Perceived  Stress, Emotional Regulation, Sleep Quality, and Executive Function Among Operating Room Nurses: A Cross-Sectional Structural Equation Modeling Study

Background: This study aims to examine the relationships among perceived stress, emotion regulation, sleep quality, and executive dysfunction in operating room nurses, who are subjected to high-pressure environments that necessitate continuous complex decision-making, multitasking, and prompt responses. Methods： 216 Chinese operating room nurses surveyed on executive function (Dysexecutive Questionnaire), perceived stress (Perceived Stress Scale with helplessness/self-efficacy subscales), emotion regulation (Emotion Regulation Questionnaire with reappraisal/suppression subscales), and sleep quality (Pittsburgh Sleep Quality Index). Structural equation modeling explored relationships among these factors. Results: In operating room nurses, Dysexecutive scores correlated significantly with helplessness and sleep quality, and weakly with self-efficacy. Emotion Regulation scores showed no overall link to Dysexecutive, but cognitive reappraisal was negatively correlated, and expressive suppression positively correlated. SEM fit was good. Helplessness positively predicted expressive suppression and sleep quality; self-efficacy negatively predicted cognitive reappraisal and expressive suppression. Helplessness indirectly impacted Dysexecutive via expressive suppression. Conclusion： For these nurses, higher helplessness and expressive suppression are strongly tied to executive dysfunction, with helplessness directly and indirectly affecting cognition via poor emotion regulation. Implications for the profession and/or patient care： These findings highlight the need for targeted interventions in OR nursing to mitigate perceived stress and foster adaptive emotion regulation such as promoting cognitive reappraisal over suppression. Such strategies could enhance executive function, reduce cognitive errors, and improve patient safety during high-stakes procedures Impact： This study addresses gaps in understanding psychosocial factors influencing executive function in OR nurses, informing workplace wellness programs and stress management training to support cognitive resilience and operational efficiency in surgical environments. Reporting Method: State here that you have adhered to relevant EQUATOR guidelines and name the reporting method. Patient or Public Contribution ：This study did not include patient or public involvement in its design, conduct, or reporting.