Development of a Nursing Practice Framework for 5G-Enabled Cross-Regional Remote Surgery

Established perioperative and nursing theories provide foundations for patient safety, adaptation, caring, communication, and professional practice. This study aimed to develop a context-specific operational framework that applies and specifies these concepts for 5G-enabled cross-regional remote surgery, particularly in relation to technology-mediated care, distributed collaboration, and adaptive nursing capacity.

This mixed-methods study combined a systematic literature review (four databases; topic search, January 2000-July 2025; foundational theory searches unrestricted) with case analysis of two cross-continental, three-site 5G-enabled robotic surgeries. The review examined how established nursing theories and perioperative practice guidance have been applied to remote, robotic, and technology-mediated surgical contexts. Literature synthesis and case analysis were integrated to identify operational domains for framework development.

Established nursing theories remained useful conceptual lenses for understanding patient safety, healthcare-system interaction, adaptation, communication, professional learning, and human responses to technologically advanced care environments. Case analysis did not indicate theoretical obsolescence; rather, it identified areas requiring context-specific operational specification in remote robotic surgical practice. The AORN perioperative patient-focused model, Roy's adaptation model, Benner's skill acquisition model, and related theories informed the proposed framework. In the two cases, remote nursing involved technological complexity, independent patient-site teams, and substantial interprofessional coordination. The proposed framework incorporates three interrelated components: (1) technology-mediated nursing, emphasizing integration of advanced technological systems into nursing judgment and care processes; (2) distributed nursing collaboration, addressing teamwork across geographically separated sites; and (3) nursing adaptive capacity, underscoring continuous learning and flexible response in dynamic technological environments. The preliminary framework may provide guidance for preoperative planning, intraoperative execution, and postoperative care in remote robotic surgery.

The preliminary framework may inform perioperative nurse managers, nursing directors, and operating room leaders in patient-site staffing and role allocation, training and competency assessment, standardized communication protocols, emergency drills, quality indicators, and distributed workflow oversight.

The framework offers a preliminary, context-specific operational foundation for cross-regional remote robotic surgery nursing. It applies, specifies, and supplements established nursing theories rather than replacing them and may support process standardization and care-quality evaluation. Further multicenter validation, instrument development, and outcome-based evaluation are needed to refine its applicability.