Periacetabular osteotomy, commonly performed for prearthritic hip dysplasia, was identified as a procedure that could benefit from an enhanced recovery after surgery pathway due to wide variation in multimodal pain management and regional anesthesia practices at our institution. The global aim of this project was to implement an enhanced recovery after surgery pathway for patients undergoing periacetabular osteotomy. Our SMART aim was to achieve greater than 70% compliance for the intraoperative medication bundle elements during the first PDSA cycle. A multidisciplinary pathway was designed and implemented with key stakeholders from the Departments of Evidence Based Practice, Anesthesiology, Orthopedic Surgery, and Perioperative Nursing. Patient data from all patients undergoing periacetabular osteotomy from 2018 to the present were analyzed, which included the baseline cohort as well as outcomes from two Plan-Do-Study-Act cycles. After ERAS implementation and two subsequent Plan-Do-Study-Act cycles, we observed a decrease in hospital length of stay from 3.34 days (95% CI [2.95, 3.72]) to 2.37 days (95% CI [2.00, 2.74]) and an intraoperative medication bundle compliance of 90%. These gains occurred with minimal change in average postoperative pain scores and no hospital readmissions within 30 days of surgery. Multidisciplinary enhanced recovery after surgery pathways continue to play a critical role in standardizing perioperative care, reducing unwarranted variation, and promoting faster recovery across paediatric populations.

Perioperative nursing based on the rapid rehabilitation concept reduces pain, accelerates recovery, and improves quality of life in children undergoing adenoidectomy.

To assess how social robots impact anxiety, pain, fear and stress in children and adolescents during perioperative nursing. A systematic review and meta-analysis of randomised controlled trials and quasi-experimental studies. Following Joanna Briggs Institute guidelines, eligible studies included participants under 21 undergoing surgery or perioperative care, used social robot interventions with comparators, assessed anxiety, pain, fear and stress, and employed randomised or quasi-experimental designs. Two independent reviewers screened and extracted data. A systematic search was conducted in April 2024 and updated twice (December 2024, October 2025) across CINAHL, Web of Science, Scopus, PubMed, Cochrane CENTRAL, Medic, PsycArticles, Institute of Electrical and Electronics Engineers and grey literature sources (Google Scholar, Mednar). Seven studies (663 participants) showed heterogeneity in social robotic interventions. A meta-analysis of two studies (302 participants) found a significant reduction in children's and adolescents' post-operative anxiety, whereas a narrative synthesis identified three studies reporting reduced perioperative anxiety. However, the interventions had little or no effect on perioperative pain, fear or stress. This review suggests that social robotic interventions may reduce perioperative anxiety in children and adolescents, potentially serving as non-pharmacological distraction tools in paediatric care. Evidence for their effects on pain, fear and stress is limited, highlighting the need for further research to identify effective interventions and clarify their role in perioperative nursing. This review highlights social robotic interventions as promising non-pharmacological tools for reducing perioperative anxiety in children and adolescents. Preferred Reporting Items for Systematic Reviews and Meta-Analyses and Synthesis Without Meta-Analysis reporting guidelines. No patient or public contribution. This review was registered in PROSPERO, the International Prospective Register of Systematic Reviews (https://www.crd.york.ac.uk/PROSPERO/view/CRD42024549796).

Impact of Specialty-Trained Perioperative Nurses on Operative Time, Costs, and Complications in Otolaryngologic Surgery.

Enhancing Safety in Pediatric Airway Management: An Integrative Review for Perioperative Settings.

Nursing Research on Postoperative Nausea and Vomiting: A Bibliometric Analysis.

Background: The perioperative context is characterized by high complexity and a significant risk of adverse events, requiring highly developed technical and non-technical competencies. Structured clinical supervision has been identified as a relevant strategy for professional development and for promoting the quality and safety of care, although the specific evidence in this context remains dispersed. Objective: To analyze the available scientific evidence on the impact of structured clinical supervision on nurses' professional development and on the quality and safety of care delivered in the perioperative setting. Methods: A systematic literature review was conducted in accordance with PRISMA 2020 recommendations. The search was performed in the PubMed, Web of Science, EBSCO, SciELO, BVS, and CONSENSUS databases and included studies published between January 2020 and October 2025 in Portuguese, English, or Spanish with full-text availability. The research question was structured according to the PICO strategy. Study selection was carried out in multiple stages (duplicate removal, screening by title and abstract, and full-text review), performed by two independent reviewers. Methodological quality was assessed using the Joanna Briggs Institute (JBI) checklists. Data synthesis was conducted through thematic narrative analysis, given the methodological heterogeneity of the included studies. Results: Twelve studies were included, predominantly qualitative and observational in nature, as well as psychometric validation studies, one Delphi study, and one quasi-experimental study. The findings show consistent convergence regarding the association between structured clinical supervision and the development of technical and non-technical competencies, namely communication, leadership, teamwork, situational awareness, and decision-making. The use of structured assessment instruments demonstrated good psychometric reliability and improved the quality of supervisory feedback. Organizational factors, such as protected time, specific training for supervisors, and role clarification, were identified as determinants of the effectiveness of the supervisory process. However, the predominance of non-experimental designs and the scarcity of objective clinical outcomes limit direct causal inference between structured supervision and measurable reduction in adverse events. Conclusions: The available evidence suggests that structured clinical supervision is a relevant component for the professional development of perioperative nurses and for strengthening the safety culture in the operating room. Despite the high conceptual consistency of the findings, the overall strength of evidence is moderate, and experimental and longitudinal studies are needed to consolidate the impact of supervision on objective clinical indicators of care quality and safety.

BackgroundThe operating room (OR) is a complex, high‐stress environment in which crisis situations place considerable demands on staff and compromise patient care. Despite the availability of crisis management training, existing research has predominantly relied on objective measures of effectiveness rather than examining nurses′ perceived preparedness to manage crises.AimThis study aims to explore nurses’ perceptions of crisis management in the OR, specifically what they perceive as a crisis situation, and which crises they consider important but feel insufficiently prepared to manage. Examining these dimensions allows for the identification of crisis situations representing priority areas for OR nurses’ training.MethodsThis exploratory qualitative study used focus group interviews with certified nurse anaesthetists, perioperative nurses, and nurse educators from anaesthesia and perioperative nursing programmes. Seven focus groups were analysed using qualitative content analysis, using an inductive approach with limited quantification.ResultsFive categories of crisis situations were identified: (1) interpersonal dynamics; (2) staffing and equipment constraints; (3) errors or incidents during the care process; (4) unexpected external events; and (5) deterioration in the patient’s condition. Participants reported feeling least prepared to manage interpersonal conflicts, emotional demands, and unexpected external events.ConclusionThis study identifies two critical training gaps. First, while nurses receive substantial training in procedural and technical crisis management, they perceive a significant lack of nontechnical skills training, particularly regarding interpersonal dynamics. Second, training related to low‐frequency, high‐impact crises appears insufficient.

The recently updated AORN "Guideline for the safe use of surgical energy devices" provides perioperative nurses with background information on surgical energy devices and ways to prevent patient and staff member injury during use. This article provides an overview of the guideline and discusses recommendations for assessment, planning, and injury prevention; surgical energy device generators; accessories; return electrodes; implanted electronic devices; and education. It also includes a clinical scenario that describes how perioperative nurses apply these recommendations in practice to prevent thermal injury and ensure the safe management of implanted electronic devices. Perioperative nurses should review the guideline in its entirety and apply the recommendations when using surgical energy devices.

Perioperative nursing presents unique challenges for novice nurses due to the highly technical environment, limited prelicensure exposure, and complex OR workflows. In response, AORN recommends structured, specialty-specific orientation programs to support knowledge acquisition, skill development, and professional socialization. Variability in onboarding experiences and extended orientation timelines have prompted enhancements to the existing perioperative orientation pathway. The revised program incorporated defined pathways, hands-on skills training, enhanced preceptor support, structured communication, and intentional socialization. Program effectiveness was evaluated using quantitative measures, including orientation length and retention, and qualitative feedback from orientees and preceptors collected through surveys and routine check-ins, including monthly "Preceptor Bubble" meetings. Outcomes demonstrated improved retention, reduced orientation duration, enhanced staff engagement, and improved safety practices. These findings support investing in structured perioperative orientation programs to strengthen workforce stability, support safe clinical practice, and facilitate nurses' transition into perioperative roles.

Intelligent technologies in operating room nursing: A bibliometric analysis of research.

Perioperative patient safety remains a major concern, as a substantial proportion of adverse events occur in surgical settings. Ensuring safe surgical care requires not only a strong safety culture among healthcare professionals but also good adherence to established safety standards. Nurses play a central role in maintaining perioperative safety in the operating room (OR). This study aims to assess perioperative compliance with established safety standards across all phases of surgical care, evaluate perioperative nurses' safety perceptions, and identify the factors associated with these perceptions. An analytical cross-sectional observational study was conducted in the OR of two university hospitals in Tunisia. An exhaustive sample of all perioperative nurses working in ten OR was targeted. Their perception of patient safety was assessed using a single-item measure adapted from the Hospital Survey on Patient Safety Culture (HSOPSC). Compliance with perioperative safety standards was evaluated through direct observation of a sample size of 266 surgical procedures, using the validated Surgical Patient Safety Observation Tool (SPOT). Descriptive and inferential statistical analyses were performed. All ethical considerations were respected. The majority of perioperative nurses rated patient safety in their units as good. Safety training (p = 0.020), regular protocol updates (p = 0.003), and effective communication (p = 0.018) were significantly associated with higher perceived safety. However, observational audit findings demonstrated that none of the SPOT dimensions reached the 90% threshold for good compliance, and the overall compliance with safety standards remained below 60%, indicating persistent weaknesses in perioperative safety practices. Communication and handover demonstrated the highest compliance (59%), whereas infection prevention was the lowest (36.5%). Although perioperative nurses reported generally favorable perceptions of patient safety, observed compliance with safety standards remained poor, highlighting a clear perception-practice gap. Key organizational factors, particularly safety training, regular protocol updates, and effective communication, were significantly associated with higher perceived safety. These findings stress the need for targeted, systemic interventions aimed at strengthening training, improving protocol dissemination, enhancing handover processes, and reinforcing infection prevention and surgical counting practices to improve perioperative patient safety.

The operating theatre is a high-risk, high-pressure environment where patient safety and surgical results may be at risk due to missed nursing care (MNC). To date, there has been no multi-centre survey exploring MNC among operating theatre nurses in China. Even though presenteeism and self-directed learning ability have been connected to the quality of care in other settings, less is known about how they relate to perioperative MNC, especially in China. To explore the current status and types of operating theatre nurses' MNC and to determine the correlation between presenteeism, self-directed learning ability and perioperative missed nursing care. A multicentre cross-sectional study was conducted among operating theatre nurses from July to September 2025 in public hospitals in Jiangsu Province, China. Data were collected using the self-developed demographic questionnaire, the MISSCARE Survey-Operating Room Scale, the Presenteeism Behaviour Questionnaire, and the Self-Directed Learning Ability Scale. Questionnaires were distributed and collected via the "Questionnaire Star" online platform. Data were analysed using SPSS version 27.0 for descriptive and inferential statistics. Binary logistic regression was used to identify factors associated with MNC. A total of 391 validated questionnaires were analysed (response rate: 94.22%). The incidence of MNC among operating theatre nurses was found to be 34.53%. Postoperative routine tasks demonstrated the highest omission rates, whereas safety-related activities had the lowest. The most frequently reported missed tasks were "checking whether the patient is wearing graduated compression stockings during surgery" and "allowing 3 minutes for antiseptic skin preparation solutions to dry". Human resource allocation (inadequate staffing and fatigue), material resource limitations, and poor teamwork emerged as primary contributors to missed care. Presenteeism was positively associated with the frequency of MNC, while self-directed learning ability showed a significant negative association-representing a previously underexplored relationship among perioperative nurses. According to the results of this study, missed nursing care is moderately prevalent among operating theatre nurses, which is correlated with organisational resources, presenteeism, and individual self-directed learning ability. To reduce missed nursing care, nursing managers may consider prioritising resolving staffing and material constraints, as well as addressing presenteeism. Enhancing self‑directed learning capabilities can be pursued as a long‑term professional development strategy alongside supportive cultural initiatives. Not applicable.

The rising use of C-arm fluoroscopy in operating rooms raises occupational safety concerns for perioperative nurses. They may face scattered ionizing radiation despite not being classified as radiation workers. This study compared posterior Crystalline Lens Density a key indicator of radiation-induced cataract among perioperative nurses working with C-arm fluoroscopy, interventional radiology staff, and a non-exposed control group to determine whether intermittent occupational exposure is associated with measurable lens changes. In this Cross-sectional comparative study, 150 participants (50 perioperative nurses with C-arm exposure, 50 non-exposed or staff, and 50 interventional radiology personnel) underwent standardized ophthalmic examination. Pentacam Nucleus Staging quantified posterior lens density; the worse eye was analyzed. Groups were compared using chi-square tests and ANCOVA with Bonferroni correction. Interventional radiology personnel exhibited significantly higher crystalline lens density (8.99 ± 1.50) compared with both perioperative nurses (8.40 ± 0.69; mean difference: 0.53, p = 0.001) and the control group (8.20 ± 0.27; mean difference: 0.70, p < 0.001). No significant difference was observed between perioperative nurses and controls (mean difference: 0.17, p = 0.539). The frequency of posterior subcapsular opacities (6.1% vs. 3.0% vs. 2.0%, p = 0.001), PNS grade ≥ 1 (17.1% vs. 8.0% vs. 3.9%, p = 0.002), and overall cataract prevalence (19.5% vs. 6.0% vs. 4.0%, p = 0.001) were all significantly higher in the interventional radiology group, with no significant differences between perioperative nurses and controls. Perioperative nurses showed no significant difference compared with unexposed controls. These findings suggest that intermittent C-arm exposure under typical distancing conditions poses minimal measurable risk. Specifically, such exposure does not appear to increase radiation-related lens changes. Clinical trial number not applicable.

This study evaluated the impact of a dedicated perioperative nursing team on operating theatre efficiency in robotic-assisted spinal surgery. A structured training programme was developed for a team of four perioperative nurses to achieve competence and autonomy in robotic system management across all phases of care. Operative data were retrospectively collected and compared between a pre-implementation phase and a post-implementation phase. A total of 130 robotic-assisted spinal procedures were analysed, including 47 performed before and 83 after team implementation. Following introduction of the specialised nursing team, mean time to surgical start decreased from 67.5 to 61.1 min, and overall operative duration was significantly reduced from 253.9 to 195.0 min. Implant execution time remained stable (30.0 min) despite a significant increase in the mean number of pedicle screws implanted per procedure from 4.9 to 6.4. Efficiency per screw improved markedly, with time per screw decreasing from 7.0 to 4.8 min. Three robotic procedures were abandoned in the pre-implementation period due to workflow-related issues, whereas no procedures were abandoned after introduction of the dedicated team. These findings demonstrate that the implementation of a specialised perioperative nursing team is associated with substantial improvements in workflow efficiency in robotic-assisted spinal surgery.

The recently updated AORN "Guideline for care and cleaning of surgical instruments" provides perioperative nurses with evidence-based guidance on instrument cleaning and ways to prevent surgical site infections. This article provides an overview of the guideline and discusses recommendations for prepurchase evaluation, processing before use, loaned items, water quality, personal protective equipment, point-of-use treatment, transport to the decontamination area, manual cleaning, and cleaning verification and inspection. A scenario illustrates the application of these practices when using a loaned instrument set. Perioperative nurses should review the guideline in its entirety and apply the recommendations to support infection prevention; protect patients and personnel; and ensure safe, evidence-based practice when caring for and cleaning surgical instruments.

Pressure injuries during the perioperative period can adversely affect postoperative outcomes and patient recovery. An essential component of prevention and patient care is systematic risk assessment. The Munro Pressure Ulcer Risk Assessment Scale is a perioperative-specific tool designed to evaluate patients' risk for pressure injuries, enabling early identification of high-risk individuals and facilitating timely preventive interventions by perioperative nurses. This methodological study aimed to evaluate the validity, reliability, and diagnostic Accuracy of the Munro Pressure Ulcer Risk Assessment Scale (Munro Scale) in adult patients undergoing surgery. This methodological study was conducted on a sample of 200 adult surgical patients from October 2024 to May 2025. Data were collected using the Munro Pressure Injury Risk Assessment Scale alongside a demographic questionnaire. The scale underwent a rigorous process of translation and cultural adaptation following established methodological standards. Psychometric testing encompasses evaluations of content validity, construct validity, and Cronbach's alpha coefficient. Out of 200 surgical patients, 37 (18.5%) developed pressure injuries, mostly classified as Stage I and Stage II. Confirmatory factor analysis (CFA) was conducted using AMOS to evaluate the construct validity of the scale, which included three latent factors: preoperative, intraoperative, and postoperative risk factors. Factor loadings for most items exceeded 0.4, indicating acceptable item relevance. Reliability analysis showed Cronbach's alpha values of 0.84, 0.62, and 0.83 for the preoperative, intraoperative, and postoperative factors, respectively. Composite reliability (CR) values were 0.83, 0.71, and 0.82, confirming acceptable internal consistency. The Munro Scale demonstrated acceptable reliability and validity, confirmatory factor analysis indicating a moderate or limited fit. This scale can be used to assess the risk of pressure injuries in perioperative patients.

Perioperative meticulous nursing in patients undergoing general anesthesia: a randomized controlled trial

Introduction: This study examined the relationship between person-centered perioperative nursing care and spiritual support perception of nurses working in surgical units. Design: In this descriptive and correlational study, 426 surgical nurses working in Türkiye between March and November 2024 constituted the sample. Data were collected using Google Forms through a personal information form, the Person-Centered Perioperative Nursing Scale, and the Perception of Spiritual Support Scales. Participants were reached using a virtual snowball sampling method. Results: The mean of the person-centered perioperative nursing scale was 80.07 ± 9.22, and spiritual support scale was 51.13 ± 6.78. There was a statistically significant difference between the institution of employment, participation in a conference on surgical nursing, and any training on person-centered perioperative care and the person-centered perioperative nursing scale (p < 0.05). Person-centered perioperative nursing had a statistically significant and positive effect on the perception of spiritual support (β = 0.265, p < 0.05), and 13% of the variance in the model was explained. Conclusion: The study found that person-centered perioperative care effectively promoted the perception of spiritual support. Therefore, nurses working in surgical settings are recommended to receive training on person-centered perioperative care to improve their perception of spiritual support, thereby enabling them to provide holistic care.

Enhanced Recovery After Surgery (ERAS) pathways have been adapted for open and lower extremity vascular surgery and increasingly guide perioperative care for older adults. However, little is known about how perioperative nurses implement ERAS-consistent and geriatric-focused practices for older patients undergoing open and hybrid aortic procedures, particularly in hybrid operating room settings and in Chinese hospitals, where pathway maturity and geriatric integration may vary across centres. To describe perioperative nurses' implementation of ERAS-consistent and geriatric-focused nursing practices for older adults undergoing open and hybrid aortic vascular surgery in China, and to identify nurse- and organisation-level factors associated with higher implementation, with attention to modifiable determinants (training, ERAS pathways, staffing). Registered nurses working in operating theatres/hybrid operating rooms, post-anaesthesia care units, intensive care/high-dependency units, vascular surgical wards and pre-assessment clinics in eight tertiary general hospitals in Shanxi Province, China, were surveyed between March and July 2024. The Geriatric-Focused Vascular ERAS Nursing Practices Questionnaire, developed from ERAS/SVS guidelines and geriatric surgery literature, measured nurse-reported implementation across perioperative domains, geriatric-focused elements, attitudes and perceived barriers. The instrument underwent expert review, pilot testing and internal consistency assessment, while more advanced psychometric testing was beyond the scope of this initial multicentre study. Data were analysed using descriptive statistics, group comparisons and multivariable linear regression; free-text responses were examined using inductive qualitative content analysis. The study was conceptually informed by a Donabedian structure-process-outcome framework and a capability-opportunity-motivation perspective on behaviour change. Of 640 eligible nurses, 428 provided analysable responses (usable response rate 66.9%). The global ERAS implementation score (1-5) was 3.41 (SD 0.49). Implementation was highest for intraoperative/post-anaesthesia practices (3.82, SD 0.61) and preoperative education/optimisation (3.63, SD 0.72), and lowest for frailty and cognitive/delirium assessment (2.71, SD 0.81). Routine frailty assessment was reported by 23.4% and routine use of structured delirium screening tools by 30.8%. Higher implementation was independently associated with ERAS-specific training (B = 0.28, p < 0.001), geriatric/frailty training (B = 0.12, p = 0.008), working in hospitals with a formal ERAS pathway (B = 0.24, p < 0.001), higher perceived staffing adequacy (B = 0.09, p = 0.004), and greater experience (B = 0.04 per 5 years, p = 0.012) (adjusted R2 = 0.38). Qualitative findings highlighted ERAS as an "ideal rather than daily reality", challenges in technology-dense environments, fragmented responsibilities, and the need for leadership and tailored education. Perioperative nurses in these tertiary hospitals reported moderate implementation of ERAS-consistent care for older adults undergoing open and hybrid aortic vascular surgery, with substantial gaps in frailty assessment, delirium screening and geriatric-tailored practices. These gaps are clinically important because they may limit timely risk recognition and tailoring of perioperative care in a high-risk older surgical population. ERAS-specific and geriatric training, hospital-level ERAS pathways, perceived staffing adequacy and experience were associated with higher implementation and represent important modifiable targets, although causal relationships cannot be inferred from this cross-sectional survey.