Date of Conferral





Health Services


Richard Palmer


AbstractThe hand-hygiene practices of nonadherent health care workers (HCWs) are a major threat to patient safety and thus continue to be a concern for healthcare leaders and administrators worldwide. Healthcare-associated infections (HAIs), which are linked to HCWs' unclean hands, are prevalent throughout global healthcare settings. Global migration in the nursing profession and intercontinental travel among direct patient care providers make it challenging for healthcare leaders to sustain HCWs' adherence to hand-hygiene practices. The purpose of this grounded study was to explore the influence of the cultural beliefs about hand-hygiene practices of foreign-born HCWs. The theory of planned behavior was used to frame and support the study. Survey Monkey was used to recruit and distribute open-ended questions to 22 foreign-born HCWs in the United States over the age of 18. MAXQDA software data helped analyze, organize, and code the data and identify themes. The 'Cultural Influential Hand-hygiene Belief Actional Model for HCWs,' which was derived from the emergent themes, may help to effect positive social change by providing administrators with valuable information about how culture influences HCWs' hand-hygiene practices. Contributing salient factors of this model that highlight the foreign-born HCWs' cultural attitudes toward hand-hygiene are positive outlook, native cultural-religious beliefs pertaining to hand-hygiene, cultural personal experiences, foreign-born hand-hygiene culture, cultural guidance, barriers, and facilitators. Further, this study adds importance to social change because the findings of this study provide needed information of how foreign-born HCWs' culture and beliefs influence their intent to perform hand-hygiene practices, which can be used to help healthcare administrators foster and improve hand-hygiene-adherent practices among HCWs.