{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T05:45:54Z","timestamp":1792129554719,"version":"4.4.0"},"reference-count":32,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T00:00:00Z","timestamp":1792022400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T00:00:00Z","timestamp":1792022400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of Advanced Nursing"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Hierarchy can inhibit nurses from raising patient\u2010safety concerns in operating rooms, yet how Chinese peri\u2010operative nurses navigate this with surgeons versus anaesthetists remains underexplored.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>To explore when and how peri\u2010operative nurses in Chinese operating rooms voice, withhold, or adapt patient\u2010safety concerns with surgeons and anaesthetists.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>A multi\u2010site qualitative descriptive study using the Critical Incident Technique, supplemented by an interpretive interprofessional workshop.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Twenty peri\u2010operative nurses from three tertiary hospitals in Taiyuan, China, were recruited through stratified purposive sampling. Each completed one in\u2010depth interview, generating 40 critical incidents, and a subsequent workshop informed interpretation. Template thematic analysis was conducted, using psychological safety and power distance as sensitizing concepts.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Three themes were developed: (1) nurses spoke up mainly when risk was concrete and imminent; (2) they used cautious linguistic and non\u2010verbal strategies to preserve professional relationships and face; (3) voice depended on prior punitive experiences, perceived openness, and task relationship. Anaesthetist\u2010directed concerns were more collaborative, whereas surgeon\u2010directed concerns required greater deference.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Speaking up was situational, relational, and shaped by hierarchical norms and local team climate, with nurses adapting concerns to different professional audiences.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Impact<\/jats:title>\n                    <jats:p>Nurse voice in Chinese operating rooms is target\u2010specific, shaped by professional jurisdiction and local team climate. Findings support nurse managers, peri\u2010operative educators, and interprofessional leaders in developing psychologically safer climates, hierarchy\u2010sensitive communication training, and role\u2010specific strategies for raising concerns with surgeons and anaesthetists.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patient or Public Contribution<\/jats:title>\n                    <jats:p>Not applicable.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jan.70794","type":"journal-article","created":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T04:59:46Z","timestamp":1792126786000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Speaking Up in Hierarchical Operating Rooms: A Qualitative Descriptive Study of Nurses' Safety Communication With Surgeons and Anaesthetists"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-6456-2335","authenticated-orcid":false,"given":"Yang","family":"Guo","sequence":"first","affiliation":[{"name":"Department of Anesthesiology Shanxi Provincial People's Hospital  Taiyuan City Shanxi Province China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yaqing","family":"Quan","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology Shanxi Provincial People's Hospital  Taiyuan City Shanxi Province China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manhong","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology Shanxi Provincial People's Hospital  Taiyuan City Shanxi Province China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Weiwei","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology Shanxi Provincial People's Hospital  Taiyuan City Shanxi Province China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,15]]},"reference":[{"issue":"1","key":"e_1_2_15_2_1","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1136\/bmjqs-2017-007163","article-title":"Speaking Up About Patient Safety Concerns: The Influence of Safety Management Approaches and Climate on Nurses' Willingness to Speak Up","volume":"28","author":"Alingh C. 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