Organizational Factors, Beliefs, Caring Behavior, and Quality of Nursing Work Life Among ICU Nurses: A Carolina Care-Informed Structural Model.

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.