Determinants of Perioperative Nurse Competencies in China: A Descriptive Predictive Study

Determinants of Perioperative Nurse Competencies in China: A Descriptive Predictive Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Determinants of Perioperative Nurse Competencies in China: A Descriptive Predictive Study Cong Fu, Kulwadee Abhicharttibutra, Wanchai Lertwatthanawilat, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7549168/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Perioperative competency is essential for ensuring high-quality patient care, enhancing job performance, and maintaining effective healthcare operations. However, the determinants of perioperative nurse competencies remain underexplored. Aims This study aimed to identify predictors of perioperative competency among operating room (OR) nurses in Chinese tertiary hospitals, including special OR training, years of OR experience, work self-efficacy, resilience, individual empowerment, workplace bullying, and ethical climate. Methods A cross-sectional predictive study was conducted among 287 OR nurses from five tertiary hospitals in China using a multi-stage sampling method. Validated Chinese versions of the Perceived Perioperative Competency Scale-Revised, Connor-Davidson Resilience Scale, Qualities of an Empowered Nurse Scale, Work Self-Efficacy Inventory, Negative Acts Questionnaire-Revised, and Hospital Ethical Climate Survey were administered. Stepwise multiple linear regression was performed to identify significant predictors. Results Years of OR experience (β = 0.376, p < 0.001), special training (β = 0.550, p < 0.001), resilience (β = 0.190, p < 0.001), individual empowerment (β = 0.217, p < 0.001), work self-efficacy (β = 0.170, p < 0.001), and ethical climate (β = 0.147, p < 0.001) positively predicted perioperative competency, whereas workplace bullying showed a negative correlation (β = − 0.098, p < 0.001). Together, these factors accounted for 79.4% of the total variance in perioperative competency. Conclusion Modifiable factors such as resilience, self-efficacy, ethical climate, and empowerment significantly influence perioperative competency. These findings highlight the need for targeted interventions to improve nursing competency and patient outcomes. Individual empowerment Nurse competency Perioperative Resilience Work self-efficacy Workplace bullying Ethical climate Introduction Surgery constitutes a fundamental treatment modality for a wide range of diseases, with millions of procedures performed globally each year. Surgical interventions are responsible for approximately 13% of disability-adjusted life years worldwide [ 1 ]. In China, more than 82 million inpatient surgeries are carried out annually, the majority (70%) in general hospitals [ 2 ], highlighting the operating room (OR) as a critical high-stakes clinical setting. OR nursing requires specialized knowledge and adaptability, driven by the rapid incorporation of advanced technologies, sophisticated instrumentation, and the need for coordinated care throughout the preoperative, intraoperative, and postoperative phases [ 3 , 4 ]. Perioperative competency—defined as the integration of clinical expertise, critical thinking, and interpersonal skills essential for ensuring patient safety and achieving successful surgical outcomes—is therefore indispensable for OR nurses [ 5 ]. This competency directly affects nursing performance, job satisfaction, patient experience, and institutional efficiency [ 6 – 8 ]. The Social Ecological Model offers a valuable framework for understanding the multi-level determinants of perioperative competency, encompassing intrapersonal, interpersonal, and organizational factors [ 9 ]. Previous research has identified several predictors at the intrapersonal level, including specialized training, clinical experience, income, resilience, self-efficacy, and empowerment [ 10 – 13 ]. At the interpersonal and organizational levels, workplace bullying and ethical climate have also been significantly associated with nursing competency [ 14 , 15 ]. However, most existing studies have focused on socio-demographic correlates or isolated psychological traits, with limited investigation into the combined predictive effects of these multi-level factors within an integrated theoretical framework. This gap is especially prominent in the Chinese context, where a considerable proportion of OR nurses are in the early stages of their careers and often encounter high workloads and challenges in skill acquisition [ 16 ]. Despite the relevance of the Social Ecological Model for capturing complex influences on clinical competency, no known studies in China have utilized this model to comprehensively examine predictors of perioperative nursing competency. Understanding the factors that influence perioperative competency is crucial for enhancing nursing practice and the quality of surgical care. Thus, this study aims to address this research gap by investigating how specialized training, clinical experience, resilience, work self-efficacy, empowerment, workplace bullying, and ethical climate collectively predict perioperative competency among OR nurses in China. METHODS Study design A descriptive predictive study was conducted to examine the level of perioperative competency among operating room (OR) nurses in tertiary hospitals in Hebei Province, China, and to identify predictors of competency, including special OR training, years of perioperative experience, work self-efficacy, resilience, individual empowerment, workplace bullying, and ethical climate. Study setting and participants The target population study was OR nurses across 22 tertiary hospitals (each with ≥ 2,500 beds) in Hebei Province, China. A multi-stage sampling method was used to randomly select one hospital from each of the five geographic regions of the province (eastern, southern, western, northern, central). The sample size was calculated based on 30 participants per variable [ 17 ], yielding a minimum requirement of 240 respondents. Accounting for a potential 20% attrition rate [ 18 ], the target sample was set at 288. Eligible participants were registered nurses with at least one year of OR experience. Nurses who were on maternity or extended sick leave (> 1 month), pursuing further education, or in managerial roles were excluded. Instruments Original authors granted permission via email for the use of all research instruments. The following instruments were employed: Demographic data form: Developed by the researchers, this form collected information on age, gender, marital status, professional job title, highest level of education, income, special OR training, and years of OR experience. Chinese Perceived Perioperative Competency Scale-Revised (C-PPCS-R): The Chinese adaptation of the PPCS-R [ 5 ], translated by Yu [ 4 ], comprises 34 items across six dimensions: foundational knowledge and skills, leadership, collaboration, proficiency, empathy, and professional development. Items are rated on a 5-point Likert scale. Cronbach`s α for the overall scale was 0.97. Total scores range from 34–170, with 102–136 indicating medium competency, 136 high [ 4 ]. Chinese Connor–Davidson Resilience Scale (CD-RISC)[ 19 ]: Translated by Yu [ 20 ], this 25-item scale measures resilience across three factors: tenacity, strength, and optimism, using a 5-point response scale. Cronbach`s α was 0.95. Total scores range from 0–100, with higher scores indicating greater resilience (0–60: low; 61–69: medium; 70–79: good; 80–100: high) [ 20 ]. Qualities of an Empowered Nurse (QEN) scale: This 19-item tool assesses individual empowerment across five dimensions: ethical values, personal integrity, professional competence, forward-looking orientation, and social interaction. Items are rated on a 5-point Likert scale. Cronbach`s α was 0.96. Total scores range from 19–95 (19–47.5: low; 47.5–66.5: medium; 66.5–95: high) [ 13 ]. Work Self-Efficacy Inventory (WS-Ei): A 30-item tool evaluating self-efficacy in workplace tasks across six dimensions: learning, problem-solving under pressure, understanding role responsibilities, teamwork, interpersonal awareness, and navigating organizational dynamics. Items use a 5-point Likert scale. Cronbach`s α was 0.97. Total scores range from 30–150 (30–90: low; 90–120: medium; 120–150: high) [ 22 ]. Chinese Negative Acts Questionnaire-Revised (NAQ-R)[ 23 ]: Translated by Xun [ 24 ], this scale measures workplace bullying across three dimensions: work-related bullying, person-related bullying, and organizational injustice, using a 5-point Likert scale. Cronbach`s α was 0.97. Scores 45 severe bullying [ 24 ]. Chinese Hospital Ethical Climate Survey (HECS)[ 25 ]: Translated by Lu [ 26 ], this tool assesses perceptions of the ethical environment across five subscales: peers, patients, managers, hospitals, and physicians. Items are rated on a 5-point Likert scale. Cronbach’s α was 0.97. Total scores range from 25–125 (25–90: low; 91–109: medium; 110–125: high) [ 26 ]. Data collection Data were collected from October to December 2024. Researchers sent online recruitment advertisements to head nurses of five hospitals, who then distributed them to OR nurse WeChat groups. Interested nurses contacted the researchers voluntarily. A total of 288 questionnaires were collected; one was excluded due to uniform responses, resulting in 287 valid samples. Data analysis Descriptive statistics were computed for demographic and scale variables. Multiple regression assumptions (homoscedasticity, normality of residuals, linearity, absence of outliers, and multicollinearity) were checked [ 18 ]. The leverage maximum value was 0.10), and VIF values ranged from 1.072–2.109 (< 10), meeting all assumptions [ 18 ]. Stepwise multiple regression was performed to identify predictors of perioperative competency at α = 0.05. Ethical considerations Ethical approval was obtained from the Institutional Review Board of [Faculty of nursing Chiang mai University] (Reference No. 080/2024), and permission was secured from each hospital. The study adhered to the Declaration of Helsinki. Participants provided voluntary informed consent, and anonymity and confidentiality were maintained throughout. Results Demographic characteristics Most participants were female (74.90%), with a mean age of 35.05 years (SD = 6.75) and married (80.50%). Years of OR experience ranged from 2–20 (92.30%), with a mean of 11.23 (SD = 6.61). Nearly half held an intermediate job title (54.70%), and most had a technical secondary school education (83.30%). Special OR training was received by 179 nurses (62.40%), and monthly income was 412.80–688.00 USD for 125 participants (43.60%) (Table 1 ). Table 1 Demographic characteristics of the study subjects (n = 287) Demographic Characteristic Frequency Percentage Age (year)༈max = 55, min = 22, x̅=35.05, SD = 6.75༉ 22–30 82 28.57 31–40 149 51.92 41–50 50 17.42 more than 50 6 2.09 Gender Female 215 74.90 Male 72 25.10 Marital status Single 49 17.10 Married 231 80.50 Others (divorced and widowed) 7 2.40 Years of OR experience (max = 38, min = 2, x̅=11.23, SD = 6.61) 2–10 134 46.70 11–20 130 45.60 21–30 20 7.00 more than 30 2 0.60 Professional Job title Junior nurse 96 33.40 Intermediate nurse 157 54.70 Senior nurse 34 11.80 Highest level of education Technical Secondary School 239 83.30 Bachelor’s Degree 48 16.70 Special OR training Yes 179 62.40 No 108 37.60 Income <3000yuan (9000yuan (>1,238.40US) 5 1.70 Description of variables As shown in Table 2 , among technical competencies, foundational knowledge and skills had the highest mean score (x̅=4.06, SD = 0.84), while proficiency had the lowest (x̅=2.89, SD = 1.33). Among non-technical competencies, collaboration scored highest (x̅=3.54, SD = 0.97), and professional development lowest (x̅=2.77, SD = 1.31). Table 2 Mean, standard deviation, maximum, and minimum of dimensions of perioperative competency Dimension Mean SD max min Foundational Knowledge and Skills* 4.06 0.84 5.00 1.50 Leadership** 3.51 1.05 5.00 1.00 Collaboration** 3.54 0.97 5.00 1.20 Proficiency* 2.89 1.33 5.00 1.00 Empathy** 3.05 1.14 5.00 1.00 Professional Development** 2.77 1.31 5.00 1.00 Note.*=Technical and **=Non-technical categories As shown in Table 3 , perioperative competency was at a medium level (x̅=115.11, SD = 12.58). Workplace bullying scores indicated severe bullying (x̅=74.76, SD = 8.61). Resilience (x̅=64.21, SD = 5.86), work self-efficacy (x̅=101.18, SD = 9.73), and individual empowerment (x̅=64.37, SD = 6.28) were at medium levels, while ethical climate was low (x̅=85.82, SD = 8.16). Table 3 Descriptive statistics, correlation analysis, and levels of variables (n = 287) Variables mean SD Perioperative competency Resilience Individual empowerment Work self-efficacy Workplace bullying Ethical climate Perioperative competency 115.11 12.58 1 Resilience 64.21 5.86 0.536* 1 Individual empowerment 64.37 6.28 0.580* 0.539* 1 Work self-efficacy 101.18 9.73 0.562* 0.506* 0.513* 1 Workplace bullying 74.76 8.61 -0.249* -0.088 -0.125* -0.241* 1 Ethical climate 85.82 8.16 0.513* 0.497* 0.491* 0.459* -0.140* 1 *p < 0.05 Table 4 Multivariate regression analysis of perioperative competency predictors (n = 287) Variables B SE β t R Adjusted R Square SE of Estimate F Model 1 Constant 101.997 1.139 89.560* .632 .397 9.767 189.247* Years of perioperative nursing experience 1.203 .087 .632 13.757* Model 2 Constant 80.891 1.858 43.541* .789 .621 7.747 234.927* Years of perioperative nursing experience 1.499 .073 .787 20.536* Special training related to OR 12.917 .994 .498 13.001* Model 3 Constant 37.507 5.028 7.460* .842 .706 6.822 229.742* Years of perioperative nursing experience 1.102 .078 .579 14.197* Special training related to OR 13.541 .878 .523 15.431* Individual empowerment .730 .080 .364 9.125* Model 4 Constant 15.523 5.641 2.752 .867 .748 6.320 212.687* Years of perioperative nursing experience .922 .076 .484 12.061* Special training related to OR 13.656 .813 .527 16.794* Individual empowerment .581 .077 .290 7.536* Work Self-efficacy .330 .048 .255 6.908* Model 5 Constant .501 5.959 .084 .881 .773 5.992 195.802* Years of perioperative nursing experience .827 .074 .435 11.123* Special training related to OR 14.057 .774 .542 18.157* Individual empowerment .471 .076 .235 6.228* Work Self-efficacy .270 .047 .209 5.792* Resilience .448 .078 .209 5.717* Model 6 Constant -10.204 6.315 -1.616 .889 .786 5.819 176.003* Years of perioperative nursing experience .735 .075 .386 9.749* Special training related to OR 14.293 .754 .551 18.958* Individual empowerment .432 .074 .216 5.829* Work Self-efficacy .248 .045 .192 5.441* Resilience .390 0.77 .182 5.042* Ethical Climate .232 .055 .150 4.237* Model 7 Constant 2.677 7.194 .372 .894 .794 5.705 158.743* Years of perioperative nursing experience .716 .074 .376 9.654* Special training related to OR 14.244 .739 .550 19.269* Individual empowerment .435 .073 .217 5.997* Work Self-efficacy .219 .045 .170 4.839* Resilience .407 .076 .190 5.361* Ethical Climate .227 .054 .147 4.229* Workplace bullying − .143 .041 − .098 -3.515* *p < 0.001 As shown in Table 4 , the final model indicated that years of OR experience (β = 0.376, p < 0.001), special OR training (β = 0.550, p < 0.001), resilience (β = 0.190, p < 0.001), individual empowerment (β = 0.217, p < 0.001), work self-efficacy (β = 0.170, p < 0.001), and ethical climate (β = 0.147, p < 0.001) positively predicted perioperative competency, while workplace bullying was negatively correlated (β=–0.098, p < 0.001). The model explained 79.4% of the variance (R = 0.894, Adjusted R²=0.794, F = 158.743, p < 0.001). Discussion Perioperative competency among OR nurses The findings of this present study indicate that the overall perioperative competency among nurses in tertiary hospitals in Hebei Province is at a moderate level (x̅ = 115.11, SD = 12.58; Table 3 ), which is consistent with previous national and international studies[3]. For instance, a survey conducted in Guangdong Province, China, also reported moderately low competency levels among operating room nurses [16]. Similarly, studies from Turkey and South Korea observed that although perioperative nurses did not demonstrate high overall competency, they performed relatively well in technical domains—such as foundational knowledge and operative skills—while exhibiting weaker non-technical competencies, including leadership and professional development [27]. This pattern may be attributed to several factors. First, staffing shortages in tertiary hospitals contribute to high surgical volumes and intense workload pressures, limiting nurses’ capacity to develop both technical and non-technical skills simultaneously [ 28 ]. Second, inconsistencies in perioperative nursing education and training systems across regions, coupled with limited opportunities for specialized training within undergraduate curricula, may hinder professional development [ 29 ]. Additionally, previous studies have identified deficits in critical thinking and research skills among nurses, underscoring the need for enhanced continuing education and institutional support to foster comprehensive competency development [ 30 ]. A notable disparity between technical and non-technical competencies was observed. The high scores in foundational knowledge and skills reflect an emphasis on standardized training and procedural rigor, aligning with existing literature [ 31 ]. However, the lower proficiency scores suggest a gap in applying acquired knowledge to complex and unpredictable clinical situations—a finding consistent with reports that advanced proficiency requires extensive practical experience and specialized training [ 31 ]. Within non-technical domains, scores in leadership, collaboration, and empathy indicated that these competencies are integrated but not fully mastered. This resonates with studies noting that interpersonal and leadership skills are often undervalued in highly technical environments such as the operating room [ 32 ]. Of particular concern is the low score in professional development, reflecting restricted opportunities for continuous learning and career advancement—an issue also highlighted in recent research on nursing education and organizational support [ 33 ]. These findings underscore the need for structured educational initiatives that integrate technical and non-technical training to promote a holistic approach to perioperative nursing excellence. Analysis of predictors of perioperative competency Guided by the Social Ecological Model [ 9 ], this study demonstrates that perioperative competency is shaped by a complex interplay of factors across intrapersonal, interpersonal, and organizational levels. The multiple regression analysis confirmed several of the hypothesized predictors. At the intrapersonal level, years of OR experience (β = 0.376, p < 0.001), specialized OR training (β = 0.550, p < 0.001), resilience (β = 0.190, p < 0.001), individual empowerment (β = 0.217, p < 0.001), and work self-efficacy (β = 0.170, p < 0.001) were significantly associated with higher perioperative competency. At the organizational level, a positive ethical climate also contributed to competency (β = 0.147, p < 0.001). In contrast, workplace bullying at the interpersonal level demonstrated a negative correlation with competency (β = − 0.098, p < 0.001). Collectively, these predictors accounted for 79.4% of the variance in perioperative competency (adjusted R² = 0.794; Table 4 ), underscoring the utility of the social ecological framework in understanding competency development. These findings affirm that perioperative competency is influenced not only by individual attributes but also by relational and contextual factors. The personal qualities of nurses, the quality of collaboration among colleagues, and the broader organizational environment each play critical roles in shaping competency. supportive interpersonal relationships and a positive ethical climate facilitate a conducive learning and working atmosphere, thereby enhancing professional competence. It is important to note, however, that other factors beyond those examined may also influence perioperative competency. Existing literature suggests that national policies, opportunities for professional development, and nurses’ decision-making abilities represent additional determinants [ 34 ]. Policy initiatives can provide structural support for competency-building programs, professional advancement opportunities may motivate skill acquisition, and decisional autonomy can further refine clinical judgment. Thus, while the current model explains a substantial proportion of variance, it does not fully capture all potential predictors of perioperative competency. Future studies incorporating these additional dimensions could yield a more comprehensive understanding of competency development in perioperative nursing. The predictive relationship between years of OR experience and perioperative competency At the intrapersonal level, years of operating room experience demonstrated a significant positive effect on perioperative competency (β = 0.372, p < 0.001; Table 4 ). This finding aligns with Gillespie’s research [ 35 ], reinforcing that greater clinical experience is closely associated with higher competency levels among OR nurses. Accumulated experience allows nurses to develop familiarity with surgical procedures, instrument handling, and emergency management—such as responding to hemorrhage or anesthesia-related incidents [ 36 ]. Furthermore, experienced nurses are able to recognize potential surgical risks, such as improper patient positioning or instrument contamination, more rapidly than novices, who often depend heavily on standardized protocols. Extended exposure to high-pressure environments also enhances stress adaptability, thereby reducing error rates under demanding conditions [ 36 ]. Additionally, nurses with longer tenure are more likely to have participated in advanced training programs (e.g., specialized surgical coordination or simulation exercises), whereas those newer to the role typically receive only basic pre-service training [ 28 ]. Thus, years of OR experience serve as a crucial predictor of perioperative nursing competency. The predictive relationship between special OR training and perioperative competency in the operating room At the intrapersonal level, specialized OR training demonstrated a strong positive correlation with perioperative competency (β = 0.550, p < 0.001; Table 4 ), indicating that such training plays a critical role in enhancing nurses’ clinical capabilities. In China, formal specialty training for operating room nurses—typically organized by the Chinese Nursing Association—spans three months, combining one month of theoretical instruction with two months of practical clinical training [ 28 ]. The curriculum is nationally standardized, and participants who pass the final assessment receive a professional certification. Nurses who undergo this structured training—which often includes simulation drills and courses in specialized surgical coordination—show improved performance in technical skills, emergency response, and teamwork compared to those without such training. The benefits of specialized training are multifaceted: it promotes efficiency in surgical coordination through standardized protocols (e.g., aseptic technique and instrument handling), reducing operational errors [ 37 ]; high-fidelity simulations enhance preparedness for managing rare complications such as hemorrhage or anesthesia accidents, thereby strengthening clinical decision-making [ 29 ]; and it facilitates exposure to advanced technologies, such as robot-assisted surgery, helping to bridge gaps left by conventional academic education [ 10 ]. To maximize effectiveness, a tiered training system is recommended—one that reinforces foundational skills for novice nurses while emphasizing leadership and management competencies for senior staff. Incorporating interdisciplinary training could further improve team collaboration and overall perioperative performance [ 37 ]. Nevertheless, the outcomes of training may vary based on individual learning capabilities and institutional resource allocation. Long-term follow-up and evaluation are essential to ensuring sustained educational impact and competency development. The predictive relationship between resilience and perioperative competency At the intrapersonal level, resilience was significantly and positively associated with perioperative competency (β = 0.190, p < 0.001; Table 4 ). Resilience refers to the ability of OR nurses to effectively cope with stress and adversity, encompassing traits such as personal competence, self-trust, adaptability, sense of control, and emotional steadiness that enable individuals to thrive under challenging conditions. Nurses with higher resilience demonstrated stronger performance in managing surgical stressors, functioning within teams, and responding to emergencies. In contrast, those with lower resilience were more susceptible to operational errors and communication difficulties under pressure. The ability to maintain composure during critical events—such as hemorrhage or equipment failure—enables resilient nurses to make calm, effective decisions [ 29 ]. Conversely, less resilient nurses may experience impaired focus under stress, increasing the risk of errors in instrument handling or delayed resuscitation [ 29 ]. Resilience also mitigates emotional exhaustion and reduces vulnerability to burnout, thereby supporting sustained performance. For instance, highly resilient nurses maintain proficiency during extended work hours—such as back-to-back surgeries or night shifts—and demonstrate greater engagement in learning from complex surgical experiences, which accelerates skill acquisition [ 11 ]. These findings are consistent with global studies on resilience among nurses [ 11 ], yet the unique demands of perioperative settings—such as high-intensity workloads and complex interpersonal dynamics—highlight the especially critical role of resilience in this specialty [ 28 ]. Within the hierarchical structure characteristic of Chinese operating rooms, nurses with higher resilience are better equipped to adapt to formal and informal leadership demands, thereby enhancing team functionality despite structural constraints. Thus, resilience constitutes a key predictor of perioperative competency, underscoring the need for structured interventions that foster resilience at both individual and organizational levels to promote sustainable professional growth. The predictive relationship between individual empowerment and perioperative competency At the intrapersonal level, this study identified a significant positive association between individual empowerment and perioperative competency (β = 0.217, p < 0.001; Table 4 ) Individual empowerment reflects a process shaped by both personal attributes—such as values, qualities, and initiative—and contextual factors within the work environment. Empowered OR nurses are often driven by social competence and a commitment to act in accordance with humanistic values [ 21 ], which fosters greater openness to adopting new technologies and enhances performance in surgical decision-making, teamwork, and emergency management. In contrast, nurses with lower levels of empowerment tend to rely more heavily on standardized protocols and demonstrate reduced adaptability in complex clinical situations. Empowerment strengthens clinical judgment by facilitating active participation in decision-making processes, such as selecting appropriate instruments intraoperatively or adapting emergency plans [ 29 ]. For instance, empowered nurses who adjust instrument placement based on surgical preferences can reduce procedural delays by up to 20% [ 6 ]. Furthermore, empowered nurses exhibit greater initiative in resource acquisition—such as obtaining specialized instruments or additional staff—and utilize informal communication channels to resolve issues efficiently, ultimately decreasing preoperative preparation time by an average of 15% [ 13 ]. Thus, individual empowerment enhances perioperative competency by promoting autonomy, improving resource mobilization, and reinforcing professional identity. However, the implementation of empowerment strategies should be tailored to align with local organizational cultures and healthcare contexts to maximize their effectiveness. The predictive relationship between work self-efficacy and perioperative competency At the intrapersonal level, work self-efficacy demonstrated a significant positive correlation with perioperative competency (β = 0.170, p < 0.001; Table 4 ). Work self-efficacy refers to nurses’ confidence in their ability to perform workplace tasks effectively and achieve desired outcomes across domains such as learning, problem-solving under pressure, role mastery, teamwork, interpersonal sensitivity, and navigating organizational dynamics [ 12 ]. Nurses with higher self-efficacy exhibited stronger performance in complex surgical coordination, emergency management, and the adoption of new technologies. In contrast, those with lower self-efficacy were more prone to hesitation during intraoperative emergencies—such as hemorrhage or equipment malfunctions—and required approximately 30% more time to adapt to new technologies [ 38 ]. This discrepancy may be attributed to the greater assurance that self-efficacious nurses possess in managing unforeseen challenges, such as rapidly identifying bleeding sources or adjusting instrument sequences, leading to more decisive clinical actions [ 39 ]. Such confidence can partly compensate for limitations in structural empowerment. For example, during laparoscopic procedures, nurses with high self-efficacy demonstrated 22% greater accuracy in instrument handling compared to their less confident counterparts [ 38 ]. Additionally, self-efficacy helps mitigate the effects of stress during prolonged surgeries or interpersonal conflicts, thereby supporting consistent performance. Neuroscientific evidence suggests that individuals with high self-efficacy show enhanced prefrontal cortex activation under stress, facilitating rational judgment and cognitive control [ 38 ]. These findings highlight the value of fostering self-efficacy through targeted interventions. Novice nurses may benefit from simulation-based training to accumulate positive experiences and build foundational confidence, while experienced nurses could reinforce their professional identity and efficacy through peer mentoring or clinical teaching. Ultimately, enhancing work self-efficacy contributes to perioperative competency by strengthening confidence, stress resilience, and the effective application of skills in clinical practice. The predictive relationship between workplace bullying and perioperative competency At the interpersonal level, workplace bullying was significantly and negatively associated with perioperative competency (β = − 0.098, p < 0.001; Table 4 ), indicating that a hostile work environment undermines both nurses’ professional motivation and clinical performance [ 14 ]. Workplace bullying is characterized by persistent and repeated interpersonal aggression—including work-related criticism, personal attacks, and intimidation—perpetrated by colleagues, supervisors, or subordinates. Such behaviors exert detrimental effects on victims’ psychological well-being and occupational functioning. Exposure to workplace bullying inflicts both physical and psychological trauma, directly impairing perioperative competency [ 40 ]. Nurses subjected to bullying are more likely to develop anxiety and depression, which diminish their resilience and capacity to cope with high-stress situations [ 41 ]. This compromised psychological state reduces their effectiveness in complex surgical environments. Furthermore, perioperative care relies heavily on interdisciplinary teamwork, and bullying erodes trust and communication among staff, leading to dysfunctional collaboration that jeopardizes surgical outcomes and patient safety [ 40 ]. As evidenced by Obeidat et al. [ 14 ], a robust negative correlation exists between workplace bullying and nursing competency. Within the socio-ecological framework [ 9 ], bullying operates at the interpersonal level yet permeates individual functioning by damaging psychosocial resources and organizational climate [ 42 ]. Thus, mitigating bullying is essential for sustaining perioperative competency. Interventions aimed at fostering psychological resilience, enhancing self-efficacy, and promoting a respectful work environment may help buffer these negative effects, ultimately supporting both nurse performance and patient safety in the operating room. The predictive relationship between ethical climate and perioperative competency At the organizational level, ethical climate was significantly and positively associated with perioperative competency (β = 0.147, p < 0.001; Table 4 ), indicating that a supportive ethical environment contributes directly to nursing proficiency through enhanced teamwork and increased job satisfaction [ 15 ]. Ethical climate is defined as the shared perception among nurses regarding ethically appropriate behavior and how moral issues are handled within the organization. It encompasses nurses’ relationships with peers, patients, managers, the hospital as a whole, and physicians [ 43 ]. In the operating room, where effective interdisciplinary interaction is critical, the quality of the ethical climate is reflected in daily practices and decision-making. Nurses working in environments with a well-established ethical climate demonstrate stronger performance in patient safety, ethical reasoning, and collaborative care. They exhibit greater discipline and consistency when confronting ethical challenges, such as responding to sudden changes in patient wishes during surgery. Conversely, those in settings with a less developed ethical climate are more prone to ethical omissions—for example, deficiencies in the informed consent process—and report burnout rates 35% higher than those in more ethically conscious institutions [ 44 ]. A clearly defined ethical climate reduces ambiguity by providing structured guidelines and facilitating ethical decision-making. For instance, in units with strong ethical climates, nurses can promptly initiate multidisciplinary consultations when unexpected intraoperative events—such as emergent hemorrhage—require rapid changes in the surgical plan. Such environments encourage nurses to assume ethical responsibility, thereby promoting operational rigor and accountability [ 45 ]. While this study reinforces the established positive correlation between ethical climate and clinical quality [ 46 ], it is important to note that ethical climates in Chinese hospitals often emphasize collective decision-making processes, including the active involvement of ethics committees, contrasting with more individualistic approaches typical in Western contexts. Therefore, cultivating a positive ethical climate can systematically strengthen perioperative competency by standardizing decision-making frameworks, strengthening team trust, and reinforcing moral responsibility. Study limitations and future research This study has several limitations that should be considered when interpreting the results. First, cross-sectional design restricts the ability to establish causal inferences among the variables, as data were collected at a single time point. Second, the sample was drawn from a specific socio-economic and cultural context within China, which may limit the generalizability of the findings to other regions or healthcare settings. Future studies should aim to include more diverse populations, encompassing various types of hospitals and geographic areas, to enhance the external validity of the results. The application of structural equation modeling could further elucidate the complex relationships between the influencing factors and perioperative competency. In addition, intervention studies designed based on these findings—such as programs targeting resilience, self-efficacy, or ethical climate—are needed to evaluate effective strategies for improving perioperative nursing competency in practical settings. Conclusion Perioperative competencies among nurses are shaped by a combination of personal attributes, collaborative support from colleagues, and the broader organizational climate within the operating room and hospital settings. Grounded in the social ecological framework, this study identified predictors of perioperative competency across intrapersonal, interpersonal, and organizational levels. At the intrapersonal level, years of operating room experience and specialized OR training were significant predictors of competency, underscoring the importance of structured educational programs and clinical exposure. At the interpersonal level, resilience, individual empowerment, and work self-efficacy contributed positively to competency, whereas workplace bullying exerted a detrimental effect. At the organizational level, a positive ethical climate was associated with enhanced perioperative competency. These findings highlight the need for multi-level strategies that address individual skill development, interpersonal dynamics, and organizational culture to effectively promote perioperative nursing excellence. Declarations Acknowledgements Researchers would like to thank the participants who devoted so graciously a part of their time to participate in the study. Author contributions Cong Fu: Conceptualization, Study design, Data collection, Drafting of the manuscript. Kulwadee Abhicharttibutra: Critical revision of the manuscript, Methodological guidance, Supervision. Wanchai Lertwatthanawilat: Critical revision of the manuscript, Supervision. Orn-Anong Wichaikhum: Critical revision of the manuscript, Supervision. All authors have read and approved the manuscript. Funding This study did not receive any funding in any form. Data availability The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request. Ethics approval and consent to participate For conducting the study, an ethical approval was obtained from the institutional review board of the Research Ethics Committee, Faculty of nursing, Chiang mai University, Thailand (No.080/2024), dated 28th June 2024; and institutional permissions were obtained from the hospital where the research was conducted. The study adhered to the principles of the Helsinki Declaration throughout the research process. Participants were informed that they could withdraw from the study at any stage. It was emphasized to participants that the research results would be published for scientific purposes without any identifying information. Consent to participate All subjects gave their informed consent for inclusion before they participated in the study. Consent for publication Not applicable. Conflicts of Interest The authors declare no competing interests. References World Health Organization. Why safe surgery is important [Internet]. 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Operating Theatre Nurse Specialist Competence to Ensure Patient Safety in the Operating Theatre: A Discursive Paper. Nurs Open. 2019;7:495-502. Andereggen L, Andereggen S, Bello C, Urman RD, Luedi MM. Technical Skills in the Operating Room: Implications for Perioperative Leadership and Patient Outcomes. Best Pract Res Clin Anaesthesiol. 2022;36:237-245. Niu A, Ma H, Chen Z, Zhu X, Luo Y. Exploring the competencies of operating room nurses in mobile surgical teams based on the Onion Model: a qualitative study. BMC Nurs. 2023;22(1):254. Bronfenbrenner U. Toward an Experimental Ecology of Human Development. Am Psychol. 1977;32(7):513-531. Yandan X. Research status of core competence of nurses in domestic operating room. Guangdong Vocat Tech Educ Res. 2020;(2):180-2. Chinese. Gillespie BM, Chaboyer W, Wallis M, Grimbeek P. Resilience in the operating room: developing and testing of a resilience model. J Adv Nurs. 2007;59(4):427–438. Raelin JA. 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Statistics and Data Analysis for Nursing Research. 2nd ed. Upper Saddle River, NJ: Pearson Prentice Hall; 2010. Connor KM, Davidson JRT. Development of a new resilience scale: The Connor-Davidson Resilience scale (CD-RISC). Depress Anxiety. 2003;18(2):76-82. Yu X, Zhang J. Factor analysis and psychometric evaluation of the Connor-Davidson resilience scale(CD-RISC) with Chinese people. Soc Behav Personal. 2007;35(1):19-30. Kuokkanen L, Leino-Kilpi H. The qualities of an empowered nurse and factors involved. J Nurs Manag. 2001; 9:273–80. Vidya D. Competency, self-efficacy, and job satisfaction as perceived by perioperative nurse. New York: Teachers College, Columbia University; 2017. Einarsen S, Hoel H, Notelaers G. Measuring exposure to bullying and harassment at work: validity, factor structure and psychometric properties of the Negative Acts Questionnaire-Revised. Work Stress. 2009;23(2):24–44. Xun HJ, Liu HX, Tian ZL. A preliminary reliability and validity study of the Chinese version of the negative acts questionnaire revised. Chin Nurs Manag. 2012;12(6):21-4. Chinese. Olson LL. Hospital nurses` perceptions of the ethical climate of their work setting. Minneapolis: University of Minnesota; 1995. Lu W. Reliability and Validity of Chinese Version of the Hospital Ethical Climate Survey Assessment and the application in Nurses. Zhengzhou: Zhengzhou University; 2018. Chinese. Sönmez B, Ayoğlu T. Validity and reliability of the perceived perioperative competency scale–revised. Nurs Health Sci. 2019;21:428–435. QI MX. Investigation and analysis of nursing management in Operating Rooms if 2201 hospitals in China. Chin J Mod Nurs. 2024;30:1688-97. Chinese. Tao H, Wu F. Implementation of Innovative Teaching Approaches for Standardized Training of New Nurses in the Operating Room. Altern Ther Health Med. 2024;30(12):411. Xu KL, Zhao B. Survey of status quo of core competence of registered nurse in Hebei province. Nurs Res. 2014;28(1):155-8. Chinese. Lee Y, Kim S. Operating room nurses want differentiated education for perioperative competencies—Based on the clinical ladder. Int J Environ Res Public Health. 2021;18(19):10290. Mu L, Wang C, Jiang LP, Fu QX, Ma W. Investigation and analysis of core competence and influencing factors of professional nurses in operating room. Chin J Med Educ. 2019;(03):231–5. Chinese. Chen X. Investigation and influencing factors analysis of core competence of operating room nurses in Grade A hospitals in Gansu Province. Lanzhou: Gansu University of Chinese Medicine; 2022. Chinese. Joko G. Factors Related to the Clinical competency of Registered Nurses: Systematic Review and Meta-Analysis. J Nurs Scholarsh. 2020;52(6):623–633. Gillespie BM, Harbeck E, Kang E, Steel C, Fairweather N, Chaboyer W. Perceptions of perioperative nursing competency: a cross-country comparison. BMC Nurs. 2018;17:12. Bajwa SJS, Mehdiratta L. Adopting Newer Strategies of Perioperative Quality Improvement: The Bandwagon Moves on. Indian J Anaesth. 2021;65:639-643. Wei L, Yi W, Chao Z, Sha Z, Yan ZG. The role of core competence training for specialized nurses in enhancing the comprehensive capabilities and core literacy of operating room nurses. Nurs Pract Res. 2024;7:621-7. Chinese. Orkaizagirre-Gómara A, Sánchez MMD, Ortiz DEJ, Ortiz DEA. Testing general self-efficacy, perceived competence, resilience, and stress among nursing students: An integrator evaluation. Nurs Health Sci. 2020;22(3):529-538. Bandura A. Self-efficacy: toward a unifying theory of behavioral change. Psychol Rev. 1977;84(2):191-215. Anusiewicz CV, Ivankova NV, Swiger PA, Gillespie GL, Li P, Patrician PA. How does workplace bullying influence nurses`abilities to provide patient care? A nurse perspective. J Clin Nurs. 2020;29:4148–4160. Spruce L. Back to Basics: Preventing Workplace Bullying. AORN J. 2019;110(3):288-297. Yang YM, Zhou LJ. Workplace bullying among operating room nurses in China: A cross-sectional survey. Perspect Psychiatr Care. 2020;57(1):27-32. Olson LL. Hospital nurses` perceptions of the ethical climate of their work setting. Diss Abstr Int. 1995;56(05):2563. Michał B, Natalia Ś, Magdalena P, Agnieszka M, Beata D. Hospital ethical climate and job satisfaction among nurses: A scoping review. Int J Environ Res Public Health. 2022;19(8):4554. Ye J, Wang L, Guo Q. Latent profiles of ethical climate and nurses’ service behavior. Nurs Ethics. 2023;30(4):626–641. Chen HM, Lu YC, Pai HC. Impact of a care task design program on novice nursing students’ self-reflection and insight, teamwork skills, and holistic nursing competency. Florence Nightingale J Nurs. 2023;31(2):69-74. Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7549168","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":528666695,"identity":"0dba1da9-51de-433c-936e-963d03679291","order_by":0,"name":"Cong Fu","email":"","orcid":"","institution":"The Affiliated Hospital of Hebei University","correspondingAuthor":false,"prefix":"","firstName":"Cong","middleName":"","lastName":"Fu","suffix":""},{"id":528666696,"identity":"144faf2c-5e15-4b30-8f0b-0b256c22fda8","order_by":1,"name":"Kulwadee 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modality for a wide range of diseases, with millions of procedures performed globally each year. Surgical interventions are responsible for approximately 13% of disability-adjusted life years worldwide [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. In China, more than 82\u0026nbsp;million inpatient surgeries are carried out annually, the majority (70%) in general hospitals [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e], highlighting the operating room (OR) as a critical high-stakes clinical setting. OR nursing requires specialized knowledge and adaptability, driven by the rapid incorporation of advanced technologies, sophisticated instrumentation, and the need for coordinated care throughout the preoperative, intraoperative, and postoperative phases [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Perioperative competency\u0026mdash;defined as the integration of clinical expertise, critical thinking, and interpersonal skills essential for ensuring patient safety and achieving successful surgical outcomes\u0026mdash;is therefore indispensable for OR nurses [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. This competency directly affects nursing performance, job satisfaction, patient experience, and institutional efficiency [\u003cspan additionalcitationids=\"CR7\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe Social Ecological Model offers a valuable framework for understanding the multi-level determinants of perioperative competency, encompassing intrapersonal, interpersonal, and organizational factors [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Previous research has identified several predictors at the intrapersonal level, including specialized training, clinical experience, income, resilience, self-efficacy, and empowerment [\u003cspan additionalcitationids=\"CR11 CR12\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. At the interpersonal and organizational levels, workplace bullying and ethical climate have also been significantly associated with nursing competency [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eHowever, most existing studies have focused on socio-demographic correlates or isolated psychological traits, with limited investigation into the combined predictive effects of these multi-level factors within an integrated theoretical framework. This gap is especially prominent in the Chinese context, where a considerable proportion of OR nurses are in the early stages of their careers and often encounter high workloads and challenges in skill acquisition [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Despite the relevance of the Social Ecological Model for capturing complex influences on clinical competency, no known studies in China have utilized this model to comprehensively examine predictors of perioperative nursing competency.\u003c/p\u003e\u003cp\u003eUnderstanding the factors that influence perioperative competency is crucial for enhancing nursing practice and the quality of surgical care. Thus, this study aims to address this research gap by investigating how specialized training, clinical experience, resilience, work self-efficacy, empowerment, workplace bullying, and ethical climate collectively predict perioperative competency among OR nurses in China.\u003c/p\u003e"},{"header":"METHODS","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eStudy design\u003c/h2\u003e\u003cp\u003e A descriptive predictive study was conducted to examine the level of perioperative competency among operating room (OR) nurses in tertiary hospitals in Hebei Province, China, and to identify predictors of competency, including special OR training, years of perioperative experience, work self-efficacy, resilience, individual empowerment, workplace bullying, and ethical climate.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eStudy setting and participants\u003c/h3\u003e\n\u003cp\u003eThe target population study was OR nurses across 22 tertiary hospitals (each with \u0026ge;\u0026thinsp;2,500 beds) in Hebei Province, China. A multi-stage sampling method was used to randomly select one hospital from each of the five geographic regions of the province (eastern, southern, western, northern, central). The sample size was calculated based on 30 participants per variable [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e], yielding a minimum requirement of 240 respondents. Accounting for a potential 20% attrition rate [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e], the target sample was set at 288. Eligible participants were registered nurses with at least one year of OR experience. Nurses who were on maternity or extended sick leave (\u0026gt;\u0026thinsp;1 month), pursuing further education, or in managerial roles were excluded.\u003c/p\u003e\n\u003ch3\u003eInstruments\u003c/h3\u003e\n\u003cp\u003eOriginal authors granted permission via email for the use of all research instruments. The following instruments were employed:\u003c/p\u003e\u003cp\u003e\u003col\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eDemographic data form: Developed by the researchers, this form collected information on age, gender, marital status, professional job title, highest level of education, income, special OR training, and years of OR experience.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eChinese Perceived Perioperative Competency Scale-Revised (C-PPCS-R): The Chinese adaptation of the PPCS-R [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e], translated by Yu [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e], comprises 34 items across six dimensions: foundational knowledge and skills, leadership, collaboration, proficiency, empathy, and professional development. Items are rated on a 5-point Likert scale. Cronbach`s α for the overall scale was 0.97. Total scores range from 34\u0026ndash;170, with 102\u0026ndash;136 indicating medium competency, \u0026lt;\u0026thinsp;102 low, and \u0026gt;\u0026thinsp;136 high [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eChinese Connor\u0026ndash;Davidson Resilience Scale (CD-RISC)[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]: Translated by Yu [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e], this 25-item scale measures resilience across three factors: tenacity, strength, and optimism, using a 5-point response scale. Cronbach`s α was 0.95. Total scores range from 0\u0026ndash;100, with higher scores indicating greater resilience (0\u0026ndash;60: low; 61\u0026ndash;69: medium; 70\u0026ndash;79: good; 80\u0026ndash;100: high) [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e].\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eQualities of an Empowered Nurse (QEN) scale: This 19-item tool assesses individual empowerment across five dimensions: ethical values, personal integrity, professional competence, forward-looking orientation, and social interaction. Items are rated on a 5-point Likert scale. Cronbach`s α was 0.96. Total scores range from 19\u0026ndash;95 (19\u0026ndash;47.5: low; 47.5\u0026ndash;66.5: medium; 66.5\u0026ndash;95: high) [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eWork Self-Efficacy Inventory (WS-Ei): A 30-item tool evaluating self-efficacy in workplace tasks across six dimensions: learning, problem-solving under pressure, understanding role responsibilities, teamwork, interpersonal awareness, and navigating organizational dynamics. Items use a 5-point Likert scale. Cronbach`s α was 0.97. Total scores range from 30\u0026ndash;150 (30\u0026ndash;90: low; 90\u0026ndash;120: medium; 120\u0026ndash;150: high) [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e].\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eChinese Negative Acts Questionnaire-Revised (NAQ-R)[\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]: Translated by Xun [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e], this scale measures workplace bullying across three dimensions: work-related bullying, person-related bullying, and organizational injustice, using a 5-point Likert scale. Cronbach`s α was 0.97. Scores\u0026thinsp;\u0026lt;\u0026thinsp;33 indicate no bullying, 33\u0026ndash;45 occasional bullying, and \u0026gt;\u0026thinsp;45 severe bullying [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e].\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eChinese Hospital Ethical Climate Survey (HECS)[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]: Translated by Lu [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e], this tool assesses perceptions of the ethical environment across five subscales: peers, patients, managers, hospitals, and physicians. Items are rated on a 5-point Likert scale. Cronbach\u0026rsquo;s α was 0.97. Total scores range from 25\u0026ndash;125 (25\u0026ndash;90: low; 91\u0026ndash;109: medium; 110\u0026ndash;125: high) [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e].\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003c/ol\u003e\u003c/p\u003e\n\u003ch3\u003eData collection\u003c/h3\u003e\n\u003cp\u003eData were collected from October to December 2024. Researchers sent online recruitment advertisements to head nurses of five hospitals, who then distributed them to OR nurse WeChat groups. Interested nurses contacted the researchers voluntarily. A total of 288 questionnaires were collected; one was excluded due to uniform responses, resulting in 287 valid samples.\u003c/p\u003e\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\u003ch2\u003eData analysis\u003c/h2\u003e\u003cp\u003eDescriptive statistics were computed for demographic and scale variables. Multiple regression assumptions (homoscedasticity, normality of residuals, linearity, absence of outliers, and multicollinearity) were checked [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. The leverage maximum value was \u0026lt;\u0026thinsp;0.20 (0.123), tolerance values ranged from 0.474\u0026ndash;0.933 (\u0026gt;\u0026thinsp;0.10), and VIF values ranged from 1.072\u0026ndash;2.109 (\u0026lt;\u0026thinsp;10), meeting all assumptions [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Stepwise multiple regression was performed to identify predictors of perioperative competency at α\u0026thinsp;=\u0026thinsp;0.05.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eEthical considerations\u003c/h2\u003e\u003cp\u003eEthical approval was obtained from the Institutional Review Board of [Faculty of nursing Chiang mai University] (Reference No. 080/2024), and permission was secured from each hospital. The study adhered to the Declaration of Helsinki. Participants provided voluntary informed consent, and anonymity and confidentiality were maintained throughout.\u003c/p\u003e\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e\u003ch2\u003eDemographic characteristics\u003c/h2\u003e\u003cp\u003eMost participants were female (74.90%), with a mean age of 35.05 years (SD\u0026thinsp;=\u0026thinsp;6.75) and married (80.50%). Years of OR experience ranged from 2\u0026ndash;20 (92.30%), with a mean of 11.23 (SD\u0026thinsp;=\u0026thinsp;6.61). Nearly half held an intermediate job title (54.70%), and most had a technical secondary school education (83.30%). Special OR training was received by 179 nurses (62.40%), and monthly income was 412.80\u0026ndash;688.00 USD for 125 participants (43.60%) (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eDemographic characteristics of the study subjects (n\u0026thinsp;=\u0026thinsp;287)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDemographic Characteristic\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFrequency\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePercentage\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAge\u003c/b\u003e(year)༈max\u0026thinsp;=\u0026thinsp;55, min\u0026thinsp;=\u0026thinsp;22, x̅=35.05, SD\u0026thinsp;=\u0026thinsp;6.75༉\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e22\u0026ndash;30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e82\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e28.57\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e31\u0026ndash;40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e149\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e51.92\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e41\u0026ndash;50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e17.42\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003emore than 50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.09\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eGender\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e215\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e74.90\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e72\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e25.10\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMarital status\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSingle\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e49\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e17.10\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMarried\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e231\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e80.50\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOthers (divorced and widowed)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.40\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eYears of OR experience\u003c/b\u003e(max\u0026thinsp;=\u0026thinsp;38, min\u0026thinsp;=\u0026thinsp;2, x̅=11.23, SD\u0026thinsp;=\u0026thinsp;6.61)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2\u0026ndash;10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e134\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e46.70\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e11\u0026ndash;20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e130\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e45.60\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e21\u0026ndash;30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7.00\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003emore than 30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.60\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eProfessional Job title\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eJunior nurse\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e96\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e33.40\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIntermediate nurse\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e157\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e54.70\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSenior nurse\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e34\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e11.80\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eHighest level of education\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTechnical Secondary School\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e239\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e83.30\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBachelor\u0026rsquo;s Degree\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e48\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e16.70\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSpecial OR training\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e179\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e62.40\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e108\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e37.60\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eIncome\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026lt;3000yuan (\u0026lt;412.80US)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e17.40\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3000-5000yuan (412.80US-688.00US)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e125\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e43.60\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e5001-7000yuan (688.00US-963.20US)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e60\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e20.90\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e7001-9000yuan (963.20US-1,238.40US)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e47\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e16.40\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026gt;9000yuan (\u0026gt;1,238.40US)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.70\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003eDescription of variables\u003c/h2\u003e\u003cp\u003eAs shown in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e, among technical competencies, foundational knowledge and skills had the highest mean score (x̅=4.06, SD\u0026thinsp;=\u0026thinsp;0.84), while proficiency had the lowest (x̅=2.89, SD\u0026thinsp;=\u0026thinsp;1.33). Among non-technical competencies, collaboration scored highest (x̅=3.54, SD\u0026thinsp;=\u0026thinsp;0.97), and professional development lowest (x̅=2.77, SD\u0026thinsp;=\u0026thinsp;1.31).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eMean, standard deviation, maximum, and minimum of dimensions of perioperative competency\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDimension\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMean\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSD\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003emax\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003emin\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFoundational Knowledge and Skills*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e4.06\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.84\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e5.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e1.50\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLeadership**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e3.51\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1.05\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e5.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e1.00\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCollaboration**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e3.54\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.97\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e5.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e1.20\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eProficiency*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2.89\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1.33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e5.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e1.00\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEmpathy**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e3.05\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1.14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e5.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e1.00\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eProfessional Development**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2.77\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1.31\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e5.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e1.00\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003eNote.*=Technical and **=Non-technical categories\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eAs shown in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e, perioperative competency was at a medium level (x̅=115.11, SD\u0026thinsp;=\u0026thinsp;12.58). Workplace bullying scores indicated severe bullying (x̅=74.76, SD\u0026thinsp;=\u0026thinsp;8.61). Resilience (x̅=64.21, SD\u0026thinsp;=\u0026thinsp;5.86), work self-efficacy (x̅=101.18, SD\u0026thinsp;=\u0026thinsp;9.73), and individual empowerment (x̅=64.37, SD\u0026thinsp;=\u0026thinsp;6.28) were at medium levels, while ethical climate was low (x̅=85.82, SD\u0026thinsp;=\u0026thinsp;8.16).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eDescriptive statistics, correlation analysis, and levels of variables (n\u0026thinsp;=\u0026thinsp;287)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"9\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariables\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003emean\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSD\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003ePerioperative competency\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eResilience\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eIndividual empowerment\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eWork self-efficacy\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003eWorkplace bullying\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c9\"\u003e\u003cp\u003eEthical climate\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePerioperative competency\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e115.11\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e12.58\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eResilience\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e64.21\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e5.86\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.536*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eIndividual empowerment\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e64.37\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e6.28\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.580*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.539*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eWork self-efficacy\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e101.18\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e9.73\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.562*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.506*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.513*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eWorkplace bullying\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e74.76\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e8.61\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-0.249*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-0.088\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-0.125*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-0.241*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eEthical climate\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e85.82\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e8.16\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.513*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.497*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.491*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.459*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e-0.140*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"9\"\u003e*p\u0026thinsp;\u0026lt;\u0026thinsp;0.05\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eMultivariate regression analysis of perioperative competency predictors (n\u0026thinsp;=\u0026thinsp;287)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"9\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariables\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eB\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSE\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eβ\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003et\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eR\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eAdjusted R Square\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003eSE of Estimate\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c9\"\u003e\u003cp\u003eF\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eModel 1\u003c/b\u003e\u003c/p\u003e\u003cp\u003eConstant\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e101.997\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1.139\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e89.560*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e.632\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e.397\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e9.767\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e189.247*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYears of perioperative nursing experience\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1.203\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.087\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.632\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e13.757*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eModel 2\u003c/b\u003e\u003c/p\u003e\u003cp\u003eConstant\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e80.891\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1.858\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e43.541*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e.789\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e.621\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e7.747\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e234.927*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYears of perioperative nursing experience\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1.499\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.073\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.787\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e20.536*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSpecial training related to OR\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e12.917\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.994\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.498\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e13.001*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eModel 3\u003c/b\u003e\u003c/p\u003e\u003cp\u003eConstant\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e37.507\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e5.028\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e7.460*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e.842\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e.706\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e6.822\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e229.742*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYears of perioperative nursing experience\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1.102\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.078\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.579\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e14.197*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSpecial training related to OR\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e13.541\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.878\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.523\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e15.431*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIndividual empowerment\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e.730\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.080\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.364\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e9.125*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eModel 4\u003c/b\u003e\u003c/p\u003e\u003cp\u003eConstant\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e15.523\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e5.641\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e2.752\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e.867\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e.748\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e6.320\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e212.687*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYears of perioperative nursing experience\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e.922\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.076\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.484\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e12.061*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSpecial training related to OR\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e13.656\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.813\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.527\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e16.794*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIndividual empowerment\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e.581\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.077\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.290\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e7.536*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWork Self-efficacy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e.330\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.048\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.255\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e6.908*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eModel 5\u003c/b\u003e\u003c/p\u003e\u003cp\u003eConstant\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e.501\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e5.959\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.084\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e.881\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e.773\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e5.992\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e195.802*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYears of perioperative nursing experience\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e.827\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.074\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.435\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e11.123*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSpecial training related to OR\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e14.057\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.774\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.542\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e18.157*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIndividual empowerment\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e.471\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.076\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.235\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e6.228*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWork Self-efficacy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e.270\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.047\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.209\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e5.792*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eResilience\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e.448\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.078\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.209\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e5.717*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eModel 6\u003c/b\u003e\u003c/p\u003e\u003cp\u003eConstant\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e-10.204\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e6.315\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e-1.616\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e.889\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e.786\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e5.819\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e176.003*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYears of perioperative nursing experience\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e.735\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.075\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.386\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e9.749*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSpecial training related to OR\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e14.293\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.754\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.551\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e18.958*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIndividual empowerment\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e.432\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.074\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.216\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e5.829*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWork Self-efficacy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e.248\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.045\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.192\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e5.441*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eResilience\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e.390\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.77\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.182\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e5.042*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEthical Climate\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e.232\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.055\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.150\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e4.237*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eModel 7\u003c/b\u003e\u003c/p\u003e\u003cp\u003eConstant\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2.677\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e7.194\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.372\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e.894\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e.794\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e5.705\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e158.743*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYears of perioperative nursing experience\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e.716\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.074\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.376\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e9.654*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSpecial training related to OR\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e14.244\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.739\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.550\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e19.269*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIndividual empowerment\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e.435\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.073\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.217\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e5.997*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWork Self-efficacy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e.219\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.045\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.170\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e4.839*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eResilience\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e.407\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.076\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.190\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e5.361*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEthical Climate\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e.227\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.054\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.147\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e4.229*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWorkplace bullying\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.143\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.041\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.098\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e-3.515*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"9\"\u003e*p\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eAs shown in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e, the final model indicated that years of OR experience (β\u0026thinsp;=\u0026thinsp;0.376, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), special OR training (β\u0026thinsp;=\u0026thinsp;0.550, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), resilience (β\u0026thinsp;=\u0026thinsp;0.190, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), individual empowerment (β\u0026thinsp;=\u0026thinsp;0.217, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), work self-efficacy (β\u0026thinsp;=\u0026thinsp;0.170, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and ethical climate (β\u0026thinsp;=\u0026thinsp;0.147, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) positively predicted perioperative competency, while workplace bullying was negatively correlated (β=\u0026ndash;0.098, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The model explained 79.4% of the variance (R\u0026thinsp;=\u0026thinsp;0.894, Adjusted R\u0026sup2;=0.794, F\u0026thinsp;=\u0026thinsp;158.743, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e\u003c/div\u003e"},{"header":"Discussion","content":"\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\u003ch2\u003ePerioperative competency among OR nurses\u003c/h2\u003e\u003cp\u003eThe findings of this present study indicate that the overall perioperative competency among nurses in tertiary hospitals in Hebei Province is at a moderate level (x̅ = 115.11, SD\u0026thinsp;=\u0026thinsp;12.58; Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e), which is consistent with previous national and international studies[3]. For instance, a survey conducted in Guangdong Province, China, also reported moderately low competency levels among operating room nurses [16]. Similarly, studies from Turkey and South Korea observed that although perioperative nurses did not demonstrate high overall competency, they performed relatively well in technical domains\u0026mdash;such as foundational knowledge and operative skills\u0026mdash;while exhibiting weaker non-technical competencies, including leadership and professional development [27].\u003c/p\u003e\u003cp\u003eThis pattern may be attributed to several factors. First, staffing shortages in tertiary hospitals contribute to high surgical volumes and intense workload pressures, limiting nurses\u0026rsquo; capacity to develop both technical and non-technical skills simultaneously [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. Second, inconsistencies in perioperative nursing education and training systems across regions, coupled with limited opportunities for specialized training within undergraduate curricula, may hinder professional development [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. Additionally, previous studies have identified deficits in critical thinking and research skills among nurses, underscoring the need for enhanced continuing education and institutional support to foster comprehensive competency development [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eA notable disparity between technical and non-technical competencies was observed. The high scores in foundational knowledge and skills reflect an emphasis on standardized training and procedural rigor, aligning with existing literature [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. However, the lower proficiency scores suggest a gap in applying acquired knowledge to complex and unpredictable clinical situations\u0026mdash;a finding consistent with reports that advanced proficiency requires extensive practical experience and specialized training [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. Within non-technical domains, scores in leadership, collaboration, and empathy indicated that these competencies are integrated but not fully mastered. This resonates with studies noting that interpersonal and leadership skills are often undervalued in highly technical environments such as the operating room [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. Of particular concern is the low score in professional development, reflecting restricted opportunities for continuous learning and career advancement\u0026mdash;an issue also highlighted in recent research on nursing education and organizational support [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. These findings underscore the need for structured educational initiatives that integrate technical and non-technical training to promote a holistic approach to perioperative nursing excellence.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\u003ch2\u003eAnalysis of predictors of perioperative competency\u003c/h2\u003e\u003cp\u003eGuided by the Social Ecological Model [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e], this study demonstrates that perioperative competency is shaped by a complex interplay of factors across intrapersonal, interpersonal, and organizational levels. The multiple regression analysis confirmed several of the hypothesized predictors. At the intrapersonal level, years of OR experience (β\u0026thinsp;=\u0026thinsp;0.376, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), specialized OR training (β\u0026thinsp;=\u0026thinsp;0.550, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), resilience (β\u0026thinsp;=\u0026thinsp;0.190, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), individual empowerment (β\u0026thinsp;=\u0026thinsp;0.217, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and work self-efficacy (β\u0026thinsp;=\u0026thinsp;0.170, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) were significantly associated with higher perioperative competency. At the organizational level, a positive ethical climate also contributed to competency (β\u0026thinsp;=\u0026thinsp;0.147, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). In contrast, workplace bullying at the interpersonal level demonstrated a negative correlation with competency (β = \u0026minus;\u0026thinsp;0.098, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Collectively, these predictors accounted for 79.4% of the variance in perioperative competency (adjusted R\u0026sup2; = 0.794; Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e), underscoring the utility of the social ecological framework in understanding competency development.\u003c/p\u003e\u003cp\u003eThese findings affirm that perioperative competency is influenced not only by individual attributes but also by relational and contextual factors. The personal qualities of nurses, the quality of collaboration among colleagues, and the broader organizational environment each play critical roles in shaping competency. supportive interpersonal relationships and a positive ethical climate facilitate a conducive learning and working atmosphere, thereby enhancing professional competence.\u003c/p\u003e\u003cp\u003eIt is important to note, however, that other factors beyond those examined may also influence perioperative competency. Existing literature suggests that national policies, opportunities for professional development, and nurses\u0026rsquo; decision-making abilities represent additional determinants [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. Policy initiatives can provide structural support for competency-building programs, professional advancement opportunities may motivate skill acquisition, and decisional autonomy can further refine clinical judgment. Thus, while the current model explains a substantial proportion of variance, it does not fully capture all potential predictors of perioperative competency. Future studies incorporating these additional dimensions could yield a more comprehensive understanding of competency development in perioperative nursing.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\u003ch2\u003eThe predictive relationship between years of OR experience and perioperative competency\u003c/h2\u003e\u003cp\u003eAt the intrapersonal level, years of operating room experience demonstrated a significant positive effect on perioperative competency (β\u0026thinsp;=\u0026thinsp;0.372, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001; Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). This finding aligns with Gillespie\u0026rsquo;s research [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e], reinforcing that greater clinical experience is closely associated with higher competency levels among OR nurses. Accumulated experience allows nurses to develop familiarity with surgical procedures, instrument handling, and emergency management\u0026mdash;such as responding to hemorrhage or anesthesia-related incidents [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. Furthermore, experienced nurses are able to recognize potential surgical risks, such as improper patient positioning or instrument contamination, more rapidly than novices, who often depend heavily on standardized protocols. Extended exposure to high-pressure environments also enhances stress adaptability, thereby reducing error rates under demanding conditions [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. Additionally, nurses with longer tenure are more likely to have participated in advanced training programs (e.g., specialized surgical coordination or simulation exercises), whereas those newer to the role typically receive only basic pre-service training [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. Thus, years of OR experience serve as a crucial predictor of perioperative nursing competency.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec16\" class=\"Section2\"\u003e\u003ch2\u003eThe predictive relationship between special OR training and perioperative competency in the operating room\u003c/h2\u003e\u003cp\u003eAt the intrapersonal level, specialized OR training demonstrated a strong positive correlation with perioperative competency (β\u0026thinsp;=\u0026thinsp;0.550, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001; Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e), indicating that such training plays a critical role in enhancing nurses\u0026rsquo; clinical capabilities. In China, formal specialty training for operating room nurses\u0026mdash;typically organized by the Chinese Nursing Association\u0026mdash;spans three months, combining one month of theoretical instruction with two months of practical clinical training [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. The curriculum is nationally standardized, and participants who pass the final assessment receive a professional certification. Nurses who undergo this structured training\u0026mdash;which often includes simulation drills and courses in specialized surgical coordination\u0026mdash;show improved performance in technical skills, emergency response, and teamwork compared to those without such training.\u003c/p\u003e\u003cp\u003eThe benefits of specialized training are multifaceted: it promotes efficiency in surgical coordination through standardized protocols (e.g., aseptic technique and instrument handling), reducing operational errors [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]; high-fidelity simulations enhance preparedness for managing rare complications such as hemorrhage or anesthesia accidents, thereby strengthening clinical decision-making [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]; and it facilitates exposure to advanced technologies, such as robot-assisted surgery, helping to bridge gaps left by conventional academic education [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. To maximize effectiveness, a tiered training system is recommended\u0026mdash;one that reinforces foundational skills for novice nurses while emphasizing leadership and management competencies for senior staff. Incorporating interdisciplinary training could further improve team collaboration and overall perioperative performance [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]. Nevertheless, the outcomes of training may vary based on individual learning capabilities and institutional resource allocation. Long-term follow-up and evaluation are essential to ensuring sustained educational impact and competency development.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec17\" class=\"Section2\"\u003e\u003ch2\u003eThe predictive relationship between resilience and perioperative competency\u003c/h2\u003e\u003cp\u003eAt the intrapersonal level, resilience was significantly and positively associated with perioperative competency (β\u0026thinsp;=\u0026thinsp;0.190, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001; Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). Resilience refers to the ability of OR nurses to effectively cope with stress and adversity, encompassing traits such as personal competence, self-trust, adaptability, sense of control, and emotional steadiness that enable individuals to thrive under challenging conditions. Nurses with higher resilience demonstrated stronger performance in managing surgical stressors, functioning within teams, and responding to emergencies. In contrast, those with lower resilience were more susceptible to operational errors and communication difficulties under pressure.\u003c/p\u003e\u003cp\u003eThe ability to maintain composure during critical events\u0026mdash;such as hemorrhage or equipment failure\u0026mdash;enables resilient nurses to make calm, effective decisions [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. Conversely, less resilient nurses may experience impaired focus under stress, increasing the risk of errors in instrument handling or delayed resuscitation [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. Resilience also mitigates emotional exhaustion and reduces vulnerability to burnout, thereby supporting sustained performance. For instance, highly resilient nurses maintain proficiency during extended work hours\u0026mdash;such as back-to-back surgeries or night shifts\u0026mdash;and demonstrate greater engagement in learning from complex surgical experiences, which accelerates skill acquisition [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThese findings are consistent with global studies on resilience among nurses [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e], yet the unique demands of perioperative settings\u0026mdash;such as high-intensity workloads and complex interpersonal dynamics\u0026mdash;highlight the especially critical role of resilience in this specialty [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. Within the hierarchical structure characteristic of Chinese operating rooms, nurses with higher resilience are better equipped to adapt to formal and informal leadership demands, thereby enhancing team functionality despite structural constraints. Thus, resilience constitutes a key predictor of perioperative competency, underscoring the need for structured interventions that foster resilience at both individual and organizational levels to promote sustainable professional growth.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec18\" class=\"Section2\"\u003e\u003ch2\u003eThe predictive relationship between individual empowerment and perioperative competency\u003c/h2\u003e\u003cp\u003eAt the intrapersonal level, this study identified a significant positive association between individual empowerment and perioperative competency (β\u0026thinsp;=\u0026thinsp;0.217, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001; Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e) Individual empowerment reflects a process shaped by both personal attributes\u0026mdash;such as values, qualities, and initiative\u0026mdash;and contextual factors within the work environment. Empowered OR nurses are often driven by social competence and a commitment to act in accordance with humanistic values [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e], which fosters greater openness to adopting new technologies and enhances performance in surgical decision-making, teamwork, and emergency management. In contrast, nurses with lower levels of empowerment tend to rely more heavily on standardized protocols and demonstrate reduced adaptability in complex clinical situations.\u003c/p\u003e\u003cp\u003eEmpowerment strengthens clinical judgment by facilitating active participation in decision-making processes, such as selecting appropriate instruments intraoperatively or adapting emergency plans [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. For instance, empowered nurses who adjust instrument placement based on surgical preferences can reduce procedural delays by up to 20% [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Furthermore, empowered nurses exhibit greater initiative in resource acquisition\u0026mdash;such as obtaining specialized instruments or additional staff\u0026mdash;and utilize informal communication channels to resolve issues efficiently, ultimately decreasing preoperative preparation time by an average of 15% [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThus, individual empowerment enhances perioperative competency by promoting autonomy, improving resource mobilization, and reinforcing professional identity. However, the implementation of empowerment strategies should be tailored to align with local organizational cultures and healthcare contexts to maximize their effectiveness.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec19\" class=\"Section2\"\u003e\u003ch2\u003eThe predictive relationship between work self-efficacy and perioperative competency\u003c/h2\u003e\u003cp\u003eAt the intrapersonal level, work self-efficacy demonstrated a significant positive correlation with perioperative competency (β\u0026thinsp;=\u0026thinsp;0.170, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001; Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). Work self-efficacy refers to nurses\u0026rsquo; confidence in their ability to perform workplace tasks effectively and achieve desired outcomes across domains such as learning, problem-solving under pressure, role mastery, teamwork, interpersonal sensitivity, and navigating organizational dynamics [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Nurses with higher self-efficacy exhibited stronger performance in complex surgical coordination, emergency management, and the adoption of new technologies. In contrast, those with lower self-efficacy were more prone to hesitation during intraoperative emergencies\u0026mdash;such as hemorrhage or equipment malfunctions\u0026mdash;and required approximately 30% more time to adapt to new technologies [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThis discrepancy may be attributed to the greater assurance that self-efficacious nurses possess in managing unforeseen challenges, such as rapidly identifying bleeding sources or adjusting instrument sequences, leading to more decisive clinical actions [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]. Such confidence can partly compensate for limitations in structural empowerment. For example, during laparoscopic procedures, nurses with high self-efficacy demonstrated 22% greater accuracy in instrument handling compared to their less confident counterparts [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. Additionally, self-efficacy helps mitigate the effects of stress during prolonged surgeries or interpersonal conflicts, thereby supporting consistent performance. Neuroscientific evidence suggests that individuals with high self-efficacy show enhanced prefrontal cortex activation under stress, facilitating rational judgment and cognitive control [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThese findings highlight the value of fostering self-efficacy through targeted interventions. Novice nurses may benefit from simulation-based training to accumulate positive experiences and build foundational confidence, while experienced nurses could reinforce their professional identity and efficacy through peer mentoring or clinical teaching. Ultimately, enhancing work self-efficacy contributes to perioperative competency by strengthening confidence, stress resilience, and the effective application of skills in clinical practice.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec20\" class=\"Section2\"\u003e\u003ch2\u003eThe predictive relationship between workplace bullying and perioperative competency\u003c/h2\u003e\u003cp\u003eAt the interpersonal level, workplace bullying was significantly and negatively associated with perioperative competency (β = \u0026minus;\u0026thinsp;0.098, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001; Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e), indicating that a hostile work environment undermines both nurses\u0026rsquo; professional motivation and clinical performance [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Workplace bullying is characterized by persistent and repeated interpersonal aggression\u0026mdash;including work-related criticism, personal attacks, and intimidation\u0026mdash;perpetrated by colleagues, supervisors, or subordinates. Such behaviors exert detrimental effects on victims\u0026rsquo; psychological well-being and occupational functioning.\u003c/p\u003e\u003cp\u003eExposure to workplace bullying inflicts both physical and psychological trauma, directly impairing perioperative competency [\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e]. Nurses subjected to bullying are more likely to develop anxiety and depression, which diminish their resilience and capacity to cope with high-stress situations [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e]. This compromised psychological state reduces their effectiveness in complex surgical environments. Furthermore, perioperative care relies heavily on interdisciplinary teamwork, and bullying erodes trust and communication among staff, leading to dysfunctional collaboration that jeopardizes surgical outcomes and patient safety [\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eAs evidenced by Obeidat et al. [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e], a robust negative correlation exists between workplace bullying and nursing competency. Within the socio-ecological framework [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e], bullying operates at the interpersonal level yet permeates individual functioning by damaging psychosocial resources and organizational climate [\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e]. Thus, mitigating bullying is essential for sustaining perioperative competency. Interventions aimed at fostering psychological resilience, enhancing self-efficacy, and promoting a respectful work environment may help buffer these negative effects, ultimately supporting both nurse performance and patient safety in the operating room.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec21\" class=\"Section2\"\u003e\u003ch2\u003eThe predictive relationship between ethical climate and perioperative competency\u003c/h2\u003e\u003cp\u003eAt the organizational level, ethical climate was significantly and positively associated with perioperative competency (β\u0026thinsp;=\u0026thinsp;0.147, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001; Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e), indicating that a supportive ethical environment contributes directly to nursing proficiency through enhanced teamwork and increased job satisfaction [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Ethical climate is defined as the shared perception among nurses regarding ethically appropriate behavior and how moral issues are handled within the organization. It encompasses nurses\u0026rsquo; relationships with peers, patients, managers, the hospital as a whole, and physicians [\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eIn the operating room, where effective interdisciplinary interaction is critical, the quality of the ethical climate is reflected in daily practices and decision-making. Nurses working in environments with a well-established ethical climate demonstrate stronger performance in patient safety, ethical reasoning, and collaborative care. They exhibit greater discipline and consistency when confronting ethical challenges, such as responding to sudden changes in patient wishes during surgery. Conversely, those in settings with a less developed ethical climate are more prone to ethical omissions\u0026mdash;for example, deficiencies in the informed consent process\u0026mdash;and report burnout rates 35% higher than those in more ethically conscious institutions [\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e].\u003c/p\u003e\u003cp\u003e A clearly defined ethical climate reduces ambiguity by providing structured guidelines and facilitating ethical decision-making. For instance, in units with strong ethical climates, nurses can promptly initiate multidisciplinary consultations when unexpected intraoperative events\u0026mdash;such as emergent hemorrhage\u0026mdash;require rapid changes in the surgical plan. Such environments encourage nurses to assume ethical responsibility, thereby promoting operational rigor and accountability [\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eWhile this study reinforces the established positive correlation between ethical climate and clinical quality [\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e], it is important to note that ethical climates in Chinese hospitals often emphasize collective decision-making processes, including the active involvement of ethics committees, contrasting with more individualistic approaches typical in Western contexts. Therefore, cultivating a positive ethical climate can systematically strengthen perioperative competency by standardizing decision-making frameworks, strengthening team trust, and reinforcing moral responsibility.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec22\" class=\"Section2\"\u003e\u003ch2\u003eStudy limitations and future research\u003c/h2\u003e\u003cp\u003eThis study has several limitations that should be considered when interpreting the results. First, cross-sectional design restricts the ability to establish causal inferences among the variables, as data were collected at a single time point. Second, the sample was drawn from a specific socio-economic and cultural context within China, which may limit the generalizability of the findings to other regions or healthcare settings.\u003c/p\u003e\u003cp\u003eFuture studies should aim to include more diverse populations, encompassing various types of hospitals and geographic areas, to enhance the external validity of the results. The application of structural equation modeling could further elucidate the complex relationships between the influencing factors and perioperative competency. In addition, intervention studies designed based on these findings\u0026mdash;such as programs targeting resilience, self-efficacy, or ethical climate\u0026mdash;are needed to evaluate effective strategies for improving perioperative nursing competency in practical settings.\u003c/p\u003e\u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003ePerioperative competencies among nurses are shaped by a combination of personal attributes, collaborative support from colleagues, and the broader organizational climate within the operating room and hospital settings. Grounded in the social ecological framework, this study identified predictors of perioperative competency across intrapersonal, interpersonal, and organizational levels.\u003c/p\u003e\u003cp\u003eAt the intrapersonal level, years of operating room experience and specialized OR training were significant predictors of competency, underscoring the importance of structured educational programs and clinical exposure. At the interpersonal level, resilience, individual empowerment, and work self-efficacy contributed positively to competency, whereas workplace bullying exerted a detrimental effect. At the organizational level, a positive ethical climate was associated with enhanced perioperative competency.\u003c/p\u003e\u003cp\u003eThese findings highlight the need for multi-level strategies that address individual skill development, interpersonal dynamics, and organizational culture to effectively promote perioperative nursing excellence.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eResearchers would like to thank the participants who devoted so graciously a part of their time to participate in the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCong Fu: Conceptualization, Study design, Data collection, Drafting of the manuscript.\u003cbr\u003e\u0026nbsp;Kulwadee Abhicharttibutra: Critical revision of the manuscript, Methodological guidance, Supervision.\u003c/p\u003e\n\u003cp\u003eWanchai Lertwatthanawilat: Critical revision of the manuscript, Supervision.\u003cbr\u003e\u0026nbsp;Orn-Anong Wichaikhum: Critical revision of the manuscript, Supervision.\u003cbr\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAll authors have read and approved the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study did not receive any funding in any form.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFor conducting the study, an ethical approval was obtained from the institutional review board of the Research Ethics Committee, Faculty of nursing, Chiang mai University, Thailand (No.080/2024), dated 28th June 2024; and institutional permissions were obtained from the hospital where the research was conducted. The study adhered to the principles of the Helsinki Declaration throughout the research process. Participants were informed that they could withdraw from the study at any stage. It was emphasized to participants that the research results would be published for scientific purposes without any identifying information.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to participate\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAll subjects gave their informed consent for inclusion before they participated in the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflicts of Interest\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eWorld Health Organization. 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Latent profiles of ethical climate and nurses\u0026rsquo; service behavior. Nurs Ethics. 2023;30(4):626\u0026ndash;641.\u003c/li\u003e\n\u003cli\u003eChen HM, Lu YC, Pai HC. Impact of a care task design program on novice nursing students\u0026rsquo; self-reflection and insight, teamwork skills, and holistic nursing competency. Florence Nightingale J Nurs. 2023;31(2):69-74.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Individual empowerment, Nurse competency, Perioperative, Resilience, Work self-efficacy, Workplace bullying, Ethical climate","lastPublishedDoi":"10.21203/rs.3.rs-7549168/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7549168/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003ePerioperative competency is essential for ensuring high-quality patient care, enhancing job performance, and maintaining effective healthcare operations. However, the determinants of perioperative nurse competencies remain underexplored.\u003c/p\u003e\u003ch2\u003eAims\u003c/h2\u003e\u003cp\u003eThis study aimed to identify predictors of perioperative competency among operating room (OR) nurses in Chinese tertiary hospitals, including special OR training, years of OR experience, work self-efficacy, resilience, individual empowerment, workplace bullying, and ethical climate.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eA cross-sectional predictive study was conducted among 287 OR nurses from five tertiary hospitals in China using a multi-stage sampling method. Validated Chinese versions of the Perceived Perioperative Competency Scale-Revised, Connor-Davidson Resilience Scale, Qualities of an Empowered Nurse Scale, Work Self-Efficacy Inventory, Negative Acts Questionnaire-Revised, and Hospital Ethical Climate Survey were administered. Stepwise multiple linear regression was performed to identify significant predictors.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eYears of OR experience (β\u0026thinsp;=\u0026thinsp;0.376, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), special training (β\u0026thinsp;=\u0026thinsp;0.550, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), resilience (β\u0026thinsp;=\u0026thinsp;0.190, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), individual empowerment (β\u0026thinsp;=\u0026thinsp;0.217, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), work self-efficacy (β\u0026thinsp;=\u0026thinsp;0.170, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and ethical climate (β\u0026thinsp;=\u0026thinsp;0.147, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) positively predicted perioperative competency, whereas workplace bullying showed a negative correlation (β = \u0026minus;\u0026thinsp;0.098, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Together, these factors accounted for 79.4% of the total variance in perioperative competency.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eModifiable factors such as resilience, self-efficacy, ethical climate, and empowerment significantly influence perioperative competency. These findings highlight the need for targeted interventions to improve nursing competency and patient outcomes.\u003c/p\u003e","manuscriptTitle":"Determinants of Perioperative Nurse Competencies in China: A Descriptive Predictive Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-15 05:40:15","doi":"10.21203/rs.3.rs-7549168/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"04966a06-cc12-4265-9348-0075037c305c","owner":[],"postedDate":"October 15th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-11-26T08:54:31+00:00","versionOfRecord":[],"versionCreatedAt":"2025-10-15 05:40:15","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7549168","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7549168","identity":"rs-7549168","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}