A mixed methods study of work system determinants of occupational fatigue among emergency nurses in Iranian public hospitals

Occupational fatigue is a major contributor to workplace hazards, injuries and health adversities in the emergency department (ED). To address the existing gap in the literature, the goal of the current study was to identify work system factors associated with occupational fatigue among Iranian ED nurses. This study adopted a sequential exploratory (Qual → Quan; two stages) mixed methods design. The function of this mixed methods design was “development”, in which the insights gained from a qualitative phase ( n = 17) formed the foundation for a quantitative stage ( n = 166) through sequential transformation of qualitative data into a conceptual model and a fatigue exposure survey. Analyses were performed via the SPSS v26, MAXQDA2018 and SmartPLS v3 software. Findings from the qualitative phase informed the development of a conceptual model of occupational fatigue, identifying twenty major themes across four levels of the work system. Using the developed survey, field study results demonstrated not only the system elements with the greatest association but also their interdependence and potential fatiguing mechanisms. The developed conceptual model and survey represent a preliminary, holistic framework for systematically identifying and assessing fatigue-related risk factors in Iranian emergency nursing, although further psychometric validation and evaluation across diverse healthcare settings are warranted.