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Critical care nurses’ clinical reasoning about physiologic monitor alarm customisation: An interpretive descriptive study

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  • Halley Ruppel
  • Marjorie Funk
  • Robin Whittemore
  • Shu‐Fen Wung
  • Christopher P. Bonafide
  • Holly Powell Kennedy

Abstract

Aims and objectives To explore clinical reasoning about alarm customisation among nurses in intensive care units. Background Critical care nurses are responsible for detecting and rapidly acting upon changes in patients’ clinical condition. Nurses use medical devices including bedside physiologic monitors to assist them in their practice. Customising alarm settings on these devices can help nurses better monitor their patients and reduce the number of clinically irrelevant alarms. As a result, customisation may also help address the problem of alarm fatigue. However, little is known about nurses' clinical reasoning with respect to customising physiologic monitor alarm settings. Design This article is an in‐depth report of the qualitative arm of a mixed methods study conducted using an interpretive descriptive methodological approach. Methods Twenty‐seven nurses were purposively sampled from three intensive care units in an academic medical centre. Semi‐structured interviews were conducted by telephone and were analysed using thematic analysis. Consolidated Criteria for Reporting Qualitative Research (COREQ) reporting guidelines were used. Results Four themes were identified from the interview data: unit alarm culture and context, nurse attributes, motivation to customise and customisation “know‐how.” A conceptual model demonstrating the relationship of these themes was developed to portray the factors that affect nurses’ customisation of alarms. Conclusions In addition to drawing on clinical data, nurses customised physiologic monitor alarms based on their level of clinical expertise and comfort. Nurses were influenced by the alarm culture on their clinical unit and colleagues’ and patients’ responses to alarms, as well as their own technical understanding of the physiologic monitors. Relevance to clinical practice The results of this study can be used to design strategies to support the application of clinical reasoning to alarm management, which may contribute to more appropriate alarm customisation practices and improvements in safety.

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  • Halley Ruppel & Marjorie Funk & Robin Whittemore & Shu‐Fen Wung & Christopher P. Bonafide & Holly Powell Kennedy, 2019. "Critical care nurses’ clinical reasoning about physiologic monitor alarm customisation: An interpretive descriptive study," Journal of Clinical Nursing, John Wiley & Sons, vol. 28(15-16), pages 3033-3041, August.
  • Handle: RePEc:wly:jocnur:v:28:y:2019:i:15-16:p:3033-3041
    DOI: 10.1111/jocn.14866
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    References listed on IDEAS

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    1. Priscilla K Gazarian & Natalie Carrier & Rachel Cohen & Haley Schram & Samara Shiromani, 2015. "A description of nurses' decision‐making in managing electrocardiographic monitor alarms," Journal of Clinical Nursing, John Wiley & Sons, vol. 24(1-2), pages 151-159, January.
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    Cited by:

    1. Soo-Joung Lee & Yun-Mi Lee & Eun Ji Seo & Youn-Jung Son, 2021. "Impact of Hospital Nurses’ Perception on Clinical Alarms and Patient Safety Culture on Alarm Management Practice," IJERPH, MDPI, vol. 18(8), pages 1-10, April.
    2. Jiasi Bi & Xin Yin & Hongyan Li & Ruitong Gao & Qing Zhang & Tangsheng Zhong & Tao Zan & Baoxing Guan & Zhen Li, 2020. "Effects of monitor alarm management training on nurses’ alarm fatigue: A randomised controlled trial," Journal of Clinical Nursing, John Wiley & Sons, vol. 29(21-22), pages 4203-4216, November.

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