Abstract
Background
Patient safety in the operating room is a process involving organized activities. Within this process, technological environments, behavioral activities, risks, procedures, and sustainability play significant roles.
Purpose
This bibliometric study provides a comprehensive and integrative review of the global literature on post-operative patient safety in nursing.
Design
Bibliometric analysis.
Methods
Data were collected using the Web of Science (WOS) database on September 18, 2024. No time constraints were imposed during the data search, and all data available up to the search date were included in the initial review. The “Biblioshiny” application provided by the Bibliometrix R package was used for analysis.
Results
The results indicate that the nursing literature on patient safety in the operating room has been increasing every year, peaking in the current period. According to the Bradford’s Law analysis, the number of journals in the first zone is insufficient, and multidisciplinary journals are included in this specialized nursing publication group. The author productivity does not align with Lotka’s Law, highlighting the need to increase the number of expert authors in this field. Developed countries are the most productive in nursing publications related to patient safety in the operating room, and collaborative publications are concentrated in these areas. Some underdeveloped countries have no publications at all. In the nursing literature, relevant research primarily focuses on “operating-room,” “patient safety,” and “communication.” There are literature gaps in the areas of complications, anxiety, and operating-room efficiency.
Conclusions
This bibliometric study provides a comprehensive and integrative review of the global literature on patient safety in the operating room within the field of nursing.
1
Introduction
Patient safety is defined by the World Health Organization (WHO) as “the prevention of preventable harm to patients and the minimisation of risks associated with healthcare”. In the operating theatre, patient safety is a process involving organised activities. Within this process, the technological environment, behavioural activities, risks, procedures and sustainability play an important role. The primary objective is to consistently manage risks that may arise in patient safety and to prevent potential harm. , Operating rooms are high-risk environments for patient harm. Errors in the operating room that threaten patient safety include wrong surgery, wrong site surgery, transfusion errors, falls, burns, electrical shocks, and leaving foreign objects in the patient. Worldwide, 240 million patients undergo surgery each year. Of these patients, seven million suffer surgical complications and one million die during or immediately after surgery. The World Health Organization has indicated that half of the harms associated with surgery are preventable. This underscores the importance of patient safety in the operating room.
Operating room nurses must prioritize the protection of patient rights in ensuring patient safety. Achieving patient safety in the operating room is the responsibility of operating room nurses and involves effective communication, teamwork, efficient use of resources, adherence to necessary procedures, prevention of potential errors, and evidence-based care. Compared to other units, operating room nurses face heavy workloads, stress, and irregular schedules. As a result, the complexity of the work environment, improper use of technological devices, monitoring errors, communication breakdowns, and time constraints can contribute to patient harm. , Systematic reviews and meta-analyses have been conducted on patient safety management in the operating room. These studies emphasise the importance of ensuring appropriate conditions for patient safety and providing the necessary training and awareness for staff. High-quality systematic reviews and meta-analyses are time consuming and often focus on a single topic, which may include a limited number of studies and introduce author bias. In addition, bibliometric studies, which provide a broader perspective, contribute to scientific production by including a large number of studies. Bibliometric analysis combines specific research questions with defined methods to explore scientific boundaries. This approach allows the analysis of relationships between objective data such as publications, authors, citations, institutions, countries, keywords and collaborations. Because it is scientifically transparent and repeatable, it allows the selection of both relevant and irrelevant studies. In addition, bibliometric analysis is recommended as a complementary methodology to traditional literature reviews because it provides a more objective approach to examining trends and performance in research. Bibliometric studies have become particularly valuable in nursing research for identifying knowledge gaps in the literature and generating new research ideas.
Although there are bibliometric studies on patient safety in the literature to our knowledge there are no bibliometric studies specifically focused on patient safety in the field of operating room nursing. This unique study is important because it targets specific outcomes related to operating room nursing. The aim of this study is to evaluate nursing research on patient safety in the operating theatre using bibliometric analysis, and to provide a structured and objective overview of the characteristics and development of this research.
In line with the main aims of the study, the following questions will be addressed:
What is the distribution of nursing research on patient safety in the operating room by country, journal and author?
What are the trends, most productive topics, and existing literature gaps in nursing research related to patient safety in the operating room?
2
Method
In recent years, bibliometric analyses have gained increasing interest and popularity. These studies involve the use of quantitative methods to evaluate bibliometric data. Scientific databases provide extensive and comprehensive bibliometric data, allowing targeted and effective access to this information. Consequently, it is noted that the data used in bibliometric analyses typically have “significantly broad and objective qualities”. These characteristics increase the reliability of the research and ensure the generalisability of the results. The articles in this meta-analysis were classified according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis)criteria.
2.1
Design
This study is a bibliometric analysis of nurse-led publications related to patient safety in the operating room. Researchers use bibliometric analysis for various reasons, such as to reveal trends in the performance of articles and journals, to identify patterns of collaboration, and to explore research components to reveal the intellectual structure of a particular area in the existing literatüre. Therefore, bibliometric analysis was the most appropriate method for our purposes
2.2
Data source and search strategy
In bibliometric analyses, the selection of the most appropriate data source for the research area and question is crucial. Different databases and sources offer different coverage and data characteristics, which directly affect the accuracy and validity of the analysis results. Therefore, choosing the right data source is essential for achieving the research objectives and ensuring the reliability of the findings. Web of Science (Core Collection) is a rich source of digital literature covering various academic disciplines. It is widely accepted by researchers due to its compilation of high quality publications. ,
As an ideal data source for bibliometric analysis, this platform provides key data in the field, making it suitable for measuring research trends and impact. The choice of Web of Science as the data source for this study is crucial to the validity and reliability of the research. Data collection was carried out on 18 November 2024 using the WOS database. There were no time restrictions on the data search, and all data available up to the search date were included in the initial search. Relevant studies for in-depth analysis were identified according to the research question using the following search terms: “patient safety” and “nurse” or “nurses” or “nursing” or “nursing staff” or “registered nurse” and “surgery” or “operation” or “surgical procedure” or “surgical treatment” or “operative” or “postoperative” or “postoperative”. Quotation marks were used in the search terms to ensure accurate results.
2.3
Study selection and extraction
Inclusion and exclusion criteria were set for the selection of research studies. The inclusion criteria were: (1) studies containing search terms in the title, keywords or abstract, and (2) articles. Exclusion criteria were: (1) articles without keywords; (2) commentaries defined as books, book chapters, editorials and letters. As a result of the search for postoperative pain in the nursing literature, 616 publications were identified. After selecting articles, review articles and early access articles, the number of publications included in the review was determined to be 607. All bibliographic data were extracted from the WOS database to create the bibliometric map. The content of each record, including full text and reference information, was selected and saved as ‘Savedrecs.txt’. As the number of search results exceeded 500, articles were downloaded in batches of 500 and then merged into a single file.
2.4
Data analysis
The ‘Biblioshiny’ application provided by the Bibliometrix R package, which provides a highly suitable interface for in-depth bibliometric analyses, was used. Biblioshiny is an open source software that provides a web interface supported by three-dimensional graphs to explore scientific collaborations, general statistics and relationships in detail.
2.5
Ethical approval
Ethical review was not required for this study.
3
Results
3.1
Main data statistics
A total of 607 nursing articles related to patient safety in the operating room were published in 293 sources between 1994 and 2024. The annual growth rate is 13.53 %, with an average article age of 6.92 years and an average number of citations per article of 22.01. A total of 14,674 references were used in the articles. The number of authors is 2677, with 18 single-author papers. The collaboration of authors in the articles is 5.23 %, while the international collaboration of authors is 13.01 % ( Table 1 ).
| Description | Results | |
|---|---|---|
| Maın Iformation About Data | Timespan | 1994:2024 |
| Sources (Journals. Books. etc.) | 293 | |
| Documents | 607 | |
| Annual Growth Rate % | 13.53 | |
| Document Average Age | 6.92 | |
| Average citations per doc | 22.01 | |
| References | 14,674 | |
| Document Contents | Keywords Plus (ID) | 848 |
| Author’s Keywords (DE) | 1278 | |
| Authors | Authors | 2677 |
| Authors of single-authored docs | 18 | |
| Authors Collaboration | Single-authored docs | 18 |
| Co-Authors per Doc | 5.23 | |
| International co-authorships % | 13.01 | |
3.2
Publication output and growth trend
The annual scientific output of nursing studies related to patient safety in the operating theatre shows that only one article was produced in 1994, 2000 and 2003, with no publications in the intervening years. In 2006 ( n = 13) and 2009 ( n = 15) there was a single digit number of publications. The highest number of publications occurred in 2023, when 54 articles were produced. By 2024, 45 articles had already been published ( Fig. 1 ).
3.3
Journals publishing articles
Analysis of the annual scientific output of nursing studies related to patient safety in the operating room revealed that the journals with the highest publication rates were: Journal of Patient Safety ( n = 15), BMJ Quality & Safety ( n = 14), BMC Health Services Research ( n = 13), Journal of Surgical Research ( n = 13) and AORN Journal ( n = 12) ( Table 2 ). According to analyses based on Bradford’s law, there are 293 productive journals in the nursing literature related to patient safety. There are 20 journals in the first zone, 76 journals in the second zone and 197 journals in the third zone ( Table 2 , Fig. 2 ).
| Journals | Rank | Freq | Cumfreq | Zone |
|---|---|---|---|---|
| Journal of Patient Safety | 1 | 15 | 15 | Zone 1 |
| BMJ Quality & Safety | 2 | 14 | 29 | Zone 1 |
| BMC Health Services Research | 3 | 13 | 42 | Zone 1 |
| Journal of Surgical Research | 4 | 13 | 55 | Zone 1 |
| AORN Journal | 5 | 12 | 67 | Zone 1 |
| Journal of Perianesthesia Nursing | 6 | 12 | 79 | Zone 1 |
| Annals of Surgery | 7 | 11 | 90 | Zone 1 |
| Journal of Clinical Nursing | 8 | 11 | 101 | Zone 1 |
| Journal of The American College Of Surgeons | 9 | 11 | 112 | Zone 1 |
| American Journal of Surgery | 10 | 10 | 122 | Zone 1 |
| BMC Nursing | 11 | 10 | 132 | Zone 1 |
| Journal of Advanced Nursing | 12 | 10 | 142 | Zone 1 |
| Patient Safety in Surgery | 13 | 10 | 152 | Zone 1 |
| Surgical Endoscopy and Other Interventional Techniques | 14 | 9 | 161 | Zone 1 |
| BMJ Open | 15 | 8 | 169 | Zone 1 |
| British Journal of Anaesthesia | 16 | 8 | 177 | Zone 1 |
| Anesthesia and Analgesia | 17 | 7 | 184 | Zone 1 |
| Journal of Nursing Management | 18 | 6 | 190 | Zone 1 |
| Nursing Open | 19 | 6 | 196 | Zone 1 |
| Acta Paulısta De Enfermagem | 20 | 5 | 201 | Zone 1 |
| Cureus Journal of Medıcal Science | 21 | 5 | 206 | Zone 2 |
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