ICU nurses' experiences, practices and support needs in ventilator alarm management: a qualitative study

To explore intensive care unit (ICU) nurses' experiences, practices and support needs in ventilator alarm management.

A qualitative descriptive study using semi-structured individual interviews and conventional content analysis.

A tertiary hospital ICU in Beijing, China.

Fifteen ICU nurses with direct experience in caring for mechanically ventilated patients and managing ventilator alarms were recruited through purposive sampling.

Analysis of the interview data using a more granular line-by-line coding approach generated 113 initial codes, which were organised into 17 code categories, 15 subthemes and 5 main themes. The five themes were (1) from alarm recognition to risk prioritisation, (2) knowledge gaps behind routine alarm responses, (3) multilevel barriers to accurate ventilator alarm management, (4) role boundaries and collaborative alarm management and (5) moving from reactive response to precision alarm management. Nurses prioritised alarms that directly threatened airway patency, ventilation or oxygenation, such as airway obstruction, circuit disconnection and apnoea ventilation. Although participants were generally able to recognise common alarm names and perform initial bedside troubleshooting, they reported challenges in identifying underlying causes, interpreting ventilator parameters and waveforms and managing alarms in complex patient-, procedure-, device- and environment-related situations. Ventilator alarm management was shaped by professional role boundaries, with nurses mainly responsible for patient assessment and nursing-manageable troubleshooting, while ventilator mode, parameter and alarm-limit adjustments were usually escalated to physicians or other senior team members. Participants expressed the need for standardised alarm assessment pathways, clear escalation criteria, layered and scenario-based training and system-level support for sustainable alarm safety.

Ventilator alarm management among ICU nurses is a dynamic clinical process involving alarm recognition, risk prioritisation, interpretation, bedside troubleshooting and interprofessional escalation. Supporting nurses to move from reactive alarm response toward more precise and systematic alarm management requires both individual competence development and organisational support, including structured pathways, targeted training and multidisciplinary alarm governance.