Moral efficacy, patient safety culture, and safety behavior among operating room nurses

BackgroundPatient safety is fundamental to universal health coverage and the health-related Sustainable Development Goals. Safety behavior among nurses, especially those in the operating room, effectively supports the achievement of patient safety objectives. However, evidence on their safety behavior levels and associated factors remains limited.AimTo investigate the mediating role of moral efficacy in the relationship between patient safety culture and safety behavior among operating room nurses.Research designA cross-sectional study.Participants and research contextFrom October to November 2025, 427 operating room nurses were recruited by convenience sampling from seven provincial-level regions in China. Data were collected using a general information questionnaire, the Nurse Safety Behavior Scale, the Hospital Survey on Patient Safety Culture, and the Moral Potency Questionnaire. Pearson's correlation, multiple linear regression, and PROCESS v4.1 Model 4 with 5000 bootstrap resamples were used for data analysis.Ethical considerationsThis study was approved by the Ethics Committee of Sichuan Provincial People's Hospital. Before accessing the questionnaire, participants reviewed an online information and informed consent page explaining the study purpose and procedures, voluntary participation, anonymity, confidentiality, and the right to withdraw before submission. Only participants who provided electronic consent were allowed to proceed. No identifiable personal data were collected, and results were reported in aggregate form.ResultsThe results revealed positive correlations between patient safety culture, moral efficacy, and nurse safety behavior (both p < 0.01). Patient safety culture is positively associated with nurse safety behavior (β = 0.426, p < 0.001). Moral efficacy plays a mediating role between patient safety culture and nurse safety behavior (β = 0.125, p < 0.001).ConclusionsNursing managers should pay close attention to patient safety culture and consider targeted and feasible strategies to strengthen nurse moral efficacy and safety-related practices, which may be beneficial for patient safety in operating rooms.