The intraoperative standard care training program for transplanted organs: A quality improvement study to enhance knowledge and self-efficacy of operating room nurses

The intraoperative standard care training program for transplanted organs: A quality improvement study to enhance knowledge and self-efficacy of operating room nurses | 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 The intraoperative standard care training program for transplanted organs: A quality improvement study to enhance knowledge and self-efficacy of operating room nurses Farkhondeh Sameipoor, Aygineh Hayrabedian, Alireza Firouzfar, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7636938/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 16 You are reading this latest preprint version Abstract Introduction : Organ transplantation, a critical intervention for end-stage organ failure, relies on precise intraoperative care by operating room personnel to ensure organ viability. In Iran, despite significant transplant activity, knowledge and self-efficacy gaps among surgical staff persist, risking complications. This study evaluated the effect of a training program on the knowledge and self-efficacy of intraoperative nurses in the standard preservation of transplantable organs. Materials and methods A quasi-experimental, single-group pre-test post-test design was conducted at Al-Zahra and Khorshid hospitals in Isfahan, Iran, from July to October 2024. Forty-nine surgical technologists and nurses participated in two one-hour educational sessions covering general and organ-specific preservation care standards for kidney and liver. Knowledge was assessed via a 20-item multiple-choice test, and self-efficacy was evaluated via a 12-item Likert-scale questionnaire. Data were collected at pre-intervention, post-intervention, and after one-month follow-up, and analyzed using repeated-measures ANOVA and Friedman tests (p < 0.05). Results Participants showed significant knowledge improvement, with mean scores rising from 4.91 ± 2.09 (24.55%) pre-intervention to 16.36 ± 1.67 (81.7%) post-intervention (p < 0.001), and slightly declining to 16.06 ± 1.77 (80.3%) at after one month follow up (p = 0.001). Self-efficacy scores increased from 31.65 ± 11.35 (moderate) to 52.85 ± 4.55 (strong) post-intervention (p < 0.001), with a minor reduction to 52.57 ± 4.63 at follow-up (p = 0.01). Conclusion Standardized training significantly enhanced operating room personnel’s knowledge and self-efficacy, with sustained effects at one month. These findings highlight the value of structured education in improving clinical competence and confidence, potentially optimizing patient outcomes in transplant surgery. Organ transplantation Intraoperative care Standard Training Operating room Knowledge Self-efficacy Introduction Organ transplantation is a transformative medical procedure, offering hope to patients with end-stage organ failure worldwide( 1 ). In Iran, over 56,953 transplants, including 48,850 kidney and 6,338 liver procedures, were performed between 1967 and 2018, reflecting significant national progress( 2 ). The success of these complex surgeries depends on precise intraoperative care to ensure organ viability, a responsibility borne by operating room personnel such as surgical technologists and nurses. However, lapses in care can result in severe complications, including infection, organ rejection, or recipient mortality ( 3 – 5 ). Despite positive attitudes toward organ donation, studies reveal deficiencies in personnel’s knowledge and performance, underscoring the need for structured training ( 6 , 7 ).Valiee et al. (2019) demonstrated that targeted education significantly enhances nurses’ knowledge and attitudes toward organ donation, highlighting the potential of training to address these gaps( 8 ). These knowledge deficits are particularly critical in the operating room environment, where personnel must master organ-specific preservation techniques, such as static cold storage or dynamic hypothermic perfusion, to prevent tissue damage ( 6 ). For instance, kidneys tolerate up to 24 hours of cold ischemia, whereas hearts and lungs require shorter preservation times ( 6 ). In Iran, despite 2,500–4,000 annual brain-death cases, only approximately 900 organ donations occurred in 2017, partly due to inadequate training among healthcare professionals( 9 ). Jameleh et al. (2019) found that enhanced staff education improves decision-making and consent rates, emphasizing training’s role in optimizing donation processes( 10 ). Operating room staff perform essential tasks, such as organ packaging and documentation, which demand adherence to standardized protocols ( 11 , 12 ). The Iranian Ministry of Health’s 2014 guidelines further stress meticulous donor care, reinforcing the urgency of equipping surgical teams with robust training( 12 ). Beyond technical expertise, self-efficacy—the belief in one’s ability to execute tasks effectively—is vital for operating room personnel to perform confidently under pressure ( 13 ). Low self-efficacy can lead to procedural errors, compromising patient safety, whereas enhanced self-efficacy fosters improved decision-making and teamwork ( 14 – 16 ). Research indicates that targeted education not only bolsters knowledge but also strengthens confidence, leading to better clinical outcomes( 15 ). In Iran, where formalized transplant care training is limited, addressing these gaps is crucial to minimize complications, optimize resource use, and enhance patient outcomes( 17 ). The reliance on experiential knowledge, without codified standards, risks inconsistencies and errors, underscoring the global relevance of standardized training for transplant care( 18 ). Recognizing the importance of addressing the educational needs of healthcare personnel, which enhances the quality of patient care, develops knowledge and skills, and improves effectiveness and efficiency( 19 ), neglecting these needs can compromise care quality, fail to address health-threatening issues, and require greater time and cost to rectify, ultimately leading to wasted economic resources and reduced societal health in the long term ( 17 ). Additionally, based on the researcher’s experience, there is a clear need to increase operating room personnel’s awareness of their duties. However, no targeted educational programs have been implemented for this purpose, with existing training focusing primarily on nurses’ knowledge and efficacy toward organ preservation during intraoperative period. Given the absence of codified standards for preservation of transplant organ care intraoperatively and just the reliance on experiential practices by personnel, this study aimed to compile and teach these standards. Consequently, the present research was conducted to evaluate the impact of standardized training on intraoperative transplant organ care processes on the knowledge and self-efficacy of operating room personnel. Materials and methods Study Design A single-group pretest–posttest quasi-experimental design was employed in this study. Data were collected at three time points: pre-intervention, post intervention, and after one month follow up. The study was conducted between July to October 2024. The study was approved by the Ethics Committee of Isfahan University of Medical Sciences. Written informed consent was obtained from all participants, who were informed of the study’s purpose, voluntary nature, and confidentiality of data. Participants could withdraw at any time without consequences. The Regional Research Ethics Committee of Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran, approved the study (Approval ID: IR.MUI.NUREMA.REC.1403.090). The researcher explained this to the participants and obtained their informed and voluntary consent. We confirmed that all methods were performed in accordance with the relevant guidelines and regulations. We confirmed that all methods were performed in accordance with the Helsinki guidelines and regulations. Setting and Participants The research was carried out at two major transplant centers, Al-Zahra and Khorshid, in Isfahan, Iran. In these medical centers kidney and liver transplants are performed. They are the only educational medical centers for organ transplantation in Isfahan. The study population comprised operating room personnel, including surgical technologists and nurses with associate or bachelor’s degrees in operating room technology or nursing, who were actively involved in transplant procedures as scrub or circulating staff. Participants were selected using convenience sampling. As we do not have specialized persons just for working in the organ transplant operating rooms (OR) we needed to include all rotatory persons with at least one year of operating room working experience and willingness to participate. Exclusion criteria included absence from any training session or incomplete questionnaire responses. A total of 49 participants were enrolled, based on a sample size calculation using a confidence interval of 95%, power of 80%, and an effect size of 0.5, accounting for a 20% attrition rate. The procedure To inform the standards of preserving organs in intra-operative period, a literature review was conducted to identify all we need for pedagogical development. Key challenges in the context were also considered, including no content about structured intra-operative organ transplantation training programs in the continuing education programs in hospitals. The current situation is such that our nurses and technologists learn to care for transplanted organs during surgery only from each other’s experiences, and no structured or formal educational program on this subject has so far been designed or implemented for them. The program was designed as a two two-hour educational sessions delivered on separate days at each hospital, focusing on standardized preservation care processes for kidney and liver during cadaver or donor transplantation. The content was developed through a comprehensive literature review and expert consultation, including the study supervisor and advisors. Three academic members including one organ transplant surgeon and two well experienced OR nurses assessed and revised the educational content. Standards were categorized into organ-general protocols applicable to all transplants and organ-specific protocols applicable to kidney and liver separately. The first session covered general standards, including organ preservation techniques (e.g., static cold storage, dynamic hypothermic perfusion), infection control, and surgical setup. The second session addressed organ-specific standards, such as preservation solution preparation and organ packaging (e.g., triple sterile bagging for liver). Adult education principles, such as learner’s self-concept, prior experience, need to know, and orientation to learning, tried to be addressed during sessions. Sessions utilized interactive methods, including slide presentations, case-based discussions, and question-and-answer segments, supplemented by educational pamphlets summarizing key points. To assess participants’ baseline knowledge, and learning needs a pre-test exam performed. The intervention was delivered by the researcher, ensuring consistency across sessions. Implementation The first session In the first session the researcher introduced the aim and purposes of the participation to this first training module. All participants employed a pre-test exam. The pre-test exam contained 20 four-option multiple-choice questions about general and specific preservation of organs during transplantation surgery. All questions had been derived from the content of the first training module. In a ten-minute time, frame while the researcher was examined page by page the answers to pre-test exam, participants again asked to fill a researcher made self-efficacy questionnaire with 12-item based on a five-point Likert scale. These insights informed participants’ baseline knowledge and were also used to stimulate their reflection and goal-setting. Subsequently the researcher started to present the first training module i.e. general standards for preserving transplant organs, through power point slides. A question-and-answer part were integrated throughout the training to ensure continuous participant interaction. With these interactive assessments we promoted active recall, reinforced key concepts, and provided a platform for individual reflection. Collectively, these methods contributed to a highly interactive, learner-centered experience, aligned with the principles of adult learning. Each participant received a pamphlet containing a summary of key points. The second session The scheduling of the second session was based on participants’ preferences and was arranged with an interval of four to five days from the first session. In this session the researcher presented the second training module i.e. kidney and liver specific preserving standards, through power point slides. Similar to the first session a question-and-answer part were integrated throughout the training to ensure continuous participant interaction. At the end of the second session a time for the first reflection had been designed. Offering individual reflections on a voluntary basis helped participants gain feedback and reflection skills. Each participant received a pamphlet containing a summary of key points. Evaluation To evaluate the effectiveness of the training module, a post test was employed. At the end of the second session participants took a 15-minute break. Subsequently they employed in the post-test exam which contained the same 20 four-option multiple-choice questions about general and specific preservation of organs during transplantation surgery to assess objective learning outcomes. They also asked to fill a researcher made self-efficacy questionnaire with 12-item based on a five-point Likert scale for the second time. Only participants who completed both modules of the training ( N = 49) were included in the analysis to ensure consistency and reliability of outcome data. Finally, sharing the correct answers with participants, the researcher gave the second opportunity for reflection and provided a narrative feedback on their overall experiences, highlight strengths of the module, and offer suggestions for future improvement. One month later, to evaluate the retention of learning, the 20 item test and the self-efficacy questionnaire were re-administered to the participants. Ultimately, the results from all three phases were analyzed and compared. Data Collection tools Using a sociodemographic data form data were collected about participants’ descriptive characteristics The sociodemographic data form consisted of closed-ended questions about age, gender, educational level, working experience and Working experience in transplant surgery rooms in years. Data were collected using two validated instruments administered at baseline, immediately post-intervention, and one-month post-intervention. Knowledge was assessed with a 20 four-option multiple-choice questions, comprising 10 items on general standards and 10 on organ-specific standards, with scores ranging from 0 to 20. Each correct answer was scored as 1, and incorrect or unanswered items as 0. Self-efficacy was measured using a 12-item questionnaire based on a five-point Likert scale (1 = strongly disagree, 5 = strongly agree), with total scores ranging from 12 to 60, categorized as weak ( 44). Both instruments were developed by the researcher, informed by prior studies and text book ( 6 , 11 , 15 , 20 , 21 , 23 , 27 ), and validated for content validity by a panel of five experts in transplant surgery and nursing education. The Content Validity Ratio (CVR) was calculated for each item using Lawshe’s method, and items with a CVR below the acceptable threshold based on the number of experts (minimum CVR = 0.69 for 5 experts) were revised or removed. The content validity index (CVI) was calculated. The overall CVI was 0.92 for the knowledge test and 0.79 for the self-efficacy questionnaire, indicating acceptable content relevance. The reliability of the efficacy questionnaire was calculated using Cronbach’s alpha coefficient, which was 0.96. Data Analysis Data were analyzed using SPSS version 25.0 (IBM Corp., Armonk, NY, USA). Descriptive statistics (mean, standard deviation, frequency, and percentage) summarized participant demographics, knowledge scores, and self-efficacy levels. Normality of data was assessed using the Shapiro-Wilk test. To compare knowledge and self-efficacy scores across the three time points, repeated-measures analysis of variance (ANOVA) was used for normally distributed data, with post-hoc pairwise comparisons adjusted by Bonferroni correction. For non-normally distributed data, the Friedman test was applied, followed by Wilcoxon signed-rank tests for pairwise comparisons. Effect sizes were calculated using partial eta-squared (η²) for ANOVA and Kendall’s W for the Friedman test. A p-value < 0.05 was considered statistically significant. Results Descriptive analyses were conducted on the final sample of 49 participants. The demographic characteristics of these participants are presented in Table 1 . Table 1 Demographic Characteristics of Operating Room Personnel (n = 49) Variable Mean ± SD / N (%) Age (years) 33.61 ± 6.76 Gender Female: 42 (85.7%) Male: 7 (14.3%) Educational Level Bachelor: 48 (98%) Associate: 1 (2%) Hospital Al-Zahra: 33 (67.3%) Khorshid: 16 (32.7%) Working experience (years) 11.91 ± 4.73 Working experience in transplant surgery rooms 4.71 ± 4.54 SD Standard deviation N Number Wilcoxon tests revealed a statistically significant increase in knowledge from baseline to immediately post-intervention (mean difference = 11.45; p < 0.001), as well as a slight decline from post-intervention to one month later, but differences were still statistically significant (mean difference = − 0.30; p = 0.001). The Friedman test confirmed a significant effect of time on consistency of knowledge scores ( χ² = 92.41, p < 0.001) (Table 2 ). Table 2 Comparison of Knowledge Scores Over Time (n = 49) Time Point Mean ± SD Min–Max % Of Total Score Statistical Test (vs. previous) Pre-intervention 4.91 ± 2.09 1–9 24.55% — Post-intervention 16.36 ± 1.67 13–20 81.7% Z = − 6.10, p < 0.001 1-month follow-up 16.06 ± 1.77 13–20 80.3% Z = − 3.21, p = 0.001 Friedman Test — — — χ² = 92.41, p < 0.001 SD Standard deviation Min minimum Max Maximum The statistical significance of changes between pre-test and post-test score was evaluated using Wilcoxon test, Z test statistic from Wilcoxon test, P P(value) indicating the significance level Paired t -tests demonstrated significant increases in self-efficacy from pre- to post-intervention (mean difference = 21.20; p < 0.001), and a small but statistically significant reduction from post-intervention to one month later (mean difference = − 0.28; p = 0.01). Repeated measures ANOVA using the Greenhouse–Geisser correction confirmed a significant time effect on self-efficacy scores ( F (1.00, 48.00) = 136.95, p < 0.001) (Table 3 ). Table 3 Comparison of Self-Efficacy Scores Over Time (n = 49) Time Point Mean ± SD Min–Max Qualitative Category (%) Statistical Test (vs. previous) Pre-intervention 31.65 ± 11.35 14–60 Low: 55.1%, Moderate: 32.7%, High: 12.2% — Post-intervention 52.85 ± 4.55 43–60 High: 98% t = -11.83, p < 0.001 1-month follow-up 52.57 ± 4.63 43–60 High: 95.9% t = 2.53, p < 0.001 R M ANOVA — — — F = 136.95, p < 0.001 SD Standard deviation Min minimum Max Maximum The statistical significance of changes between pre-test and post-test score was evaluated using Repeated Measure ANOVA test, t test statistic from Repeated Measure ANOVA test, P P(value) indicating the significance level Discussion Prior to the intervention, participants showed limited knowledge, particularly regarding liver and kidney organ care, with an overall mean knowledge score reflecting less than 25% of the maximum score. This knowledge gap may stem from the infrequent exposure to transplant cases, the lack of standard in-service education, and limited practical training opportunities—a challenge also highlighted by Smith et al. (2019), who found that only 44.3% of Australian perioperative nurses were familiar with laws related to organ donation and procurement surgeries despite positive attitudes toward donation practice( 20 ). Post-intervention, the overall knowledge scores increased significantly, surpassing 80% of the total possible score, with meaningful improvements in both general and organ-specific domains. These results support the findings of Ross et al. (2021), who observed that a single educational session significantly enhanced the confidence and understanding of organ procurement among OR nurses and surgical technologists( 21 ). It also aligns with Smith et al. (2019), who emphasized the need for more education in perioperative care related to organ donation, noting that knowledge levels increased following structured programs( 20 ). The retention of high knowledge levels one month later indicates that the training program was both practical and well-aligned with participants’ clinical needs, mirroring the effectiveness of similarly designed interventions noted in studies such as Oh et al. (2019)( 22 ). These findings are in agreement with Azadi et al. (2022), who demonstrated that visual self-assessment training led to long-term retention of CPR knowledge among operating room technicians( 23 ). However, Watson and Dark (2012) emphasized that knowledge about organ preservation requires hands-on practice in addition to training, suggesting that retention may decline over longer intervals without reinforcement( 24 ). Jing et al. (2018) similarly warned that knowledge gained through lectures alone may not be sufficient for retention unless embedded into routine workflow practices( 25 ). These findings highlight the critical role of well-designed educational interventions in enhancing and maintaining clinical knowledge among healthcare professionals. The study also demonstrated a substantial increase in self-efficacy scores following the intervention. Before training, over half of the participants reported low self-efficacy, while immediately after training, 98% reported strong self-efficacy. This marked improvement is in line with Bandura’s (1997) social cognitive theory, which posits that self-efficacy is built through mastery experiences and performance accomplishments( 13 ). The results are consistent with those of AliZadeh et al. (2022), who showed that clinical education on pain management significantly improved the self-efficacy of nursing students( 26 ) and Babai et al. (2019), whose study confirmed the positive impact of stress management education on self-efficacy in clinical nurses( 27 ). Self-efficacy gains persisted one month after the intervention, indicating not only short-term effects but also the long-term value of training. Kaya and Bakir (2024) emphasized that higher self-efficacy correlates with stronger clinical decision-making abilities among perioperative nurses, supporting our conclusion that educational strategies can foster confidence and professional competence( 28 ). These findings highlight the sustained impact of targeted training programs in empowering clinical staff through enhanced self-efficacy, which is essential for ensuring quality care in high-stakes surgical environments. Study limitations First, reliance on self-reported data for measuring self-efficacy introduces the risk of response bias, as participants may have misreported their self-efficacy due to job-related concerns or perceived expectations. To control for this variable, negatively phrased items were incorporated into the self-efficacy questionnaire. Conducting two self-efficacy assessments i.e. immediate and one month after intervention in the form of rechecks contributed to controlling this variable. Second, the study was conducted in selected hospitals in Isfahan, which limits the generalizability of the findings to other regions or healthcare settings with different resources, infrastructures, or case volumes. Study implications The training program designed in this study can be used to train both skilled and novice operating room nurses working in organ transplant centers, as well as operating room students. Additionally, care standards are revised periodically, and it is the responsibility of managers to ensure that OR nurses and surgical technologists remain up to date. However, administrators can enhance the quality of surgical services provided to patients by sharing this educational program to other centers and implementing it in the form of face-to-face and more practical workshops. However, conducting studies for generalization, examining the impact of implementing this training program on patient care quality in the operating room and its clinical outcomes, as well as carrying out comparative research among different therapeutic environments and countries to gain insights into the structural differences and similarities of various nations that affect the formulation of supportive policies, are needed. Conclusion This study confirms that standardized training significantly enhances the knowledge and self-efficacy of operating room personnel in preservation care for transplant, with the effects sustained one-month post-intervention. These findings highlight the critical role of education in addressing knowledge gaps related to organ preservation care during surgery. We suggest that implementing such training programs periodically can improve clinical practice and patient outcomes. Therefore, we suggest for including such educational contents in continuous educational programs of operating room nurses and surgical technologists. Future research should explore their impact in relation to other transplantable organs and across varied clinical settings. Abbreviations OR Operating Room CVR Content Validity Ratio CVI Content Validity Index Declarations Acknowledgements We would like to express our heartfelt gratitude to all the participants of this study, OR nurses, surgical technologists, surgeons and academic members of nursing faculty. Together, we have established a collaborative group that continues to share knowledge and experiences, furthering the development of care in our country. The authors feel it necessary to express their sincere thanks and appreciation to the respected officials of Isfahan University of Medical Sciences, Isfahan, Iran and the respected teaching and research assistants for financial support which helped us in the implementation of this study. Author Contribution F.S. Data curation, Writing – original draft. project training, preparation of training materials, conducting training sessions, evaluation of training activities, participant support and guidance. A.H. Scientific director, Writing – review & editing. A.F. Scientific director, review & editing. A.A. Conceptualization, data curation, formal analysis, methodology, project administration, writing – original draft, writing, project training, preparation of training materials, conducting training sessions, evaluation of training activities, participant support and guidance. Funding This study was funded and supported by Isfahan University of Medical Sciences, Isfahan, Iran, (Approval ID: IR.MUI.NUREMA.REC.1403.090). (Grant No. 62000). Data availability The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request. Ethical approval and consent to participate The Regional Research Ethics Committee of Isfahan University of Medical Sciences, Isfahan, Iran, approved the study (Approval ID: IR.MUI.NUREMA.REC.1403.090). The researcher explained this to the participants and obtained their informed and voluntary consent. We confirmed that all methods were performed in accordance with the relevant guidelines and regulations. We confirmed that all methods were performed in accordance with the Helsinki guidelines and regulations. Clinical trial number: not applicable Consent for publication Not applicable. Competing Interests The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. Author details 1- Farkhondeh Sameipoor: Master student, Department of Operating Room, Student research committee, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran 2- Aygineh Hayrabedian: Instructor, Department of operating room, Nursing and midwifery care research center, School of nursing and midwifery, Isfahan university of medical sciences, Isfahan, Iran 3- Alireza Firouzfar: Assistant Professor, Department of General Surgery, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran 4- Akram Aarabi: Associate Professor, Department of operating room, Nursing and midwifery care research center, School of nursing and midwifery, Isfahan university of medical sciences, Isfahan, Iran. Corresponding author. 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The Effect of Education by Visual Self-assessment on the Operating Room Techni-cian's Knowledge, Self-esteem, and Performance in Advanced Cardiopulmonary Resuscitation. Iran J Nurs. 2021;34(133):66–81. https://doi.org/10.32598/IJN.34.5.6 . Watson C, Dark J. Organ transplantation: historical perspective and current practice. Br J Anaesth. 2012;108(suppl1):i29–42. https://doi.org/10.1093/bja/aer384 . Alizadeh M, Baljani E, Rezaee M. Evaluation of the Effectiveness of Promoting Pain Self-Management on Functional Self-Efficacy of Nursing Students in the Care of Patients. Res Med Educ. 2023;15(1):5–12. https://doi.org/10.32592/rmegums.15.1.5 . Babaie E, Golestani T, Nazoktabar H, Entezari R. The effect of stress management training on self-efficacy and quality of life in nurses of Government hospitals in Tehran City. J Health Care. 2020;22(2):157–67. https://doi.org/10.52547/jhc.22.2.157 . Kaya S, Bakir GK. The relationship between clinical decision-making levels and self-efficacy levels of operating room nurses. Perioperative Care Operating Room Manage. 2024;37:100416. https://doi.org/10.1016/j.pcorm.2024.100416 . Additional Declarations No competing interests reported. Supplementary Files Suplementarymaterial1.docx Supplementary material 1. Suplementarymaterial2.docx Supplementary material 2. 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12:46:18","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":691206,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7636938/v1/f712e7c2-6381-40ba-ae15-58bbc69639ae.pdf"},{"id":99313820,"identity":"eff0d52a-af6b-4786-9de2-b0eff01bd834","added_by":"auto","created_at":"2025-12-31 16:20:31","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":26814,"visible":true,"origin":"","legend":"\u003cp\u003eSupplementary material 1.\u003c/p\u003e","description":"","filename":"Suplementarymaterial1.docx","url":"https://assets-eu.researchsquare.com/files/rs-7636938/v1/f760a421fafc07b9c85b514b.docx"},{"id":99313951,"identity":"21458181-7928-4349-9d0c-aa08e8d314c8","added_by":"auto","created_at":"2025-12-31 16:20:39","extension":"docx","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":27370,"visible":true,"origin":"","legend":"\u003cp\u003eSupplementary material 2.\u003c/p\u003e","description":"","filename":"Suplementarymaterial2.docx","url":"https://assets-eu.researchsquare.com/files/rs-7636938/v1/03e29d94cf593f9789710f5b.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"The intraoperative standard care training program for transplanted organs: A quality improvement study to enhance knowledge and self-efficacy of operating room nurses","fulltext":[{"header":"Introduction","content":"\u003cp\u003eOrgan transplantation is a transformative medical procedure, offering hope to patients with end-stage organ failure worldwide(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). In Iran, over 56,953 transplants, including 48,850 kidney and 6,338 liver procedures, were performed between 1967 and 2018, reflecting significant national progress(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). The success of these complex surgeries depends on precise intraoperative care to ensure organ viability, a responsibility borne by operating room personnel such as surgical technologists and nurses. However, lapses in care can result in severe complications, including infection, organ rejection, or recipient mortality (\u003cspan additionalcitationids=\"CR4\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). Despite positive attitudes toward organ donation, studies reveal deficiencies in personnel\u0026rsquo;s knowledge and performance, underscoring the need for structured training (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e).Valiee et al. (2019) demonstrated that targeted education significantly enhances nurses\u0026rsquo; knowledge and attitudes toward organ donation, highlighting the potential of training to address these gaps(\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThese knowledge deficits are particularly critical in the operating room environment, where personnel must master organ-specific preservation techniques, such as static cold storage or dynamic hypothermic perfusion, to prevent tissue damage (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). For instance, kidneys tolerate up to 24 hours of cold ischemia, whereas hearts and lungs require shorter preservation times (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). In Iran, despite 2,500\u0026ndash;4,000 annual brain-death cases, only approximately 900 organ donations occurred in 2017, partly due to inadequate training among healthcare professionals(\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). Jameleh et al. (2019) found that enhanced staff education improves decision-making and consent rates, emphasizing training\u0026rsquo;s role in optimizing donation processes(\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). Operating room staff perform essential tasks, such as organ packaging and documentation, which demand adherence to standardized protocols (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). The Iranian Ministry of Health\u0026rsquo;s 2014 guidelines further stress meticulous donor care, reinforcing the urgency of equipping surgical teams with robust training(\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eBeyond technical expertise, self-efficacy\u0026mdash;the belief in one\u0026rsquo;s ability to execute tasks effectively\u0026mdash;is vital for operating room personnel to perform confidently under pressure (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). Low self-efficacy can lead to procedural errors, compromising patient safety, whereas enhanced self-efficacy fosters improved decision-making and teamwork (\u003cspan additionalcitationids=\"CR15\" citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). Research indicates that targeted education not only bolsters knowledge but also strengthens confidence, leading to better clinical outcomes(\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). In Iran, where formalized transplant care training is limited, addressing these gaps is crucial to minimize complications, optimize resource use, and enhance patient outcomes(\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). The reliance on experiential knowledge, without codified standards, risks inconsistencies and errors, underscoring the global relevance of standardized training for transplant care(\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eRecognizing the importance of addressing the educational needs of healthcare personnel, which enhances the quality of patient care, develops knowledge and skills, and improves effectiveness and efficiency(\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e), neglecting these needs can compromise care quality, fail to address health-threatening issues, and require greater time and cost to rectify, ultimately leading to wasted economic resources and reduced societal health in the long term (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). Additionally, based on the researcher\u0026rsquo;s experience, there is a clear need to increase operating room personnel\u0026rsquo;s awareness of their duties. However, no targeted educational programs have been implemented for this purpose, with existing training focusing primarily on nurses\u0026rsquo; knowledge and efficacy toward organ preservation during intraoperative period. Given the absence of codified standards for preservation of transplant organ care intraoperatively and just the reliance on experiential practices by personnel, this study aimed to compile and teach these standards. Consequently, the present research was conducted to evaluate the impact of standardized training on intraoperative transplant organ care processes on the knowledge and self-efficacy of operating room personnel.\u003c/p\u003e"},{"header":"Materials and methods","content":"\u003cp\u003eStudy Design\u003c/p\u003e \u003cp\u003eA single-group pretest\u0026ndash;posttest quasi-experimental design was employed in this study. Data were collected at three time points: pre-intervention, post intervention, and after one month follow up. The study was conducted between July to October 2024. The study was approved by the Ethics Committee of Isfahan University of Medical Sciences. Written informed consent was obtained from all participants, who were informed of the study\u0026rsquo;s purpose, voluntary nature, and confidentiality of data. Participants could withdraw at any time without consequences. The Regional Research Ethics Committee of Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran, approved the study (Approval ID: IR.MUI.NUREMA.REC.1403.090). The researcher explained this to the participants and obtained their informed and voluntary consent. We confirmed that all methods were performed in accordance with the relevant guidelines and regulations. We confirmed that all methods were performed in accordance with the Helsinki guidelines and regulations.\u003c/p\u003e \u003cp\u003eSetting and Participants\u003c/p\u003e \u003cp\u003eThe research was carried out at two major transplant centers, Al-Zahra and Khorshid, in Isfahan, Iran. In these medical centers kidney and liver transplants are performed. They are the only educational medical centers for organ transplantation in Isfahan. The study population comprised operating room personnel, including surgical technologists and nurses with associate or bachelor\u0026rsquo;s degrees in operating room technology or nursing, who were actively involved in transplant procedures as scrub or circulating staff. Participants were selected using convenience sampling. As we do not have specialized persons just for working in the organ transplant operating rooms (OR) we needed to include all rotatory persons with at least one year of operating room working experience and willingness to participate. Exclusion criteria included absence from any training session or incomplete questionnaire responses. A total of 49 participants were enrolled, based on a sample size calculation using a confidence interval of 95%, power of 80%, and an effect size of 0.5, accounting for a 20% attrition rate.\u003c/p\u003e \u003cp\u003eThe procedure\u003c/p\u003e \u003cp\u003eTo inform the standards of preserving organs in intra-operative period, a literature review was conducted to identify all we need for pedagogical development. Key challenges in the context were also considered, including no content about structured intra-operative organ transplantation training programs in the continuing education programs in hospitals. The current situation is such that our nurses and technologists learn to care for transplanted organs during surgery only from each other\u0026rsquo;s experiences, and no structured or formal educational program on this subject has so far been designed or implemented for them.\u003c/p\u003e \u003cp\u003eThe program was designed as a two two-hour educational sessions delivered on separate days at each hospital, focusing on standardized preservation care processes for kidney and liver during cadaver or donor transplantation. The content was developed through a comprehensive literature review and expert consultation, including the study supervisor and advisors. Three academic members including one organ transplant surgeon and two well experienced OR nurses assessed and revised the educational content. Standards were categorized into organ-general protocols applicable to all transplants and organ-specific protocols applicable to kidney and liver separately. The first session covered general standards, including organ preservation techniques (e.g., static cold storage, dynamic hypothermic perfusion), infection control, and surgical setup. The second session addressed organ-specific standards, such as preservation solution preparation and organ packaging (e.g., triple sterile bagging for liver). Adult education principles, such as learner\u0026rsquo;s self-concept, prior experience, need to know, and orientation to learning, tried to be addressed during sessions. Sessions utilized interactive methods, including slide presentations, case-based discussions, and question-and-answer segments, supplemented by educational pamphlets summarizing key points. To assess participants\u0026rsquo; baseline knowledge, and learning needs a pre-test exam performed. The intervention was delivered by the researcher, ensuring consistency across sessions.\u003c/p\u003e \u003cp\u003eImplementation\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eThe first session\u003c/h2\u003e \u003cp\u003eIn the first session the researcher introduced the aim and purposes of the participation to this first training module. All participants employed a pre-test exam. The pre-test exam contained 20 four-option multiple-choice questions about general and specific preservation of organs during transplantation surgery. All questions had been derived from the content of the first training module. In a ten-minute time, frame while the researcher was examined page by page the answers to pre-test exam, participants again asked to fill a researcher made self-efficacy questionnaire with 12-item based on a five-point Likert scale. These insights informed participants\u0026rsquo; baseline knowledge and were also used to stimulate their reflection and goal-setting. Subsequently the researcher started to present the first training module i.e. general standards for preserving transplant organs, through power point slides. A question-and-answer part were integrated throughout the training to ensure continuous participant interaction. With these interactive assessments we promoted active recall, reinforced key concepts, and provided a platform for individual reflection. Collectively, these methods contributed to a highly interactive, learner-centered experience, aligned with the principles of adult learning. Each participant received a pamphlet containing a summary of key points.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eThe second session\u003c/h3\u003e\n\u003cp\u003eThe scheduling of the second session was based on participants\u0026rsquo; preferences and was arranged with an interval of four to five days from the first session. In this session the researcher presented the second training module i.e. kidney and liver specific preserving standards, through power point slides. Similar to the first session a question-and-answer part were integrated throughout the training to ensure continuous participant interaction. At the end of the second session a time for the first reflection had been designed. Offering individual reflections on a voluntary basis helped participants gain feedback and reflection skills. Each participant received a pamphlet containing a summary of key points.\u003c/p\u003e\n\u003ch3\u003eEvaluation\u003c/h3\u003e\n\u003cp\u003eTo evaluate the effectiveness of the training module, a post test was employed. At the end of the second session participants took a 15-minute break. Subsequently they employed in the post-test exam which contained the same 20 four-option multiple-choice questions about general and specific preservation of organs during transplantation surgery to assess objective learning outcomes. They also asked to fill a researcher made self-efficacy questionnaire with 12-item based on a five-point Likert scale for the second time. Only participants who completed both modules of the training (\u003cem\u003eN\u003c/em\u003e\u0026thinsp;=\u0026thinsp;49) were included in the analysis to ensure consistency and reliability of outcome data. Finally, sharing the correct answers with participants, the researcher gave the second opportunity for reflection and provided a narrative feedback on their overall experiences, highlight strengths of the module, and offer suggestions for future improvement.\u003c/p\u003e \u003cp\u003eOne month later, to evaluate the retention of learning, the 20 item test and the self-efficacy questionnaire were re-administered to the participants. Ultimately, the results from all three phases were analyzed and compared.\u003c/p\u003e\n\u003ch3\u003eData Collection tools\u003c/h3\u003e\n\u003cp\u003eUsing a sociodemographic data form data were collected about participants\u0026rsquo; descriptive characteristics The sociodemographic data form consisted of closed-ended questions about age, gender, educational level, working experience and Working experience in transplant surgery rooms in years. Data were collected using two validated instruments administered at baseline, immediately post-intervention, and one-month post-intervention. Knowledge was assessed with a 20 four-option multiple-choice questions, comprising 10 items on general standards and 10 on organ-specific standards, with scores ranging from 0 to 20. Each correct answer was scored as 1, and incorrect or unanswered items as 0. Self-efficacy was measured using a 12-item questionnaire based on a five-point Likert scale (1\u0026thinsp;=\u0026thinsp;strongly disagree, 5\u0026thinsp;=\u0026thinsp;strongly agree), with total scores ranging from 12 to 60, categorized as weak (\u0026lt;\u0026thinsp;28), moderate (28\u0026ndash;44), or strong (\u0026gt;\u0026thinsp;44). Both instruments were developed by the researcher, informed by prior studies and text book (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e), and validated for content validity by a panel of five experts in transplant surgery and nursing education. The Content Validity Ratio (CVR) was calculated for each item using Lawshe\u0026rsquo;s method, and items with a CVR below the acceptable threshold based on the number of experts (minimum CVR\u0026thinsp;=\u0026thinsp;0.69 for 5 experts) were revised or removed. The content validity index (CVI) was calculated. The overall CVI was 0.92 for the knowledge test and 0.79 for the self-efficacy questionnaire, indicating acceptable content relevance. The reliability of the efficacy questionnaire was calculated using Cronbach\u0026rsquo;s alpha coefficient, which was 0.96.\u003c/p\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eData Analysis\u003c/h2\u003e \u003cp\u003eData were analyzed using SPSS version 25.0 (IBM Corp., Armonk, NY, USA). Descriptive statistics (mean, standard deviation, frequency, and percentage) summarized participant demographics, knowledge scores, and self-efficacy levels. Normality of data was assessed using the Shapiro-Wilk test. To compare knowledge and self-efficacy scores across the three time points, repeated-measures analysis of variance (ANOVA) was used for normally distributed data, with post-hoc pairwise comparisons adjusted by Bonferroni correction. For non-normally distributed data, the Friedman test was applied, followed by Wilcoxon signed-rank tests for pairwise comparisons. Effect sizes were calculated using partial eta-squared (η\u0026sup2;) for ANOVA and Kendall\u0026rsquo;s W for the Friedman test. A p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eDescriptive analyses were conducted on the final sample of 49 participants. The demographic characteristics of these participants are presented in 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 Operating Room Personnel (n\u0026thinsp;=\u0026thinsp;49)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD / N (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e33.61\u0026thinsp;\u0026plusmn;\u0026thinsp;6.76\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale: 42 (85.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale: 7 (14.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eEducational Level\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBachelor: 48 (98%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAssociate: 1 (2%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eHospital\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAl-Zahra: 33 (67.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eKhorshid: 16 (32.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWorking experience (years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11.91\u0026thinsp;\u0026plusmn;\u0026thinsp;4.73\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWorking experience in transplant surgery rooms\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.71\u0026thinsp;\u0026plusmn;\u0026thinsp;4.54\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"2\"\u003eSD Standard deviation N Number\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eWilcoxon tests revealed a statistically significant increase in knowledge from baseline to immediately post-intervention (mean difference\u0026thinsp;=\u0026thinsp;11.45; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), as well as a slight decline from post-intervention to one month later, but differences were still statistically significant (mean difference = \u0026minus;\u0026thinsp;0.30; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.001). The Friedman test confirmed a significant effect of time on consistency of knowledge scores (\u003cem\u003eχ\u0026sup2;\u003c/em\u003e = 92.41, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001) (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\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\u003eComparison of Knowledge Scores Over Time (n\u0026thinsp;=\u0026thinsp;49)\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=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" 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 \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTime Point\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMin\u0026ndash;Max\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e% Of Total Score\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eStatistical Test (vs. previous)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePre-intervention\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.91\u0026thinsp;\u0026plusmn;\u0026thinsp;2.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u0026ndash;9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e24.55%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePost-intervention\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16.36\u0026thinsp;\u0026plusmn;\u0026thinsp;1.67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13\u0026ndash;20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e81.7%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eZ\u003c/em\u003e = \u0026minus;\u0026thinsp;6.10, \u003cem\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1-month follow-up\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16.06\u0026thinsp;\u0026plusmn;\u0026thinsp;1.77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13\u0026ndash;20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e80.3%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eZ\u003c/em\u003e = \u0026minus;\u0026thinsp;3.21, \u003cem\u003ep\u0026thinsp;=\u0026thinsp;0.001\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFriedman Test\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eχ\u0026sup2;\u003c/em\u003e = 92.41, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eSD Standard deviation Min minimum Max Maximum\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe statistical significance of changes between pre-test and post-test score was evaluated using Wilcoxon test, Z test statistic from Wilcoxon test, P P(value) indicating the significance level\u003c/p\u003e \u003cp\u003ePaired \u003cem\u003et\u003c/em\u003e-tests demonstrated significant increases in self-efficacy from pre- to post-intervention (mean difference\u0026thinsp;=\u0026thinsp;21.20; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and a small but statistically significant reduction from post-intervention to one month later (mean difference = \u0026minus;\u0026thinsp;0.28; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.01). Repeated measures ANOVA using the Greenhouse\u0026ndash;Geisser correction confirmed a significant time effect on self-efficacy scores (\u003cem\u003eF\u003c/em\u003e(1.00, 48.00)\u0026thinsp;=\u0026thinsp;136.95, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001) (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\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\u003eComparison of Self-Efficacy Scores Over Time (n\u0026thinsp;=\u0026thinsp;49)\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=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" 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 \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTime Point\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMin\u0026ndash;Max\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eQualitative Category (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eStatistical Test (vs. previous)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePre-intervention\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e31.65\u0026thinsp;\u0026plusmn;\u0026thinsp;11.35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14\u0026ndash;60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eLow: 55.1%, Moderate: 32.7%, High: 12.2%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePost-intervention\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e52.85\u0026thinsp;\u0026plusmn;\u0026thinsp;4.55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e43\u0026ndash;60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eHigh: 98%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003et\u003c/em\u003e = -11.83, \u003cem\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1-month follow-up\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e52.57\u0026thinsp;\u0026plusmn;\u0026thinsp;4.63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e43\u0026ndash;60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eHigh: 95.9%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003et\u003c/em\u003e\u0026thinsp;=\u0026thinsp;2.53, \u003cem\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eR M ANOVA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eF\u003c/em\u003e\u0026thinsp;=\u0026thinsp;136.95, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eSD Standard deviation Min minimum Max Maximum\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe statistical significance of changes between pre-test and post-test score was evaluated using Repeated Measure ANOVA test, t test statistic from Repeated Measure ANOVA test, P P(value) indicating the significance level\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003ePrior to the intervention, participants showed limited knowledge, particularly regarding liver and kidney organ care, with an overall mean knowledge score reflecting less than 25% of the maximum score. This knowledge gap may stem from the infrequent exposure to transplant cases, the lack of standard in-service education, and limited practical training opportunities\u0026mdash;a challenge also highlighted by Smith et al. (2019), who found that only 44.3% of Australian perioperative nurses were familiar with laws related to organ donation and procurement surgeries despite positive attitudes toward donation practice(\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e).\u003c/p\u003e \u003cp\u003ePost-intervention, the overall knowledge scores increased significantly, surpassing 80% of the total possible score, with meaningful improvements in both general and organ-specific domains. These results support the findings of Ross et al. (2021), who observed that a single educational session significantly enhanced the confidence and understanding of organ procurement among OR nurses and surgical technologists(\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). It also aligns with Smith et al. (2019), who emphasized the need for more education in perioperative care related to organ donation, noting that knowledge levels increased following structured programs(\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). The retention of high knowledge levels one month later indicates that the training program was both practical and well-aligned with participants\u0026rsquo; clinical needs, mirroring the effectiveness of similarly designed interventions noted in studies such as Oh et al. (2019)(\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). These findings are in agreement with Azadi et al. (2022), who demonstrated that visual self-assessment training led to long-term retention of CPR knowledge among operating room technicians(\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). However, Watson and Dark (2012) emphasized that knowledge about organ preservation requires hands-on practice in addition to training, suggesting that retention may decline over longer intervals without reinforcement(\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). Jing et al. (2018) similarly warned that knowledge gained through lectures alone may not be sufficient for retention unless embedded into routine workflow practices(\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e). These findings highlight the critical role of well-designed educational interventions in enhancing and maintaining clinical knowledge among healthcare professionals.\u003c/p\u003e \u003cp\u003eThe study also demonstrated a substantial increase in self-efficacy scores following the intervention. Before training, over half of the participants reported low self-efficacy, while immediately after training, 98% reported strong self-efficacy. This marked improvement is in line with Bandura\u0026rsquo;s (1997) social cognitive theory, which posits that self-efficacy is built through mastery experiences and performance accomplishments(\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). The results are consistent with those of AliZadeh et al. (2022), who showed that clinical education on pain management significantly improved the self-efficacy of nursing students(\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e) and Babai et al. (2019), whose study confirmed the positive impact of stress management education on self-efficacy in clinical nurses(\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e). Self-efficacy gains persisted one month after the intervention, indicating not only short-term effects but also the long-term value of training. Kaya and Bakir (2024) emphasized that higher self-efficacy correlates with stronger clinical decision-making abilities among perioperative nurses, supporting our conclusion that educational strategies can foster confidence and professional competence(\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e). These findings highlight the sustained impact of targeted training programs in empowering clinical staff through enhanced self-efficacy, which is essential for ensuring quality care in high-stakes surgical environments.\u003c/p\u003e\n\u003ch3\u003eStudy limitations\u003c/h3\u003e\n\u003cp\u003eFirst, reliance on self-reported data for measuring self-efficacy introduces the risk of response bias, as participants may have misreported their self-efficacy due to job-related concerns or perceived expectations. To control for this variable, negatively phrased items were incorporated into the self-efficacy questionnaire. Conducting two self-efficacy assessments i.e. immediate and one month after intervention in the form of rechecks contributed to controlling this variable. Second, the study was conducted in selected hospitals in Isfahan, which limits the generalizability of the findings to other regions or healthcare settings with different resources, infrastructures, or case volumes.\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eStudy implications\u003c/h2\u003e \u003cp\u003eThe training program designed in this study can be used to train both skilled and novice operating room nurses working in organ transplant centers, as well as operating room students. Additionally, care standards are revised periodically, and it is the responsibility of managers to ensure that OR nurses and surgical technologists remain up to date. However, administrators can enhance the quality of surgical services provided to patients by sharing this educational program to other centers and implementing it in the form of face-to-face and more practical workshops.\u003c/p\u003e \u003cp\u003eHowever, conducting studies for generalization, examining the impact of implementing this training program on patient care quality in the operating room and its clinical outcomes, as well as carrying out comparative research among different therapeutic environments and countries to gain insights into the structural differences and similarities of various nations that affect the formulation of supportive policies, are needed.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study confirms that standardized training significantly enhances the knowledge and self-efficacy of operating room personnel in preservation care for transplant, with the effects sustained one-month post-intervention. These findings highlight the critical role of education in addressing knowledge gaps related to organ preservation care during surgery. We suggest that implementing such training programs periodically can improve clinical practice and patient outcomes. Therefore, we suggest for including such educational contents in continuous educational programs of operating room nurses and surgical technologists. Future research should explore their impact in relation to other transplantable organs and across varied clinical settings.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eOR\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eOperating Room\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCVR\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eContent Validity Ratio\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCVI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eContent Validity Index\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe would like to express our heartfelt gratitude to all the participants of this study, OR nurses, surgical technologists, surgeons and academic members of nursing faculty. Together, we have established a collaborative group that continues to share knowledge and experiences, furthering the development of care in our country. The authors feel it necessary to express their sincere thanks and appreciation to the respected officials of Isfahan University of Medical Sciences, Isfahan, Iran and the respected teaching and research assistants for financial support which helped us in the implementation of this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contribution\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eF.S.\u0026nbsp;\u003c/strong\u003eData curation, Writing \u0026ndash; original draft. project training, preparation of training materials, conducting training sessions, evaluation of training activities, participant support and guidance. \u003cstrong\u003eA.H.\u003c/strong\u003e Scientific director, Writing \u0026ndash; review \u0026amp; editing. \u003cstrong\u003eA.F.\u003c/strong\u003e Scientific director, review \u0026amp; editing. \u0026nbsp; \u003cstrong\u003eA.A.\u0026nbsp;\u003c/strong\u003eConceptualization, data curation, formal analysis, methodology, project administration, writing \u0026ndash; original draft, writing, project training, preparation of training materials, conducting training sessions, evaluation of training activities, participant support and guidance.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was funded and supported by Isfahan University of Medical Sciences, Isfahan, Iran, (Approval ID: IR.MUI.NUREMA.REC.1403.090). (Grant No. 62000).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u0026nbsp;\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\u003eEthical approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe Regional Research Ethics Committee of \u0026nbsp;Isfahan University of Medical Sciences, Isfahan, Iran, approved the study (Approval ID: IR.MUI.NUREMA.REC.1403.090). The researcher explained this to the participants and obtained their informed and voluntary consent. We confirmed that all methods were performed in accordance with the relevant guidelines and regulations. We confirmed that all methods were performed in accordance with the Helsinki guidelines and regulations.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eClinical trial number: not applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor details\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e1- \u003cstrong\u003eFarkhondeh Sameipoor:\u003c/strong\u003e Master student, Department of Operating Room, Student research committee, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran\u003c/p\u003e\n\u003cp\u003e2- \u003cstrong\u003eAygineh Hayrabedian:\u003c/strong\u003e Instructor, Department of operating room, Nursing and midwifery care research center, School of nursing and midwifery, Isfahan university of medical sciences, Isfahan, Iran\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e3- \u003cstrong\u003eAlireza Firouzfar:\u003c/strong\u003e Assistant Professor, Department of General Surgery, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran\u003c/p\u003e\n\u003cp\u003e4- \u003cstrong\u003eAkram Aarabi:\u003c/strong\u003e Associate Professor, Department of operating room, Nursing and midwifery care research center, School of nursing and midwifery, Isfahan university of medical sciences, Isfahan, Iran. 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Res Med Educ. 2023;15(1):5\u0026ndash;12. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.32592/rmegums.15.1.5\u003c/span\u003e\u003cspan address=\"10.32592/rmegums.15.1.5\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBabaie E, Golestani T, Nazoktabar H, Entezari R. The effect of stress management training on self-efficacy and quality of life in nurses of Government hospitals in Tehran City. J Health Care. 2020;22(2):157\u0026ndash;67. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.52547/jhc.22.2.157\u003c/span\u003e\u003cspan address=\"10.52547/jhc.22.2.157\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKaya S, Bakir GK. The relationship between clinical decision-making levels and self-efficacy levels of operating room nurses. Perioperative Care Operating Room Manage. 2024;37:100416. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.pcorm.2024.100416\u003c/span\u003e\u003cspan address=\"10.1016/j.pcorm.2024.100416\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"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":"bmc-medical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meed","sideBox":"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meed/default.aspx","title":"BMC Medical Education","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Organ transplantation, Intraoperative care, Standard, Training, Operating room, Knowledge, Self-efficacy","lastPublishedDoi":"10.21203/rs.3.rs-7636938/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7636938/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eIntroduction\u003c/h2\u003e \u003cp\u003e: Organ transplantation, a critical intervention for end-stage organ failure, relies on precise intraoperative care by operating room personnel to ensure organ viability. In Iran, despite significant transplant activity, knowledge and self-efficacy gaps among surgical staff persist, risking complications. This study evaluated the effect of a training program on the knowledge and self-efficacy of intraoperative nurses in the standard preservation of transplantable organs.\u003c/p\u003e\u003ch2\u003eMaterials and methods\u003c/h2\u003e \u003cp\u003eA quasi-experimental, single-group pre-test post-test design was conducted at Al-Zahra and Khorshid hospitals in Isfahan, Iran, from July to October 2024. Forty-nine surgical technologists and nurses participated in two one-hour educational sessions covering general and organ-specific preservation care standards for kidney and liver. Knowledge was assessed via a 20-item multiple-choice test, and self-efficacy was evaluated via a 12-item Likert-scale questionnaire. Data were collected at pre-intervention, post-intervention, and after one-month follow-up, and analyzed using repeated-measures ANOVA and Friedman tests (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eParticipants showed significant knowledge improvement, with mean scores rising from 4.91\u0026thinsp;\u0026plusmn;\u0026thinsp;2.09 (24.55%) pre-intervention to 16.36\u0026thinsp;\u0026plusmn;\u0026thinsp;1.67 (81.7%) post-intervention (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and slightly declining to 16.06\u0026thinsp;\u0026plusmn;\u0026thinsp;1.77 (80.3%) at after one month follow up (p\u0026thinsp;=\u0026thinsp;0.001). Self-efficacy scores increased from 31.65\u0026thinsp;\u0026plusmn;\u0026thinsp;11.35 (moderate) to 52.85\u0026thinsp;\u0026plusmn;\u0026thinsp;4.55 (strong) post-intervention (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), with a minor reduction to 52.57\u0026thinsp;\u0026plusmn;\u0026thinsp;4.63 at follow-up (p\u0026thinsp;=\u0026thinsp;0.01).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eStandardized training significantly enhanced operating room personnel\u0026rsquo;s knowledge and self-efficacy, with sustained effects at one month. These findings highlight the value of structured education in improving clinical competence and confidence, potentially optimizing patient outcomes in transplant surgery.\u003c/p\u003e","manuscriptTitle":"The intraoperative standard care training program for transplanted organs: A quality improvement study to enhance knowledge and self-efficacy of operating room nurses","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-26 10:20:54","doi":"10.21203/rs.3.rs-7636938/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-02-02T13:24:25+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-01-29T07:59:08+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"231018164364053845577462822268326712498","date":"2026-01-09T09:27:22+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"120562059958920534470924685290525886448","date":"2026-01-05T04:34:26+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-12-31T13:39:42+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"238586555876496344436583984055748512594","date":"2025-12-31T10:32:15+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-12-30T08:51:07+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"205779797379174651212353708859704503645","date":"2025-12-27T09:09:29+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"176444076787217522699165232390520866906","date":"2025-12-26T12:07:24+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"124171155412318237417750260566862267712","date":"2025-12-25T06:16:11+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"301030235464801230531918096085958326953","date":"2025-12-24T15:25:58+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-12-24T11:51:05+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-11-21T09:56:58+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-10-08T11:36:32+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-10-08T05:13:46+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Medical Education","date":"2025-10-08T05:10:34+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meed","sideBox":"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meed/default.aspx","title":"BMC Medical Education","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"e70f757a-117f-4125-8aaa-23152796c1de","owner":[],"postedDate":"December 26th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-02-19T07:53:49+00:00","versionOfRecord":[],"versionCreatedAt":"2025-12-26 10:20:54","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7636938","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7636938","identity":"rs-7636938","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}