Identification and prioritisation of ergonomic and psychological factors influencing the performance of operating room nurses: A mixed methods study

Introduction: Operating room nurses worldwide face combined ergonomic and psychological challenges that can compromise their performance and job satisfaction, as well as patient safety. While numerous studies have examined these issues separately, little is known about their integrated effects, particularly in resource-constrained healthcare systems. Objective: This mixed methods study aimed to identify and prioritise psychological and ergonomic factors affecting the performance of operating room nurses in public hospitals in Ilam, Iran, and propose actionable strategies to improve their working conditions. Methods: The study involved three participant groups in two sequential phases. In the qualitative phase, semi-structured interviews were conducted with 20 participants (nursing managers, clinical psychologists and experienced operating room nurses), followed by thematic analysis using MAXQDA 2020. Findings were refined through a Delphi panel of 15 experts. In the quantitative phase, 169 operating room nurses were selected from a population of 300 via stratified random sampling, and factors were ranked using the Friedman test. The study was approved by the Ethics Committee of Ilam University of Medical Sciences (IR.MEDILAM.REC.1404.119) in accordance with the Declaration of Helsinki. Results: Qualitative analysis revealed five major thematic categories (psychological, organisational, supportive, ergonomic, technological) and 32 sub-themes, narrowed to 22 factors after screening. Ergonomic priorities included ‘workplace design’ (mean rank = 18.25±1.85), ‘ergonomic equipment’ (17.80±1.82) and ‘body posture’ (16.45±1.78). Key organisational and psychological factors were ‘supportive leadership style’ (16.20±2.01) and ‘occupational self-efficacy’ (15.90±1.97), respectively. Conclusion: Enhancing operating room nurses’ performance requires addressing both ergonomic and psychological dimensions. Redesigning workspaces, providing ergonomic tools and implementing psychological training programs are critical for improving workplace conditions. These findings offer actionable insights for hospital management to optimise nurse performance and wellbeing.