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Alarm Fatigue: A Concept Analysis | OJNI Archive - Vol. No. 2. Source: OJNI Volume 1.
Number 2by. Patricia West, MS, RN. Patricia Abbott, Ph. D, RN, FAAN. . Piper Probst, MSN, RN- BC. Abstract. Alarm fatigue has emerged as a growing concern for patient safety in healthcare. There is a need for a clear and common understanding of the concept to assist in the development of effective strategies and policies to eradicate the multi- dimensional aspects of the alarm fatigue phenomena affecting the nursing practice arena.
The concept of alarm fatigue will be examined based on the method developed by Walker and Avant (1. Additionally, empirical referents are identified and illustrations of the concept are presented in model, borderline, and contrary cases. Keywords: concept analysis, alarm fatigue, nursing, technology, distractions. Contextual Information of Alarm Fatigue. Many background noises and disruptive sounds echo through hospitals today.
Porter also edited the succeeding edition, Webster’s International Dictionary of the English Language (1890), which was an expansion of the American Dictionary. It contained about 175,000 entries. In 1900, Webster’s. Main Entry: vol·ca·no Pronunciation: väl-k-n, v l-Function: noun Inflected Form(s): plural -noes or -nos Etymology: from Italian or Spanish; Italian vulcano 'volcano,' from Spanish vulcán, from Latin Volcanus, Vulcanus.
Many of the sounds heard by patients, families, and staff are derived from a blend of human and mechanical sounds. As technology has advanced over the years, the multiple medical device systems used to monitor patients for potential problems have increased along with the sensitivity of the alarm signals contributing to the noisy hospital environment. Unfortunately with the growing number of patients requiring medical technology monitoring, the alarm sounds echoing in the clinical practice area are increasing at a colossal rate resulting in nurses subjected to too many alarms triggering an issue for concern called alarm fatigue. Alarm fatigue, defined in the literature is the desensitization of a clinician to an alarm stimulus that results from sensory overload causing the response of an alarm to be delayed or missed (Mc. Cartney, 2. 01. 2). Alarm fatigue is acknowledged as a contributor to clinicians’ environmental distractions and interferes with the ability of clinicians to perform critical patient care responsibilities resulting in patient safety issues. Thus, alarm management has emerged as an increasing concern in health care, and is currently the focus of a National Patient Safety Goal (NPSG) for 2.
TJC, 2. 01. 3, June). According to The Joint Commission (TJC) between 2. TJC, 2. 01. 3, April). Of these incidences, the majority were associated with alarm malfunction, alarm misuse, or inadequate alarm settings leading to the most common contributing factor- alarm fatigue. Additionally, the TJC indicates that the number of alarm signals per patient per day can reach over several hundred depending on the specific unit in the hospital, and it is estimated that between 8. TJC, 2. 01. 3, April). These false alarm occurrences could be related to a multitude of conditions, but the most common reasons cited in the literature are the wide range of parameter settings of the alarms, the lack of adjustment of alarms to individual patient conditions for a specific patient population, the improper positioning of a sensor on a patient or the lack of proper skin preparation prior to application of the sensor (AACN, 2.
Cvach, 2. 01. 2; TJC, 2. As a result, a high occurrence of alarm noise is heard by clinicians resulting in a possible “cry wolf” effect leading to reductions in clinician responses to alarm signals. Alarm fatigue is a growing problem in health care that needs to be addressed. Likewise, alarm fatigue is an increasingly common term used in the health care environment, but its meaning is ill defined.
A more constructive and comprehensive definition of alarm fatigue in healthcare is needed. A clear and common understanding of the concept will assist in future research and help to more clearly articulate the dimensions of alarm fatigue in the practice arena.
The concept of alarm fatigue therefore will be the focus of this concept analysis paper. Method. The method of Walker and Avant (1. The method presented in this paper includes the following steps: (a) select a concept, (b) determine the aims or purposes of the analysis, (c) identify all uses of the concept, (d) determine the defining attributes, (e) identify a model case, (f) identify additional cases, (g) identify antecedents and consequences, and (h) define empirical referents (Walker & Avant, 2. This method was chosen because it is the easiest to understand and master, especially for the novice.
Each of these eight steps will be addressed as part of the concept analysis of alarm fatigue, and then summarized at the conclusion. Data Sources. A literature search on alarm fatigue was conducted with the assistance of a reference librarian to identify the uses of the term from various disciplines and to establish a clear conceptualization of the concept. As discussed in Walker and Avant (2. A series of key searches using the terms such as alarm, fatigue, alarm and fatigue, clinical alarms, fatigue or stress, auditory or mental fatigue in CINAHL, PUBMED, MEDLINE, and Web of Science databases, respectively.
Additionally, definitions published in English dictionaries were sought. Literature between 2. English. The resulting literature was initially screened by reviewing titles and abstracts for relevance, and the selected materials were subsequently retrieved and reviewed in full. Concept Analysis. Concept Selection: The selection of a concept to be analyzed is always the first step in the concept analysis.
The concept of alarm fatigue is chosen as the area of attention presented by the author in this analysis. As described earlier, alarm fatigue is a pressing clinical issue and one that requires concerted effort to ameliorate. Efforts to address alarm fatigue are thwarted by a lack of a clear definition of the concept and diffuse understanding. Aims of the Analysis. The second step in the concept analysis of alarm fatigue is determining the purpose of the analysis. The principle aim of this concept analysis is to clarify the meaning of the concept of alarm fatigue that will contribute a shared understanding of its use within health care and future nursing research. A common articulation of the concept will heighten the awareness of the components of the phenomenon leading to collaborative exploration efforts of nursing and health care technology research to construct evidence- based practice recommendations and policy development to aid in alarm reduction for safe patient outcomes.
Identify Uses of the Concept. Walker and Avant (2. To understand how the term alarm fatigue was conceived and used, dictionary definitions were sought from various English and health- related dictionaries. As this is a two- word concept, the words “alarm” and “fatigue” were explored independently in the various dictionaries since the combined term yielded no search results. Additionally, the term “alarm fatigue” was explored independently in the healthcare and nursing literature since it has been vastly used and written about in these disciplines in relation to patient safety and noise levels in hospitals. Alarm: According to the Cambridge online dictionary, the word alarm was referred to as, “sudden anxiety and fear especially that something very bad or dangerous might happen” (2.
The Merriam- Webster online dictionary defined alarm as, “a device that makes a sound as a warning of signal” (2. In addition, the Oxford Dictionary of Nursing defined alarm as, “a device for helping people with hearing difficulties that indicates the occurrence of an event by signal” (Martin & Mc.
Ferran, 2. 00. 8a). The Merriam- Webster online thesaurus defined alarm as, “suspicion or fear of future harm or misfortune” (2. Fatigue: The Merriam- Webster online dictionary defined fatigue as, “the state of being very tired” (2. Stedman’s online Medical Dictionary defined fatigue as, “the state following a period of mental or bodily activity, characterized by a lessened capacity or motivation for work and reduced efficiency of accomplishment” (2.
The Cambridge online dictionary defined fatigue as, “the condition of being extremely exhausted” (2. In addition, the Merriam- Webster online thesaurus defined fatigue as, “a complete depletion of energy or strength” (2. As well, the Oxford Dictionary of Nursing defined fatigue as, “the inability of an organism, an organ, or a tissue to give a normal response to a stimulus until a certain recovery period has elapsed” (Martin & Mc. Ferran, 2. 00. 8b).
Alarm Fatigue: According to Cvach (2. The Emergency Care Research Institute (ECRI, 2. These alarms may reflect the need for actual interventions from nurses or they may be false alarms requiring no nursing action.
Tanner (2. 01. 3) describes alarm fatigue in relation to nurses becoming anesthetized to alarm sounds as a result of excessive auditory exposure causing a slower response time of a clinician. According to Keller (2. Logan (2. 01. 1), alarm fatigue occurs when caregivers become overwhelmed with the large number of clinical alarms such that critical or significant events can be missed or ignored. Wikllund and Kendler (2.
Defining Attributes: The fourth step in the concept analysis of alarm fatigue is to determine the defining attributes. Attributes are those characteristics of a concept that appear over and over again in the literature and they are most frequently associated with the concept allowing the broadest insight into it (Walker & Avant, 2. Therefore, alarm fatigue encompasses three defining attributes: an environment with excessive and repeated situations; a lessened motivation and interest in surroundings; and a diminished capacity for physical and mental work. Identify a Model Case: The fifth step in the concept analysis of alarm fatigue is the construction of a model case which is a “pure” illustration of the use of the concept that includes all of its critical attributes (Walker & Avant, 2. In other words, the model case is a “real- world” extraction of the concept. An example model case of alarm fatigue is presented here. Kathy is a school nurse at a local elementary school in which over 5.
On average, Kathy sees over 3.