant themes and sub-themes [25]. The choice of this method was primarily based on the need to explore how existing theoretical constructs (initial motivation and caring processes) manifest in real-world contexts. By starting with Self-Determination Theory and Swanson’s Caring Theory, this approach allows for a systematic examination and presentation of how volunteers’ motivations and caring behaviors align with or extend key theoretical concepts, while also leaving space for new empirical findings to emerge during the research process. When analyzing the data, the two researchers independently coded the materials based on the predetermined theoretical framework. If new phenomena or content emerged that could not be explained by the existing framework, new codes were created to expand or modify the current theory. Before coding the data, the first author listened to the audio recordings multiple times to ensure semantic consistency between the audio and transcribed text, avoiding transcription errors. The research team met online every two days via Tencent Meeting to discuss any discrepancies in the coding and to reach a consensus. Data collection and analysis were conducted simultaneously. When the interview data from volunteers in the same occupation became sufficiently diverse and overlapped, indicating saturation, an additional 2–3 volunteers were interviewed [26]. Once no new themes emerged, the researchers proceeded to interview other groups until the data reached saturation. Through this theory-guided yet flexible analytical process, the research team was able to systematically identify and summarize the themes and sub-themes related to the initial motivations and caring strategies of volunteers with a nursing background providing services to urban home-based older adults. The final coding structure and the resulting themes and sub-themes, along with key examples, are presented in Tables 3 and 4, summarizing the main findings of the study.
Table 3
Summary of themes and sub-themes (motivation to participate)
Themes | Sub-themes | Codes | Example of key sentences |
|---|---|---|---|
I. Extrinsic motivation | Organizational call | Party member community outreach | “Party members have regular community outreach activities, such as visiting older adults who live alone to provide volunteer services, and I signed up for it.” (T1) |
Organized volunteer activities | “Our hospital’s oncology center runs a “Happy Station,” where we organize some volunteer activities.” (N3) | ||
Practical Tasks | Social practice activities | “Every summer, I take students to the community’s day care center for social practice activities.” (T4) | |
II. Intrinsic motivation | Altruism | Joining an organization spontaneously | “I joined the Youth Association in my first year of university, and as a volunteer, the school regularly organized events that I found interesting, so I attended.” (S2) |
Spontaneous direct participation | “At first, I thought it would be fun, so I wanted to participate.” (S3) | ||
Work extension | “In my work, I discovered that manyolder adults in the community lack first aid knowledge or basic health concepts. I hope to help them address these issues through free lectures and volunteer activities.” (T2) | ||
Emotional belonging | Making up for regrets | “Because my parents passed away before they grew old, I feel like I missed the experience of learning how to treat older adults well, so I really want to make up for that by helping other older adults.” (T3) | |
Driven by compassion | “The area I manage consists of residents living at the lowest level of society. Outside of work, I can’t help but feel driven to care for and assist them.” (N14) | ||
Reciprocity in aging | “I believe everyone will grow old one day, and I just hope that when I’m old, there will be people who will provide services like we do now. If we don’t do it now, others might not do it in the future.” (N13) | ||
Self-fulfillment | Applying knowledge in practice | “I voluntarily joined a volunteer organization, hoping to apply the knowledge I learned from books.” (S4) | |
Accumulating material | “As a nursing teacher, I hope that through volunteering I can gain insights and bring them into my classroom.” (T1) |
Table 4
Summary of themes and Sub-themes (Strategies Applied)
Themes | Sub-themes | Codes | Examples of key sentences |
|---|---|---|---|
III. Maintaining belief | Maintaining a hope-filled attitude | Strengthening psychological resilience | “Some older adults have flaunting psychology, which can easily disgust people and lead to unpleasant arguments. At this time, we should adjust our mentality to deal with it.” (S3) |
Improving service capability | “Volunteers still need solid professional knowledge and have excellent communication skills.” (N7) | ||
Following up on service quality | Service effectiveness evaluation | “We should reflect on whether the services we provide are useful to them and what changes we should make next.” (T4) | |
Following up if necessary | “I still hope to keep in touch with one or two old people willing to cooperate and really need help so that it may be more meaningful.” (S1) | ||
IV. Knowing | Establishing service relationships | Selection of suitable objects | “I think we should be careful in choosing the target. Older adults with serious illnesses need help, but we should think twice if there is a high risk of dispute.” (N6) |
Clear identification | “If you wear a volunteer’s red vest or a certificate, others will not be so alert to you. After all, many fraudsters are targeting older adults.” (T1) | ||
Asking family members for consent | “We also need to communicate with their families. For example, it would be good to vaccinate older adults with the COVID−19 vaccine; however, if their families do not agree, there will be further disagreements.” (N13) | ||
Conducting thorough assessments | Based on individual evaluation | “Before I offer help, I must first assess his actual situation to facilitate targeted services.” (N1) | |
V. Being with | Improving communication skills | Using communication skills | “When chatting, if an old man suddenly gets excited or sad, I will touch his shoulder, or shake his hand, or pour him a glass of water to calm him down. If he stands up, I will assist him in gradually sitting down on the sofa.” (N14) |
Speaking and acting cautiously | “Please avoid asking sensitive questions when meeting older adults for the first time. Do not wander around if you go to the old man’s house.” (T1) | ||
Providing companionship and interaction | Diversifying service forms | “On important festivals, we will go to older adults’ homes and work with them to make handmade moon cakes, zongzi, glutinous rice balls, and dumplings, which will help us bridge the psychological gap with them.” (N13) | |
Avoiding imposing burdens | Principle of moderation | “Neither rush to complete the service nor provide excessive assistance when the demand is not urgent.” (S2) | |
Advance in regular order | “We need to be more patient with older adults who live alone and spend more time convincing them to accept voluntary services. But if the resistance is strong, there is no need to force it deliberately; otherwise, it will be bad.” (T1) | ||
VI. Doing for | Giving early warnings | Timely reminder | “Older adults frequently dismiss nonfatal diseases. If he is found to be seriously ill, he must be urged to seek medical treatment or be hospitalized.” (N8) |
Tailoring approaches to individuals | Varying with each individual | “If you feel that older adults have good compliance, you can directly inform them with some precautions. However, for those who are unable to cooperate, we must assist their primary caregivers in changing the concept of care.” (N3) | |
Fostering social connections | Encouraging social interaction | “Encourage older adults to maintain moderate social activities according to their personal preferences and abilities.” (N8) | |
VII. Enabling | Generating alternatives | Actively seeking help | “I think we can mobilize students in school or interns in hospitals to participate in volunteer services under the guidance of teachers.” (N5) |
Restructuring cognitive | Guiding correct perceptions | “Guide them to view diseases correctly.” (N9) | |
Learn to identify authenticity | “Learn to identify false information or scams in daily life.” (S3) | ||
Encouraging independence | Avoiding continued dependence | “Considering that volunteers may find it difficult to provide long-term service, it is necessary to guide older adults in advance. Through encouraging communication, we can boost their confidence and gradually reduce their reliance on external help.” (N9) |
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Trustworthiness
In this study, we adopted the four evaluative criteria proposed by Lincoln and Guba (1985) to ensure the credibility, transferability, dependability, and confirmability of the research findings [27]. During the preparation phase, all researchers had attended training or lectures related to qualitative research and had reviewed extensive literature relevant to the study. Before the formal interviews, three volunteers were selected for a pilot interview, and the interview guide was revised and refined based on the actual interview experience. At the same time, we ensured that each participant was fully informed and gave their consent. The formal interviews were conducted using purposive sampling, including standard and maximum variation sampling, to ensure the homogeneity and representativeness of the research subjects. The interview time and location were chosen by the volunteers to facilitate their better participation. After the interviews, the researcher personally checked the transcriptions repeatedly. Two researchers independently analyzed and coded the data, reaching a consensus through meetings and discussions. During the data analysis, the researchers repeatedly read and immersed themselves in the data for an in-depth understanding and sensitivity, to ensure no critical information was overlooked. The written records and categories extracted from the analysis were also confirmed by the participants, which further enhanced the credibility and accuracy of the research findings.
Results
Table 2 depicts the socio-demographic details of the volunteers. All participants had had several experiences providing volunteer services to urban home-based older adults. Each participant was assigned a unique code. The first letter of the code corresponds to the participant’s occupation, where ‘N’ represents a nurse, ‘S’ stands for a nursing student, and ‘T’ indicates a nursing teacher.
Motivation to participate
Themes I: Extrinsic motivation
Participants reported both extrinsic and intrinsic motivations for their involvement in volunteer services, with extrinsic motivations being less frequently mentioned. Extrinsic motivation is the drive to engage in an activity due to external factors such as rewards, recognition, or obligations imposed by others.
Organizational call
For nurses at various levels of hospitals, the primary extrinsic drivers were organizational initiatives, such as Party member community outreach and volunteer activities organized by healthcare institutions.
Party members have regular community outreach activities, such as visiting older adults who live alone to provide volunteer services, and I signed up for it. (T1).Our hospital’s oncology center runs a “Happy Station”, where we organize some volunteer activities. (N3).
Practical tasks
For nursing faculty and students in higher education, participation was primarily motivated by extracurricular social practice activities.
Every summer, I take students to the community’s day care center for social practice activities. (T4).
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Themes II: Intrinsic motivation
The vast majority of participants reported intrinsic motivation. Intrinsic motivation is the drive to engage in an activity for its own inherent enjoyment or interest, deriving satisfaction from the activity itself.
Altruism
The primary drivers were a genuine interest in volunteering, which led them to either spontaneously join organizations related to volunteer services or directly provide unpaid support or assistance to older individuals in familiar communities.
I joined the Youth Association in my first year of university, and as a volunteer, the school regularly organized events that I found interesting, so I attended. (S2).At first, I thought it would be fun, so I wanted to participate. (S3).
Additionally, some participants observed pressing needs within the home environments of certain older adults during their clinical work and voluntarily provided out-of-hospital assistance.
In my work, I discovered that manyolder adults in the community lack first aid knowledge or basic health concepts. I hope to help them address these issues through free lectures and volunteer activities. (T2).
Emotional belonging
Some participants were motivated by compassion to engage in volunteer services.
In my work, I discovered that manyolder adults in the community lack first aid knowledge or basic health concepts. I hope to help them address these issues through free lectures and volunteer activities. (T2).
While others believed that supporting older adults in their youth would lead to reciprocal support in their own old age.
I believe everyone will grow old one day, and I just hope that when I’m old, there will be people who will provide services like we do now. If we don’t do it now, others might not do it in the future. (N13).
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Furthermore, some reported participating in volunteer activities to compensate for perceived regrets or gaps in their own life experiences.
Because my parents passed away before they grew old, I feel like I missed the experience of learning how to treat older adults well, so I really want to make up for that by helping other older adults. (T3).
Self-fulfillment
These actions reflect their strong sense of social responsibility. Some participants noted that their involvement in volunteer services was initially aimed at enhancing their skills, such as applying theoretical knowledge in practice or accumulating practical experience.
I voluntarily joined a volunteer organization, hoping to apply the knowledge I learned from books. (S4).As a nursing teacher, I hope that through volunteering I can gain insights and bring them into my classroom. (T1).
Strategies applied
Themes III: Maintaining belief
“Maintaining belief” primarily involves encouraging volunteers to develop strong mental resilience and service capabilities to adapt to unforeseen challenges, as well as fostering an awareness of service quality control and follow-up.
Maintaining a hope-filled attitude
Many participants put forward useful suggestions on self-improvement. First, it was considered important for volunteers to learn to adjust their mindset to adapt to changing situations when assisting older adults.
Some older adults have flaunting psychology, which can easily disgust people and lead to unpleasant arguments. At this time, we should adjust our mentality to deal with it. (S3).When interacting with older adults, it is necessary to maintain a positive attitude. It is easy to gain their approval with less denial, blame, and dispute. (T3).
Second, professional quality required improvement.
Volunteers still need solid professional knowledge and have excellent communication skills. (N7).
Third, keen insight should be developed for improved identification of potential problems in older adults.
Many older adults are hesitant to express their emotions and expose their weaknesses or discomfort, which can easily lead to delays in their illness. As a result, we must assist them in locating problems on time. (S3).
Lastly, it would be better to equip necessary service aids for door-to-door service to improve the professionalism and technical expertise of the service.
We usually bring some commonly used diagnostic tools, such as sphygmomanometer, blood glucose meter, stethoscope, and sometimes models of cardiopulmonary resuscitation, fixed splints, and other first-aid demonstration molds. (T2).If it is centralized propaganda, we will also prepare a PowerPoint presentation and bring brochures. (T3).
Following up on service quality
After providing assistance, the volunteers should also confirm whether older adults really benefitted from it, and consider how to improve the service in the future to improve its effectiveness.
We should reflect on whether the services we provide are useful to them and what changes we should make next. (T4).
Despite the shortage of volunteer service resources, volunteers should consider providing follow-up services for individual older adults when necessary.
I still hope to keep in touch with one or two old people willing to cooperate and really need help so that it may be more meaningful. (S1).
Themes IV: Knowing
“Knowing” emphasizes using effective methods to gather key information while also ensuring the proper identification of the most suitable recipients for volunteer services.
Establishing service relationships
Several participants emphasized the priority of services, especially in terms of the limited number of volunteers.
I think we should be careful in choosing the target. Older adults with serious illnesses need help, but we should think twice if there is a high risk of dispute. (N6).
Some participants mentioned that clearly identifying oneself to gain the full trust of older adults is an important prerequisite for smooth service delivery.
If you wear a volunteer’s red vest or a certificate, others will not be so alert to you. After all, many fraudsters are targeting older adults. (T1).
To prevent future unnecessary disputes, a few participants recommended obtaining the approval of family members before providing older adults with assistance.
We also need to communicate with their families. For example, it would be good to vaccinate older adults with the COVID-19 vaccine; however, if their families do not agree, there will be further disagreements. (N13).
Conducting thorough assessments
While several participants mentioned that the services required should be evaluated according to specific individual needs of older adults.
Before I offer help, I must first assess his actual situation to facilitate targeted services. (N1).
Themes V: Being with
“Being with” refers to the importance of providing emotional support and companionship in a thoughtful manner while ensuring that no burden is imposed.
Improving communication skills
Communication with older adults requires a proper use of skills. Listening more, speaking less, being sincere and patient, and using proper body language are all helpful in getting into the old man’s heart.
You should listen more and understand their ideas and needs while talking. (N4).While solving problems, I believe we should first learn to think in terms of empathy. (T3).When chatting, if an old man suddenly gets excited or sad, I will touch his shoulder, or shake his hand, or pour him a glass of water to calm him down. If he stands up, I will assist him in gradually sitting down on the sofa. (N14).
If you visit an older adult for the first time, you must be careful with your words and actions to gain their trust.
Please avoid asking sensitive questions when meeting older adults for the first time. Do not wander around if you go to the old man’s house. (T1).We should respect others’ living habits and pay attention to some words used in language communication. (S2).When we talk with old people for the first time, we should not easily break through their psychological defenses to make them feel insecure. (N6).
Providing companionship and interaction
Effective interaction with older adults helps to eliminate the barriers between the volunteer and the person they are assisting and would improve the response and compliance of the latter.
On important festivals, we will go to older adults’ homes and work with them to make handmade moon cakes, zongzi, glutinous rice balls, and dumplings, which will help us bridge the psychological gap with them. (N13).
It can sometimes be difficult to correct unhealthy behaviors and choices in older adults simply by repeating information on health guidance, and some strategies to promote knowledge internalization should be introduced.
Although many older adults have serious chronic diseases and are overweight, they still go their own way. Try to stimulate them by demonstrating some serious consequences, such as negative examples, pictures, or videos, or inviting some older adults to share their own experiences. (N8).
Avoiding imposing
To avoid imposing any burden, it’s important to follow the principle of moderation when assisting older adults.
Neither rush to complete the service nor provide excessive assistance when the demand is not urgent. (S2).
Meanwhile, the help provided by volunteers should also be given step-by-step and be easily accepted by older adults rather than imposed on them).
We need to be more patient with older adults who live alone and spend more time convincing them to accept voluntary services. But if the resistance is strong, there is no need to force it deliberately; otherwise, it will be bad. (T1).
Themes VI: Doing for
“Doing for” emphasizes providing practical and appropriate support or assistance to meet older adults’ needs.
Giving early warnings
Given the passivity of older adults in seeking medical treatment or physical examination, volunteers should remind them timely.
Older adults frequently dismiss nonfatal diseases. If he is found to be seriously ill, he must be urged to seek medical treatment or be hospitalized. (N8).
Tailoring approaches to individuals
Some participants indicated that volunteers should try to provide services that are specifically targeted for individual older adults.
If you feel that older adults have good compliance, you can directly inform them with some precautions. However, for those who are unable to cooperate, we must assist their primary caregivers in changing the concept of care. (N3).
Fostering social connections
Only a few participants emphasized the importance of encouraging older adults to engage in moderate social activities based on their personal preferences and circumstances.
Encourage older adults to maintain moderate social activities according to their personal preferences and abilities. (N8).
Themes VII: Enabling
The “enabling” strategy focuses on offering alternative solutions and enhancing older adults’ autonomy, helping them manage their lives as external support decreases.
Generating alternatives
Many participants highlighted the need to seek broader support, such as social assistance or involving students and retirees.
Try to connect with the community as early as possible and sort out the situation of older adults who require community service. We can educate collectively to expand the scope of benefits before concentrating on individuals. (N3).I think we can mobilize students in school or interns in hospitals to participate in volunteer services under the guidance of teachers. (N5).It would be great if we could organize those caring retired doctors or nurses to volunteer for home-based older adults. (N8).
Restructuring cognitive
Another key aspect is providing guidance to older adults. Volunteers should help them form accurate perceptions and recognize false advertising or low-quality products.
Guide them to view diseases correctly. (N9).Learn to identify false information or scams in daily life. (S3).
Encouraging independence
Additionally, volunteers should avoid fostering dependence, aiming to empower older adults to manage their health independently after services end and handle future challenges on their own.
Considering that volunteers may find it difficult to provide long-term service, it is necessary to guide older adults in advance. Through encouraging communication, we can boost their confidence and gradually reduce their reliance on external help. (N9).
Discussion
Previous studies have reported little on the motivations of young volunteers to participate, primarily focusing on methods or strategies to retain volunteers rather than on their initial reasons for joining [28, 29]. Given the altruistic nature of volunteer work, the biggest challenge for expanding the volunteer force is not attrition but rather the recruitment channels. Therefore, it is equally important to explore the initial motivations of young volunteers. Such exploration can not only help broaden recruitment channels to attract a large number of new volunteers, but also enable the provision of targeted guidance and matching strategies based on the characteristics and types of their initial motivations, thereby helping these volunteers maintain a high level of enthusiasm for participation.
This study reveals that the primary motivations for personnel with nursing background to engage in community-based volunteer services for older adults include both intrinsic and extrinsic motivations. In terms of extrinsic motivation, there is a noticeable difference between nursing personnel and the combined group of nursing teachers and students. Personnel with nursing background often join volunteer teams through party activities or organizational assignments, while the combined group of nursing teachers and students typically participate through social practice activities. Previous studies addressing extrinsic motivation have mainly discussed the continuity of volunteer behavior, indicating that although volunteer service is driven by intrinsic motivation, external motivation is necessary to foster a strong commitment to volunteerism [29, 30]. For example, Xin et al. [31] found that social support, standardized management, and related benefits serve as extrinsic motivators for volunteers to continue providing services to older adults in the community. This may be due to the fact that volunteers with nursing background, faced with work or academic pressures, find it more challenging to actively dedicate time and energy to volunteer work, making this engagement more passive [4, 32]. However, given their expertise in health management and their rich experience in patient interaction and communication accumulated in clinical settings, volunteers with nursing background are among the ideal candidates to provide diverse services to older adults [33]. Therefore, by leveraging and guiding these extrinsic motivators, more volunteers with nursing background can be encouraged to participate, whether through direct involvement or indirectly by providing professional support or assistance to other volunteers. Moreover, based on the guidance of Self-Determination Theory, such extrinsic motivation alone is unlikely to sustain long-term intrinsic drive [20]; it is necessary to convert this motivation into intrinsic motivation to achieve continuous participation and retention.
This study identified intrinsic motivations that include altruism, emotional belonging, and self-fulfillment, aligning with the findings of Boz & Palaz [34]. In the study by Boz and Palaz, the key motivational factors for volunteering were summarized as altruism, a sense of belonging, and personal growth. Specifically, altruism encompasses helping those in need, fulfilling moral responsibilities, and being driven by cultural or value-based motivations; a sense of belonging reflects social connections, shared goals, and the desire to avoid loneliness; while personal growth includes skill acquisition, career advancement, and enhanced self-esteem. In another study, participants also cited intrinsic motivations such as serving the community, improving well-being and health, gaining approval from friends and family, establishing connections, avoiding loneliness, and enhancing self-worth [35]. A distinct aspect of this study, however, is that participants viewed altruism not only as a prompt for active involvement in volunteer work but also as an extension of their professional roles-providing support after recognizing urgent needs among older adults in home settings through their work. Regarding emotional belonging, participants highlighted empathy, making up for past regrets, and the experience of role reversal as key factors driving their enthusiasm for joining volunteer teams. Interestingly, this awareness of role reversal is particularly insightful and could offer strategic guidance for encouraging greater volunteer participation.
Although Swanson’s Caring Theory was initially applied in clinical nursing settings, it also aligns well with the contextual needs of community-based volunteer services for older adults. Key elements of this theory include establishing short-term relationships with recipients, prioritizing communication as a central service component, ensuring a comprehensive and orderly service process, and balancing immediate assistance with the long-term goal of fostering independence and self-care abilities in those receiving care [21]. These aspects are particularly important in community volunteering.
Based on the service experience of volunteers with nursing background, this study proposed many countermeasures to improve service quality, including maintaining belief, knowing, being with, doing for, and enabling. The excellent quality of volunteers involves the premise and guarantee to provide high-quality services for older adults [36]. To gain the trust of older adults and reduce emotional exhaustion [37], it is necessary for the volunteer to adjust their mindset and attitude when dealing with older adults, such as using less denial, less blame, and less dispute. However, the accumulation of negative emotions appears inevitable when assisting older adults. Interestingly, a previous report described the two-way impact of interaction with the caregivers of older adults, which may benefit the positive experiences of volunteers [38]. Another study emphasized the importance of self-value in maintaining enthusiasm for volunteer service [15]. In addition to continuously increasing knowledge reserves, improving communication skills is also required for volunteers. Volunteers should also consciously strengthen their insight into the service process, especially in the face of older adults who cannot easily communicate their problems [39]. Moreover, if conditions permit, volunteers can also carry cardiopulmonary resuscitation models, fixed splints, brochures, and other aids to enhance the effectiveness of demonstrations. Notably, providing follow-up services after obtaining sufficient trust can be more beneficial to ensure the smooth operation of services. Even proper self-disclosure may be an effective way to build a trusting relationship [40]. Similarly, the evaluation of service effectiveness should also be considered.
This study also suggested that volunteers should pay attention to strategies and methods involved in the service process. Before assisting, volunteers should apply the “Knowing” principle to select suitable services, prioritizing urgent needs as some are less pressing [5]. Meanwhile, volunteers should clearly identify themselves and obtain consent from families if necessary. Another study has shown that sometimes volunteers may have conflicts with the families of older adults [41]. However, it is undeniable that some families may also provide great support for voluntary service [42]. Subsequently, volunteers should conduct personalized assessments to provide more practical support and assistance.
Emotional support through “being with” is also an important strategy, enabling better communication and interaction. To understand the real thoughts of older adults, volunteers should use reasonable communication skills. The communication skills mentioned most by volunteers were listening more, speaking less, establishing an awareness of empathy, and the proper use of body language [43]. If the service location is at home, volunteers should also pay attention to their words and actions, such as speaking appropriately and not wandering around. Positive interactions with older adults can also help to improve their negative attitudes and compliance. For example, making handmade noodles with them during the festival would be an effective way to let them feel the warmth of the family. Furthermore, when giving health guidance to older adults, volunteers should avoid forcing information on them, and vivid examples and on-site demonstrations are often easier to accept and internalize. In providing specific assistance through “doing for”, strategies such as offering timely reminders, accommodating individual needs, and encouraging social interaction are beneficial.
The present study also emphasized that the most essential step is “enabling”. Broadly speaking, enabling should encompass both volunteers and older adults. To ensure that volunteer services are efficient and fully utilized, actively seeking external support is also essential. volunteers should actively seek help from the community. It would also be useful to encourage retired medical staff and medical students to participate [44, 45] as they would be most suited to serving the needs of older adults [44]. For older adults, participants highlighted the importance of helping them rebuild cognitive skills, such as guiding them to adopt positive perspectives and learn to distinguish between true and false information. Additionally, to prevent older adults from becoming overly reliant on volunteer services and experiencing regressive effects after service ends, volunteers should incorporate “separation training” during the final stages of service to reduce ongoing dependency.
Limitations
This study has several limitations. First, as a qualitative study, the purpose of sampling was to recruit participants from individual health institutions or universities in a large city, limiting the generalizability of the findings. Second, there were fewer male participants in this study because only a few male volunteers with nursing background were present in the selected center. Finally, this study only recruited volunteers with nursing background from developed cities in central China, and did not include the motivations and strategies for volunteers serving home-based older adults in rural and underdeveloped areas.
Conclusions
This study revealed the initial motivations of volunteers with nursing background engaged in community-based services for older adults, covering both extrinsic and intrinsic motivations. Extrinsic motivations included organizational call and practical tasks, while intrinsic motivations involved altruism, emotional belonging, and self-fulfillment. These findings provide valuable insights and opportunities for government and relevant organizations to enhance volunteer support systems, particularly in recruiting and retaining scarce volunteers with professional backgrounds. To ensure the systematization and orderliness of services, volunteers with nursing background should also adopt structured practical strategies, including “maintaining belief”, “knowing”, “being with”, “doing for”, and “enabling”. These experiences will support government and organizations in providing targeted training, supervision, and management for volunteers, strengthening their roles in coordination and support. The significant findings of this study will promote the development of urban community volunteer services, helping to alleviate burdens on care institutions and home caregivers while improving the quality of life and well-being of older adults.
Acknowledgements
The authors gratefully acknowledge the support from Tongji Medical College, Huazhong University of Science and Technology.
Declarations
Ethics approval and consent to participate
The research protocol was approved by the Medical Ethics Committee of Tongji Medical College, Huazhong University of Science and Technology (Ethical review No. S053). Participants’ identity information was anonymized to protect their personal information. Informed consent was obtained from all subjects. All methods were carried out in accordance with relevant guidelines and regulations.
Consent for publication
Not applicable.
Competing interests
The authors declare no competing interests.
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