{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T05:56:41Z","timestamp":1790834201053,"version":"4.1.0"},"reference-count":61,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T00:00:00Z","timestamp":1790726400000},"content-version":"vor","delay-in-days":272,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100008809","name":"University of Hail","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100008809","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of Nursing Management"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Strengthening patient safety culture (PSC) is essential for enhancing clinical practice, teamwork, and nursing leadership in surgical settings. However, evidence on interventions that promote PSC in operating rooms (ORs) in low\u2010 and middle\u2010income countries remains limited.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To evaluate the association between a multifaceted intervention and PSC perceptions among OR professionals in a resource\u2010limited setting.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      A quasiexperimental, nonrandomized before\u2010and\u2010after study with a concurrent control group was conducted over 21\u2009months across 12 ORs in two tertiary hospitals in Tunisia. One hospital served as the intervention site and the other as the control site. All eligible healthcare professionals (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009347; surgeons, anesthesiologists, nurses, OR specialized nurses, and assistant caregivers) were invited to participate. The intervention focused on implementing the Surgical Safety Checklist (SSC) and included team\u2010based training, practice runs, awareness campaigns, local nurse champions, continuous mentorship, and audit and feedback processes. Data were collected at three time points (baseline, postintervention, and follow\u2010up) using the French version of the Hospital Survey on PSC. All data were anonymized to ensure confidentiality.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The intervention was associated with significant and sustained improvements in four key dimensions of PSC: \u201cOrganizational learning\u2013continuous improvement\u201d increased from 37.7% to 50.6%, \u201cTeamwork within units\u201d from 47.6% to 59.1%, \u201cCommunication openness\u201d from 27.2% to 46.2%, and \u201cTeamwork across units\u201d from 29.2% to 37.5%. The overall perceived level of safety increased from 70.7% at baseline to 82.4% postintervention and was sustained at follow\u2010up.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>A multifaceted intervention focusing on SSC implementation and incorporating team\u2010based training, continuous feedback, and supported practice was associated with improved PSC perceptions in a resource\u2010limited setting. Such approaches may support the sustainable integration of safety protocols into routine surgical practice.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Implications for Nursing Management<\/jats:title>\n                    <jats:p>Findings highlight the critical role of nurse champions and the active engagement of OR managers in leading safety initiatives. Structured implementation support, including mentorship, continuous training, and audit and feedback, may facilitate adherence to the SSC. For perioperative nursing leaders in resource\u2010limited settings, strong leadership engagement and organizational support are essential to sustain long\u2010term implementation of safe surgical practices.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1155\/jonm\/4718057","type":"journal-article","created":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T04:56:32Z","timestamp":1790830592000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Improving Patient Safety Culture Perceptions in Resource\u2010Limited Operating Rooms: A Nurse\u2010Led Multifaceted Implementation of the WHO Surgical Safety Checklist"],"prefix":"10.1155","volume":"2026","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7697-0332","authenticated-orcid":false,"given":"Wiem","family":"Aouicha","sequence":"first","affiliation":[{"name":"Nursing Administration Department College of Nursing University of Hail  Hail Saudi Arabia  uoh.edu.sa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamed Ayoub","family":"Tlili","sequence":"additional","affiliation":[{"name":"Nursing Administration Department College of Nursing University of Hail  Hail Saudi Arabia  uoh.edu.sa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9631-8870","authenticated-orcid":false,"given":"Bushra","family":"Alshammari","sequence":"additional","affiliation":[{"name":"Medical Surgical Nursing Department College of Nursing University of Hail  Hail 2440 Saudi Arabia  uoh.edu.sa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hamdi","family":"Lamine","sequence":"additional","affiliation":[{"name":"Community Health Nursing Department College of Nursing University of Hail  Hail Saudi Arabia  uoh.edu.sa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nahed Mousa","family":"Saber","sequence":"additional","affiliation":[{"name":"Maternal and Child Health Nursing Department College of Nursing University of Hail  Hail Saudi Arabia  uoh.edu.sa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nojoud Abdullah","family":"Alrashidi","sequence":"additional","affiliation":[{"name":"Maternal and Child Health Nursing Department College of Nursing University of Hail  Hail Saudi Arabia  uoh.edu.sa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amany Ali Abd","family":"Elsalam","sequence":"additional","affiliation":[{"name":"Maternal and Child Health Nursing Department College of Nursing University of Hail  Hail Saudi Arabia  uoh.edu.sa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hadya Obied","family":"Alenzi","sequence":"additional","affiliation":[{"name":"Maternal and Child Health Nursing Department College of Nursing University of Hail  Hail Saudi Arabia  uoh.edu.sa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samah Ramadan Ibrahim","family":"Elrefaey","sequence":"additional","affiliation":[{"name":"Psychiatric and Mental Health Nursing Department College of Nursing Benha University  Benha Egypt  bu.edu.eg"},{"name":"Community and Mental Health Nursing Department College of Nursing Najran University  Najran Saudi Arabia  nu.edu.sa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammad","family":"Alboliteeh","sequence":"additional","affiliation":[{"name":"Nursing Administration Department College of Nursing University of Hail  Hail Saudi Arabia  uoh.edu.sa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Houyem Said","family":"Latiri","sequence":"additional","affiliation":[{"name":"Faculty of Medicine of Sousse University of Sousse  Sousse Tunisia  uc.rnu.tn"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manel","family":"Mallouli","sequence":"additional","affiliation":[{"name":"Faculty of Medicine of Sousse University of Sousse  Sousse Tunisia  uc.rnu.tn"},{"name":"Laboratory of Research \u201cLR12ES03\u201d Faculty of Medicine of Sousse University of Sousse  Sousse Tunisia  uc.rnu.tn"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Areej Ali Fahad","family":"Alshammary","sequence":"additional","affiliation":[{"name":"Aja Long Term Care Hospital &amp; 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