The mediating role of nurses' social networks between sleep quality and safety behavior: A mixed-methods study

Objective: To investigate the pathways through which nurses' social networks and sleep quality influence their safety behaviors, and to provide a theoretical basis for developing targeted interventions. Methods: A mixed-methods study was conducted. In June-August 2024, 418 nurses were recruited via convenience sampling to complete a face-to-face survey assessing the Pittsburgh Sleep Quality Index (PSQI), degree centrality of individual social networks, perceived social support, and safety behavior. Path analysis was performed using AMOS 26.0 to test a hypothesized model. In November 2024, 23 nurses were purposively sampled for semi-structured interviews. Thematic analysis was conducted using NVivo 12.6 to explore the influencing factors and pathways related to nurses’ safety behavior. Results : Path analysis revealed that poorer sleep quality directly predicted reduced safety behavior (β = -0.213, P< 0.001) and indirectly predicted it through two significant mediators: lower social network degree centrality (β = -0.098, P < 0.001) and reduced perceived social support (β = -0.058, p = 0.002). A significant serial mediation pathway was identified, wherein sleep quality sequentially affected degree centrality and then perceived social support, ultimately impacting safety behavior (β = -0.087, P = 00.003). This indirect pathway accounted for 18.09% of the total effect. Qualitative findings further elucidated specific job demands and resources that influence nurses' safety behavior. Conclusion: This study demonstrates that robust social networks and strong perceived social support promote nurses' safety behavior, while poor sleep quality undermines it. The findings highlight a critical pathway through which sleep quality exerts its influence. Nursing managers should prioritize interventions aimed at improving sleep quality and actively foster a supportive social environment to enhance safety performance.