Contextual factors influencing the acute care registered nurse's response to clinical alarms

Abstract

Nurses are faced with a multitude of clinical alarms on a daily basis. There is an inherent expectation that upon hearing an alarm the nurse will immediately respond to assess the situation and initiate appropriate action to correct the problem. Yet this does not always occur. Issues with alarm responsiveness can pose a serious threat to patient safety.

The purpose of this qualitative study was to develop a broader understanding of the contextual factors that influenced the acute care nurse's response to clinical alarms. This study used an interpretive phenomenological methodology to study the lived experiences of the nurses who encounter alarms in the medical-surgical patient care setting.

The study was conducted in two community hospitals in southern California over a 9-week period. Four focus groups were conducted with a total of 28 participants. A tiered schedule approach was used to facilitate concurrent analysis and refinement of the interview questions. Data saturation was achieved after the last focus group. Each focus group was digitally recorded and each audio file was transcribed.

The sample consisted of 28 participants whose average age was 42.8 years, had been an RN for 10.9 years, and had been in their current position for 4.3 years. The majority of the sample was female (96%) and worked full time (75%) on the day shift (61%). Sixty four percent of the sample held an associate degree, 22% had a baccalaureate degree, and 14% had a master's degree.

Analysis of the focus group transcripts revealed the nurses used alarms tones to identify devices and alarm conditions. They used a priority setting approach to answer the alarms which was influence by a number of contextual factors. These were identified as acuity of the alarm condition (three subfactors—life-threatening physiological issues, patient safety issues, and patient comfort issues), patient satisfaction (three subfactors—noise, customer service, and prior experience as a patient), experience as a nurse, unit leadership, personal motivation, availability of resources (two subfactors—time and energy), competing priorities, patient assignment, and special patient situations (two subfactors—isolation patient and effort-intensive patient and/or family).