Evaluation of alarm fatigue of nurses working in the COVID‐19 Intensive Care Service: A mixed methods study

Abstract

Aims and Objectives To reveal the existence of alarms in COVID‐19 intensive care units, where medical devices with alarm function are frequently used, the effects of alarms on nurses, especially their on‐the‐job performances and social lives, and their coping methods. Methodology/Methods This was a mixed design, including descriptive and qualitative research methods with two stages, and was carried out between March and April 2021. The study adhered to the STROBE checklist for cross‐sectional studies and the COREQ guidelines for qualitative studies. Setting Nurses in the COVID‐19 intensive care unit of a university hospital constituted the sample. 58 nurses participated in the quantitative data phase, and 18 nurses in the qualitative interviews. Results More than half of the nurses worked in the COVID‐19 intensive care unit for more than 5 months and overtime, and 87.9 had day and night shifts. The monthly income level of 65.5% was between the hunger and poverty lines, and 12.1 % received psychiatric support in the last 6 months. A positive and significant relationship was found between the mean score obtained from the alarm fatigue questionnaire and the level of discomfort felt due to the alarms (1–10 points) (p = 0.001). Five themes and thirty sub‐themes were emerged in the focus group interviews. Conclusion The number of alarms of the medical devices in the COVID‐19 intensive care units was more than the other intensive care units, resulting in fatigue in nurses. Since alarm fatigue is directly related to patient safety, the effective management of medical device alarms can reduce alarm fatigue and prevent potentially dangerous outcomes. Relevance to clinical practice Nurses care for patients with severe clinical conditions in COVID‐19 intensive care units. This situation caused them to be exposed to more alarms. Nurses should make efforts to reduce their alarm intensity.

A Brief Questionnaire for Measuring Alarm Fatigue in Nurses and Physicians in Intensive Care Units

“…Torabizadeh et al [11] made the rst and so far the only attempt to systematically construct a reliable instrument for measuring alarm fatigue in nurses. Some studies, of which ve were peer-reviewed [12][13][14][15][16] and two were published as dissertation manuscripts [17,18], already used Torabizadeh et al's questionnaire, while others took it as a resource to build their own custom questionnaire [19]. We welcome this trend towards using a standardised, uniformly agreedupon instrument in clinical alarm research.…”

Evaluation of alarm fatigue in nurses working in intensive care units and alarm fatigue

“…This indicates that although alarm fatigue is present, nurses in the intensive care unit still act by alarm management. In the study of Akturan et al 10 in which they evaluated the alarm fatigue of nurses working in COVID-19 intensive care units, they stated that nurses were more sensitive to the alarms of some patients whose clinical condition worsened and to the alarms of some devices during night shifts (such as being more sensitive to mechanical ventilators than to the sound of the infusion pump). It has also been suggested that nurses who work overtime and are less active on the night shift compared to the day shift may cause them to hear alarms more and react negatively.…”

“…"The heavy workload in some shifts prevents my quick response to alarms" 66.6% of the participants answered this question as heavy workload sometimes-usuallyalways prevents them from responding to alarms. In the study of Akturan et al 10 "the necessity to wear personal protective equipment" was determined as a factor that increases alarm fatigue in a process such as a pandemic where workload increases. The international patient safety commission has made some recommendations by setting targets for 'Improving Clinical Alarm Systems.…”

“…Since it will be difficult for intensive care nurses to develop appropriate behaviors for alarm management, appropriate approaches should be developed to support this team. 10 Improving working hours and conditions in institutions, establishing the alarm management process, inter professional cooperation and timely intervention of the technical support team can reduce this problem. "I pay less attention to the alarms of the equipment during visiting hours" was answered as "never" at a rate of 63%, which can be interpreted as the intensive care nurses continuing the alarm management process despite all their fatigue and ensuring patient safety.…”

“…According to the study of Akturan et al 10 being a university and high school graduate led to significant differences in the alarm fatigue scores of nurses. The university graduate group showed better positive practices to reduce alarm fatigue.…”