Factors Influencing Hand Hygiene Speak-Up as Perceived by Nursing Students with Clinical Practice Experience: An Application of the Theory of Planned Behavior

Background and Aim: Hand hygiene is a cornerstone of infection prevention, and speaking up about hand hygiene non-compliance is increasingly emphasized as a key patient safety behavior. Although nursing students are future healthcare professionals, evidence regarding their hand hygiene speak-up behavior remains limited. This study aimed to identify factors influencing hand hygiene speak-up likelihood among nursing students during clinical practice. Methods A descriptive cross-sectional design was used. Participants were nursing students with clinical practice experience. Data were collected using validated instruments measuring the clinical learning environment, hand hygiene awareness, patient safety culture, hand hygiene speak-up climate, and hand hygiene speak-up. Data were analyzed using descriptive statistics, independent t-tests, Pearson’s correlation coefficients, and multiple regression analysis. Results Hand hygiene speak-up likelihood was significantly correlated with the clinical learning environment (r = .276, p < .001), hand hygiene awareness (r = .203, p = .012), patient safety culture (r = .261, p = .001), and hand hygiene speak-up climate (r = .346, p < .001). Multiple regression analysis identified hand hygiene speak-up climate (β = .242, p = .035) and duration of hand hygiene education (β = .185, p = .021) as significant predictors, explaining 13.1% of the variance. Conclusion Hand hygiene speak-up among nursing students is a multidimensional behavior influenced by educational exposure and organizational climate rather than individual awareness alone. Establishing a psychologically safe clinical learning environment and implementing repeated, simulation-based hand hygiene education are essential to strengthen nursing students’ willingness and confidence to speak up for patient safety.