NURS 522 Week 3 Article Critique on Teamwork in the Operating Room Example

Article Critique: Chen et al.'s 2026 Meta-Synthesis of What Helps and Hinders Teamwork Between Operating Room Nurses and Other Practitioners

Introduction

Teams perform only as well as the conditions around them allow, a theme that runs through the first chapters of Wheelan (2016). Chen et al. (2026) examined those conditions in one of health care's most demanding team settings, the operating room, by synthesizing qualitative research on the facilitators of and barriers to teamwork between operating room nurses and other practitioners. This critique summarizes the article, appraises its strengths and limitations, tests its conclusions against other recent evidence, and evaluates its usefulness for nurse leaders responsible for team performance.

Summary of the Article

Chen et al. (2026) set out to synthesize qualitative studies on what helps and hinders teamwork between operating room nurses and the surgeons, anesthesia providers and other practitioners they work with. The authors conducted a systematic review and meta-synthesis, registered in advance in an international register of reviews, and searched nine databases, including PubMed, Embase, Scopus, CINAHL and PsycINFO as well as three Chinese databases, for studies published from January 2014 to September 2025, adding snowball and gray literature searching. Of 4,839 records, 29 qualitative studies met the inclusion criteria. Two researchers extracted data independently, and the findings were managed in NVivo and synthesized into two overarching themes. Facilitators were professional skills, role awareness, team familiarity, a patient-centered culture and effective leadership. Barriers were individualistic behavior, a hierarchical culture, insufficient resources, punitive management and environmental constraints. The authors concluded that these factors operate at individual, interpersonal and systemic levels, and that improving teamwork requires interventions at all three levels at once, including fostering psychological safety and inclusive leadership.

Strengths

The review has several clear strengths. Registering the protocol before beginning reduces the risk that the authors changed their methods after seeing the results. The search was broad and multilingual, and including Chinese databases alongside English-language ones widens the range of health systems represented, which matters for a topic shaped by culture and hierarchy. Independent data extraction by two researchers is a recognized safeguard against error and individual bias. The sample of 29 studies is large for a qualitative synthesis and spans more than a decade. Finally, the findings are organized into levels that a manager can act on, which makes the review more useful than a long list of themes. By sorting causes into individual, interpersonal and systemic levels, the authors give leaders a way to see which barriers they can fix through training and which require changes to the organization itself.

Limitations

The review also has limitations a reader should weigh. Qualitative meta-syntheses depend on the quality of the included studies, and readers should check how the authors appraised each study and whether weaker studies shaped the themes. A confidence rating for each synthesized finding, using an approach such as ConQual or GRADE-CERQual, would show how much trust each theme deserves; readers should look for one before giving every theme equal weight. The facilitators and barriers are also broad categories, such as "effective leadership," that are hard to turn into specific actions without the detail of the primary studies. Because the included studies come from many countries, findings about hierarchy may reflect differences between health systems that a single synthesis cannot fully separate. Finally, qualitative evidence describes what participants experienced and believed, so the review cannot show that any facilitator causes better patient outcomes, a point the authors' call for improved perioperative safety should be read with.

Comparison With Other Recent Evidence

Other recent reviews support the article's emphasis on leadership and psychological safety. In a qualitative systematic review of nurses' perceptions of leadership and moral distress, Bolton et al. (2026) found that leadership shaped nurses' psychological safety, ethical decision making and resilience, and that inadequate support worsened moral distress. Their review included only two studies, which limits its weight, but its direction matches Chen et al.'s finding that punitive management harms teamwork. A meta-analysis of 19 studies with 8,360 nurses found that leadership transparency was associated with less workplace cynicism, greater trust and better team alignment (Oweidat et al., 2026), which supports Chen et al.'s view that leaders influence teamwork through the culture they create. A systematic review of communication competence in nurse managers likewise treated communication as essential for team coordination and the safety of care (González-García et al., 2026). Together, these sources suggest that Chen et al.'s leadership findings are not unique to the operating room. They also point to a gap the article could not fill: none of these reviews tested whether a specific leadership intervention changes team behavior or patient outcomes. That question would require intervention studies, such as trials of structured briefings or leadership training with measured outcomes, and it is the natural next step for research in this area.

Relevance to Nursing Leadership and the Course

The article connects directly to the integrated model of group development described by Wheelan (2016), in which teams move from dependency and inclusion through conflict to trust, structure and productive work. Several of Chen et al.'s barriers, such as hierarchy and individualistic behavior, are signs of a team stuck in the early stages, while facilitators such as role awareness and team familiarity describe the trust and structure of a mature team. One practical implication concerns staffing: if team familiarity helps, then constantly rotating nurses and surgeons through unfamiliar teams works against the development Wheelan describes. A nurse leader could respond by keeping stable core teams for complex specialties, holding brief structured briefings that clarify roles, and replacing punitive responses to errors with learning reviews. The Organization Support Checklist assigned this week offers a way to assess whether an employer provides the systemic support Chen et al. identify.

Conclusion

Chen et al. (2026) provide a well-designed, broad synthesis of qualitative evidence on operating room teamwork, with a registered protocol, a multilingual search and a useful multilevel framework. Its conclusions about leadership, hierarchy and psychological safety are consistent with other recent reviews, though readers should look for confidence ratings and recognize that qualitative findings describe experience rather than prove effects. For nurse leaders, the article is worth applying, particularly its message that teamwork improves only when individual skills, team relationships and organizational systems are addressed together.

References

Bolton, S., Baldwin, A., Adams, A. M. N., Willis, E., Cutmore, E., Johnston, S., Snaith, N., & Dafny, H. A. (2026). The moral of the story: Perception of leadership with moral distress in registered nurses: A qualitative systematic review. Journal of Clinical Nursing, 35(10), 4106-4123. https://doi.org/10.1111/jocn.70354

Chen, Y., Zhang, Y., Zhang, J., & Luo, J. (2026). Facilitators of and barriers to teamwork between operating room nurses and other practitioners: A meta-synthesis of qualitative studies. BMJ Open, 16(4), Article e098386. https://doi.org/10.1136/bmjopen-2024-098386

González-García, A., Marqués-Sánchez, P., Martín-Vázquez, C., Serrano-Gemes, G., Bermejo-Martínez, D., & Pérez-González, S. (2026). Characteristics of communication competency in nurse managers: A systematic review. Healthcare, 14(17), Article 2814. https://doi.org/10.3390/healthcare14172814

Oweidat, L., Ayyad, A., Alosta, M., Al Mugheed, K., ALBashtawy, M., & Alkhawaldeh, A. (2026). Relationship between leadership transparency and workplace cynicism among nurses: A systematic review and meta-analysis. Nursing Management, 33(5), 34-41. https://doi.org/10.7748/nm.2026.e2209

Wheelan, S. A. (2016). Creating effective teams: A guide for members and leaders (5th ed.). SAGE Publications.