Aims and objectives To describe how nurses and nurse managers consider sustainable development principles in their daily work, how well they recognise these principles and how these principles are considered in decision‐making in perioperative work. Background Sustainable development involves interpersonal social and cultural relations and long‐term economic and ecological thinking in societal decision‐making. These dimensions are well‐suited for a foundation of decision‐making in acute health care. No previous research has been performed on perioperative work from the sustainable development perspective. Design Qualitative descriptive design was used. Data were collected from perioperative nurses (n = 20) and nurse managers (n = 6) working in five surgical departments in a Finnish university hospital. Data were analysed by content analysis. The reporting follows qualitative research checklist (COREQ). Results The principles of sustainable development were poorly known among the participants. Nurse managers considered their opportunities to influence decision‐making were reduced by their limited economic knowledge. Resource use, individuality, and ecological viewpoints were emphasised in the decision‐making process in perioperative work. Conclusions Findings reveal that perioperative nurses and nurse managers are aware of economic and ecological sustainability, but they do not actively consider it as part of their work. Social and cultural sustainability must be developed further in decision‐making in perioperative work. Relevance to clinical practice Perioperative nurses and nurse managers consider that it is important to develop the principles of sustainable development in perioperative work. This research indicates that economic understanding is not guiding decision‐making, and there is a lack of knowledge about the benefits of ecological procedures. Social and cultural sustainability are not connected in perioperative work, although there is collaboration between the surgical team and the patient is essential. This study helps to organise operating room management effectively and diversely.

Introduction The mechanism underlying the development of excessive daytime sleepiness (EDS) in obstructive sleep apnea (OSA) remains unclear. Thus, we characterised the association between sleep architecture and EDS in individuals with and without OSA. Methods 1876 suspected OSA patients reporting daytime sleepiness underwent in-lab polysomnography and next-day multiple sleep latency test (MSLT). We investigated sleep architecture characteristics in OSA (apnea-hypopnea index [AHI]≥5, n=1508) and non-OSA (AHI<5, n=368) patients with and without EDS (MSLT≤10-minutes and MSLT>10-minutes). Sleep architecture was quantified by N1, N2, N3, REM, total sleep time (TST), and wake after sleep onset (WASO). Results OSA patients with EDS had less N1 (median: 10.0 vs 12.0-minutes, p<0.05) and N3 (60.2 vs 71.5-minutes, p<0.05) sleep, less WASO (43.0 vs 51.0-minutes, p<0.05), more N2 (210.5 vs 189.0-minutes, p<0.05) sleep, and higher TST (365.0 vs 351.5-minutes, p<0.05) than non-EDS patients. No difference was observed in the amount of REM (70.0 vs 67.5-minutes, p=0.46) sleep. Non-OSA patients with EDS had less WASO (31.5 vs 40.0-minutes, p<0.05), more N2 (188.5 vs 177.5-minutes, p<0.05) sleep, and higher TST (374.5 vs 359.0-minutes, p<0.05) and the amount of REM sleep (76.5 vs 68.5-minutes, p<0.05) than non-EDS patients. Discussion While EDS was associated with less WASO and greater TST and N2 in both OSA and non-OSA groups, there was also characteristic differences. Non-OSA patients with EDS have greater REM sleep duration, while OSA patients with EDS have less N3 sleep. There is likely a complex bi-directional relationship between sleep architecture and EDS reflecting acute/chronic sleep disruption and compensatory mechanisms.