Safety performance behaviors of hospital nurses from the perspective of social cognition theory.

Objectives: This study aimed to investigate the safety performance behaviors of hospital nurses by developing and testing a comprehensive model based on social cognitive theory (SCT). Methods: A cross-sectional, survey-based study was conducted. Data were collected from 269 registered nurses across multiple hospitals in Quanzhou, China, via an online questionnaire. Previously validated scales were adapted to measure the constructs. The proposed research model and hypotheses were tested using partial least squares structural equation modeling (PLS-SEM). Results: The results showed that safety climate had a significant positive effect on safety motivation (β = 0.716, p < 0.001). Safety motivation, in turn, positively influenced both safety compliance (β = 0.498, p < 0.001) and safety participation (β = 0.195, p < 0.01). Anticipation orientation mediated the relationship between safety motivation and both safety behaviors. Psychological ownership for safety promotion was a strong predictor of anticipation orientation (β = 0.537, p < 0.001). Furthermore, co-worker support positively moderated the relationship between safety motivation and safety participation (β = 0.220, p < 0.01) but did not have a significant moderating effect on the motivation-compliance relationship. Conclusions: The findings underscore the importance of a multi-faceted approach to enhancing nurse safety performance. Healthcare institutions should prioritize fostering a positive safety climate, cultivating nurses' psychological ownership of safety, and strengthening co-worker support networks to effectively translate motivation into proactive safety behaviors. This study advances the application of SCT in nursing safety by integrating organizational, cognitive, and social factors into a unified framework.