Digital Gaze and Vicarious Trauma Among Intensive Care Unit Nurses in Alarm-Monitoring Ecologies: Qualitative...

Area of Science:

• Digital Health
• Sociotechnical Systems
• Human-Computer Interaction

Background:

• Intensive care units (ICUs) use continuous physiological monitoring and frequent alarms to detect patient deterioration.
• Alarm fatigue is a known issue, but the impact of monitoring systems on nurses' attention, visibility, accountability, and emotional strain is less understood.
• Understanding these experiences is vital for designing safer monitoring displays, alarm behaviors, communication routines, and AI-supported systems.

Purpose of the Study:

• To explore how ICU nurses experience continuous monitoring and alarms as a digital work environment.
• To investigate the influence of digital gaze, vicarious trauma-related emotional strain, and perceived accountability.
• To identify design-relevant system needs for improved monitoring.

Main Methods:

• A qualitative interview study was conducted with 15 ICU nurses in Hangzhou, China.
• Semistructured interviews covered monitoring routines, alarm responses, perceived data pressure, after-shift experiences, coping strategies, and design suggestions.
• Data were analyzed using reflexive thematic analysis.

Main Results:

• Continuous monitoring created a 'digital gaze,' leading to constant watch, alarm-driven interruptions, and scrutiny of bedside responses.
• Patient deterioration and death were perceived through monitoring technologies (waveforms, alarms, numerical data).
• Monitoring-related stress extended post-shift, involving lingering sounds, images, and work messages, with nurses highlighting needs for clearer alarm prioritization, fewer nonactionable alerts, and better communication boundaries.

Conclusions:

• Continuous monitoring and alarms significantly shape ICU nurses' work beyond workflow and patient safety, constituting a digital health and sociotechnical design issue.
• These systems affect nurses' attention, perceived accountability, emotional strain, and recovery.
• Future monitoring systems require co-design and evaluation focusing on how displays, alarm behavior, communication, and AI tools impact clinicians' work, recovery, and sense of surveillance.