Intraoperative handover, beyond checklists, towards culture and safety a scoping review

Intraoperative handovers among operating room (OR) nurses are critical high-risk transitions in which incomplete communication can compromise patient safety. Despite international safety goals and structured protocols, practice remains inconsistent. This scoping review aimed to identify and conceptually map the existing literature on OR nurses’ practices and experiences of intraoperative handovers. The review followed the Joanna Briggs Institute (JBI) methodology and the PRISMA-ScR guidelines. Using the Population, Concept, Context (PCC) framework (Population: OR nurses; Concept: handover communication; Context: intraoperative care), we conducted systematic searches in MEDLINE, CINAHL and Web of Science, supplemented by grey literature. Eligible sources included qualitative, quantitative and mixed-methods studies published in English or Scandinavian languages. The data were analysed using narrative conceptual mapping supported by NVivo. Nineteen sources were included, predominantly qualitative studies and field reports. Three conceptual themes emerged: (1) r isk management as an implicit practice – nurses safeguard patient safety through vigilance and compensatory strategies, (2) standardisation as a procedural anchor – structured tools and checklists improve clarity but may constrain adaptability and (3) relational complexity as a contextual determinant – hierarchical norms and psychological safety shape communication quality. Evidence highlights that handovers are socially negotiated processes rather than routine technical exchanges. Intraoperative handovers are complex high-risk transitions influenced by procedural, relational and systemic factors. While structured tools reduce omissions, rigid application risks undermining clinical judgment. Future strategies should integrate flexible standardisation with cultural and organisational reforms that foster psychological safety and shared accountability.