Constructing Relational Safety in Pediatric Surgery: The Pediatric Perioperative Relational Safety Theory

Area of Science:

• Nursing Science
• Pediatric Healthcare
• Patient Safety

Background:

• Children face significant relational vulnerability during surgery due to separation, loss of control, and altered consciousness.
• Existing perioperative theories may not fully address the relational dynamics crucial for pediatric patient safety.

Purpose of the Study:

• To advance a middle-range nursing theory, the Pediatric Perioperative Relational Safety Theory.
• To conceptualize relational safety as a dynamic, nurse-mediated process co-constructed among nurses, children, and families.
• To identify key relational mechanisms influencing pediatric perioperative experiences.

Main Methods:

• Development of a middle-range nursing theory based on existing literature and clinical understanding.
• Identification of five interrelated constructs: Congruent Communication, Integrated Parental Presence, Supported Child Agency, Protected Personal Integrity, and Transitional Continuity.
• Formulation of nine propositions to explain the links between relational mechanisms and patient outcomes.

Main Results:

• The theory defines relational safety as a co-constructed process across perioperative phases.
• Five modifiable relational mechanisms are specified to enhance safety.
• Nine propositions outline pathways from these mechanisms to perioperative responses and psychosocial trajectories.

Conclusions:

• The Pediatric Perioperative Relational Safety Theory positions relational safety as a core nursing function in the perioperative setting.
• This theory integrates and extends existing perioperative knowledge.
• It provides a framework for improving perioperative nursing practice, research, and patient safety for children and families.