Asian Journal of Medicine and Health

Background: Globally, the complexity of surgical procedures has increased due to changes in the delivery of care. Perioperative care requires competence to promote patient safety and self-care. This includes medical assessment to identify comorbidities, screening to identify risk factors and patient risk assessment. Postoperative care depends on the invasiveness of the procedure and is divided into two phases: (a) the immediate postoperative period, usually after major procedures, when the patient may need to be transferred to critical care or recovery units; and (b) the late postoperative period, when some patients experience physiological and functional decline after surgery. Patient safety issues and communication errors may emerge when operating room nurses are under stress and perform multiple tasks that interfere with cognitive processes. Studies show that errors occur when nurses do not understand their roles or do not feel supported, valued or respected. Therefore, clinical and communication competence is important for establishing a culture of patient safety. Objectives: This integrative literature review synthesizes existing evidence on strategies, interventions and factors that enhance nurses' clinical and communication competence in perioperative care within the surgical context. The review seeks to identify how these competencies contribute to patient safety, teamwork, surgical efficiency and the quality of perioperative outcomes. It also helps to determine gaps in current knowledge among operating room nurses in terms of clinical and communication skills within the surgical team.

Methods: An integrative review approach was used to examine qualitative, quantitative and mixed-method studies related to operating room nursing competence. The review was guided by the Population-Concept-Context framework and followed a structured search and selection process. The databases searched included ScienceDirect, CINAHL, PubMed, Google Scholar, Elsevier and EBSCOhost. The literature inclusion criteria were peer-reviewed journals, full-text articles and studies published in English from January 2021 to May 2026. Eligible articles focused on operating room nurses or perioperative nurses, and on clinical and communication competence that enhances knowledge, skills and attitudes in the delivery of care. The methodological quality of the studies was established using critical appraisal tools. Data were extracted, compared and analyzed through thematic synthesis to identify emerging themes. Results: Ten studies were included in the final review. Three major themes emerged from the synthesis: (1) education, training and mentorship; (2) a supportive environment and accurate information flow; and (3) team collaboration and patient advocacy. The reviewed evidence suggests that structured training, mentoring, reflective learning and clinical exposure support the development of perioperative competence. A supportive work environment and clear communication among surgeons, anesthesiologists, nurses and other team members were identified as important for reducing misunderstandings, stress and communication barriers. Team collaboration and patient advocacy were also emphasized as central elements of safe perioperative practice and enhanced surgical team performance. Conclusion: Clinical and communication competence are important components of operating room nursing practice. Strengthening education, mentorship, communication systems and collaborative team culture may support safer and more coordinated perioperative care. This review highlights the need for healthcare institutions to implement evidence-based strategies that enhance competence among operating room nurses in surgical settings.