Intensive Care Unit Nurses' Perceptions and Experiences of Clinical Alarms: A Systematic Review of Qualitative...

Area of Science:

• Nursing Science
• Patient Safety
• Healthcare Technology

Background:

• Clinical alarm management is a critical patient safety issue in intensive care units (ICUs).
• High rates of non-actionable alarms lead to alarm fatigue, increased cognitive load, and delayed responses among nurses, paradoxically undermining patient safety.

Purpose of the Study:

• To systematically synthesize and appraise qualitative evidence on ICU nurses' experiences, perceptions, and coping behaviors regarding clinical alarms.
• To understand the multifaceted challenges and strategies related to clinical alarm management from the nurses' perspective.

Main Methods:

• A systematic review of qualitative evidence was conducted using meta-aggregation.
• A comprehensive search of eight databases was performed, and included studies were critically appraised using the Joanna Briggs Institute's Critical Appraisal Checklist.
• Data synthesis employed the meta-aggregation approach, with confidence in findings assessed using the ConQual approach.

Main Results:

• Fourteen studies were synthesized, revealing four key findings: the "Perceptual Paradox" of alarms as both essential and burdensome, nurses' alarm response as situated clinical judgment, a multi-level system influencing alarm response (individual, contextual, organizational), and nurses' expectations for intelligent support, training, and autonomy.
• Nurses perceive alarms as both a vital safety mechanism and a significant clinical burden.
• Alarm response is an evolving practice influenced by individual, contextual, and organizational factors, with nurses expecting better training and technological support.

Conclusions:

• Effective alarm management is a socio-technical challenge stemming from a core perceptual paradox.
• Sustainable solutions require technological optimization, positive safety cultures, and enhanced clinical expertise to empower nurses.
• Interventions should focus on competency-based training, non-punitive safety cultures, and human-centered technology design to reduce cognitive load and support clinical judgment.