Abstract
Background
Community hospital nurses worldwide operate as frontline responders in resource-constrained environments. In such settings, sustaining humanistic caring ability, a cornerstone of patient satisfaction and overall service quality, is increasingly challenged by both external organizational factors and the internal psychological resilience of the nursing staff. This study addresses that gap by examining how organizational climate mediates the relationship between nurses’ psychological resilience and their caring behaviors, offering actionable insights for healthcare systems globally to safeguard the quality of nursing care in community hospitals.
Objectives
The purpose of this study is to explore the factors influencing the caring behaviors of nurses in community hospitals, and to investigate the mediating influence of organizational climate on the correlation between caring behavior and psychological resilience among community hospital nurses.
Method
This study utilized a cross-sectional design and recruited 231 nurses from 20 community hospitals in four main urban areas of Chongqing through convenience sampling. Nurses who met the inclusion criteria completed an online survey using self-report scales for caring behavior, psychological resilience, and organizational climate between November 2022 and March 2023. The potential mediating effect was examined using the Process Macro and bootstrap methods.
Results
Caring behavior was positively correlated with psychological resilience and organizational climate (r = 0.446, p < 0.001; r = 0.429, p < 0.001, respectively). Furthermore, the psychological resilience of nurses has a significant direct effect on their caring behavior (B = 0.34, p < 0.001). Organizational atmosphere could mediate the indirect path from psychological resilience to caring behavior (B = 0.22, p < 0.001).
Conclusion
Organizational climate partially mediated the relationship between psychological resilience and caring behavior. Moreover, years of service and professional title emerged as key factors that can enhance caring behavior by fostering a supportive organizational climate and bolstering nurses’ psychological resilience. Thus, targeted interventions aimed at optimizing the organizational environment and strengthening resilience may provide an effective strategy for improving caring behavior among community hospital nurses.
Clinical trail number
Not applicable.
Keywords: Community hospital nurses, Caring behavior, Psychological resilience, Organizational climate
Introduction
During the COVID-19 pandemic, community hospitals became vital hubs for outbreak management. Beyond their primary clinical duties, nurses in these settings assumed the essential tasks of monitoring and isolating community members. The extraordinary demands and inherent occupational risks of this work require constant vigilance, which may inadvertently compromise the humanistic aspects of patient care. As we transition into the post-pandemic era, it is imperative to recognize and reinforce the caring behaviors of community hospital nurses to ensure ongoing improvements in patient care quality.
The term “caring behavior” refers to the actions, conducts, and behaviors exhibited by professional nurses as they provide their patients with attention, protection, and concern [1]. It is believed that through their caring behavior, nurses can maintain and potentially enhance a patient’s physical and emotional well-being. Moreover, such behavior can elevate patient satisfaction with healthcare services and the quality of nursing care provided [2]. A comparative analysis of two prior studies indicates that the caring competency of nurses in China tends to be lower than that reported in equivalent research conducted in other developed nations [3, 4]. Recent research [5] suggests that the caring behavior of clinical nurses is influenced by a variety of factors, including the nature of their work environments and the demographic characteristics of the patient populations they attend to. Additionally, the frequent undertaking of night shifts significantly impacts the decline in caring behavior among nurses. In a similar vein, nurses who have undergone training in humanitarian care demonstrate a greater propensity for caring behavior than those who have not received such training.
Nevertheless, scholarly investigation into the caring behaviors exhibited by community hospital nurses remains relatively sparse. Therefore, an expanded research effort in this area is crucial to comprehensively identify its determinants, thereby facilitating the sustainable development and professional improvement of nursing care within community hospital settings.
Background
Psychological resilience is defined as a dynamic process of adaptation to adversity, traumatic occurrences, disasters, hazards, or critical stressors [6]. It is unequivocally acknowledged that the vocation of community nursing is fraught with considerable stress and peril. The intense workload can have detrimental effects on the physical and mental well-being of community nurses, which may profoundly compromise their ability to demonstrate caring behavior [7]. Medical professionals who possess elevated levels of resilience may experience a range of positive outcomes in the aftermath of high-stress epidemics, including reduced stress levels, enhanced mental health, lower instances of burnout, and a mitigation of post-traumatic stress disorder symptoms [8, 9].
The organizational climate exerts a favorable influence on the manifestation of caring behavior. It is conceptualized as the collective subjective perceptions and emotional responses of the organization’s members to the inherent internal environmental attributes [10]. Organizational climate has been observed to have a direct impact on the ability to provide care to patients and their families [11]. A prior study [12] has established a positive correlation between organizational climate and caring behavior. The empathetic demeanor of head nurses and fellow colleagues towards patients and their kin serves as a motivational force for the nursing staff. The organizational climate facilitates the internalization of caring behaviors. It enables nurses to integrate the care provided by their peers into the comprehensive nursing process for patients and their families, comprehend the emotional experiences of those afflicted with illness, and cultivate a sense of empathy.
Psychological resilience exerts a notable influence on the organizational climate. Serving as a crucial link between the organizational structure and the internal behavior of its personnel, the organizational climate plays a pivotal role in shaping individuals’ psychological and behavioral responses. Organizational climate pertains to employees’ enduring perceptions of their work environment. The high-stress nature of nursing can undermine the psychological stability of nurses, impeding their ability to perform their duties effectively. In such scenarios, a positive organizational climate can not only mitigate the psychological impact of adversity but also bolster nurses’ sense of self-efficacy [13–15]. Nurses with high levels of psychological resilience tend to experience diminished stress and emotional fatigue [16], which, in turn, can optimize their capacity to provide humanistic care and deliver enhanced emotional support to patients.
This study addresses the gap in empirical research on nurses’ caring behaviors in community hospital settings, an area well studied in general hospitals but under explored in community contexts. Accordingly, our objectives were to identify the factors influencing caring behaviors among community hospital nurses and to examine the mediating role of organizational climate in the relationship between psychological resilience and caring behavior. By establishing this empirical foundation, we aim to inform the development of targeted intervention strategies to strengthen caring behaviors in community hospital nursing practice.
Method
Study design and participants
The methodology was cross-sectional, and we adhered to the STROBE Cross Sectional Checklist to guide our reporting. We used convenient sampling to recruit 231 nurses from 20 community hospitals in four main urban districts of Chongqing. These hospitals were selected to represent typical urban community healthcare settings in Chongqing, with comparable patient demographics and workload patterns. The inclusion criteria were: (1) clinical in-service nurses holding a nurse practitioner qualification certificate; (2) proficiency in reading and writing Mandarin to ensure accurate comprehension of study materials; (3) provision of informed consent and voluntary participation.
The exclusion criteria were nurses who were not on duty or who were on sick leave, maternity leave, or studying abroad. The minimal sample size was calculated using G*Power (α = 0.05, power = 0.80, effect size f²=0.15), resulting in N = 200 [17]. Of the 250 invited nurses, 231 consented to participate and completed the questionnaires, resulting in a response rate of 92.40%.
Instruments
Socio-demographic data
Drawing on a comprehensive literature review, the research team crafted a bespoke demographic data questionnaire to gather essential information regarding community hospital nurses. The questionnaire encompasses six key parameters: age, marital status, educational level, professional title, working years, and community hospital.
Nurse caring behaviors inventory
The Caring Behaviors Inventory (CBI) represents one of the pioneering assessment tools crafted upon Jean Watson’s philosophical framework of human caring [18]. In this study, researchers adopted a streamlined version of the nurse care behavior scale. This scale assesses the perceptions of caring behaviors exhibited by nurses across 24 items, which are categorized into three distinct subscales: support and assurance, knowledge and skill, respect and connection. Respondents are provided with a range of options from 1 (never) to 6 (always) [19]. Each subscale, as well as the composite scale, is evaluated with mean scores, where elevated ratings signify a higher frequency of caring behaviors perceived by the recipients of care. The test-retest reliability coefficients for the three subscales are 0.794, 0.633, and 0.575, respectively, with a Cronbach’s α score of 0.959, indicating a robust level of internal consistency.
Chinese version of the connor-davidson resilience scale
The psychological resilience of the participants involved in the research was assessed utilizing the Chinese version of the Connor-Davidson Mental Resilience Scale [20]. The scale comprises 25 items that encompass three pivotal dimensions: tenacity, strength, and optimism. Each item is scored on a scale from 0 (never) to 4 (always), culminating in an aggregate score that ranges from 0 to 100. The cumulative score is computed by summing the responses to all items, with higher scores denoting elevated levels of psychological resilience. In the context of this investigation, the test-retest reliability coefficients for the three dimensions were found to be 0.924, 0.889, and 0.704, respectively, with a Cronbach’s α value of 0.951, indicating high internal consistency.
Nursing organizational atmosphere scale
The Nursing Organizational Atmosphere Scale, developed by Liping He and colleagues [21], was utilized to ascertain the prevailing organizational climate within community hospitals. This scale encompasses 24 items distributed across four key dimensions: fairness support behavior, colleague behavior, interpersonal atmosphere behavior, and the presence of both intimacy and aggression within the atmosphere. Respondents are required to rate each item on a scale from 1 (very non-conformant) to 5 (very conformant). Scores at the higher end of this scale suggest more favorable perceptions of the workplace environment. The present study yielded a Cronbach’s α coefficient of 0.927, which attests to the scale’s reliability.
Data collection and ethical consideration
The Ethics Committee of Chongqing Medical University approved the study (approval no. 2022192). Data were collected via an online survey platform from November 2022 to March 2023. Prior to survey implementation, the investigators liaised with each community hospital ’s management to present the research details and secure ethical clearance. After obtaining consent from the director of the nursing department, the team entered the hospitals and delivered a standardized explanation of the study’s objectives, significance, and confidentiality policy to potential participants. Upon signing the informed consent form, participants scanned a QR code to access the questionnaire, which was configured to permit only one submission per mobile device and required approximately 10 min to complete. We ensured data authenticity through one-on-one, face-to-face guidance and on-site provision of survey links. Questionnaires exhibiting entirely identical responses or exceptionally short completion times were excluded. To minimize bias, we compared the demographic characteristics of early and late respondents; no statistically significant differences were observed.
Data analysis
SPSS version 26.0 was employed for data analysis. Descriptive statistics were utilized to report the demographic characteristics of the participants. Independent samples t-tests were conducted to compare the characteristics between two groups, while analysis of variance (ANOVA) was applied to compare among three or more groups, assessing the differences in community hospital nurses’ characteristics with respect to age, marital status, educational level, professional title, and working years. Pearson’s correlation coefficients were computed to examine the relationships between caring behavior, psychological resilience, and organizational climate. The mediating role of organizational climate on the relationship between caring behavior and psychological resilience was examined utilizing the Process Macro, with the analysis being performed via the bootstrap method.
Results
Characteristics of community hospital nurses and differences in caring behavior
A total of 231 participants completed this survey. Among them, 15 questionnaires were eliminated due to data quality issues, leaving 216 valid questionnaires. Almost half of the participants (40.7%) were aged between 30 and 39. Most participants (76.4%) were married, and most had a bachelor’s degree (56.0%). Nearly half of the people (41.7%) had professional titles as caregivers. A preponderance of participants (59.7%) had accumulated work experience ranging from 12 to 22 years. A marked disparity in caring behavior was observed in correlation with marital status, as indicated by the analysis of participant characteristics (F = 8.943, p = 0.003), educational level (F = 36.087, p = 0.000), and professional title (F = 43.889, p = 0.000). Those with professional titles designated as “Supervisor nurse and above” exhibited a higher level of caring behavior in comparison to those titled “Staff nurse.” In terms of educational level, a greater degree of caring behavior was noted among individuals holding a bachelor’s degree or higher, as opposed to those with a technical secondary school education (Table 1).
Table 1.
Characteristics of community hospital nurses and differences in caring behavior (N = 216)
| Characteristics categories | N (%) | CBI | F | p | |
|---|---|---|---|---|---|
| Age (years) | 20–29 | 86(39.8%) | 114.15 ± 13.70 | 2.078 | 0.128 |
| 30–39 | 88(40.7%) | 117.14 ± 11.45 | |||
| 40–60 | 42(19.4%) | 118.69 ± 14.33 | |||
| Marital Status | Unmarried | 51(23.6%) | 111.57 ± 12.82 | 8.943 | 0.003 |
| Married | 165(76.4%) | 117.70 ± 12.78 | |||
| Educational level | Technical secondary school | 20(9.3%) | 107.40 ± 13.53 | 36.087 | 0.000 |
| Diploma | 75(34.7%) | 109.29 ± 12.77 | |||
| Bachelor degree and above | 121(56.0%) | 122.02 ± 9.87 | |||
| Professional title | Staff nurse | 57(26.4%) | 106.58 ± 13.28 | 43.889 | 0.000 |
| Senior nurse | 90(41.7%) | 115.67 ± 10.66 | |||
| Supervisor nurse and above | 69(31.9%) | 125.00 ± 9.27 | |||
| Working years | 0–11 | 129(59.7%) | 114.95 ± 13.25 | 1.610 | 0.202 |
| 12–22 | 60(27.8%) | 118.02 ± 11.80 | |||
| 25–36 | 27(12.5%) | 118.52 ± 14.22 | |||
Pearson correlation analysis among caring behavior, psychological resilience, and organizational climate
The results showed that caring behavior was positively correlated with psychological resilience and organizational climate (r = 0.406, p < 0.001; r = 0.389, p < 0.001, respectively). Additionally, there was a favorable correlation found between organizational climate and psychological resilience (r = 0.512, p < 0.001) (Table 2).
Table 2.
Pearson correlation analysis of correlations among caring behavior, psychological resilience, and organizational climate (N = 216)
| Variables | Caring behavior | Psychological resilience | Organizational climate |
|---|---|---|---|
| Caring behavior | 1 | ||
| Psychological resilience | 0.446** | 1 | |
| Organizational climate | 0.429** | 0.639** | 1 |
**p < 0.01
Mediating the effect of organizational climate
To ascertain the mediating influence of organizational climate, we developed a foundational mediation model in accordance with established procedures for assessing mediator effects. Regression analysis of the variables within this model indicated that the level of psychological resilience among nurses exerted a significant positive influence on their caring behavior (B = 0.56, p < 0.001). Furthermore, psychological resilience was found to positively impact organizational climate (B = 0.49, p < 0.001). When both organizational climate and psychological resilience were concurrently employed to predict the caring behavior of nurses, both path coefficients demonstrated statistical significance (B = 0.34, p < 0.001; B = 0.45, p < 0.001). The comprehensive regression analysis results are provided in Table 3, while the mediation effect model is depicted in Fig. 1.
Table 3.
Regression analysis of the relationship between variables in the mediation model (N = 216)
| Dependent variable | Independent variable | R 2 | F | t | B |
|---|---|---|---|---|---|
| Caring behavior | Psychological resilience | 0.22 | 19.45 | 5.37 | 0.56** |
| Organizational climate | Psychological resilience | 0.42 | 50.25 | 10.44 | 0.49** |
| Caring behavior | Psychological resilience | 0.25 | 17.36 | 2.70 | 0.34** |
| Organizational climate | 2.99 | 0.45** |
**p < 0.001
Fig. 1.
Mediation model of effects of organizational climate on the relationship between psychological resilience and Caring behavior (N = 216). **p < 0.001
As demonstrated by the mediatory impact on the organizational climate, the indirect effect amounted to 0.22. The substantial mediatory influence of the organizational climate was confirmed by the 95% confidence interval (CI), which ranged from 0.36 to 0.77 and did not encompass the value of 0. This finding ascertains that the hypothesized mediatory pathway posited within the research is indeed present, with a mediatory effect size of 54.55% (the ratio of indirect effect and total effect) (Table 4).
Table 4.
The mediating effects of organizational climate on the relationship between psychological resilience and caring behavior (N = 216)
| Effect | Effect value | SE | Bootstrap 95%CI | |
|---|---|---|---|---|
| LLCI | ULCI | |||
| Total effect | 0.56 | 0.11 | 0.36 | 0.77 |
| Direct effect | 0.34 | 0.13 | 0.09 | 0.59 |
| Indirect effect | 0.22 | 0.06 | 0.12 | 0.35 |
SE: standard error. CI: confidence interval
Discussion
This study examined the correlation between caring behavior and psychological resilience among nurses working in community hospitals, as well as the mediating role of organizational climate. The results indicated that psychological resilience exerted both direct and indirect effects on caring behavior, with organizational climate acting as a mediator in the relationship between psychological resilience and caring behavior.
The investigation revealed that caring behavior was significantly influenced by working years and professional titles, aligning with the findings of previous literature [22, 23]. Nurses with more extensive work experience and elevated professional titles tend to exhibit higher scores in humanistic care ability. Experienced senior nurses, in particular, demonstrate greater sensitivity to the emotional needs of patients and their families compared to their younger counterparts, enabling them to employ more appropriate and reasonable care strategies [24]. Furthermore, the reform of the medical personnel system has resulted in most newly hired nurses being employed on a contractual basis. Confronted with equivalent work intensities, these nurses often receive fewer benefits and career advancement opportunities compared to their formally employed peers [25]. This disparity contributes to reduced job satisfaction and manifests as a deficiency in patient care and empathy.
The CBI score in this study exceeded the average benchmark, thereby corroborating the findings of previous investigations [5, 26]. This suggests that community hospital nurses predominantly exhibit a positive self-perception of their caring behaviors. An analysis of the scale dimension scores reveals that the knowledge and skills domain boasts a notably high score. This indicates that nurses possess strong professional capabilities and are able to promptly meet patients’ physiological needs, thereby offering crucial life support. Consistently high ratings were also observed in the area of patient information confidentiality, signifying that nurses are adept at safeguarding patient privacy and maintaining a strong sense of professional ethics. Nonetheless, the dimension of companionship scored poorly, potentially attributable to staffing shortages and nurse burnout. These factors contribute to a situation where nurses are overwhelmed with therapeutic duties and fundamental care, leaving them with insufficient time and energy to engage in meaningful companionship with patients.
In contradistinction to the findings reported by Guo [27] pertaining to the psychological resilience of nurses employed in tertiary hospitals, this study indicates that nurses working in community hospitals exhibit superior levels of psychological resilience. Such divergences might be attributed to the fact that tertiary hospital nurses face greater psychological challenges in their daily work due to the complexity of patient conditions and the large number of patients. They may be more prone to occupational fatigue and psychological vulnerability. However, the dimension of optimism within psychological resilience was found to be scoring notably low. This could be a consequence of low income, insufficient training support and low social recognition of nurses in community hospitals. Consequently, it is advisable for nurses to cultivate a positive and hopeful demeanor, to enhance their psychological well-being judiciously, and to maintain an optimistic outlook in their professional encounters, despite experiencing pressure.
Our study yielded a higher score on the organizational climate scale than the two previous studies [28, 29]. Participants rated the dimension of fair support behavior notably high and displayed a clear propensity for collaboration and mutual care. This outcome suggests that an equitable work environment and strong intrateam relationships sustain a positive psychological state among nurses, which in turn fosters organizational health and enhances each nurse’s subjective motivation. Empirical evidence indicates that community hospital nurses demonstrate higher levels of caring behavior than their counterparts in acute care hospitals, likely reflecting differences in organizational climate [30, 31]. Supportive factors such as manageable workloads, family-centered care models that cultivate empathy, flexible organizational structures, and long-term patient relationships in community settings contrast with the high-pressure workflows and rigid hierarchies typical of acute care hospitals. Prior research confirms that positive work environments and reduced task burdens improve nurses’ caring behavior [32]. Conversely, conflictual relationships between head nurses and staff have adversely impacted the organizational atmosphere; barriers to information sharing and generational gaps bear responsibility for this situation. Therefore, it is crucial to encourage nurses to articulate their perspectives more frequently and for head nurses to engage in regular communication with staff and remain receptive to the ideas of the younger generation.
This study identified a significant positive correlation between the psychological resilience and the caring behavior of nurses in community hospitals, aligning with the findings of Wang [33]. Owing to the relatively late initiation of the development of the nursing profession in China and the country’s vast population, nurses in China generally encounter numerous challenges, such as heavy workload, disrespect from doctors, and difficulties in communicating with patients. These factors can engender negative emotions such as depression and anxiety [34]. The prolonged effects of these adverse emotions can, in turn, influence their caring behavior. Possessing greater psychological resilience may imply that nurses are equipped with more robust internal resources to mitigate the deleterious effects of working under pressure. The capacity for adaptability aids nurses in swiftly adjusting their mental state in response to stress, thereby enabling the provision of rational and compassionate care [35].
The investigation revealed that the organizational climate acts as a partial mediator between psychological resilience and caring behavior. A cross-sectional study demonstrated that favorable organizational climate was conducive to nurses’ integration of a caring ethos into their professional practice, thereby enhancing their caring gestures towards patients [36]. Concurrently, the organizational climate exerts a significant influence on psychological resilience. An Australian-based survey indicated that a robust organizational climate is positively associated with elevated levels of psychological resilience and overall well-being [37]. As a result, there exists a propitious relationship between the perceptions of the organization’s ambient internal environment by nurses and their capacity to manage stress effectively. This correlation has the potential to substantially augment the competencies of nurses in facilitating the social, psychological, and physical recuperation of their patients.
Limitations
This study has several limitations to note. First, because participants were drawn exclusively from selected community hospitals in Chongqing, the generalisability of our findings to community hospital nurses nationwide is limited. Future research should involve larger sample sizes and expand the survey scope across diverse regions to provide a more comprehensive evaluation. Second, the cross-sectional design precludes longitudinal assessment of the interactions under investigation. Future longitudinal and intervention studies are required to monitor and improve nurses’ caring behaviours over time. Third, data collection relied primarily on self-reporting by nurses, which may introduce social desirability bias. Addressing these limitations in future research will strengthen our understanding of the factors influencing caring behaviours among community hospital nurses.
Implications
This research offers some specific directions for the managers of community hospitals to formulate corresponding measures for enhancing the care behaviors of nurses. Future research should explore the effectiveness of interventions aimed at enhancing organizational climate and psychological resilience among these nurses. More experimental studies should be conducted to evaluate the impact of customized training programs or organizational modifications on these factors. Hospital leaders should strengthen humanistic care for nurses by improving the quality of the work environment, facilitating nurses’ adaptation to professional requirements, and providing additional avenues for emotional support, thereby enabling them to deliver more effective patient care. The hospital administrative department should consider increasing the welfare benefits for nursing staff in community hospitals and granting them more opportunities for professional development. Furthermore, nursing educators can integrate psychological resilience training into nursing humanities courses to better prepare student nurses for the challenges they might encounter in their careers. It is also highly recommended that the whole society make efforts to enhance the understanding of nurses, who are indispensable in healthcare, including their duties, challenges, dedication and sacrifices, to create a better supportive environment for them to provide high-quality services to the community.
Conclusions
This study provides a theoretical foundation for enhancing caring behavior among community hospital nursing staff. Our findings indicate that years of service and professional title are key factors that contribute to improved caring behavior. In addition, psychological resilience and organizational climate showed positive associations with caring behavior, with organizational climate mediating the link between resilience and caring practice. The interplay of these factors offers valuable insights for supporting the professional growth of community hospital nurses. By fostering a positive organizational climate and strengthening psychological resilience, healthcare leaders can create an environment that not only promotes compassionate practice but also enhances nurses’ wellbeing and job satisfaction. Such strategies are essential for reducing burnout and improving the quality of patient care. Future research should include targeted intervention studies to identify effective educational approaches and to develop specific training resources that systematically cultivate caring behavior among nurses.
Acknowledgements
We are appreciative of every participant who consented to complete the surveys and enabled our research.
Author contributions
Y and Z collaborated to finish the study conceptualization, design, data collection and analysis, and the original drafting of the manuscript. F contributed to the conceptualization of the study design, revision of the manuscript, and supervision of the research process. The final manuscript was reviewed and approved by all authors.
Funding
This study was supported by Social Science Planning Projects of Chongqing Municipality [grant numbers 2024PY65].
Data availability
The data generated or inspected in this study were not available to the public due to confidentiality agreements with the participants. Nevertheless, they can be acquired from the corresponding author upon reasonable request.
Declarations
Ethics approval and consent to participate
The methods and design of this study followed the principles of the Declaration of Helsinki. All participants were informed about the principles of voluntary participation and confidentiality, the study’s objectives, and the requirements for completing the questionnaire. After written informed consent was obtained, the questionnaire was distributed online. The Ethics Committee of Chongqing Medical University granted ethical approval in September 2022, with the registration number 2022192. All methods were performed in accordance with the relevant guidelines.
Consent for publication
Not applicable.
Competing interests
The authors declare no competing interests.
Footnotes
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
The data generated or inspected in this study were not available to the public due to confidentiality agreements with the participants. Nevertheless, they can be acquired from the corresponding author upon reasonable request.