Received: 7 September 2019 Revised: 26 September 2019
DOI: 10.1002/hpm.2920
RESEARCH ARTICLE
The relationship between health care providers'
perceived work climate, organizational
commitment, and caring efficacy at pediatric
intensive care units, Cairo University
Mona Adel Soliman Attia1
Shaimaa A.M. Abd El Fatah1 | Sally Kamal Ibrahem2 |
Nancy A.S. Gomaa3
1
Public Health Department, Faculty of
Medicine, Cairo University, Giza, Egypt
2
Pediatrics Department, Faculty of Medicine,
Cairo University, Giza, Egypt
3
Pediatrics and Neonatology, Pediatrics
Department, Cairo University, Giza, Egypt
Correspondence
Mona Adel Soliman Attia, 28 Mohamed
Mekled Street, Nasr City, Cairo, Egypt.
Email: monaadelsoliman@gmail.com
Int J Health Plann Mgmt. 2019;1–13.
Accepted: 5 October 2019
| Meray Rene Labib Youseff2 |
Summary
Background: Healthy work environment has a significant
impact on patients, health care workers, and organizations.
Objectives: In a trial to set up strategies to control stressors
and weaknesses in the work environment, the present study
took place in pediatric intensive care units (PICUs) to explore
the work environment and its impact on the organization
commitment and caring efficacy of health care providers.
Methods: This study is a descriptive cross-sectional study,
conducted over a period of 9 months starting from October
2018. A self-administered questionnaire, based on “The
American Association of Critical Care Nurses Standards for
Establishing and Sustaining Healthy Work Environments” and
“Brewer & Look's organizational commitment scale and the-
ory of self-efficacy,” was given to 63 physicians and 73 nurses
of PICUs at Cairo University Children Hospital in Egypt.
Results: Nurses were significantly more pleased with their
work climate and more committed to their organization and
had higher self-efficacy than physicians. A significant direct
correlation was detected between healthy environment
perception and organizational commitment and between
organization commitment and perceived caring efficacy.
Conclusion and Recommendations: The study findings
might be incorporated into practice to create a positive
wileyonlinelibrary.com/journal/hpm © 2019 John Wiley & Sons, Ltd. 1
2 SOLIMAN ATTIA ET AL.

PICUs' environment, enhance staff satisfaction, and effi-

ciency to promote quality of care paying attention to the
junior staff especially physicians. Additional studies are
required to recognize the coping strategies that health care
providers use and to test the effectiveness of professional
development program along with healthy environment
interventions.

KEYWORDS
caring efficacy, organizational commitment, PICU, work
environment

1 | I N T RO D UC T I O N

Work environment, also called “work culture” or “work climate,” has become a necessary aspect in health services
research; it has been shown in many studies to have a significant impact on patients, health care personnel, and
organizations.1
Work climate is composed of a bunch of practices that endorse staff engagement and organizational commit-
ment. The latter is considered one of the crucial outcomes of human resource strategies. It is seen as the main factor
in achieving competitive performance and organizational success as worker commitment is characterized by many
valuable outcomes including acceptance of the values and goals of the organization in addition to having a strong
faith in such values and goals, an eagerness to work hard for the organization, and a willingness to keep membership
in the organization.2
To attain a high-performance work environment (HPWE), practices must contain sufficient material resources,
human resource management practices that focus on developing staff skills, and a number of managerial practices.
These include workers' participation in decision making, proper communication, and facilitation of information
sharing.1
Work environment is seen as a main source of occupational stress (OS), also called “work place stress” or “job
stress,” which is defined by The National Institute for Occupational Safety and Health as the injurious physical and
emotional reactions that happen when the work requirements do not match the resources, capabilities, or needs of
the staff member.3
Many studies showed increased rates of anxiety, depression, suicide, and substance use among health care
workers more than other professions and that they are linked to job stress.4
Hospital working conditions can affect not only the health providers' well-being but also the quality of care pro-
vided to patients and patient satisfaction.4,5 Hospital stressors can affect the health providers' cognitive processes
and hamper their performance in various ways such as poor communication, diagnosis and treatment mistakes, and
patient death.6 They can also lead to early career disruptions, absenteeism, burnout, and quitting.5
Available statistics revealed increase in the prevalence of OS and its cost in health care systems over the past
decades. This is due to lack of productivity resulting from staff conflicts, absenteeism, burnout, recruitment and
retention problems, legal action, health care consumption, and rapid turnover.7
As per organizational theory, intensive care units (ICUs) are considered as a complex organization of services.
This complexity comes from enormous uncertainty in the care process and rapid decision making required by the
ICU urgent situations.8 Consequently, stress of ICU staff members has been described to have particular sensitivity
as it produces pressure and stress when dealing especially with neonates and infants. The staff members become
SOLIMAN ATTIA ET AL. 3

irritable as a result of relationships between staff, teamwork demands, special emotions when managing patients that
are at risk of dying, and continuous fluctuations between success and failure. All these conditions precipitate feelings
of insufficiency and insecurity that negatively impact interpersonal relationships and disturb the health care pro-
viders' capabilities in building good relations with their colleagues and families of patients.9
Factors improving quality of health care services would observably reduce infant and children mortality. Human
resources can shape service quality, thus exploring current situation, and set up strategies to control stressors and
weaknesses in the work environment that could maximize the staff self-efficacy and the quality of services.10 There-
fore, the present study is intended to investigate the influence of work environment and its stressors on the health
care providers' organizational commitment and caring efficacy. The study is conducted on physicians and nurses in
the pediatric intensive care units (PICUs) of Abou Elreesh Children Hospital, Cairo University, Egypt.

2 | METHODS

2.1 | Study design and study setting

This study is a descriptive cross-sectional one that involved the health care providers (physicians and nurses) of the
PICUs located on the ground floor and fourth, sixth, and seventh floors of Japanese and Elmonira building of Abou
Elreesh Children Hospital and on the seventh floor of Abou Elreesh Children Hospital. This hospital is a teaching hos-
pital that belongs to Cairo University. All the PICUs covered under this study have similar organizational and staffing
structures. The study was conducted over a period of 9 months starting December 2018 until August 2019.

2.2 | Sample size and sampling technique

All physicians and nursing staff present in the four PICUs who consented to participate in the study included 63 out
of total 63 physicians and 73 out of total 77 nurses with 2.9% nonresponse rate due to lack of interest, lack of time,
or high workload.

2.3 | Data collection tools

Data were collected through a self-administered questionnaire that included six sections: The first section contained
socio-demographic and occupational data on age, sex, educational level, marital status, job category, and years of
experience; the second one was a Critical Elements of a Healthy Work Environment Scale to assess the participants'
perspectives towards the PICUs' work conditions adopting The American Association of Critical Care Nurses (AACN)
Critical Care Nurse Work Environment Scale that was developed in 2006 based on the AACN Standards for Esta-
blishing and Sustaining Healthy Work Environments.11 It was proved valid and reliable with Cronbach's alpha of.80
or more. The scale included the six essential standards of healthy work environment with three items each. The six
dimensions included collaboration, communication, staffing, decision making, recognition, and leadership.
The study participants were asked to tell about their work conditions whether they are satisfactory or not on a
5-point Likert-type scale as follows, always, often, sometimes, rarely, or never, which scored 4, 3, 2, 1, and 0, respec-
tively, with total maximum achieved score of 72. The higher the perceived score, the healthier is the work environ-
ment from the employee perspectives.
Regarding the third section of the questionnaire, it was concerned with the sources of work stress obtained from
the OS scale used by Kamel Al-Hawajreh in 2011.12 It was based on review and translation of similar tools used by Fon-
tana in 199313 and Ivancevich and Matteson in 200214 to detect the level of stress among PICUs' health care providers.
Its reliability analysis revealed Cronbach's alpha coefficient of.89. The scale included 31 items on all probable sources of
stress related to the PICUs' environment and its effect on the health care providers' social life and level of social sup-
port. The scale has five possible responses for each item; the responses of never, rarely, often, and always were scored
4 SOLIMAN ATTIA ET AL.

1, 2, 3, 4, and 5, respectively, with total maximum score of 155. The higher the score is, the more the stressors and the
level of work stress are among the study participants. The fourth section of the present study questionnaire is an orga-
nizational commitment scale with.88 Cronbach's alpha coefficient to determine the extent of commitment of PICUs'
health care providers to their hospitals. It was also obtained from Kamel Al-Hawajreh study12 based on Mowday, Steers,
and Porter scale15 and Brewer and Look scale.16 It included 14 items covering other opportunities for work,
mismatching with policies and procedures and incentives for staying in job. The scale used a 3-point Likert scale for
responses with choices of agree, uncertain, or disagree, which were scored 3, 2, and 1, respectively, with total maximum
score of 42. The higher the achieved score is, the more the participants' commitment is to their hospitals.
The fifth section of the study questionnaire is a caring efficacy scale (CES), which was developed by Coates in
199717 based on the theory of self-efficacy. It was adapted by Watson in 200918; its Cronbach's alpha coefficient
values range between.85 and.95. The CES with its two parts, positive CES and negative CES, assesses health care
givers' belief in his/her ability to express a caring orientation and to build up caring relationships with patients.
The positive caring efficacy part of the CES included 14 items about health care providers-patient relationship,
patients' care approaches, listening and compliance to patients' needs, patients support and respect, and doing the
best in order to alleviate patients' suffering. The following three choices were available for each item, agree, neutral,
and disagree, and scored 2, 1, and 0, respectively. The negative caring efficacy part of the CES included 16 items
about ability to express sense of caring, analyze what can be done for patients, and listen to patients. In this part of
the scale, three possible responses were present for each item, the responses of agree, neutral, and disagree, which
were scored 0, 1, and 2, respectively, to balance its negative items. The maximum score that can be achieved is 60;
higher scores are associated with higher belief of self-efficacy.
The final section of the study questionnaire was a nursing activity scale (NAS), which was completed by the
PICUs' nursing staff. It is a revision of the Schutzenhofer Professional Autonomy Scale that was developed to mea-
sure professional autonomy in nurses with Cronbach's alpha coefficient value ranges19,20 from.81 to.92. It included
27 items regarding development of individual's work plan, making rounds in the patients' units, development of
assessment tools appropriate to the area of practice, and other nurses' consultation recording patients' assessment
data and its use. In this part of the scale, three possible responses were present for each item, the responses of very
likely, likely, and unlikely, which were scored 2, 1, and 0, respectively, with total maximum achieved score of 54. The
higher the NAS score is, the more the professional autonomy is.

2.4 | Data analysis

All collected data were revised for completeness and logical consistency. Precoded data were entered on the com-
puter using a database developed for data entry on Microsoft Office Excel program for Windows 10. Data were then
transferred to the computer program Statistical Package for the Social Science (SPSS) release 22 for Microsoft Win-
dows for data analysis.
Data were summarized using number, and percentages for qualitative variables, mean, standard deviation,
median, and interquartile range were used for quantitative variables. Comparison between two groups (physicians
and nurses) was done using Mann Whitney test of significance. Correlation between different scores was done using
Spearman correlation.
P values less than.05 were considered statistically significant.

2.5 | Ethical considerations

The used questionnaire was anonymous and voluntary. The respondents were asked to sign written consents after
explaining the objectives of the research. The researcher treated the health care providers according to the Helsinki
Declaration of biomedical ethics. The researcher obtained administrative approvals from the hospital and PICUs'
managers.
SOLIMAN ATTIA ET AL. 5

3 | RESULTS

Table 1 showed that about 60% of the health care personnel involved in the study were females. Only 43.4% of the
study participants were married. The age ranged from 20 to 59 years old. Nearly half of the study participants
(49.3%) were nurses, and 32.4% were resident physicians; their median years of experience were 4 years.
PICUs' nurses and physicians were significantly different regarding the healthy work environment total score and
its domains except for relationships and recognition as displayed in Table 2. Also, a statistically significant difference
between PICUs' nurses and physicians was detected in the CES and organization commitment score, where nurses
were more satisfied with the PICUs climate and more committed to their organization and had higher self-efficacy

T A B L E 1 Socio-demographic and occupational background of the health care personnel in the four general
pediatric ICUs, Abou Elreesh Hospitals, Cairo University

Participant's Identity

Physicians Nurses Whole Sample

(n = 63, 46.3%) (n = 73, 53.7%) (n = 136, 100%)
Participant's sex
Male 38 (60.3) 17 (23.3) 55 (40.4)
Female 25 (39.7) 56 (76.7) 81 (59.6)
Age
Mean ± SD 29.3 ± 4.9 29.2 ± 8.8 29 ± 7
Median (IQR) 28 (26-30) 26 (24-30) 27 (25-30)
Experience years
Mean ± SD 5.5 ± 4.5 8.5 ± 8.4 7±7
Median (IQR) 4 (3-6) 6 (2-10) 4 (3-9)
Job category
Resident doctor 44 (69.8) 44 (32.4)
Assistant lecturer 8 (12.7) 8 (5.9)
Lecturer 5 (7.9) 5 (3.7)
Associate professor/Professor 6 (9.5) 6 (4.4)
Nurse 67 (91.8) 67 (49.3)
Chief nurse 6 (8.2) 6 (4.4)
Marital status
Married 22 (34.9) 37 (50.7) 59 (43.4)
Single 41 (65.1) 34 (46.6) 75 (55.1)
Widow 0 (0) 1 (1.4) 1 (0.7)
Divorced 0 (0) 1 (1.4) 1 (0.7)
Educational grade
Bachelor of Medicine 34 (54) 34 (25)
Master (medicine) 18 (28.6) 18 (13.2)
MD (medicine) 11 (17.5) 11 (8.1)
Bachelor of Faculty of Nursing 20 (27.4) 20 (14.7)
High Institute of Nursing 26 (35.6) 26 (19.1)
Nursing Diploma 27 (37) 27 (19.9)
6 SOLIMAN ATTIA ET AL.

T A B L E 2 Health care personnel's perception regarding their work climate, caring efficacy, and organizational
commitment by participants' identity

Participants' Identity

Physicians (n = 63) Nurses (n = 73) P value

1. Total communication score
Mean ± SD 9.1 ± 1.5 10.4 ± 1.7 <.001
Median (IQR) 9 (8-10) 10 (9-12)
2. Total collaboration score
Mean ± SD 8.7 ± 1.8 9.7 ± 2.2 .002
Median (IQR) 9 (7-10) 10 (8-12)
3. Total decision making score
Mean ± SD 9.6 ± 1.5 8.3 ± 2.2 <.001
Median (IQR) 9 (9-11) 8 (6-10)
4. Total staffing score
Mean ± SD 8 ± 1.5 10.6 ± 1.7 <.001
Median (IQR) 8 (7-9) 11 (10-12)
5. Total recognition score
Mean ± SD 9.3 ± 1.4 9.1 ± 2.1 .461
Median (IQR) 9 (8-10) 9 (7-11)
6. Total leadership score
Mean ± SD 9.9 ± 1.4 10.3 ± 1.8 .113
Median (IQR) 10 (9-11) 11 (9-12)
Healthy work environment total score
Mean ± SD 54.7 ± 6.5 58.3 ± 8.5 .004
Median (IQR) 54 (50-60) 60 (54-64)
Sources of work stress total score
Mean ± SD 85.4 ± 11.3 84.1 ± 18.6 .068
Median (IQR) 87 (78-95) 82 (75-91)
Caring efficacy scale total
Mean ± SD 16.9 ± 19.3 24 ± 20.6 .032
Median (IQR) 17 (5-26) 26 (8-39)
Organization commitment total score
Mean ± SD 29.8 ± 4.6 32 ± 5.1 .016
Median (IQR) 31 (27-32) 32 (29-35)

Note. The significant p values are meant to be bold.

than physicians. The mean scores were 58.3 ± 8.5, 32 ± 5.1, and 24 ± 20.6, respectively, in comparison with physi-
cians mean scores of 54.7 ± 6.5, 29.8 ± 4.6, and 16.9 ± 19.3, respectively.
Table 3 showed statistically significant direct correlation between the physicians' satisfaction about communica-
tion at work and both age and work experience years with r coefficient of .277 and .270, respectively. Also, it
showed statistically significant direct correlation between sense of autonomy and both age and work experience
years again in physicians only with r coefficient of.260 and.270, respectively. However, no significant correlations
were detected between age and each of the following: work stressors perception, caring efficacy, and organization
commitment.
SOLIMAN ATTIA ET AL. 7

T A B L E 3 Correlation of age and years of experience with all work environment domains, health providers
efficacy, and organizational commitment scores within the whole sample and within physicians and nurses
separately

Physicians (n = 63) Nurses (n = 73) All (n = 136)

Experience Experience Experience

Age years Age years Age years
1. Total communication score r .277 .270 .081 .084 .085 .177
P .028 .032 .494 .479 .325 .039
2. Total collaboration score r .233 .225 −.160 −.136 −.074 −.011
P .067 .076 .176 .253 .394 .903
3. Total decision making score r .260 .270 .036 .053 .177 .060
P .040 .032 .762 .659 .040 .489
4. Total staffing score r .065 .023 .022 .016 −.096 .070
P .611 .860 .855 .891 .267 .421
5. Total recognition score r −.016 −.027 .178 .185 .142 .128
P .898 .833 .131 .117 .100 .137
6. Total leadership score r .112 .071 .153 .150 .103 .132
P .384 .579 .197 .206 .234 .125
Healthy work environment total score r .257 .232 .051 .072 .069 .127
P .042 .067 .668 .547 .427 .141
Sources of work stress total score r −.057 −.024 .032 .034 .040 −.001
P .656 .849 .789 .773 .645 .987
Caring efficacy scale total r .054 .067 .017 .027 .006 .051
P .674 .600 .886 .819 .945 .558
Nursing activity scale total r .085 .083
P .476 .487
Organization commitment total score r .043 .078 −.068 −.079 −.048 −.002
P .741 .542 .565 .507 .576 .981

Note. The significant values (p & r) are meant to be bold.

Similarly, no significant correlations were detected between years of work experience and each of the following:
work stressors perception, caring efficacy, and organization commitment.
There was a statistically significant negative correlation between work stressors score and healthy work environ-
ment score and between work stressors and recognition score among the health care personnel (r = .2 and.251,
respectively) as displayed in Table 4. Also, a significant direct correlation between healthy environment total score
with all its dimensions except for the decision making one and organizational commitment was presented.
Table 5 displayed the correlation between the work stressors score, the organizational commitment, and caring
efficacy. It revealed a statistically significant direct correlation between organization commitment and CES in both
physicians and nurses (r = .244).

4 | DISCUSSION

By comparing physicians' and nurses' findings, the current study concluded that nurses significantly perceived the
PICUs' environment as healthy more than perceived by physicians. In addition, they were more committed to their
8 SOLIMAN ATTIA ET AL.

hospital than physicians. This finding could be interpreted by the fact that different professionals have diverse cul-
tures, ie, medical and nursing cultures. In addition to the fact that physicians work in more than one place seeking
better income.
Similarly, a study that was conducted in 2012 among physicians and nurses in 19 ICUs at Alexandria, Egypt, rev-
ealed statistically significant difference between the perception of physicians and nurses towards the organizational
culture dimensions.21
Regarding the difference in organizational commitment between physicians and nurses, the current study find-
ings were in line with Obeidollah Faraji study results that showed a significant difference between different jobs
(administrative employees, nurses, and physicians) in such a way that physicians had lower commitment to their
organization than nurses and administrative employees.22
By investigating the relation between the participants' socio-demographic characteristics (age and work experi-
ence years) and the commitment to their organization, the current study revealed no statistically significant correla-
tion. This finding is similar to Abd El-Fatah study who found no statistically significant association too.23
On the contrary, a study that was conducted in a nonprofit health care organization in New York to investigate
the degrees of organizational commitment among nurses established the significant effect of age and work experi-
ence years on the organization commitment.24 Also, a study that was conducted in Dubai hospitals, United Arab
Emirates, in 2018 demonstrated a high level of commitment among nurses with more total years of experience.25
However, it was observed by Fedayi in 2019 that the levels of physicians' affective commitment lessened as their
ages and professional experience increased.26
The discrepancy between the above results and the present study findings might be related to generally low
organizational commitment level among the study participants, as larger organizations had a lower individual commit-
ment. Moreover, lower commitment of intensive care staff in hospitals with more beds was indicated because of low
salaries, OS, and critical care work conditions, which all apply to Abou Elreesh Teaching Children hospital.27
Also, the current study showed that the commitment mean score was significantly higher in nurses than in physi-
cians and that commitment score was significantly directly correlated to sources of stress score in nurses; however,
no significant correlation was detected between them in physicians, a finding that could be explained by a study that
examined the effect of stress on employees with different degrees of commitment and found that staff who had a
high organizational commitment level experienced more stress than staff who were less committed.28 Alternatively,
other researchers as Kobasa and Antosrusk observed in 1998 that organizational commitment protected the individ-
ual from stress, either because committed individuals had connected strongly to the individuals at work or because
they had found meaning in the work they do.29
Also, Kamel Al-Hawajreh in 201112 and Syeda in 201730 reported a statistically significant negative effect of OS
on organizational commitment.
Regarding healthy environment total score and organizational commitment score, the current study results rev-
ealed a statistically significant direct correlation between them, also between each of healthy environment dimen-
sions' score and organizational commitment score except for the decision making one. This result might be related to
the fact that the more notice and guidance staff feel on behalf of their managers and the more recognition they get,
the more they try to improve their job. Through improving their job, they become more satisfied, and therefore, they
own more organizational commitment. This finding is supported by Ghorbanhosseini in 201331 whose study revealed
a significant positive impact of organizational culture on employees and their organizational commitment. This goes
in line with Hoff and Mandell findings,32 which showed high organizational commitment in case of supportive and
comfortable work environment.
Similarly, a study that was conducted in public hospitals of North Cyprus in 2018 found that organizational cli-
mate was statistically significant in shaping the employees' organizational commitment and perceived organizational
performance. This means that if the employees in these public hospitals positively perceive the organizational envi-
ronment, they will have higher degrees of organizational commitment.33
T A B L E 4 Correlation between work environment domains and health providers' caring efficacy and organizational commitment within the whole sample and within
physicians and nurses separately

1. Total 2. Total 4. Total 5. Total 6. Total Healthy work

communication collaboration 3. Total decision staffing recognition leadership environment total
score score making score score score score score
SOLIMAN ATTIA ET AL.

All (n = Sources of work r −.119 −.162 −.007 −.077 −.251 −.147 −.200
136) stress total score P .169 .060 .934 .374 .003 .087 .020
Caring efficacy scale r .206 .162 .120 .024 −.022 −.083 .077
total P .016 .060 .162 .778 .803 .336 .374
Organization r .362 .308 .105 .297 .186 .190 .329
commitment total P <.001 <.001 .225 <.001 .030 .027 <.001
score
Physicians Sources of work r −.244 −.228 −.110 −.127 −.421 −.481 −.348
(n = 63) stress total score P .053 .072 .391 .321 .001 <.001 .005
Caring efficacy scale r .062 .070 −.002 −.201 −.231 −.320 −.163
total P .627 .588 .988 .114 .068 .011 .201
Organization r .340 .333 .104 .154 .356 .226 .297
commitment total P .006 .008 .418 .229 .004 .075 .018
score
Nurses (n Sources of work r .061 −.055 −.103 .170 −.183 .134 .016
= 73) stress total score P .609 .642 .386 .150 .120 .258 .896
Caring efficacy scale r .237 .192 .278 −.103 .131 .067 .189
total P .044 .104 .017 .385 .268 .575 .110
Nursing activity scale r .155 .051 .222 .032 .203 .162 .144
total P .190 .666 .060 .788 .085 .172 .224
Organization r .339 .254 .218 .233 .137 .167 .247
commitment total P .003 .030 .064 .047 .247 .157 .035
score

Note. The significant values (p & r) are meant to be bold.

9
10 SOLIMAN ATTIA ET AL.

T A B L E 5 Correlation between sources of work stress, health providers' caring efficacy and organizational
commitment within the whole sample and within physicians and nurses separately

Sources of work stress Caring efficacy Nursing activity

total score scale total scale total
All Caring efficacy scale total r .038
(n = 136) P .664
Organization commitment r .082 .244
total score
P .345 .004
Physicians Caring efficacy scale total r −.035
(n = 63) P .782
Organization commitment r −.052 .257
total score
P .684 .042
Nurses Caring efficacy scale total r .103
(n = 73) P .384
Nursing activity scale r .140 .089
total
P .237 .452
Organization commitment r .238 .192 .620
total score
P .043 .104 <.001

Note. The significant values (p & r) are meant to be bold.

These findings indicated that organizational culture is an essential factor in developing or altering values and atti-
tudes besides creating proper behavioral patterns and organizational commitment for employees. However, our find-
ings contradict Retno and Priyotomo study findings as their study showed that medical doctors fidelity is not
affected by the organizational culture; however, the organizational commitment level of medical professions is
strongly related to the behavior of leaders.34
Research has revealed that in the context of work, self-efficacy is a main personal resource. Also, working life
research has given considerable attention to cognitive and task-oriented aspects of self-efficacy, representing staff
perceptions of their ability to successfully accomplish work tasks.35 Self-efficacy in health care is manifested as
health care personnel feeling confident and capable to perform caring behaviors and build up caring relationships
with patients.17
The present study showed no statistically significant correlation between socio-demographic variables (age and
years of experience) and perceived caring efficacy, a finding that might be interpreted by the study of Jones and his
colleagues, which found that confidence is developed from a supportive process and proficiency.36 Also, Bandura in
1994 reported that the tasks that individual masters were the most enlightening factor of self-efficacy and that vicar-
ious experiences were effective in efficacy development.37 Professional development programs that include the
strategies of self-efficacy such as mastery experiences, vicarious experiences, verbal persuasion, and enhancement
of physiological and affective states might also develop the perceived confidence and abilities at all levels of experi-
ence. It might also lead to developing caring relationships with patients and decision making in the health care pro-
viders' caring practice.38 Conversely, the findings of Carol Reida and her colleagues oppose the current study finding.
It showed a significant relationship between the years of experience and self-efficacy expectations and caring behav-
iors among nurses as measured by the CES. These studies suggested that more experienced nurses might be capable
of perceiving challenging tasks as ones motivating them to be more proficient in caring for their patients.39
SOLIMAN ATTIA ET AL. 11

As for the NAS, its mean score in the present study showed significant direct relation with the organizational com-
mitment mean score. This means that the degree of nurses' perceived autonomy had an impact on their organizational
commitment, similar to the findings of a study that was conducted in Philippines in nine hospitals in the year 2017.
The study expressed a positive correlation between perceived autonomy in decision making and staff commitment.40
The above associations revealed an important issue in the acute and critical care context since health care pro-
viders often face complex and unanticipated situations in this setting. Hence, they need a work climate that is char-
acterized by autonomy to make their own decisions and reciprocal support. This can be enforced by management
through establishing a participative leadership style and promoting nurse-physician collaboration.

5 | C O N C L U S I O N A N D R E C O M M EN D A T I O N S

Abou Elreesh Hospital managers may incorporate the findings of the current study into practice to create a positive
PICUs' environment, enhance staff satisfaction, and improve the hospital human resource investment and effective-
ness. The aim is to promote quality of care and reduce children mortality. Furthermore, they may implement a health
care providers' professional development program using targeted strategies of self-efficacy in order to help in the
development of their perceived self-efficacy. This will have a positive effect on the proper care they provide and
enables them develop appropriate relationships with patients. Further studies are needed to identify and clarify the
specific coping strategies adopted by health care providers. Such studies are also required to increase understanding
regarding the relationship between the stress experience and stress effects and also to test the effectiveness of pro-
fessional development program together with healthy environment interventions. The results of the current study
indicated that managers of the studied hospitals should give attention to the junior staff focusing their effort on phy-
sicians as their mean years of experience were much less than that of nurses. Moreover, the study revealed that
physicians perceived work environment as less healthy than nurses and showed less commitment to their hospital
than nurses.

5.1 | Limitations of the study

The sample in this study was limited to pediatric critical care health care providers working in one of the teaching
hospitals in Egypt, which limits the generalization of results to other teaching hospitals.

ACKNOWLEDGEMEN TS

Thanks to the health providers who participated in the current study in spite of being busy and to the managers of
the studied PICUs for facilitating the researchers' work. Special thanks to Professor Nargis Albert, Professor of Public
Health, Cairo University, for her guidance throughout the study. This study is self-funded. There is no conflict of
interest of any type for all authors.

AUTHOR CONTRIBUTIONS

Each author has made a substantial contributions to the following. Dr Mona Adel Soliman: the conception and design
of the study, drafting the article, and final approval of the version to be submitted. Dr Meray Rene Labib Youseff:
interpretation of data, revising the article critically for important intellectual content, and final approval of the version
to be submitted. Dr Shaimaa AM Abdelfatah: analysis and interpretation of data, drafting the article, and final
approval of the version to be submitted. Dr Sally Kamal Ibrahim: acquisition of data, drafting the article, and final
approval of the version to be submitted. Dr Nancy Gomaa: acquisition of data, drafting the article, and final approval
of the version to be submitted.
12 SOLIMAN ATTIA ET AL.

ORCID

Mona Adel Soliman Attia https://orcid.org/0000-0002-3872-9417

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How to cite this article: Attia MAS, Youseff MRL, Abd El Fatah SAM, Ibrahem SK, Gomaa NAS. The
relationship between health care providers' perceived work climate, organizational commitment, and caring
efficacy at pediatric intensive care units, Cairo University. Int J Health Plann Mgmt. 2019;1–13. https://doi.
org/10.1002/hpm.2920