The relationships among alarm fatigue, compassion fatigue, burnout and compassion satisfaction in critical care and step-down nurses

Alarm fatigue and sleep quality in medical staff-a Polish-Czech-Slovak study on workplace ergonomics

Background

Alarms are crucial in informing Healthcare Workers (HCWs) about critical patient needs, but unmanaged frequency and noise of alarms can de-sensitize medical staff and compromise patient safety. Alarm fatigue is identified as the major cause of the clinical alarm management problem. It occurs when the medical staff is overwhelmed by the number of clinical alarms.

Methods

The survey was conducted online using Google's form-making tools from June to July 2023. There were three parts to the survey used in the study: a socio-demographic metric, the Alarm Fatigue Assessment Questionnaire (AFAQ), and The Pittsburgh Sleep Quality Index (PSQI). A significance level of 0.05 was used in the analysis.

Results

The survey included 756 medical professionals from three European countries (Slovakia, the Czech Republic and Poland). The participants in the study were 42 years old on average, and they had 12 years of work experience. 603 out of 756 survey participants had poor sleep quality, 147 had good sleep quality, and 6 did not provide an answer. This study analyzed the alarm fatigue levels of respondents in every country. In the Czech Republic, Poland and Slovakia, a statistically significant association (p = 0.039, p = 0.001, p < 0.001) was found between alarm fatigue and sleep quality in medical staff.

Conclusion

Based on our study, alarm fatigue and sleep quality of HCWs are correlated. Therefore, alarm fatigue and sleep hygiene should be monitored.

Artificial Intelligence and Machine Learning Applications in Critically Ill Brain Injured Patients

The utilization of Artificial Intelligence (AI) and Machine Learning (ML) is paving the way for significant strides in patient diagnosis, treatment, and prognostication in neurocritical care. These technologies offer the potential to unravel complex patterns within vast datasets ranging from vast clinical data and EEG (electroencephalogram) readings to advanced cerebral imaging facilitating a more nuanced understanding of patient conditions. Despite their promise, the implementation of AI and ML faces substantial hurdles. Historical biases within training data, the challenge of interpreting multifaceted data streams, and the "black box" nature of ML algorithms present barriers to widespread clinical adoption. Moreover, ethical considerations around data privacy and the need for transparent, explainable models remain paramount to ensure trust and efficacy in clinical decision-making.This article reflects on the emergence of AI and ML as integral tools in neurocritical care, discussing their roles from the perspective of both their scientific promise and the associated challenges. We underscore the importance of extensive validation in diverse clinical settings to ensure the generalizability of ML models, particularly considering their potential to inform critical medical decisions such as withdrawal of life-sustaining therapies. Advancement in computational capabilities is essential for implementing ML in clinical settings, allowing for real-time analysis and decision support at the point of care. As AI and ML are poised to become commonplace in clinical practice, it is incumbent upon health care professionals to understand and oversee these technologies, ensuring they adhere to the highest safety standards and contribute to the realization of personalized medicine. This engagement will be pivotal in integrating AI and ML into patient care, optimizing outcomes in neurocritical care through informed and data-driven decision-making.

Pro-Con Debate: Universal Versus Selective Continuous Monitoring of Postoperative Patients

In this Pro-Con commentary article, we discuss use of continuous physiologic monitoring for clinical deterioration, specifically respiratory depression in the postoperative population. The Pro position advocates for 24/7 continuous surveillance monitoring of all patients starting in the postanesthesia care unit until discharge from the hospital. The strongest arguments for universal monitoring relate to inadequate assessment and algorithms for patient risk. We argue that the need for hospitalization in and of itself is a sufficient predictor of an individual's risk for unexpected respiratory deterioration. In addition, general care units carry the added risk that even the most severe respiratory events will not be recognized in a timely fashion, largely due to higher patient to nurse staffing ratios and limited intermittent vital signs assessments (e.g., every 4 hours). Continuous monitoring configured properly using a "surveillance model" can adequately detect patients' respiratory deterioration while minimizing alarm fatigue and the costs of the surveillance systems. The Con position advocates for a mixed approach of time-limited continuous pulse oximetry monitoring for all patients receiving opioids, with additional remote pulse oximetry monitoring for patients identified as having a high risk of respiratory depression. Alarm fatigue, clinical resource limitations, and cost are the strongest arguments for selective monitoring, which is a more targeted approach. The proponents of the con position acknowledge that postoperative respiratory monitoring is certainly indicated for all patients, but not all patients need the same level of monitoring. The analysis and discussion of each point of view describes who, when, where, and how continuous monitoring should be implemented. Consideration of various system-level factors are addressed, including clinical resource availability, alarm design, system costs, patient and staff acceptance, risk-assessment algorithms, and respiratory event detection. Literature is reviewed, findings are described, and recommendations for design of monitoring systems and implementation of monitoring are described for the pro and con positions.

Machine Alarm Fatigue among Hemodialysis Nurses in 29 Tertiary Hospitals

OBJECTIVES

 To understand the status quo and related influencing factors of machine alarm fatigue of hemodialysis nurses in tertiary hospitals in Liaoning Province.

METHODS

 This cross-sectional study employed convenience sampling to select 460 nurses from 29 tertiary hospitals in Liaoning Province, who are involved in hemodialysis care. Surveys were conducted using the General Information Questionnaire, Alarm Fatigue Scale, National Aeronautics and Space Administration Task Load Index, and Maslach Burnout Inventory Scale.

RESULTS

 The overall machine alarm fatigue score for 460 hemodialysis nurses from 29 tertiary hospitals in Liaoning Province was 17.04 ± 3.21, indicating a moderate level. The multiple linear regression analysis shows that years of experience in hemodialysis nursing, the number of patients managed per shift, whether specialized nursing training has been received, self-reported health status, emotional exhaustion, and workload have statistically significant associations with alarm fatigue among hemodialysis nurses (p < 0.05). Among them, the years of experience in hemodialysis nursing are negatively correlated with alarm fatigue among hemodialysis nurses, whereas the number of patients managed per shift and workload are positively correlated with alarm fatigue among hemodialysis nurses.

CONCLUSION

 This study indicates that certain demographic factors, workload, and occupational burnout are associated with machine alarm fatigue among hemodialysis nurses. Therefore, hemodialysis-related managers should establish a Machine Alarm Management System, implement Personalized Thresholds and Delayed Alarms, ensure reasonable staffing arrangements, improve compassion fatigue, and enhance anticipatory care. Our findings have implications for improving the health and well-being of hemodialysis nurses, providing a conducive environment for professional training in hemodialysis, and ultimately addressing the current situation of machine alarm fatigue among hemodialysis nurses.

Alarm fatigue and perceived stress among critical care nurses in the intensive care units: Palestinian perspectives

OBJECTIVE

The frequency of alarms generated by monitors and other electro-medical devices is undeniably valuable but can simultaneously escalate the workload for healthcare professionals, potentially subjecting intensive care unit nurses to alarm fatigue. The aim of this study is to investigate alarm fatigue and stress levels among critical care nursing personnel. Additionally, the study aims to assess predictors for both alarm fatigue and perceived stress.

METHODOLOGY

A descriptive cross-sectional study recruited 187 Intensive Care Unit (ICU) nurses from hospitals located in the northern and central regions of the West Bank, Palestine. Data were gathered through online surveys due to logistic concerns using the Alarm Fatigue Scale and the Perceived Stress Scale. The research was conducted between November 2023 and January 2024.

RESULTS

The mean overall alarm fatigue score was 23.36 (SD = 5.57) out of 44. The study showed that 62.6% of the participating ICU nurses experience average to high degree of alarm fatigue, while 69.5% experience average to high levels of perceived stress. A significant positive Pearson correlation was found between stress and alarm fatigue (0.40, P < 0.01). Important predictors of alarm fatigue include perceived stress, nurse-to-patient ratio, gender, and years of experience, while important predictors of perceived stress include alarm fatigue, type of working shift and hospital unit.

CONCLUSION

Alarm fatigue can compromise the timely intervention required to prevent adverse outcomes by causing delayed responses or missed critical alarm, which can have major ramifications for patient safety. Addressing stress is crucial for mitigating alarm fatigue and fostering a supportive work environment to ensure optimal patient care. Consequently, exploring strategies to alleviate the negative impacts of alarm fatigue on critical care nurses' stress merits further investigation in future research studies.

Caring to care: Nurturing ICU healthcare professionals' wellbeing for enhanced patient safety

Healthcare professionals working in the Intensive Care Unit (ICU) care for patients suffering from a critical illness and their relatives. Working within a team of people with different personalities, competencies, and specialties, with constraints and demands might contribute to a working environment that is prone to conflicts and disagreements. This highlights that the ICU is a stressful place that can threaten healthcare professionals' wellbeing. This article aims to address the concept of wellbeing by describing how the stressful ICU work-environment threatens the wellbeing of health professionals and discussing how this situation jeopardizes patient safety. To promote wellbeing, it is imperative to explore actionable interventions such as improve communication skills, educational sessions on stress management, or mindfulness. Promoting ICU healthcare professionals' wellbeing through evidence-based strategies will not only increase their personal resilience but might contribute to a safer and more efficient patient care.

Adaptation and validation of the Turkish version of the alarm fatigue assessment questionnaire

OBJECTIVE

Alarm fatigue may endanger the safety of patients by negatively affecting nurses' concentration and ability to provide effective care. Identifying alarm fatigue and taking appropriate measures are critical in preventing medical errors and for nurses to work with high motivation. This study aimed to test the psychometric properties of the Turkish version of the 23-item Alarm Fatigue Assessment Questionnaire (AFAQ).

METHOD

The study was conducted between February 2022 and April 2022 and included nurses with at least one year of clinical or intensive care experience. The data were collected via a web-based questionnaire. During the adaptation of AFAQ, language, content, and construct validity were evaluated; reliability was examined by internal consistency analysis.

RESULTS

The item and scale content validity index of AFAQ were found to be high (>0.80). The Kaiser-Meyer-Olkin measure of sampling adequacy indicated an adequate sampling (0.85); Bartlett's test of sphericity χ2 was 1935.074, p<0.001. Exploratory factor analysis (EFA) showed that the 21-item scale had a five-factor structure, explaining 51.606% of the total variance, and the factor loadings of the items were >0.30 (0.422-0.803). Confirmatory factor analysis (CFA) showed that the five-factor model had a good fit index (χ2/df=1.855, SRMR=0.039, RMSEA=0.048, CFI=0.915, and TLI=0.908) and appropriate factor loadings (>0.30). The internal consistency of AFAQ (Cronbach's alpha coefficient) was 0.85, and the corrected item-total correlations were between 0.32-0.55.

CONCLUSION

The results indicated that the Turkish version of the Alarm Fatigue Assessment Questionnaire was sufficiently valid and reliable to measure alarm fatigue in nurses.

Nurses' alarm fatigue, influencing factors, and its relationship with burnout in the critical care units: A cross-sectional study

BACKGROUND

Excessive number of alarms and false and nonactionable alarms may lead to alarm fatigue. Alarm fatigue could easily contribute to burnout. Burnout may reduce nurses' sensitivity to alarms, thus affecting patients' safety due to insufficient response to the alarms. However, no study has examined nurses' alarm fatigue in Ghana.

OBJECTIVES

The objective of this study was to investigate the level of alarm fatigue and its associated factors, as well as determine its relationship with burnout among nurses working in the critical care units of hospitals in Ghana.

METHODS

The cross-sectional study was conducted in critical care units of five hospitals in Ghana from November 2021 to January 2022. A total of 364 nurses were recruited and completed the questionnaire. Alarm fatigue was assessed by the alarm fatigue questionnaire, which was originally developed in Chinese and was translated into English using a standard protocol. Burnout was assessed using the Maslach Burnout Inventory.

RESULTS

The overall alarm fatigue score was 76.43 ± 27.80 out of 124. Longer years working at the critical care unit (B = -2.50, 95% confidence interval [CI]: -4.62, -0.37) and having policies related to alarm management (B = -10.77, 95% CI: -3.50, -18.04) were associated with a decreased risk of alarm fatigue, while working in neonatal intensive care unit (B = 16.35, 95% CI: 2.48, 30.21) and postanesthesia care unit (B = 15.16; 95% CI: 0.32, 30.01), and having anxiety and stress (B = 8.15, 95% CI: 1.30, 15.00) were associated with an increased risk of alarm fatigue. In addition, alarm fatigue was positively associated with emotional exhaustion (r = 0.52, P < 0.001) and depersonalisation (r = 0.43, P < 0.001) but not personal accomplishment (r = -0.09, P = 0.100).

CONCLUSION

Critical care nurses in Ghana experienced higher levels of alarm fatigue, which is affected by multiple factors. There is a significant link between nurses' alarm fatigue and burnout. Our findings provide important guidance for future intervention programs to improve critical care nurses' alarm fatigue by introducing policies on alarm management and improving nurses' psychological health, with a special focus on nurses with shorter working years and working in neonatal intensive care unit and postanesthesia care unit.

The effect of intelligent management interventions in intensive care units to reduce false alarms: An integrative review

Objective

In intensive care units (ICU), frequent false alarms from medical equipment can cause alarm fatigue among nurses, which might lead to delayed or missed responses and increased risk of adverse patient events. This review was conducted to evaluate the effectiveness of intelligent management interventions to reduce false alarms in ICU.

Method

Following the framework of Whitmore and Knafl, the reviewers systematically searched six databases: PubMed, EMBASE, CINAHL, OVID, Cochrane Library, and Scopus, and studies included intelligent management of clinical alarms published in the English or Chinese language from the inception of each database to December 2022 were retrieved. The researchers used the PICOS framework to formulate the search strategy, developed keywords, screened literature, and assessed the studies' quality using the Joanna Briggs Institute-Meta-Analysis of Statistics, Assessment, and Review Instrument (JBI-MAStARI). The review was preregistered on PROSPERO (CRD42023411552).

Results

Seven studies met the inclusion criteria. The results showed that different interventions for intelligent management of alarms were beneficial in reducing the number of false alarms, the duration of alarms, the response time to important alarms for nurses, and the alarm fatigue levels among nurses. Positive results were found in practice after the application of the novel alarm management approaches.

Conclusion

Intelligent management intervention may be an effective way to reduce false alarms. The application of systems or tools for the intelligent management of clinical alarms is urgent in hospitals. To ensure more effective patient monitoring and less distress for nurses, more alarm management approaches combined with artificial intelligence will be needed in the future to enable accurate identification of critical alarms, ensure nurses are responding accurately to alarms, and make a real difference to alarm-ridden healthcare environments.

Compassion fatigue and stress related to cardiopulmonary resuscitation: a study of critical care nurses' experiences

BACKGROUND

Cardiopulmonary resuscitation (CPR) is considered one of the most stressful experiences in critical care nursing; it directly and indirectly leads to compassion fatigue and burnout.

AIM

Determine the levels of and relationship between postcode stress and compassion fatigue.

DESIGN AND METHODS

A descriptive-correlational study using 300 critical care nurses from five intensive care units in two hospitals was conducted.

TOOLS

Demographic and work-related data, the Postcode Stress Scale, and the Professional Quality of Life Scale: Compassion Fatigue subscale.

RESULTS

Nurses had moderate to high postcode stress and compassion fatigue (67.98 ± 16.39 and 65.40±14.34, respectively). Moreover, there was a significant positive correlation between postcode stress, burnout (r=0.350, p=<0.001), secondary traumatic stress (r=0.518, p=<0.001), and subsequently, compassion fatigue (r=0.449, p=<0.001). In addition, higher levels of postcode stress were associated with higher levels of compassion fatigue with its subscales: burnout and secondary traumatic stress, with a coefficient of determination for compassion fatigue (0.199), burnout subscale (0.121), and secondary traumatic stress (0.266).

CONCLUSION

Critical care nurses involved in resuscitation experiences are susceptible to postcode stress, burnout, secondary traumatic stress, and compassion fatigue. There is a significant relationship between these factors, with higher levels of postcode stress contributing to higher levels of compassion fatigue and its subscales: burnout and secondary traumatic stress. These results highlight the importance of addressing and managing the psychological well-being of nurses in resuscitation settings to mitigate the adverse effects of stress and promote their overall resilience and well-being.

The effects of alarm fatigue on the tendency to make medical errors in nurses working in intensive care units

BACKGROUND

Alarm fatigue resulting from exposure to multiple alarms is an important problem that threatens patient safety. The fact that each device in intensive care units works with different alarm systems increases the number and variety of alarms.

AIM

The aim of this study was to determine the effects of alarm fatigue on the tendency of nurses working in intensive care units to make medical errors.

STUDY DESIGN

A cross-sectional and correlational design were used in this study. The study was carried out with 382 intensive care nurses who could be reached via an electronic questionnaire. Data were collected using a 'Personal Information Form', the 'Alarm Fatigue Scale (AFS)' and the 'Medical Error Tendency Scale in Nursing (METSN)'.

RESULTS

The mean age of the nurses who were included in the study was 31.52 ± 5.66. While 70.2% of the participants were women, 67% had bachelor's degrees, and 65.4% had been working in the intensive care unit for 1-5 years. The mean total METSN score of the participants was 229.29 ± 15.32, and their mean total AFS score was 20.02 ± 6.15. A negative and weak significant correlation was found between the total mean AFS and METSN scores of the participants (r = -0.275; p < .001). As the alarm fatigue levels of the participants increased, their medical error tendencies increased. It was determined that a one-unit increase in the alarm fatigue level of intensive care nurses increased their tendency to make medical errors by 0.263 units (p < .001).

CONCLUSIONS

It was found that the nurses had a low tendency to make medical errors and moderate levels of alarm fatigue, and an increase in their alarm fatigue levels significantly increased their medical error tendencies.

RELEVANCE TO CLINICAL PRACTICE

Institutions should establish alarm management procedures in units with multiple alarm systems, such as intensive care units, and examine the effects of alarms on employees.

Finding the right words: A focus group investigation of nurses' experiences of writing diaries for intensive care patients with a poor prognosis

BACKGROUND

The overall purpose of diaries written during an intensive care stay is to help patients fill in memory gaps from the illness trajectory, which might promote long-term psychological recovery. Diaries have also been shown to benefit nurses in maintaining a view of the patient as a person in the highly technical environment and to promote reflection. There is a lack of research on how nurses might be affected by writing a diary for critically ill patients with a poor prognosis.

OBJECTIVES

The aim of this study was to investigate nurses' experience of writing diaries for intensive care patients with a poor prognosis.

METHODS

This study has a qualitative descriptive design and was inspired by the methodology of interpretive description. Twenty-three nurses from three Norwegian hospitals with a well-established practice of writing diaries participated in four focus groups. Reflexive thematic analysis was used. The study was reported according to the Consolidated Criteria for Reporting Qualitative Research checklist.

FINDINGS

The overarching theme resulting from our analysis was "Finding the right words". This theme represents the challenge of writing in view of the uncertainty of the patient's survival and of who would read the diary. It was important to strike the right tone with these uncertainties in mind. When the patient's life could not be saved, the purpose of the diary expanded to comforting the family. To put an extra effort into making the diary something special when the patient was dying was also a meaningful activity for the nurses.

CONCLUSIONS

Diaries may serve other purposes than helping patients to understand their critical illness trajectory. In cases of a poor prognosis, nurses adapted their writing to comfort the family rather than informing the patient. Diary writing was meaningful for the nurses in managing care of the dying patient.

The relationship between alarm fatigue and burnout among critical care nurses: A cross-sectional study

BACKGROUND

Alarm fatigue has significant negative impacts on nurses and patient safety. However, the relationship between alarm fatigue and burnout is still unclear.

AIMS

This study aimed to explore the relationship between alarm fatigue and burnout among critical care nurses.

STUDY DESIGN

A descriptive-analytical cross-sectional study design was used. Data were collected from five hospitals in mainland China between January 2022 and March 2022. A general information questionnaire, the Chinese version of the Intensive Care Unit Nurse Alarm Fatigue Questionnaire, and the Chinese version of the Maslach Burnout Inventory were used.

RESULTS

A total of 236 critical care nurses were enrolled in this study. The mean score of alarm fatigue among critical care nurses was 21.11 ± 6.83. The results showed that critical care nurses experienced moderate alarm fatigue levels, and most nurses had moderate to high levels of burnout. The multiple linear regression analyses showed that alarm fatigue was independently associated with emotional exhaustion, depersonalization dimensions, and reduced personal accomplishment dimension.

CONCLUSIONS

Alarm fatigue was associated with burnout among critical care nurses. Reducing critical care nurses' alarm fatigue may help to alleviate burnout.

RELEVANCE TO CLINICAL PRACTICE

Managers should provide comprehensive training for nurses and promote the application of artificial intelligence technology in alarm management to reduce alarm fatigue and improve burnout among critical care nurses.

Investigating compassion fatigue and predictive factors in paediatric surgery nurses

BACKGROUND

Nurses provide care to meet the complex needs of patients in the increasing workload in the health system and are at risk of compassion fatigue. The concept of compassion fatigue has begun drawing attention in the last decade, as it negatively affects nurses' physical and mental health, job performance and satisfaction, and therefore patient care quality.

OBJECTIVES

This study was to examine compassion fatigue and predictive factors in paediatric surgery nurses.

PARTICIPANTS AND RESEARCH CONTEXT

The study was cross-sectional, predictive and quantitative. It was conducted with the 135 paediatric surgery nurses. The data were sent to the email addresses of the members via Google Survey. Research data were collected with the Nurse Information Form, Compassion Fatigue Scale, Life Satisfaction Scale and Multidimensional Perceived Social Support Scale.

ETHICAL CONSIDERATIONS

After obtaining the approval of the University's ethics committee, the study was carried out after obtaining participants' informed written and verbal consent.

RESULTS

There was a difference between the level of compassion fatigue according to the paediatric surgery unit that worked the longest and the thought of changing their profession. Burn unit nurses and nurses who were considering changing professions have higher compassion fatigue scores. When the predictors of compassion fatigue were examined, the thought of changing the nursing profession and life satisfaction were significant predictors of compassion fatigue. The thought of changing the nursing profession and life satisfaction explained 22% of compassion fatigue. The same variables and the longest working period of the paediatric surgery unit were the estimators of the level of occupational burnout; explaining 29% of occupational burnout.

CONCLUSIONS

Compassion fatigue, life satisfaction and perceived social support of paediatric surgery nurses are moderate. Compassion fatigue is affected by working time, the thought of changing the profession, life satisfaction and perceived social support.

Correlation between professional quality of life and alarm fatigue symptoms among intensive care unit nurses

Introduction

Medical devices and equipment are necessary for accurate and continuous monitoring of the patients admitted to intensive care units, one of which is alarm systems. Frequent sounds of alarms can affect nurses' concentration and accuracy when providing care. Complications such as headache, fatigue, and stress occur after repeated alarms, leading to poor quality of professional life among nurses. This study aimed to determine the relationship between quality of professional life and alarm fatigue syndrome among intensive care unit nurses.

Methods

This cross-sectional study used convenience sampling to select nurses working in intensive care units from three hospitals in southern Iran in 2021 (n = 201). Data were collected using three questionnaires, including sociodemographic form, the professional quality of life questionnaire (ProQOL), and the alarm fatigue symptom (AFS) scale.

Results

The mean scores of compassion satisfaction (CS), burnout, secondary traumatic stress (STS) (subscales of the ProQOL), and AFS were 34.66 ± 7.54, 28.98 ± 7.59, 27.69 ± 5.87, and 13.48 ± 7.32, respectively. The majority of them had no or mild AFS, moderate CS, burnout, and STS. Among the study variables, only AFS were a significant predictor of CS and STS among ICU nurses. In addition, work experience in ICU, AFS, and a second job were significant predictors of burnout among ICU nurses.

Conclusions

The study results showed a significant relationship between alarm fatigue syndrome, burnout, STS, and CS. Given that more than half of the nurses in the intensive care unit in the present study experienced some degree of alarm fatigue syndrome, it is necessary to plan and implement interventions to better manage the alarms in the intensive care unit.

The Relationship Between Compassion Fatigue and Nursing Care Quality in Intensive Care Units: A Correlational Study in Northeast of Iran

Intensive care unit (ICU) nurses are repetitively exposed to traumatic situations and stressful events, which can lead to compassion fatigue (CF). Compassion fatigue can negatively affect the nurses' emotional and physical health and job satisfaction. The aim of this study was to evaluate the relationship between CF and nursing care quality in ICU. This descriptive-correlational study was conducted on 46 ICU nurses and 138 ICU patients, in 2 referral hospitals in Gorgan, Northeast of Iran in 2020. Participants were selected using stratified random sampling. Data were collected using CF and nursing care quality questionnaires. The results of this study showed that most nurses were women (n = 31, 67.4%), with mean age of 28.58 ± 4.80 years. The mean patients' age was 49.22 ± 22.01 years and 87 (63%) of them were male. The severity of CF in most ICU nurses (54.3%) was moderate, with a mean score of 86.21 ± 16.78. Among of the subscales, psychosomatic score was higher than the rest of subscales (0.53 ± 0.26). Nursing care quality was at the optimal level (91.3%) with the mean score of 81.51 ± 9.93. The highest scores of nursing care were related to subscale of medications, intake, and output (0.92 ± 0.23). In this study, there was a weak and inverse relationship between CF and nursing care quality (r = -0.28; P = .058). The results of this study indicate a weak, nonsignificant inverse relationship between CF and nursing care quality in ICU.

Determining Factors of Alarm Fatigue among Nurses in Intensive Care Units-A Polish Pilot Study

INTRODUCTION

With the development of medical technology, clinical alarms from various medical devices, which are rapidly increasing, are becoming a new problem in intensive care units. The aim of this study was to evaluate alarm fatigue in Polish nurses employed in Intensive Care Units and identify the factors associated with alarm fatigue.

METHODS

A cross-sectional study. The study used the nurses' alarm fatigue questionnaire by Torabizadeh. The study covered 400 Intensive Care Unit nurses. The data were collected from February to June 2021.

RESULTS

The overall mean score of alarm fatigue was 25.8 ± 5.8. Participation in training programs related to the use of monitoring devices available in the ward, both regularly (ß = -0.21) and once (ß = -0.17), negatively correlated with nurses' alarm fatigue. On the other hand, alarm fatigue was positively associated with 12 h shifts [vs. 8 h shifts and 24 h shifts] (ß = 0.11) and employment in Intensive Cardiac Surveillance Units-including Cardiac Surgery [vs. other Intensive Care Units] (ß = 0.10).

CONCLUSION

Monitoring device alarms constitute a significant burden on Polish Intensive Care Unit nurses, in particular those who do not take part in training on the operation of monitoring devices available in their ward. It is necessary to improve Intensive Care Unit personnel's awareness of the consequences of overburdening and alarm fatigue, as well as to identify fatigue-related factors.

Effects of work-family conflict and anxiety in the relationship between work-related stress and job burnout in Chinese female nurses: A chained mediation modeling analysis

BACKGROUND

Job burnout among nurses has been a challenging problem in recent years globally and in China. Work-related stress, work-life interference and mental health have been shown to be associated with nurse job burnout. However, the underlying mechanisms remain not fully understood. This study aims to examine the complex relationships linking work-related stress to nurse burnout among Chinese nurses.

METHODS

Study data were collected from female nurses (n = 2172) in cities of Wuhan, Shiyan and Jingzhou, Hubei Province of China. Job burnout was used as outcome variable, work-related stress was the predictor, work-life interference and anxiety symptoms were mediators. Mediation and chained mediation modeling analysis were used for data analysis.

RESULTS

The association between work-related stress and job burnout was significantly mediated by work-family conflict (indirect effect[95%CI] = 0.05[0.05,0.06]) and anxiety symptoms (indirect effect = 0.42[0.36,0.49]), respectively. Further, a chained mediation mechanism was observed with work-family conflict and anxiety symptoms consecutively mediated the relationship between work-related stress and job burnout (indirect effect = 0.02[0.01,0.02]).

LIMITATIONS

The data were collected in one province in central China, so it needs caution when generalizing the study findings to other regions within or outside of China.

CONCLUSION

Work-related stress exerts effects on job burnout through work-family conflict and anxiety symptoms among female nurses in China. Work-related stress-based burnout prevention must consider both work-family conflict and mental health problems.

Leadership styles' influence on ICU nurses' quality of professional life: A cross-sectional study

BACKGROUND

Intensive Care Units are emotionally intense environments where professional autonomy and interprofessional collaboration are essential. Nurses are at high risk of burnout, and the level of compassion satisfaction has a deep impact on the quality of their professional life. Although leadership styles and burnout have been the subject of an extensive body of research, there is an existing gap regarding the relationship between leadership strategies and intensive care nurses' quality of working life and the impact on their compassion satisfaction. Specifically, there is a lack of literature in southern European countries concerning the influence of organizational and cultural contexts.

AIM

To evaluate the impact of nurse managers' leadership styles on Intensive Care Unit nurses' job satisfaction and compassion satisfaction.

DESIGN

A cross-sectional study.

METHODS

An online set of validated tests was sent to a non-probabilistic sample of nurses, recruited via the Italian association of intensive care and emergency nursing website. The set of tests consisted of the Empowering Leadership Questionnaire, Compassion Satisfaction Scale, and McCloskey Mueller Satisfaction Scale. Nurses actively working in intensive care and critical care settings were included in this study. ICU managers and leaders were excluded.

RESULTS

308 nurses (response rate 63,2%) completed the questionnaires. Statistical analysis showed that the Leadership dimension of "Showing concern towards the team" had a significant effect on Compassion Satisfaction. In addition, this dimension had an effect on nurses' overall job satisfaction on five out of eight subscales.

CONCLUSIONS

Leaders' authentic listening, communication, and participation capabilities have a positive impact on nurses' job and compassion satisfaction. The interest for team well-being, taking time to discuss team concerns, and working closely with the team affects unpredicted factors like working hours, flexibility in shift scheduling, satisfaction about recognition, and career advancement.

RELEVANCE TO CLINICAL PRACTICE

Results suggest that nurse managers can draw on/adopt leadership strategies oriented to authentic listening and interaction with the team in order to manage organizational issues, increase nurses' professional quality of life and prevent burnout.

Alarm fatigue among nurses working in intensive care and other inpatient clinics

BACKGROUND

Alarm fatigue is an important technological hazard that adversely affects patient safety and the healthcare team. Nurses can be exposed to an excessive amount of alarms during their work which may lead to alarm fatigue.

OBJECTIVE

To determine the experiences of alarm fatigue among nurses working in intensive care units and other inpatient clinics.

METHODS

This descriptive study was conducted in university hospitals in five cities in Turkey between August and December 2019. A total of 592 nurses participated in this study. The data was collected using questionnaires and the Visual Analog Scale (0 to 10 points) was used to determine the level of alarm fatigue.

RESULTS

More than half of the nurses experienced problems, especially false alarms, caused by devices. Alarm fatigue decreased with increasing age and working years. Nurses reported appropriate actions in solving problems, but also had practices that may increase the risk of error, such as turning off or muting alarms or turning off equipment.

CONCLUSION

Alarm fatigue is mostly caused by false alarms. It can lead to physical fatigue, increased workload and decreased concentration, resulting in an increased possibility of error. Management of alarm fatigue is necessary in preventing a compromise in patients' safety and improving quality of care.

Determinants of Medical Equipment Alarm Fatigue in Practicing Nurses: A Systematic Review

Objective

This study aimed to systematically evaluate the level of medical equipment alarm fatigue and its influencing factors among clinical nurses.

Methods

PubMed, Embase, CNKI, and Wanfang databases were systematically searched to identify articles on alarm fatigue of clinical nurses published before September 25, 2022. According to the evaluation criteria of prevalence studies recommended by JBI Evidence-Based Health Care Center, the quality of the literature meeting the inclusion criteria was evaluated, and Stata MP17 software was used for meta-analysis.

Results

A total of 14 cross-sectional studies were included, with a total sample of 2,848 nurses. The results showed that the alarm fatigue score of clinical nurses was 21.76 (95% CI [20.27, 23.25]). Subgroup analysis showed that the nurses who worked night shift and had lower professional title had higher alarm fatigue.

Conclusion

The alarm fatigue of clinical nurses was at a moderate level. To reduce the alarm fatigue level of clinical nurses, nursing managers should strengthen the alarm safety awareness of nurses, rationally arrange nurse manpower, carry out training to actively improve the alarm management ability of nurses, and optimize the alarm level and frequency of alarm equipment.

Mental fatigue and negative emotion among nurses during the COVID-19 pandemic

COVID-19 is a major public health event affecting the people worldwide. Nurses are still under immense psychological pressure. This study aimed to explore the relationship between mental fatigue and negative emotions among frontline medical staff during the COVID-19 pandemic. The study was conducted in August 2020, which included 419 medical staff between 17 to 28 years. The Fatigue Scale, Multidimensional Mental Flexibility Questionnaire, Cognitive Fusion Scale, and Depression-Anxiety-Stress Brief Version Scale were used. During the data collection period, the pandemic was under control in China and continued worldwide. The results indicated that 27.7% of the medical staff experienced depression, and 32.3% of them feel stressed. Specifically, first, correlation analyses showed significant positive pairwise correlations between mental fatigue, psychological inflexibility, cognitive fusion, and negative emotions among nurses. Second, mediation model tests showed statistically significant mediating effects of psychological inflexibility and cognitive fusion between mental fatigue on nurses' negative emotions, and statistically, significant chain mediating effects of psychological inflexibility and cognitive fusion. Mental fatigue indirectly affects nurses' negative effects through the mediating effects of psychological inflexibility, cognitive fusion, and the chain mediating effects of psychological inflexibility and cognitive fusion, respectively. the negative effects of mental fatigue come from impairment of cognitive functioning, and interventions using acceptance and commitment therapy for mental fatigue and negative emotions are more effective since both psychological inflexibility and cognitive fusion are important components of the therapy.

Alarm fatigue in nurses working in intensive care units: A multicenter study

BACKGROUND: Technological progress improves health care efficiency, quality, safety, and cost, supporting clinical activity in various scenarios, such as Intensive Care Unit (ICU). A timely response to alarms from monitors and other ICU electromedical devices is therefore crucial. The number of false alarms tend to desensitize care providers increasing the risk of experiencing alarm fatigue and, at times, lead to severe consequences for patients. OBJECTIVES: To assess the psychometric properties of the Italian version of the Alarm Fatigue Questionnaire and to explore the phenomenon of alarm fatigue among nurses working in intensive care settings. METHODS: The CVI-I was calculated to evaluate the validity of the content of the tool. Construct validity was investigated through exploratory factor analysis. Cronbach’s alpha coefficient (α) was used to examine the internal consistency of the scale and Spearman’s rho coefficient to test for stability. We designed a multicentre cross-sectional survey. A convenience sample of nurses from 4 Major Italian hospitals was recruited. The nurses completed the Italian version of the Alarm Fatigue Questionnaire. RESULTS: The content validity index CVI-S of the scale (CVI-S) was 91.11%; Cronbach’s alpha coefficient was 0.71. The Italian version of the tool explained 67.18%of the overall variance. 396 nurses were enrolled (79.84%). The overall level of alarm fatigue was Me = 29 [22;30]. 42.17%of the sample reported prior experience with alarm fatigue incidents. CONCLUSIONS: The extension of alarm fatigue requires the adoption of a preventive intervention plan. The Italian version of the Alarm Fatigue Questionnaire shows promising psychometric properties.

Trauma, Compassion Fatigue, and Burnout in Nurses: The Nurse Leader's Response

Within health care, trauma-informed care has become an embedded approach in caring for patients; however, nurse leaders are not always prepared to lead nurses with a background of trauma. Nurses' past trauma, coupled with workplace stressors, may result in compassion fatigue, burnout, and secondary traumatic stress. Nurse leader engagement and trauma-informed leadership approaches are imperative to mitigate and mediate the effects of trauma in nurses as the COVID-19 pandemic recedes.

Compassion satisfaction, resilience and passion for work among nurses and physicians working in intensive care units: A mixed method systematic review

OBJECTIVE

To identify, appraise, and synthesise current evidence on prevalence, correlates, and interventions to enhance compassion satisfaction, resilience, and passion for work among nurses and physicians working in intensive care units.

METHODS

A mixed methods systematic review was conducted. The comprehensive search used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Seven databases (MEDLINE, EMBASE, CINAHL, JBI, ProQuest, PsycINFO, and Cochrane Library) were searched for literature published between January 2011 and June 2021. The Mixed Methods Appraisal Tool was used to assess methodological quality. Data from included studies were analysed using a convergent mixed methods design. The protocol was prospectively registered (PROSPERO 2021 CRD42021252051).

RESULTS

A total of 37 studies met the inclusion criteria. Most studies reported moderate levels of compassion satisfaction among intensive care health professionals, whereas levels of resilience varied. Compassion satisfaction and resilience were positively correlated, but relationships between compassion satisfaction and resilience and other correlates (personal factors, psychological factors, and work-related factors) were inconsistently reported. Only four interventions aimed to improve compassion satisfaction or resilience among intensive care health professionals. None of the included studies investigated passion for work.

CONCLUSION

Compassion satisfaction, resilience, and passion for work among staff in the intensive care unit are important in the current global COVID-19 pandemic. Health professionals report a moderate level of compassion satisfaction but findings in relation to resilience are mixed. No studies examined passion for work. Further research to determine ongoing psychological wellbeing and professional quality of life and evaluate tailored interventions to support intensive care staff well-being is recommended.

Requirements for bespoke ICU Dashboard in response to the COVID-19 Pandemic

Background

Intensive care units (ICUs) around the world are in high demand due to patients with COVID-19 requiring hospitalization. As researchers at the University of Bristol, we were approached to develop a bespoke data visualization dashboard to assist two local ICUs during the pandemic that will centralize disparate data sources in the ICU to help reduce the cognitive load on busy ICU staff in the ever-evolving pandemic.

Objective

The aim of this study was to conduct interviews with ICU staff in University Hospitals Bristol and Weston National Health Service Foundation Trust to elicit requirements for a bespoke dashboard to monitor the high volume of patients, particularly during the COVID-19 pandemic.

Methods

We conducted six semistructured interviews with clinical staff to obtain an overview of their requirements for the dashboard and to ensure its ultimate suitability for end users. Interview questions aimed to understand the job roles undertaken in the ICU, potential uses of the dashboard, specific issues associated with managing COVID-19 patients, key data of interest, and any concerns about the introduction of a dashboard into the ICU.

Results

From our interviews, we found the following design requirements: (1) a flexible dashboard, where the functionality can be updated quickly and effectively to respond to emerging information about the management of this new disease; (2) a mobile dashboard, which allows staff to move around on wards with a dashboard, thus potentially replacing paper forms to enable detailed and consistent data entry; (3) a customizable and intuitive dashboard, where individual users would be able to customize the appearance of the dashboard to suit their role; (4) real-time data and trend analysis via informative data visualizations that help busy ICU staff to understand a patient’s clinical trajectory; and (5) the ability to manage tasks and staff, tracking both staff and patient movements, handovers, and task monitoring to ensure the highest quality of care.

Conclusions

The findings of this study confirm that digital solutions for ICU use would potentially reduce the cognitive load of ICU staff and reduce clinical errors at a time of notably high demand of intensive health care.

Improved Patient Monitoring with a Novel Multisensory Smartwatch Application

The design of medical alarms has been heavily criticized in the past decade. Auditory medical alarms have poor learnability, discernibility, and relevance, leading to poor patient outcomes, and alarm fatigue, and overall poor informatic system design. We developed a novel trimodal patient monitoring smartwatch application for patient monitoring. Participants completed two phases: (1) control and (2) our novel trimodal system while identifying alarms (heart rate, oxygenation, and blood pressure) and completing a cognitively demanding task. Alarms were auditory icons presented as either solo or co-alarms. Participant performance was assessed by accuracy and response time (RT) of alarm identification. Using the novel system, accuracy was significantly improved overall (p < 0.01) and in co-alarm situations (p < 0.01), but not for solo alarms (p = 0.484). RT was also significantly faster (p < 0.01) while using the novel system for all alarm types. Participants reported decreased mental workload using the novel system. This feasibility study shows that our novel alarm system performs better than current standards. Improvements in accuracy, RT and perceived mental workload indicate the potential of this system to have a positive impact on medical informatic systems and clinical monitoring, for both the patient and the clinician.

Compassion fatigue among haemodialysis nurses in public and private hospitals in China

AIM

This study was conducted to identify and compare the levels of compassion fatigue and job satisfaction among haemodialysis nurses in public and private hospitals in China and explore explanatory factors based on sociodemographic and occupational characteristics.

METHODS

A descriptive study was conducted using a self-designed demographic questionnaire, the Professional Quality of Life Scale and the Minnesota Satisfaction Questionnaire, with responses from 283 haemodialysis nurses working at six public and private hospitals in China between June and November 2018.

RESULTS

The compassion fatigue score of public hospital nurses was significantly higher than that of private hospital nurses. Univariate analysis showed that there were significant differences in compassion fatigue among nurses based on the number of years worked, nature of employment, and education level. Correlational analysis showed a negative correlation between overall job satisfaction and compassion fatigue in both public and private hospitals. Multiple regression analysis showed that compassion fatigue among haemodialysis nurses in public hospitals was associated with years worked, type of employment, and intrinsic and extrinsic satisfaction, whereas in private hospitals, education level, years worked, and intrinsic and extrinsic satisfaction were significant.

CONCLUSION

Haemodialysis nurses in public hospitals are more likely to develop compassion fatigue than those in private hospitals.