From leadership research to district action: Organizational Factors, Beliefs, Caring Behavior, and Quality of Nursing Work Life Among ICU Nurses: A Carolina Care–Informed Structural Model

AI-assisted editorial implementation guide. Proposed district actions are separate from the original authors’ findings and recommendations. Independent peer review of this guide is not asserted.

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Evidence and transfer

Education-related source: verify which participants, institutions and outcomes were actually studied before district adoption. Source publication type: research-article. License and identity checks do not establish study quality or causality.

Original authors’ abstract, reproduced under the source license:

Background The quality of nursing work life (QNWL) is essential to maintain nurses’ well‐being and professional performance, particularly in the intensive care unit (ICU) where workload, stress, and ethical challenges are high. Nurse characteristics, job demands, organizational support, Beliefs, and caring behavior are considered potential determinants of QNWL, but evidence regarding their pathways and mechanisms remains scarce. Aim To analyze the effects of nurse‐related, job‐related, and organizational factors on nurses’ Beliefs, caring behavior, and QNWL among ICU nurses using a Carolina Care–based structural model, including the partial mediating roles of Beliefs and caring behavior. Study Design A cross‐sectional design was applied to 200 ICU nurses from four hospitals. Data were collected using validated questionnaires assessing nurse characteristics, job factors, organizational support, Beliefs, and caring behavior, and QNWL PLS‐SEM was employed to evaluate convergent validity, construct reliability, and the inner model. Results Nurse factors had a significant negative influence on Beliefs (β = −0.208; p < 0.001), whereas organizational factors strongly and positively affected both Beliefs (β = 0.534; p < 0.001) and caring behavior (β = 0.333; p < 0.001). Beliefs significantly influenced caring behavior (β = 0.242; p = 0.001), while caring behavior strongly predicted QNWL (β = 0.533; p < 0.001). Job factors did not significantly affect Beliefs (β = 0.067; p = 0.390), which was described as nonsignificant. The measurement model showed acceptable convergent validity and composite reliability for the main constructs, although the Beliefs construct was modeled using a single global indicator and the job factor construct showed Cronbach’s alpha slightly below the conventional threshold. The evaluation of the structural model showed that the endogenous variable had an R 2 value of 0.284, indicating a relatively modest level of explained variance. In addition, the Q 2 value of 0.219 suggests that the model demonstrates an acceptable level of predictive relevance. Conclusions Organizational factors were the strongest predictors of Beliefs and caring behavior, both of which significantly improved QNWL. Supportive leadership, institutional policies, and recognition systems play key roles in shaping nurses’ Beliefs and behaviors. Organizational support emerges as the most powerful level for change, directly leading to the practice recommendations. Implications for clinical practice include strengthening organizational support, providing structured training, and enhancing recognition programs to improve QNWL and sustain a resilient, caring nursing workforce. Relevance to Clinical Practice This study highlights that improving ICU nurses’ QNWL depends largely on strengthening organizational support, including supportive leadership, clear policies, and meaningful recognition. By fostering nurses’ Beliefs and caring behavior through structured education, mentoring, and a caring‐based practice environment, hospitals can enhance QNWL and sustain a resilient, compassionate ICU nursing workforce.

Study methods

A quantitative cross‐sectional design was used to develop and test a Carolina Care–based structural model of palliative nursing in the ICU. Data were analyzed using partial least squares–structural equation modeling (PLS‐SEM) to examine the direct and mediated effects of nurse‐related, job‐related, and organizational factors on Beliefs, caring behavior, and QNWL. PLS‐SEM was chosen due to its suitability for testing complex models with multiple constructs and its ability to focus on prediction, making it ideal for examining both direct and indirect effects of nurse‐related, job‐related, and organizational factors on QNWL.

Limitations

This study has several limitations: • Cross‐Sectional Design: The cross‐sectional nature of the study limits causal inference, as it only provides a snapshot of the relationships between variables at one point in time. • Self‐Report Bias: The use of self‐report‐based questionnaires may introduce bias, as respondents may provide socially desirable answers or may not accurately recall experiences. • Convenience/Purposive Sampling: Since purposive sampling was used, the sample may not be fully representative of the larger population of ICU nurses, even within the four hospitals, which could limit the generalizability of the findings. • Common Method Variance (CMV): The reliance on a single self‐report questionnaire at one time point may lead to common method bias, inflating correlations between constructs. This should be considered when interpreting the findings. • Context Specificity: The model was tested in Indonesian public hospitals, and its applicability to other settings, such as private hospitals or culturally distinct contexts (e.g., conflict zones with extreme stress), remains unknown. Future research should explore the model’s applicability in different healthcare settings and cultural contexts. • The study did not collect data on the total number of eligible ICU nurses across the four hospitals, the number approached, the recruitment yield, the response rate, or the numbers who declined participation or were excluded. This limits the ability to fully assess potential selection bias and may restrict the external validity and generalizability of the findings beyond the study settings.

A 90-day district inquiry

Days 1–15 · Appraise. Read the source methods, recruitment, comparator, outcomes and limitations. Record how the study setting differs from your district and which claim the design can support.
Days 16–30 · Design. Choose one recurring leadership practice described in the source. Map its participants, incentives and constraints to a district setting, then design a small reversible staff pilot with an accountable owner. Agree participation, privacy protections, baseline and stopping rules before starting.
Days 31–60 · Observe. Collect the pre-agreed measures, keep a log of implementation changes and invite confidential voluntary feedback. Preserve existing support for staff and learners.
Days 61–90 · Decide. Record implementation fidelity, staff review time, task quality and unintended burdens against a baseline. Use a comparison team where feasible and document alternative explanations before expanding. Make a dated decision to stop, revise or extend the inquiry.

Board decision brief

Present the local problem, source setting, evidence limits, intervention, responsible owner, total cost, measured changes and uncertainty. Separate staff perceptions, implementation measures and student learning outcomes.

Attribution and reuse

Tintin Sukartini; Yulis Setiya Dewi; Herdina Mariyanti; Vimala Ramoo; G. Kanchana; Muhammad Fikri Al-Faruq; Adinda Nurul Hamidah; Yumna Raihanatu; Alfi Syahri. Organizational Factors, Beliefs, Caring Behavior, and Quality of Nursing Work Life Among ICU Nurses: A Carolina Care–Informed Structural Model. Nursing Research and Practice (2026-09-01). https://doi.org/10.1155/nrp/6830564

Prepared 2026-11-07. Source authorship and DOI are preserved. The abstract and source passages are attributed extracts; this editorial guide is offered under the same CC BY 4.0 license.