Surgical Readiness to Inform Nursing Leadership and Perioperative Management: A Concept Analysis

ABSTRACT

Aims

This concept analysis aimed to clarify and integrate the multidimensional concept of surgical readiness across nursing, medicine and anaesthesiology, and to identify its defining attributes, antecedents, consequences and empirical referents to guide nursing practice and research.

Design

A concept analysis was conducted using Walker and Avant's (2019) eight‐step method, integrating literature from nursing, medicine and anaesthesiology to develop an integrated interpretation of surgical readiness.

Methods

A structured literature search was conducted using PubMed, Wiley Online Library and ScienceDirect to identify English‐language literature published between 2000 and 2025 that addressed the concept of surgical readiness. Twenty‐five full‐text articles met the inclusion criteria and were analysed. The literature was examined using Walker and Avant's concept analysis method to identify the uses, defining attributes, antecedents, consequences and empirical referents of surgical readiness. Findings were synthesized across disciplinary perspectives to develop an integrative conceptual definition relevant to nursing practice.

Results

The literature revealed considerable inconsistency in how surgical readiness was conceptualized and measured across disciplines, underscoring the need for an integrated conceptual framework. Five defining attributes emerged: holistic preparedness, physiological optimization, psychological confidence, collaborative participation and systemic efficiency. Antecedents included comprehensive assessment, patient education, physiological optimization and team coordination. Consequences included potential associations with patient safety, psychological well‐being, procedural efficiency, interprofessional collaboration and quality improvement. Empirical referents were identified at patient (physiological stability, anxiety level), professional (communication, documentation) and system levels (availability of surgical resources, safety checklists). The integrated definition conceptualizes surgical readiness as a dynamic, multidimensional state characterized by the alignment of patient, professional and system‐level preparedness, encompassing physical optimization, psychological confidence, collaborative participation and coordinated organizational support for perioperative care.

Implications for the Profession and/or Patient Care

This concept analysis provides a clearer and more comprehensive understanding of surgical readiness by integrating patient‐, professional‐ and system‐level dimensions. The clarified concept may support nurses and interdisciplinary teams in developing more comprehensive approaches to preoperative assessment, patient preparation, care coordination and perioperative safety.

Patient or Public Contribution

No patient or public contribution.

1. Introduction

Surgery represents a critical transition in a patient's healthcare journey, requiring comprehensive preparation to support safe perioperative care and optimal postoperative outcomes. Consequently, the concept of surgical readiness has received increasing attention across perioperative practice. Despite its widespread use, surgical readiness is frequently interpreted as completion of biomedical and procedural requirements, including laboratory investigations, pre‐anaesthesia assessment, informed consent and operating room preparation (Herrera‐Usagre et al. 2019; Hines et al. 2015; Wade et al. 2023). Several scholars distinguish readiness from preparedness, emphasizing that readiness extends beyond physical preparation to encompass patients' confidence, engagement and capacity to participate actively in their perioperative care (Torres and Macindo 2018). Nevertheless, nursing scholars and practitioners acknowledge that readiness encompasses more than just physiological optimization; it also involves psychological preparedness (Conner‐Spady et al. 2014), knowledge comprehension (Bao et al. 2022), emotional stability (Torres et al. 2020) and social support (Torres et al. 2021). This multidimensional nature suggests that surgical readiness is not a static preoperative condition but a dynamic and holistic process that includes physical, cognitive and emotional components (Torres and Macindo 2018). However, previous work on preoperative readiness has largely approached readiness from a patient‐centred perspective. A systematic review by Torres et al. (2021) synthesized preoperative patient readiness across 28 studies and highlighted physical, psychological, social, emotional and informational dimensions of preparation, while also considering the health‐system context through the Perioperative Patient Focused Model. Although this work substantially advanced understanding of preoperative patient readiness, patient‐, professional‐ and system‐level perspectives have not yet been fully integrated within a broader conceptualization of surgical readiness. Existing readiness assessment tools have similarly emphasized patient‐level dimensions (Torres and Macindo 2018; Torres et al. 2021). Moreover, nursing, medicine and anaesthesiology have approached surgical readiness from different disciplinary perspectives, contributing to semantic inconsistency and variability in its conceptualization, operationalization and measurement. This lack of conceptual clarity limits the comparability of findings and the development of standardized assessment tools in perioperative care. The absence of a unified conceptual framework may limit the availability of a consistent theoretical foundation for nurses to assess, document and evaluate surgical readiness within perioperative care. The present analysis therefore extends existing patient‐centred perspectives by conceptualizing surgical readiness across three interdependent levels: the patient, healthcare professionals and the healthcare system. By synthesizing perspectives from nursing, medicine and anaesthesiology, this analysis positions surgical readiness not solely as an individual patient state but as a broader multidimensional construct involving the alignment of patient preparedness, professional coordination and system preparedness.

Concept analysis provides a systematic approach to clarifying concepts that may be inconsistently defined or applied in clinical practice, thereby supporting a shared understanding of their meaning. As knowledge evolves over time, conceptual understanding should be regarded as a dynamic and ongoing process that is responsive to emerging knowledge and experience (Meleis 2005). In nursing research, concept analysis facilitates examination of the fundamental elements of a concept by revealing its internal structure and critical attributes (Walker and Avant 2019). Accordingly, this concept analysis applies Walker and Avant's (2019) framework to clarify the conceptual boundaries of surgical readiness, identify its defining attributes, antecedents, consequences and empirical referents and establish an integrated conceptual framework to guide future nursing practice, research, education, leadership and perioperative policy.

2. Methods

2.1. Concept Analysis Framework

This concept analysis was conducted using the eight‐step method proposed by Walker and Avant (2019), a widely recognized approach for clarifying ambiguous or evolving concepts in nursing. The framework provides a systematic process for identifying the defining attributes, antecedents, consequences, model, borderline, related and contrary cases and empirical referents of a concept, thereby strengthening its theoretical foundation and facilitating its application in research and clinical practice. Given the conceptual ambiguity surrounding surgical readiness across nursing, medicine and anaesthesiology, Walker and Avant's framework was considered appropriate for examining and integrating existing knowledge from multiple disciplinary perspectives.

2.2. Literature Search Strategy

Relevant literature was identified through a structured literature search using PubMed, Wiley Online Library and ScienceDirect. These literature sources were used to identify publications relevant to the conceptualization of surgical readiness and its application across the health disciplines examined in this analysis. The search was supplemented by manual screening of the reference lists of included articles to identify additional conceptually relevant literature. English‐language articles published between January 2000 and January 2025 were searched. The search period was selected to capture the contemporary development of the concept of surgical readiness. The following search string was used: (‘surgical readiness’ OR ‘surgical patient readiness’ OR ‘surgical preparedness’). The Boolean operator OR was used to retrieve literature relevant to the conceptualization of surgical readiness.

2.3. Eligibility Criteria and Study Selection

Studies were included if they (1) were published in English between January 2000 and January 2025; (2) were available as full‐text articles; (3) employed quantitative, qualitative, mixed‐methods, review or conceptually relevant research designs and (4) addressed the concept, characteristics, dimensions, assessment or application of surgical readiness or closely related concepts within perioperative care. Editorials, letters to the editor, conference abstracts, study protocols, opinion papers and publications unrelated to the concept of surgical readiness were excluded.

The literature selection process was undertaken collaboratively by all authors. Records identified through the database search were first screened for duplicate publications. Titles and abstracts of the remaining records were then reviewed to determine their relevance to the concept of surgical readiness. Articles considered potentially eligible underwent full‐text assessment against the predefined eligibility criteria. Any differences in study selection were resolved through discussion until consensus was reached among all authors.

A total of 255 records were identified through database searching. After removing four duplicate records, 251 records underwent title and abstract screening. Of these, 223 records were excluded because they did not address the concept of surgical readiness or did not meet the eligibility criteria. The remaining 28 full‐text articles were assessed for eligibility, and three non‐research publications were excluded. Consequently, 25 articles were included in the final concept analysis. The literature identification and selection process is presented in Figure 1 to enhance transparency regarding the selection of literature included in the concept analysis.

FIGURE 1.

The literature identification and selection process. The figure illustrates the process of identifying, screening and selecting literature for inclusion in the concept analysis of surgical readiness.

The included literature was analysed according to Walker and Avant's eight‐step concept analysis method. The analysis involved identifying the uses and definitions of surgical readiness across nursing, medicine and anaesthesiology, followed by the identification of defining attributes, model, borderline, related and contrary cases, antecedents, consequences and empirical referents. Findings were compared and synthesized across disciplines to develop an integrative conceptual definition of surgical readiness and to identify its defining attributes, antecedents, consequences and empirical referents.

2.4. Identifying Uses and Definitions of the Concept

To comprehend the depth and scope of this concept, it is necessary to explore the linguistic and disciplinary roots of both components as defined across authoritative sources such as the Cambridge Academic Content Dictionary (Cambridge University Press n.d.), the Oxford Learner's Dictionaries (Oxford University Press n.d.) and the Medical Dictionary (Merriam‐Webster n.d.). The term surgical consistently appears as an adjective describing something related to, used in, or resulting from surgery. Across all three dictionaries, the definitions converge on three key aspects: the procedural, the functional and the outcome dimensions. Procedurally, surgical refers to interventions and techniques performed in the operative context, while functionally it denotes instruments, supplies or personnel directly involved in surgical care. The outcome dimension, as reflected in the Medical Dictionary, extends the meaning to include conditions or effects that arise after surgical intervention. Collectively, these meanings suggest that surgery encompasses not only the act of operating but also the broader environment, personnel and consequences associated with surgical practice. The term surgery deepens this understanding by focusing on the discipline and practice of operative medicine. Definitions from Cambridge, Oxford and medical sources all emphasize surgery as a form of medical treatment that involves making an incision in the body to repair or remove damaged parts. However, the Medical Dictionary broadens this definition by including multiple layers of meaning: surgery as a branch of health science, as a physical location where operations occur and as the professional activity or skill set of surgeons. This multidimensional portrayal highlights that surgery represents not only a technical procedure but also a field of expertise and a structured system within healthcare delivery. Thus, surgery and surgical procedures together frame a domain that combines medical intervention, technical precision and professional identity.

In contrast, the term readiness introduces the notion of preparedness and willingness concepts that transcend the physical to include psychological and emotional dimensions. Both the Cambridge and Oxford dictionaries define readiness as a state of being ready or prepared for something, while the Medical Dictionary adds a psychological layer by referring to readiness as the capability or willingness to learn or act. This highlights the duality of readiness: it involves both objective preparedness, such as having the necessary conditions in place, and subjective willingness, which reflects mental and emotional acceptance or motivation. Within the healthcare context, readiness may therefore refer to a combination of physiological stability, emotional acceptance and cognitive understanding prior to a significant medical procedure.

When these two concepts regarding surgery and readiness are integrated, the term surgical readiness embodies a complex, holistic state. According to the Cambridge and Oxford dictionaries, surgical readiness is defined simply as ‘the state of being ready or prepared for surgery’. However, a conceptual synthesis of the component terms reveals that the meaning extends far beyond mere preparedness. Surgical readiness encompasses physical readiness, which refers to clinical optimization and medical stability before an operation; psychological readiness, which involves the patient's emotional and cognitive preparedness to undergo surgery; and system readiness, which includes the readiness of healthcare professionals, surgical teams and institutional systems to provide safe and effective surgical care. Therefore, surgical readiness can be understood as a multidimensional construct integrating physical, psychological and systemic domains. It represents not only the patient's medical preparedness for surgery but also the collective readiness of all elements involved in the surgical process. This concept aligns closely with holistic perspectives in healthcare, emphasizing the interconnection between body, mind and system in achieving optimal surgical outcomes.

The concept of surgical readiness has evolved as an interdisciplinary construct that spans across the fields of nursing, medicine and anaesthesiology. Although each discipline defines and applies the term within its own professional lens, all share a common aim of ensuring optimal preparation and safety prior to surgical intervention. An integrative analysis of definitions across these three fields reveals not only their disciplinary distinctions but also a strong conceptual alignment that positions surgical readiness as both a state and a process of multidimensional preparedness.

From the nursing perspective, surgical readiness represents a holistic, patient‐centred state involving physical, psychological, emotional and spiritual preparedness (Torres and Macindo 2018; Bao et al. 2022; Wahl et al. 2024). It is characterized by the patient's confidence, understanding and willingness to undergo surgery, achieved through collaboration, education and emotional support provided by nurses and the healthcare team (Torres et al. 2020, 2021). Nursing scholars view readiness as a subjective and experiential construct that emphasizes patient empowerment and shared decision‐making, aligning with the broader nursing philosophy of holistic care (Torres and Macindo 2018; Wahl et al. 2024; Williams, Varnfield, et al. 2024; Williams, Woods, et al. 2024).

In contrast, the medical perspective defines surgical readiness through the lens of clinical optimization and operational capability (Hokynková et al. 2025; Kanth et al. 2013; Kwiatkowski et al. 2022; Wong et al. 2020). It encompasses the measurable physiological, metabolic and functional parameters that indicate a patient's suitability for surgery (Aronson et al. 2019; Hokynková et al. 2025). Medical readiness also includes system‐level and professional preparedness, ensuring that surgical teams, institutions and environments are adequately equipped, trained and organized to deliver effective care (Donohue et al. 2025; Ismail and Huda 2009; Knudson et al. 2018; Sikakulya et al. 2021). Within this field, readiness serves as a standard of clinical safety and organizational efficiency, linking patient outcomes with procedural and systemic performance (Aronson et al. 2019; Ismail and Huda 2009; Hokynková et al. 2025).

The anaesthesiology perspective narrows the concept into a procedural and temporal domain, focusing on the period when all preoperative preparations, both physiological and logistical, are complete, and the patient is fully stabilized for the surgical incision to commence. It captures the moment of transition between preparation and surgical action, serving as an indicator of coordination, efficiency and synchronization among anaesthesia, nursing and surgical teams (Santos and Gray 2008; Sharma et al. 2014).

Although these disciplinary perspectives collectively contribute to the current understanding of surgical readiness, further critical evaluation is required to examine their conceptual consistency, strengths, limitations and implications for nursing practice and research.

2.5. Critical Evaluation of the Existing Literature

The concept of surgical readiness has evolved considerably over the past two decades, reflecting changing perspectives in perioperative care. Early literature primarily viewed readiness from a process‐ and procedure‐oriented perspective, emphasizing completion of preoperative tasks, operating room efficiency and physiological suitability to proceed with surgery. These approaches largely focused on whether predefined procedural requirements had been fulfilled rather than on the patient's overall preparedness for the surgical experience (Santos and Gray 2008; Ismail and Huda 2009).

Subsequent literature progressively expanded the concept by recognizing that successful surgery depends not only on physiological optimization but also on patients' psychological preparation, understanding of the surgical process, engagement in decision‐making and availability of interpersonal support. Contemporary nursing and perioperative research increasingly conceptualize surgical readiness as a multidimensional, patient‐centred construct encompassing physical, psychological, emotional, informational and interpersonal dimensions of preparedness (Torres and Macindo 2018; Torres et al. 2020; Aronson et al. 2019; Wahl et al. 2024).

Despite substantial conceptual progress, no unified framework has yet integrated these diverse perspectives into a comprehensive definition of surgical readiness. Consequently, considerable variation persists in its terminology, conceptual boundaries, defining attributes and approaches to assessment across perioperative disciplines. Most studies continue to examine isolated components of readiness, such as patient education, anxiety reduction, health optimization or perioperative risk assessment, rather than conceptualizing surgical readiness as an integrated phenomenon. Existing assessment approaches similarly tend to focus on specific domains or clinical indicators, resulting in considerable variability in how readiness is defined, operationalized and measured across disciplines (Torres et al. 2021; Williams, Varnfield, et al. 2024; Williams, Woods, et al. 2024; Hokynková et al. 2025).

Furthermore, the meaning of surgical readiness differs substantially across healthcare disciplines. Nursing literature primarily describes readiness as patients' perceived preparedness for surgery, whereas anaesthesiology often operationalizes readiness as procedural efficiency or readiness for surgical incision, orthopaedic literature focuses on physiological or wound healing status sufficient to proceed with surgery, and other specialties emphasize discipline‐specific clinical criteria. Such semantic variation has contributed to conceptual ambiguity and limited the development of a standardized framework applicable across perioperative settings.

Accordingly, the present concept analysis synthesizes evidence from nursing, medicine and anaesthesiology to develop an integrated conceptual framework of surgical readiness. By integrating diverse disciplinary perspectives, this analysis clarifies the defining attributes, antecedents, consequences and empirical referents of surgical readiness, thereby providing a conceptual foundation for standardized assessment, nursing interventions, interdisciplinary collaboration, research, education, leadership and perioperative policy.

2.6. Defining Attributes, Antecedents and Consequences of Surgical Readiness

2.6.1. Defining Attributes

Through synthesis of findings across nursing, medicine and anaesthesiology, five defining attributes emerged that characterize surgical readiness and distinguish it from related concepts such as preoperative preparation, surgical capacity and patient education:

1. Holistic Preparedness: Surgical readiness embodies a multidimensional state that integrates physical, psychological, emotional, social and spiritual aspects of preoperative preparation. This attribute, widely reflected in nursing literature (Torres and Macindo 2018; Wahl et al. 2024), acknowledges that true readiness extends beyond physiological optimization to encompass the patient's mental acceptance, emotional balance and understanding of the surgical process.

2. Physical and Physiological Optimization: Across medical studies, surgical readiness is consistently defined by the patient's achievement of clinical stability and optimization prior to surgery (Kwiatkowski et al. 2022; Wahl et al. 2024). This includes the normalization of vital parameters, control of comorbidities, adequate nutrition and overall fitness for anaesthesia and surgery. Physiological optimization represents the tangible, biomedical foundation upon which readiness rests.

3. Psychological Confidence and Willingness: Readiness involves not only being physically prepared but also possessing emotional acceptance and psychological assurance to proceed with surgery. Nursing studies highlight the importance of patient empowerment, self‐efficacy and readiness to make informed decisions (Torres et al. 2020, 2021). This internal sense of confidence differentiates readiness from mere procedural compliance.

4. Collaborative and Coordinated Participation: Surgical readiness is inherently relational. It is achieved through effective interaction among patients, families and multidisciplinary healthcare teams. Coordination among nurses, physicians and anaesthesiologists supports comprehensive assessment of the patient's readiness, addressing both clinical and emotional needs (Bao et al. 2022; Williams, Varnfield, et al. 2024; Williams, Woods, et al. 2024).

5. Systemic and Procedural Efficiency: Particularly evident in the medical and anaesthesiology literature, readiness also encompasses the healthcare system's ability to support safe and efficient surgery. This includes the availability of equipment, skilled staff and structured workflows that minimize delays and risks (Donohue et al. 2025; Sharma et al. 2014). Within this view, readiness represents both human and institutional capability to initiate surgery safely.

Based on the synthesis of the defining attributes identified across nursing, medicine and anaesthesiology, surgical readiness is conceptually defined as follows: Surgical readiness is a dynamic, multidimensional state of preparedness that integrates physical, psychological, emotional, interpersonal and systemic dimensions to support safe and effective surgical care. It reflects the alignment of the patient's holistic preparedness, the healthcare team's collaborative competence, and the healthcare system's organizational capacity to deliver high‐quality perioperative care.

2.6.2. Defining Antecedents

The literature consistently indicates that surgical readiness develops through several interrelated preparatory processes rather than a single event. Across nursing, medicine, and anaesthesiology, four major antecedents were identified as essential prerequisites for achieving surgical readiness.

1. Comprehensive Preoperative Assessment: The process begins with systematic evaluation of the patient's medical, psychological and social status. This includes diagnostic testing, risk evaluation and mental health screening to determine suitability for surgery (Aronson et al. 2019; Walker and Avant 2019). Without such assessment, readiness cannot be accurately established.

2. Patient Education and Information Exchange: Effective communication and education form the foundation of psychological readiness. When patients understand the purpose, risks and expected outcomes of surgery, they are more likely to feel confident and prepared (Torres et al. 2020). Educational interventions, including e‐health tools, may support patients' knowledge and emotional preparedness (Wade et al. 2023).

3. Optimization and Stabilization Processes: Readiness presupposes that the patient's physiological, nutritional and metabolic states have been optimized through preoperative interventions (Kanth et al. 2013; Hokynková et al. 2025). These processes support patients in meeting clinical requirements for anaesthesia and surgery.

4. Team Coordination and Institutional Preparedness: The readiness of surgical personnel and facilities must precede patient readiness. Interdisciplinary collaboration, availability of surgical resources and adherence to infection control measures (Sikakulya et al. 2021) represent important antecedents of technical and procedural readiness at the system level.

Collectively, these antecedents demonstrate that surgical readiness develops through the interaction of patient preparation, clinical optimization, interdisciplinary collaboration and organizational support, rather than through patient factors alone.

2.6.3. Defining Consequences

The literature associates surgical readiness with a range of potentially favourable outcomes for patients, healthcare professionals and healthcare systems. Five major consequences were identified through the conceptual synthesis.

1. Enhanced Patient Safety and Surgical Outcomes: Surgical readiness has been associated with favourable indicators of perioperative safety and recovery. Physiological optimization and psychological preparedness, as components of readiness, may be relevant to perioperative safety, anxiety and recovery outcomes (Aronson et al. 2019; Williams, Varnfield, et al. 2024; Williams, Woods, et al. 2024).

2. Improved Psychological Well‐being and Satisfaction: Greater readiness may be associated with a stronger sense of control, lower fear, greater confidence in healthcare providers and more positive perceptions of care. These psychological and relational outcomes have been described as relevant consequences of patient preparedness for surgery (Torres et al. 2021).

3. Efficient Surgical Workflow and Reduced Delays: From anaesthesiology and systems perspectives, readiness is associated with procedural coordination, timely transitions to surgery and efficient operating room processes. These indicators suggest the potential relevance of surgical readiness to organizational efficiency, although its direct effect on institutional productivity requires further empirical investigation (Santos and Gray 2008; Wong et al. 2020).

4. Strengthened Interprofessional Collaboration: Surgical readiness involves effective teamwork and coordination among healthcare professionals. Collaborative assessment, patient education and clinical optimization may support interdisciplinary communication and shared responsibility for perioperative care (Donohue et al. 2025; Wade et al. 2023).

5. Foundation for Quality Improvement and Policy Development: Conceptual clarity regarding surgical readiness may inform the development of standardized preoperative protocols and performance indicators, while also providing a conceptual basis for quality‐improvement and policy initiatives related to patient safety, health education and system preparedness, particularly in high‐risk or resource‐limited environments (Knudson et al. 2018).

These consequences suggest that surgical readiness extends beyond preparation for the surgical procedure and may have relevance to perioperative safety, recovery, interprofessional collaboration and healthcare quality. However, the relationships between surgical readiness and these outcomes require further empirical evaluation.

2.7. Integrative Interpretation

In synthesis, surgical readiness is conceptualized as a multidimensional and interdependent state that arises from a sequence of antecedent processes and is characterized by the defining attributes identified in this analysis. It develops through comprehensive assessment, education, clinical optimization, interdisciplinary coordination and organizational preparedness, culminating in an aligned state of preparedness across patient, professional and system levels. The identified consequences, including patient safety, psychological well‐being, procedural efficiency, interprofessional collaboration and quality improvement, represent potential outcomes associated with surgical readiness rather than effects established by the present concept analysis. The interrelationships among antecedents, defining attributes, consequences and empirical referents are summarized in Table 1.

TABLE 1.

Integrated summary of the concept of surgical readiness.

Conceptual component	Description	Examples/indicators
Defining attributes	Core characteristics that define surgical readiness as a multidimensional and dynamic state.
Holistic preparedness	Integration of physical, psychological, emotional and spiritual readiness; the patient demonstrates balanced well‐being and confidence before surgery.	Patient expresses calmness and acceptance; maintains stable mood and positive expectations.
Physical and physiological optimization	Achievement of clinical stability and control of comorbidities prior to surgery.	Normalized vital signs; optimized blood pressure and glucose levels.
Psychological confidence and willingness	Emotional assurance, reduced anxiety and active participation in surgical decision‐making.	Low anxiety scores on Hospital Anxiety and Depression Scale (HADS) or State–Trait Anxiety Inventory (STAI); informed consent with clear understanding.
Collaborative and coordinated participation	Active engagement among patients, family members and healthcare professionals to ensure readiness.	Family participation in preparation; multidisciplinary team communication.
Systemic and procedural efficiency	Institutional and procedural readiness ensuring smooth surgical processes.	Completion of WHO Surgical Safety Checklist; availability of surgical equipment and staff.
Antecedents	Conditions that must occur before readiness is achieved.
Comprehensive preoperative assessment	Evaluation of physical, psychological and social factors to determine surgical suitability.	Laboratory and imaging tests; psychological screening.
Patient education and information exchange	Effective communication and education to enhance understanding and participation.	Preoperative teaching sessions; teach‐back verification.
Optimization and stabilization	Correction of physiological abnormalities and management of chronic conditions.	Blood pressure control; nutritional support.
Team coordination and institutional preparedness	Collaboration among healthcare professionals and readiness of surgical systems.	Interdisciplinary meetings; operating room preparedness.
Consequences	Outcomes resulting from achieving surgical readiness.
Enhanced patient safety and outcomes	Reduction of complications and improvement of recovery.	Shorter hospital stays, lower postoperative risk.
Improved psychological well‐being	Reduction in anxiety and enhancement of confidence.	Positive patient self‐report.
Efficient surgical workflow	Timely and coordinated surgical performance.	On‐time surgery start; reduced intraoperative delay.
Strengthened interprofessional collaboration	Improved teamwork and communication.	Documented interdisciplinary readiness assessments.
Quality improvement and policy development	Institutional enhancement of perioperative safety culture.	Readiness adopted as a performance indicator (KPI).
Empirical referents	Observable and measurable indicators that demonstrate the presence of surgical readiness.
Patient‐level indicators	Physiological stability, psychological calmness, informed decision‐making.	Readiness scales (Preoperative Assessment of Readiness Tool [PART]), (Perioperative Readiness Questionnaire [PRQ]); vital signs; patient statements.
Professional‐level indicators	Teamwork, documentation and communication.	Completed preoperative checklists; multidisciplinary notes.
System‐level indicators	Infrastructure, policy and procedural readiness.	WHO Surgical Safety Checklist; sterilization audits; readiness bundles implemented.

Note: This table was developed by the authors based on an integrative concept analysis of surgical readiness across nursing, medicine and anaesthesiology literature.

This comprehensive understanding strengthens the conceptual foundation of surgical readiness by integrating human experience, clinical considerations and procedural dimensions. It also highlights the relevance of surgical readiness to perioperative care and the need for continued empirical validation and conceptual refinement across healthcare disciplines.

2.8. Developing the Model Case

The following case illustrates all defining attributes of surgical readiness identified in the present concept analysis.

Mr. A, a 65‐year‐old man, was diagnosed with acute cholangitis and scheduled for elective laparoscopic cholecystectomy in 2 weeks. He had uncontrolled hypertension and dyslipidaemia but no previous surgical experience. He lived with his wife and son, who actively supported his preparation by encouraging medication adherence, healthy nutrition, regular physical activity and providing emotional reassurance. As part of his coping strategy, his spiritual beliefs and regular family prayer provided emotional comfort throughout the preoperative period, strengthening his confidence and psychological preparedness for surgery.

At the preoperative clinic, the multidisciplinary team conducted a comprehensive assessment to optimize his physical condition before surgery. His hypertension and dyslipidaemia were stabilized through medication adjustment and ongoing monitoring. The surgeon explained the surgical procedure, expected benefits, potential risks and anticipated recovery, allowing Mr. A to make an informed decision and supporting his understanding of the operation.

The nursing team provided individualized education on breathing exercises, early mobilization, wound care, postoperative self‐monitoring, dietary management and pain control. Teach‐back was used to confirm understanding, reinforce key information and identify remaining concerns. Mr. A actively participated in the discussion, asked questions and demonstrated confidence in performing the recommended preoperative and postoperative self‐care activities.

Throughout the preparation period, physicians, nurses, anaesthesiologists and other healthcare professionals communicated closely to coordinate his care and optimize his readiness. Preoperative laboratory investigations, anaesthesia assessment, medication reconciliation, infection prevention measures and surgical safety protocols were completed according to institutional guidelines. Necessary surgical resources, equipment and personnel were confirmed to be available before the scheduled operation.

On the day of surgery, Mr. A arrived at the operating room calm, confident, and well informed. He verbalized that he understood the surgical procedure, expected recovery, and his role in postoperative rehabilitation. His family remained supportive, and the healthcare team confirmed that all preoperative requirements had been completed. These patient‐, professional‐ and system‐level indicators collectively reflected his preparedness to proceed with surgery.

This model case demonstrates all five defining attributes of surgical readiness. Mr. A achieved holistic preparedness through physical optimization, psychological and emotional readiness, effective patient engagement, coordinated interdisciplinary collaboration and organizational preparedness. The alignment of these dimensions was reflected in his confidence and physiological stability before surgery, illustrating surgical readiness as a dynamic, integrated and multidimensional concept. The simultaneous presence of all five defining attributes distinguishes this case as a true model case of surgical readiness.

2.9. Identify Additional Cases

2.9.1. Contrary Case

The following contrary case demonstrates the absence of the defining attributes of surgical readiness.

Mr. D, a 68‐year‐old man requiring urgent abdominal surgery, arrived at the hospital without adequate preoperative assessment or optimization of his medical condition. He received minimal information regarding the planned operation and remained highly anxious about the procedure. His family was unavailable to provide emotional support, and communication among members of the healthcare team was fragmented. Essential preoperative documentation was incomplete, and several institutional safety procedures were delayed because of inadequate coordination.

As a result, surgery was postponed while unresolved clinical and organizational issues were addressed. The patient remained distressed, expressed little understanding of the surgical process and lacked confidence in postoperative recovery.

Consequently, this case represents a true contrary case of surgical readiness because none of the defining attributes required for comprehensive surgical readiness were achieved.

This contrary case demonstrates the absence of the defining attributes of surgical readiness. Physical optimization, psychological preparedness, patient engagement, interdisciplinary collaboration and organizational preparedness were all lacking. This case illustrates that completion of isolated procedural activities alone is insufficient to establish surgical readiness. The absence of all defining attributes clearly differentiates this case from the concept of surgical readiness.

2.9.2. Borderline Case

The following borderline case demonstrates only some of the defining attributes of surgical readiness.

Mrs. B, a 70‐year‐old woman with symptomatic cholelithiasis, was scheduled for elective laparoscopic cholecystectomy. Her hypertension and diabetes were well controlled, and all required laboratory investigations and preoperative assessments had been completed. She received routine information regarding fasting, medication management and the surgical procedure.

Although Mrs. B was considered medically fit for surgery, she remained anxious about anaesthesia and postoperative pain. She was reluctant to ask questions during consultations and felt uncertain about her recovery after discharge. Limited communication between the healthcare team and her family resulted in inadequate emotional support and insufficient preparation for postoperative self‐care.

The surgical team confirmed that all institutional protocols had been completed, and surgery proceeded as scheduled without administrative or organizational barriers.

This case demonstrates only some defining attributes of surgical readiness. Physical optimization, professional coordination and organizational preparedness were achieved; however, psychological preparedness, patient engagement and effective interpersonal support remained insufficient. Consequently, this case represents a borderline example rather than a complete demonstration of surgical readiness.

This borderline case demonstrates only some of the defining attributes of surgical readiness. Although physical optimization, patient education, interdisciplinary collaboration, and organizational preparedness were achieved, psychological preparedness and effective emotional support remained incomplete. Consequently, surgical readiness was only partially achieved, illustrating that comprehensive readiness requires integration of both clinical and psychosocial dimensions. The absence of complete psychological and interpersonal preparedness prevents this case from representing a true model case.

2.9.3. Related Case

The following related case describes effective preoperative preparation but does not fully represent surgical readiness.

Mr. C, a 62‐year‐old man scheduled for elective abdominal surgery, completed all required laboratory investigations, imaging studies, anaesthesia consultation and hospital admission procedures. He received standardized written instructions regarding fasting, medication management and arrival time on the day of surgery.

Although all routine preoperative processes were completed successfully, no individualized assessment of his psychological concerns, informational needs, confidence or family support was conducted. Patient education was limited to standard institutional instructions, and no multidisciplinary planning or shared decision‐making occurred beyond routine clinical practice.

This case illustrates comprehensive preoperative preparation rather than surgical readiness. Although procedural requirements were completed successfully, the multidimensional attributes of patient engagement, psychological preparedness, individualized education and coordinated interdisciplinary support were not fully addressed. Therefore, the case is related to but distinct from the concept of surgical readiness.

This related case illustrates a concept closely associated with surgical readiness but does not represent surgical readiness itself. Although routine preoperative preparation was completed successfully, individualized psychological assessment, patient engagement, family involvement and integrated interdisciplinary coordination were limited. Therefore, this case represents preoperative preparation rather than the multidimensional concept of surgical readiness.

3. Define Empirical Referents

Empirical referents represent the observable and measurable indicators through which the concept of surgical readiness can be assessed in practice. Based on the defining attributes identified in this analysis, these referents can be distinguished as direct measures of surgical readiness and proxy or domain‐specific indicators. Direct measures refer to instruments specifically developed to assess readiness for surgery, whereas proxy indicators assess specific domains related to readiness, such as physiological optimization, psychological preparedness, communication, procedural completion or system preparedness, without independently representing the multidimensional construct of surgical readiness.

At the patient level, direct measures include instruments specifically developed to assess readiness for surgery, such as the Preoperative Assessment of Readiness Tool (PART) (Torres et al. 2021). These instruments assess patient‐level dimensions of readiness. In contrast, physiological parameters, such as stable vital signs, normal laboratory values, adequate nutritional status and functional capacity, serve as proxy indicators of physiological optimization (Aronson et al. 2019; Knudson et al. 2018). Psychological measures, including the Hospital Anxiety and Depression Scale (HADS) and the State‐Trait Anxiety Inventory (STAI), assess psychological states relevant to readiness and therefore represent domain‐specific proxy indicators rather than direct measures of surgical readiness (Torres et al. 2021; Wade et al. 2023). Patient understanding of the surgical procedure, anaesthesia and postoperative expectations, assessed through methods such as teach‐back, similarly reflects informational preparedness as a component of readiness (Torres et al. 2021).

At the professional level, the literature primarily identifies proxy indicators of readiness rather than direct measures of the multidimensional construct. These include effective interprofessional communication, the quality of handovers, adherence to structured communication frameworks such as SBAR, and shared decision‐making between healthcare professionals and patients (Donohue et al. 2025). Nursing assessments of patients' understanding, anxiety and coping also provide observable indicators of psychological and educational preparedness (Torres et al. 2021). These indicators reflect collaborative participation and professional preparedness but should not be interpreted as direct measures of surgical readiness.

At the system level, proxy indicators include completion of standardized safety and preoperative checklists, confirmation of required resources and documentation, and evidence of organizational preparedness for surgery. Tools such as the WHO Surgical Safety Checklist provide observable indicators of procedural and system preparedness and support verification that essential safety processes have been completed before surgery (World Health Organization 2009; Wong et al. 2020). However, checklist completion represents a domain‐specific indicator of system preparedness rather than a direct measure of the broader multidimensional construct of surgical readiness.

In practice, direct readiness measures and domain‐specific proxy indicators serve complementary purposes. The PART provides direct patient‐level assessments of readiness (Torres et al. 2021), whereas measures such as HADS and STAI assess psychological domains relevant to readiness (Wade et al. 2023). Structured communication assessments and safety checklists similarly provide proxy indicators of professional and system preparedness (World Health Organization 2009; Wong et al. 2020). These measures may provide complementary information across multiple dimensions relevant to surgical readiness; however, proxy indicators should not be interpreted as equivalent to direct measures of the overall construct.

In summary, the empirical referents of surgical readiness encompass patient‐, professional‐ and system‐level dimensions. Direct readiness measures provide patient‐level assessments of the construct, whereas physiological parameters, psychological states, patient understanding, interprofessional communication, procedural safety processes and organizational preparedness serve as proxy or domain‐specific indicators of relevant components of readiness. These referents provide complementary means of operationalizing the concept across its multiple dimensions; however, proxy indicators should be interpreted as reflecting specific components of readiness rather than the multidimensional construct in its entirety.

4. Implications for Nursing Practice and Research

From a nursing perspective, the concept of surgical readiness reinforces the central role of nurses as key facilitators of holistic preparation. Nurses serve as the connecting link between the patient's emotional world and the clinical environment, integrating medical optimization with psychological and spiritual care. Through assessment, education, and emotional support, nurses can address patients' physical, informational, psychological and emotional needs and support their preparedness for surgery. This reflects nursing's core values of person‐centred care, empathy and empowerment. The identified conceptual attributes—holistic preparedness, physiological optimization, psychological confidence, collaborative participation and system efficiency—suggest the value of extending nursing practice beyond routine preoperative tasks toward a more comprehensive readiness framework. For example, assessment of surgical readiness may encompass not only laboratory results and completion of informed consent but also the patient's anxiety, coping mechanisms and support networks. Integrating such multidimensional assessment into preoperative care may support a more comprehensive evaluation of patient preparedness and facilitate individualized planning across physical, psychological and social dimensions. Further empirical research is needed to determine whether readiness‐focused approaches are associated with improved perioperative outcomes, reduced surgical anxiety or more efficient recovery. At the interprofessional level, the concept emphasizes that surgical readiness is a shared responsibility. Effective communication and collaboration among surgeons, anaesthesiologists and nurses are important for addressing the medical, procedural, psychological and logistical dimensions of readiness. Nursing leadership may facilitate such collaboration through structured communication tools, interprofessional huddles and standardized readiness checklists. From a systems perspective, surgical readiness has implications for organizational quality, safety and care coordination. Hospitals and surgical centres may consider readiness not merely as an individual patient variable but also as reflecting broader systemic preparedness and coordination of perioperative care. Institution‐wide readiness protocols, including structured safety checklists and preoperative readiness pathways, may provide a framework for standardizing care processes, supporting care coordination and promoting a culture of perioperative safety.

In terms of education, integrating the concept of surgical readiness into preoperative and perioperative nursing curricula may help prepare future nurses to assess both physiological and psychosocial dimensions of readiness. Simulation‐based education and role‐playing may also provide opportunities to develop communication and psychological assessment skills relevant to readiness evaluation.

Regarding research implications, the multidimensional definition developed in this analysis may provide a conceptual foundation for the development and validation of comprehensive readiness assessment tools. While existing instruments, such as the Preoperative Assessment of Readiness Tool (PART), primarily assess patient‐level dimensions of readiness, future studies should integrate system‐level and interprofessional dimensions. Research should also explore the relationship between levels of surgical readiness and postoperative outcomes, such as complication rates, length of stay and patient satisfaction. Furthermore, qualitative research could deepen understanding of how patients, families and healthcare providers experience readiness across different surgical contexts, including elective versus emergency, high‐risk versus low‐risk and resource‐rich versus resource‐limited settings. Such inquiry may help refine the cultural and contextual nuances of the concept and inform the applicability of readiness frameworks across diverse settings.

Finally, at the policy and quality‐improvement level, the clarified concept of surgical readiness may inform the development of institutional approaches that support preoperative education, psychosocial support and multidisciplinary coordination. With further empirical validation, surgical readiness may also have potential as an indicator of perioperative care quality and patient‐centeredness.

5. Limitations

This concept analysis was informed by a structured literature search using focused terminology related to surgical readiness across selected literature sources, supplemented by manual screening of reference lists. Although this approach identified conceptually relevant literature across nursing, medicine and anaesthesiology, the use of focused search terms and selected sources may have limited the identification of literature employing alternative terminology for readiness in the perioperative context. Therefore, some relevant perspectives may not have been captured. Future concept analyses may build on the present findings by incorporating broader terminology and additional interdisciplinary databases as the concept continues to evolve.

6. Conclusion

This concept analysis conceptualizes surgical readiness as a dynamic and multidimensional construct extending beyond conventional preoperative preparation. By integrating perspectives from nursing, medicine and anaesthesiology, surgical readiness encompasses the alignment of patient preparedness, professional coordination and system preparedness across the perioperative context. The clarified concept and its defining attributes, antecedents, consequences and empirical referents provide a conceptual foundation for further development, application and empirical evaluation of surgical readiness in perioperative nursing and healthcare.

Author Contributions

Supreeda Monkong: conceptualization, investigation, writing – original draft, methodology, validation, writing – review and editing, formal analysis, data curation, supervision. Suchira Chaiviboontham: conceptualization, investigation, methodology, validation, writing – review and editing. Chatkamon Prachuablarp: conceptualization, investigation, writing – original draft, methodology, validation, writing – review and editing, formal analysis, data curation.

Funding

The authors have nothing to report.

Conflicts of Interest

The authors declare no conflicts of interest.

Data Availability Statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.