Date of Award

2023

Degree Name

Master of Philosophy (School of Nursing, Midwifery, Health Sciences and Physiotherapy

First Supervisor

Dr Benjamin Hay

Second Supervisor

Dr Angela Owens

Abstract

Introduction: Alarm fatigue is a consequence of sensory overload due to frequent nuisance alarms from physiologic monitoring devices. This ‘cry wolf’ phenomenon occurs frequently in the context of continuous cardiac monitoring and ST segment monitoring.

Research significance: The effect of these alarm types on nurses’ perceived alarm fatigue in Australian settings is yet to be examined. Accordingly, this thesis explores registered nurses (RN’s) perception of alarm fatigue. The effect of ST segment monitoring on perceived alarm fatigue, as well as the necessary resources for RNs to reduce alarm fatigue is also a focus of this thesis.

Methodology: The research was guided by a convergent mixed methods approach. The Healthcare Technology Foundation’s (HTF) Clinical Alarms Survey (CAS) tool was adapted to the Australian setting and administered to a convenience sample of 28 critical care RNs employed in the intensive care services (ICS) and coronary care unit (CCU) of a tertiary hospital in New South Wales, Australia. The quantitative data underwent descriptive and inferential analysis. A purposive sample of six survey participants engaged in one-on-one semi-structured online interviews to explore perceived alarm fatigue. The qualitative findings underwent reflexive thematic analysis. Both datasets were amalgamated, with the quantitative findings supplementing the narrative findings.

Results: Staff with less clinical experience and education reported increased complexity and challenges with managing ST segment monitoring. The themes of clinical experience, knowledge, technology, nursing workload and the value of alarms were found to be pivotal in participant’s perceived alarm fatigue. Narrative survey data revealed concerns related to alarm fatigue and alarm distress in both patients and staff, with clinical experience reported to affect alarm management. The survey results indicated that nuisance alarms, though frequent and disruptive, had a limited effect on the nursing response to alarms.

Conclusion: Alarm fatigue was present in the study participants; however, it did not affect each participant equally. Nurse’s clinical experience and knowledge affected both alarm management and perceived alarm fatigue. ST segment monitoring was reported to contribute to alarm fatigue, but the effect was limited due to the urgency of the alarms and the relevance of the alarms to patient outcomes. The participants requested alarm management education, usable technology, changes to policy and appropriate staffing to manage alarm fatigue.

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