EMPATHY in the orthopaedic and trauma operating theatre: A practice framework for environmental safety and protective perioperative nursing.

Orthopaedic and trauma surgery depends on a controlled operating theatre environment, particularly when implants, arthroplasty, spinal instrumentation, fracture fixation or open trauma procedures are involved. Existing guidance describes numerous environmental and infection-prevention requirements, but these are often dispersed across engineering standards, infection-control documents and perioperative practice recommendations. This practice development paper proposes EMPATHY as a mnemonic framework for orthopaedic and trauma operating theatres. The framework was developed through conceptual synthesis of published guidance and perioperative nursing literature, followed by mapping of seven environmental domains to observable nursing behaviours: Environmental lighting, Microbiological vigilance, Positive pressure and protected traffic, Airflow discipline, Thermal protection, Humidity control and Yell/noise reduction. EMPATHY is not intended to replace local standards or validated checklists. Instead, it offers indicative practice benchmarks that can support education, briefing, environmental awareness and local quality improvement. The framework also reframes empathy in the operating theatre as protective perioperative empathy: safeguarding dignity, aseptic integrity, thermal comfort and communication safety when the patient is anaesthetised or physically vulnerable. Future work should formally evaluate the framework's acceptability, educational value and effect on practice behaviours.