Among the recent patient safety incidents in Korea, surgery-related patient safety accidents accounted for 39.6%, including "not checking patient identification", "retaining foreign surgical bodies after surgery", and "wrong site surgery errors" [1]. Further, 48.8% of patients suffered complications due to patient safety incidents, and 122 deaths were reported [2]. As such, patient safety incidents that occur in operating rooms not only cause serious irreparable harm to patients but can also lead to death [3]. Various patient safety management activities are implemented to prevent patient safety incidents, such as presenting and implementing guidelines, applying evidence-based standard protocols, educating to prevent recurrence in the event of patient safety incidents, and enforcing the Patient Safety Act to prevent patient safety incidents [1]. However, the number of patient safety incidents in the operating room has continued to increase, from 8 in 2016 to 281 in 2020 [2]. Therefore, it is necessary to find efficient measures related to patient safety management activities in the operating room. This study examines person-centered perioperative nursing and competencies of patient safety for operating room nurses.

Person-centered nursing refers to respecting a human's individuality and meeting mental, social, and physical needs in providing care [4]. Person-centered nursing is engaging nursing recipients in the planning and implementing of nursing care and communicating and empathizing with them based on this dignity and individuality. It provides holistic care to nursing recipients central to the healthcare system [5]. In person-centered nursing environments, nurses focus on human beings and improve their own job satisfaction by reducing criticism of each other through mindfulness and creating more trusting and collaborative nursing environments through consider [6]. This person-centered nursing reduces patient safety problems, including reducing mortality and infection rates in cancer patients and fall incidents [7]. Surgical patients develop anxiety and fear during surgery and recovery through temporary loss of communication and self-defense skills [8]. This significantly affects patients' recovery and prognosis [9]. Here, the increasing demand for person-centered nursing in the operating room has led to the Perioperative Patient-Focused Model. Unlike the nursing process in general wards, this model consists of four areas, patient safety, behavioral response, physiological response, and health system, centering on surgical patients, and includes the physical and mental realms, guiding the person-centered patient safety management activities throughout surgical nursing [10]. In a previous study on colorectal surgery patients, operating room nurses increased patient participation by assessing patient needs, implementing nursing interventions, and educating patients based on person-centered nursing. This reduced surgical site infections and shortened hospital stays [11]. Person-centered nursing has also made it more practical and safer to handle anesthetic drugs in operating rooms [12]. In other countries, models and guidelines for person-centered perioperative nursing are presented, and research on the topic is active in healthcare services and patient safety management activities. Yet, most studies in Korea were conducted on nurses in intensive care units [13, 14], long-term care hospitals [15, 16], and nursing students [17]. A study on nursing students [17] showed that person-centered nursing was significantly correlated with patient safety competency.

Patient safety competency refers to the knowledge, skills, and attitudes that nurses must have to protect patients from unnecessary harm [18]. Operating room nurses perform a variety of tasks during surgery, including the safe management of specimens, safe operation of high-risk medical devices required for surgery, sterility of surgical instruments, and response to emergencies [19], requiring broad competencies such as high professionalism, skills, and accurate communication with medical staff [20]. Here, much of nurses' work relates to patient safety practices. Operating room nurses follow detailed guidelines according to standard protocols, from surgical preparation to anesthesia and recovery, to prevent patient safety incidents [21]. The patient safety competency of operating room nurses is crucial for patient safety management activities because it protects patients from unnecessary risks and can prevent irreversible serious safety incidents [22].

However, few studies on operating room nurses examine the relationship between person-centered perioperative nursing, patient safety competencies, and patient safety activities. Therefore, we investigate the influences of operating room nurses' person-centered perioperative nursing and patient safety competencies that focus on individual patients' needs to prevent patient safety incidents during operation, providing evidence to improve the quality of patient safety management activities.

This study assessed person-centered perioperative nursing and patient safety competency for operating room nurses to examine their influences on patient safety management activities. In this study, the person-centered perioperative nursing of operating room nurses was 3.86 points, which was higher than the 3.51 points in a previous study on intensive care unit nurses [13], even though it is difficult to make a direct comparison due to the different tools used. Even at the time of the development of person-centered perioperative nursing tools, the score was high at 3.92 points [25], so it can be considered that the person-centered perioperative nursing of operating room nurses is higher. The reason for the higher score is likely that, in operating rooms, direct interaction and communication with patients took place before the administration of sedatives or anesthetics, so the score was higher because they interacted with patients for a shorter period than in general wards or intensive care units. In addition, the person-centered perioperative nursing tool includes factors of surgical nursing professionalism and emotional aspects such as interaction, respect, and comfort. Unlike other person-centered nursing tools, surgical nursing expertise is based on the knowledge and skills of operating room nurses, reflecting the characteristics of operating room nurses who need to keep abreast of the latest surgical nursing trends and constantly cultivate new knowledge, skills, and attitudes [25], which may have influenced the score.

The level of patient safety competency of operating room nurses was 3.88 points, similar to the average score of 3.91 in Park and Kim's [22] study. Due to the growing concern for patient safety, the Patient Safety Act was established in 2016, which guides patient safety-related professionals. However, these professionals manage the entire hospital and, as the operating room requires differentiated education due to the unique departmental environment, a nurse dedicated to patient safety education should be assigned in the operating room to provide continuous and systematic patient safety education. The level of patient safety management activity was 4.55 out of 5, similar to the 4.58 in a previous study [22] but higher than the 4.28 score in another study [8]. In that study [8], 46% had experience in medical institution certification evaluation. Still, in our study, 84.8% had experience in medical institution certification evaluation, indicating that the experience of certification evaluation seems to have influenced patient safety management activities and that the experience of certification evaluation positively impacts patient safety management activities [28]. In addition, the experience of patient safety education influences patient safety management activities [20], and all participants in this study received patient safety education, suggesting that patient safety education had a positive effect on patient safety management activities.

Patient safety competency was the biggest factor in operating room nurses' patient safety management activities. A systematic review of the patient safety activities of nurses in Korea [29] showed that patient safety competency was the highest correlation among factors related to nurses' patient safety activities, and the results of our study confirm that patient safety competency of operating room nurses is a crucial influencing factor in patient safety management activities. In this study, both patient safety competency and patient safety management activities were higher as age was older, total clinical and operating room experience was longer, and job positions were higher, which appears to be due to multiple training on patient safety and experience related to patient safety experience while working. Nurses with high patient safety competency can predict and prepare for patient safety incidents from the preparation of surgery to the entire progress of surgery and perform patient safety management activities by continuous monitoring. Therefore, patient safety competency can be improved by sharing and communicating patient safety experiences through patient safety education [30]. Further, by sharing patient safety incidents, nurses who lack patient safety experience can improve patient safety competency by having indirect experience.

The second factor influencing patient safety management activities of operating room nurses was person-centered perioperative nursing. Operating room nurses have been shown to influence actual patient safety nursing activities by assessing patient needs, performing nursing interventions, and educating and engaging patients based on person-centered nursing [11]. In a previous study on nursing students [17], person-centered care was significantly correlated with patient safety management competency. It was also an influencing factor in students' confidence in performing patient safety management. Communication skills are necessary for person-centered perioperative nursing, which requires listening to and interacting with individual patients' needs [31]. Patient safety management activities in operating rooms are important activities directly related to the patient's life. Failure to accurately identify or count patients may cause irreversible patient injury [32]. Such patient safety incidents can be prevented through good communication [33]. Therefore, to improve person-centered nursing, a positive nursing working environment such as a sufficient workforce, material support, and various education and programs should be prioritized [34]. Person-centered nursing refers to the shift from a passive treatment model to one where patients actively participate in their treatment. In a study on pancreatic cancer surgery patients [35], an interactive app was developed where patients can regularly report symptoms and receive self-management support for postoperative care as an intervention to promote person-centered nursing, which increased self-management activities. Therefore, operating room nurses must improve patient safety management activities through person-centered perioperative nursing, including patient identification, reflecting patient needs, and reducing patient anxiety by conducting smooth communication. In this study, person-centered perioperative nursing was increased as age and clinical experience increased. Since nurses acquire good communication skills in resolving conflicts with patients, caregivers, and medical staff they work with [34] and high-quality person-centered perioperative nursing can be achieved through good communication with patients, a skilled nursing workforce is required.

This study found that person-centered perioperative nursing and patient safety competency are important factors in operating room nurses' patient safety management activities. This study significantly examines the level of person-centered perioperative nursing of operating room nurses based on human-centered nursing that has recently been studied to confirm this as an influencing factor for patient safety management activities. However, since we included hospitals in specific areas, our results cannot be generalized. Further, patient safety management activities may differ from actual performance because our data were self-reported.

This study was conducted to investigate the levels of person-centered perioperative nursing and patient safety competency of operating room nurses to identify their impact on patient safety management activities and provide evidence for how to enhance patient safety management activities of operating room nurses. Person-centered perioperative nursing for operating room nurses was 3.86 points (out of 5) and patient safety competency was 3.88 points (out of 5), identified as factors influencing patient safety management activities. Thus, to strengthen patient safety management activities, person-centered perioperative nursing, and patient safety competency of operating room nurses, an efficient nursing working environment along with systematic and continuous education and programs must be created.

Based on our findings, we suggest: first, we included hospitals in a metropolitan area and there was no distinction between tertiary and general hospitals, so it is difficult to generalize the results. Future research on hospitals of various regions and sizes will be needed. Second, we only examined the level of person-centered perioperative nursing. So, there is a need for further study to identify the relevant factors of person-centered perioperative nursing of operating room nurses. Third, we suggest intervention studies on program development and operation to strengthen person-centered perioperative nursing and patient safety competency.