PhD in Nursing Science Program

The Effect of Social Influence on Nurses' Hand Hygiene Behaviors

Dissertation under the direction of Professor Jana Lauderdale and Professor Ann Minnick

The purpose of this two-phase study was to describe the effects of social influence on critical care nurses' hand hygiene behaviors. Guided by the Theory of Planned Behavior, the phase-one qualitative study captured a modal set of nurse salient hand hygiene beliefs using a free response open-ended survey. Findings indicate nurse participants look to nurses as their hand hygiene referent. Phase-two was a cross-sectional descriptive study designed to determine the contributions of nurses' hand hygiene attitudes, subjective norms, and perceived control on observed and self-reported hand hygiene performance using the self-administered Patient Safety Opinion Survey (informed by phase-one findings) and iScrub application (used for hand hygiene observations). There was no statistically significant association of nurses' attitude scores with hand hygiene behavior (beta=-0. IO (observed), beta=0.03 (self-report), p > 0.05). Nurses' subjective norm and perceived control scores were statistically significant contributors to their observed (Norms: beta= 0.32, p = 0.001; Control: beta= 0.20, p = 0.036) and self-reported (Norms: beta= 0.21,p = 0.028; Control: beta= 0.35,p < 0.001) hand hygiene behavior. These findings suggest that interventions to increase hand hygiene subjective norm and perceived control scores may increase hand hygiene behavior. Consequently, future hand hygiene work should focus on exploring social strategies with particular attention to the nurse leader because nurses identified them as the most important referent. Nurses observed hand hygiene median was 55% with their tendency to self-report a much higher 90% thus suggesting if actual hand hygiene performance statistics are desired, self-report is an inaccurate measure.