The complexity of the work environment conditions results in an increasing demand of the nurse’s time and effort away from the patient, when her focus should be on the health, healing, and alleviation of suffering of the patient (Gottlieb, 2014). Among the different hospital units, the critical care units are specialized units characterized by dynamic, stressful working environment. The critical care nurse work environment conditions play a principal role in the caring process thus impacting patient outcomes, patient and nurse satisfaction, and financial costs (Boev, 2012; Rose, 2011; Ulrich et al., 2014). Effective relationships among the multidisciplinary team members in this environment also impact the outcomes of critically ill patients (Rose, 2011). The structure of the work environment provides conditions that can empower nurses, enabling them to be effective throughout all levels of the organization, or create a sense of powerlessness, which may influence patient and staff relationships (Boev, 2012; Purdy, Spence Laschinger, Finegan, Kerr, & Olivera, 2010; Rose, 2011; Ulrich et al., 2014). The conditions of the work environment that may empower nurses are access to opportunities, information, support, resources, and positive work relationships with peers/colleagues, patients/families, and mentors (Roche, Morsi, & Chandler, 2009).
Nurses’ ability to provide efficacious care is based in the nurse’s belief in self and his/her ability to achieve a desired outcome. The nurse’s confidence in his/her competencies and the availability within the work environment of conditions that lead to empowerment are needed in order for him/her to take charge of the patient’s health and healing (Gottlieb, 2014). The nurse who perceives herself as efficacious exhibits caring attitudes, establishes caring relationships, and is satisfied with the quality of the care she is providing to her patients (Coates, 1997). Work environments that make available the adequate conditions for nurses’ result in positive outcomes for patients and nurses (Purdy et al., 2010). Thus, understanding the influence of the conditions for work effectiveness of today’s caring environment on the nurses’ perception of their caring efficacy may provide insight into this process in order to promote caring attitudes and behaviors in the work environment.
The purpose of this study was to explore the conditions in the work environment that may contribute to caring efficacy of critical care nurses in Puerto Rico. The study measured nurses’ perceptions of the empowering structures in the work environment, and the relationship to their perceived caring efficacy and explored the correlation between sociodemographic factors of age, education, and experience of work empowerment and/or caring efficacy.
Methods:
The Conditions for Work Effectiveness Questionnaire and Caring Efficacy Scale were used to assess the association between the nurses’ work environment conditions and caring efficacy. The instruments were translated to Spanish and adapted to the Puerto Rican culture. Using convenience sampling, the instruments were paired and administered to nurses from selected critical care units of hospitals in Puerto Rico. Participation was voluntary.
Results:
Findings support that there is no relationship between the working conditions environment and caring efficacy. Supplemental findings, however, support a significant positive correlation between relationships with patients and families and caring efficacy.
Conclusion:
This study was able to demonstrate that sociodemographic, environmental, and individual factors influence caring behaviors. This is a fact supported by Bandura’s Social Cognitive Theory (1997). Caring behaviors are not a consequence of environmental influences but of positive work relationships. Work relationships influence the nurse’s beliefs in her ability to exhibit caring behaviors. Therefore, positive, meaningful work relationships and relational competence must be fostered for nursing to have a more powerful influence in healthcare.
Caring efficacy, as measured by the CES, was higher in the Hispanic population than in other tested populations (Coates, 1997; Sadler, 2003). The influence of cultural elements—familyism, respect, trust, personal relationships, and spirituality—in the nursing care of Hispanic and Latino populations need to be studied. Results also imply that special attention must be given to the provision of professional growth, development, and advancement especially to older nurses.
This study intended to determine the relationship between the variables and their value to influence the nurses’ perceptions regarding their caring relations and confidence in expressing caring behaviors in the critical care work environment. The findings of this study support the proposition that the importance of nurses’ relationships in the work environment needs to be recognized. The nurse relational competence (Chandler, 1992) needs to be further assessed and developed in order to grasp a deeper understanding of the dynamics of the caring processes. This fact can no longer be ignored. It is the true essence of nursing. Relationships with patients and families is one of the key components in the caring environment (Chandler, 1992a).
Based on the study findings, the following specific recommendations are presented:
- Develop mentoring and career-coaching programs to foster relationships with mentors as a source of opportunity and support to nurses, especially older nurses. This includes the creation of training programs for older nurses to become mentors and achieve recognition for it.
- Clinical recognition programs recognizing the importance of the relationships with patients and families to nurses and their caring behaviors must be in place to empower nurses.
- Organizational programs promoting formal education to advanced practice roles must be in place.
- Integrate the dynamics of relational competence to the BSN curriculum to enhance the student’s ability to promote caring behaviors.
- Further research is required to evaluate the impact of cultural elements in caring behaviors.
- Develop qualitative research to gather data through interviews, focus groups, or similar methods that can contribute to a better understanding of the cultural elements in caring for Hispanic and Latino populations.