Clinical alarm-related behavior scores of nurses (n = 2368)_
| Behavior items | Never do like this (n, %) | Not normally do like this (n, %) | Occasionally do like this (n, %) | Often do like this (n, %) | Always do like this (n, %) | Number | Minimum | Maximum | Mean ± SD |
|---|---|---|---|---|---|---|---|---|---|
| Dimension 1: alarm settings | 5 | 5 | 25 | 19.24 ± 3.88 | |||||
| 1. When using alarming devices, adjusting alarm-related settings. | 18 (0.8) | 87 (3.7) | 490 (20.7) | 952 (40.2) | 821 (34.7) | 1 | 1 | 5 | 4.04 ± 0.88 |
| 2. Setting personalized alarm thresholds according to patient condition. | 40 (1.7) | 198 (8.4) | 583 (24.6) | 887 (37.5) | 660 (27.9) | 1 | 1 | 5 | 3.81 ± 0.99 |
| 3. With the changes of patient conditions, adjusting alarm settings. | 78 (3.3) | 288 (12.2) | 444 (18.8) | 826 (34.9) | 732 (30.9) | 1 | 1 | 5 | 3.78 ± 1.11 |
| 4. While rotating shifts, checking alarm settings. | 39 (1.6) | 204 (8.6) | 490 (20.7) | 793 (32.5) | 842 (35.6) | 1 | 1 | 5 | 3.93 ± 1.03 |
| 5. Adjusting alarm volume according to the environment and time of ward. | 73 (3.1) | 291 (12.3) | 587 (24.8) | 792 (33.4) | 625 (26.4) | 1 | 1 | 5 | 3.68 ± 1.09 |
| Dimension 2: alarm notifications | 2 | 2 | 10 | 6.25 ± 1.84 | |||||
| 1. You will be alerted to alarm by patient or escort. | 361 (15.2) | 545 (23.0) | 723 (30.5) | 537 (22.7) | 202 (8.5) | 1 | 1 | 5 | 2.86 ± 1.18 |
| 2. Missing alarm because you can’t hear it. | 133 (5.6) | 195 (8.2) | 962 (40.6) | 769 (32.5) | 309 (13.0) | 1 | 1 | 5 | 3.39 ± 1.00 |
| Dimension 3: alarm recognitions | 2 | 2 | 10 | 7.63 ± 1.68 | |||||
| 1. You can accurately identify the alarm-triggering device according to alarm signal. | 35 (1.5) | 121 (5.1) | 460 (19.4) | 1148 (48.5) | 604 (25.5) | 1 | 1 | 5 | 3.91 ± 0.88 |
| 2. According to different alarm signals, identifying different levels of alarm | 68 (2.9) | 218 (9.2) | 555 (23.4) | 1001 (42.3) | 526 (22.2) | 1 | 1 | 5 | 3.72 ± 1.00 |
| Dimension 4: alarm responses | 7 | 15 | 35 | 27.99 ± 3.64 | |||||
| 1. Responding to all alarms generated in the responsible area. | 21 (0.9) | 91 (3.8) | 307 (13.0) | 1024 (43.2) | 925 (39.1) | 1 | 1 | 5 | 4.16 ± 0.85 |
| 2. Upon receiving an alarm signal, responding immediately. | 9 (0.4) | 30 (1.3) | 153 (6.5) | 1011 (42.7) | 1165 (49.2) | 1 | 1 | 5 | 4.39 ± 0.70 |
| 3. When multiple alarms occur simultaneously, you order the responses according to the priority level of alarms. | 15 (0.6) | 69 (2.9) | 226 (9.5) | 934 (39.4) | 1124 (47.5) | 1 | 1 | 5 | 4.30 ± 0.81 |
| 4. Correctly handling various events leading to alarms. | 15 (0.6) | 37 (1.6) | 286 (12.1) | 1264 (47.5) | 766 (32.3) | 1 | 1 | 5 | 4.15 ± 0.74 |
| 5. You will not respond to alarms that you believe are false or interfere with. | 186 (7.9) | 355 (15.0) | 640 (27.0) | 867 (36.6) | 320 (13.5) | 1 | 1 | 5 | 3.33 ± 1.12 |
| 6. For frequent false or interfering alarms, turning off/muting alarm. | 166 (7.0) | 308 (13.0) | 673 (28.4) | 784 (33.1) | 437 (18.5) | 1 | 1 | 5 | 3.43 ± 1.14 |
| 7. For alarms that you cannot handle, actively seeking the assistance of other colleagues. | 11 (0.5) | 41 (1.7) | 317 (13.4) | 1018 (43.0) | 981 (41.4) | 1 | 1 | 5 | 4.23 ± 0.78 |
| Dimension 5: alarm learning | 1 | 1 | 5 | 4.02 ± 0.85 | |||||
| Actively seeking ways of acquiring alarm-related knowledge. | 11 (0.5) | 78 (3.3) | 533 (22.5) | 971 (41.0) | 775 (32.7) | 1 | 1 | 5 | 4.02 ± 0.85 |
| Total behavior score | 17 | 33 | 85 | 65.14 ± 7.95 |
Multivariate linear regression analysis of alarm behaviors and related_
| Items | Non-standardization coefficient | 95%confidence interval of B | |||||
|---|---|---|---|---|---|---|---|
| B | SE | B’ | t | P-value | Lower bound | Upperbound | |
| 1. Age | 0.000 | 0.083 | 0.000 | 0.003 | 0.997 | −0.163 | 0.164 |
| 2. Hospital level (control = tertiary hospital) | −0.165 | 0.320 | −0.010 | −0.517 | 0.605 | −0.793 | 0.462 |
| 2.1 Affiliated Hospital of University (control = yes) | 0.005 | 0.350 | 0.000 | 0.016 | 0.988 | −0.681 | 0.692 |
| 3. Surgery Department (control = ICU) | −2.960 | 0.457 | −0.178 | −6.477 | 0.000 | −3.856 | −2.064 |
| 4. Internal Medicine Department (control = ICU) | −2.637 | 0.455 | −0.151 | −5.794 | 0.000 | −3.529 | −1.744 |
| 5. Pediatrics Department (control = ICU) | −2.298 | 0.615 | −0.080 | −3.739 | 0.000 | −3.504 | −1.093 |
| 6. Emergency Department (control = ICU) | −2.237 | 0.678 | −0.065 | −3.299 | 0.001 | −3.567 | −0.908 |
| 7. Anesthesia operating Department (control = ICU) | −1.667 | 0.746 | −0.043 | −2.235 | 0.026 | −3.130 | −0.204 |
| 8. Other department (control = ICU) | −1.047 | 0.749 | −0.027 | −1.398 | 0.162 | −2.515 | 0.421 |
| 9. Professional title (from low to high) | −0.627 | 0.296 | −0.061 | −2.120 | 0.034 | −1.208 | −0.047 |
| 10. Education level (from low to high) | 0.005 | 0.350 | 0.000 | 0.016 | 0.988 | −0.681 | 0.692 |
| 11. Working seniority | 0.130 | 0.072 | 0.111 | 1.812 | 0.070 | −0.011 | 0.271 |
| 12. Have received alarm-related training or not (control = have) | −1.546 | 0.353 | −0.079 | −4.384 | 0.000 | −2.238 | −0.855 |
| 13. Willing to attend alarm-related training or not (from willing to unwilling) | 0.292 | 0.309 | 0.016 | 0.944 | 0.345 | −0.314 | 0.897 |
| 14. In 3 years, have the alarm management improvement project or not (control = yes) | −1.503 | 0.351 | −0.083 | −4.280 | 0.000 | −2.192 | −0.815 |
| 15. Have used auxiliary technology to improve alarm management? (control = yes) | 0.417 | 0.291 | 0.026 | 1.431 | 0.152 | −0.154 | 0.989 |
| 16. Department or hospital have alarm management system or not.(control = have) | −1.617 | 0.372 | −0.087 | −4.352 | 0.000 | −2.346 | −0.889 |
| 17. Total alarm knowledge Score | 0.282 | 0.055 | 0.091 | 5.128 | 0.000 | 0.174 | 0.390 |
| 18. Total Alarm attitude Score | 0.478 | 0.027 | 0.313 | 17.551 | 0.000 | 0.425 | 0.532 |
Factors that influence nurses’ clinical alarm behavior_
| Factors | Variable name | Assignment statement |
|---|---|---|
| Age (age) | X1 | |
| X1.1 | 20–25: Yes = 1, no = 0 (reference) | |
| X1.2 | 26–30: Yes = 1, no = 0 | |
| X1.3 | 31–35: Yes = 1, no = 0 | |
| X1.4 | 36–40: Yes = 1, no = 0 | |
| X1.5 | 36–40: Yes = 1, no = 0 | |
| X1.6 | 41–45: Yes = 1, no = 0 | |
| X1.7 | Over 46: Yes = 1, no = 0 | |
| Hospital level | X2 | Level 3 hospitals = 1 |
| Department | X3 | Level 2 hospitals = 2 |
| X3.1 | ICU: Yes = 1, no = 0 (control) | |
| X3.2 | Surgery: Yes = 1, no = 0 | |
| X3.3 | Internal medicine: yes = 1, no = 0 | |
| X3.4 | Pediatrics: yes = 1, no = 0 | |
| X3.5 | Emergency anesthesia surgery department: yes = 1, no = 0 | |
| X3.6 | Others: is = 1, no = 0 | |
| Title | X4 | |
| X4.1 | Nurse: Yes = 1, no = 0 (control) | |
| X4.2 | Nurse: Yes = 1, no = 0 | |
| X4.3 | Nurse in charge: yes = 1, no = 0 | |
| X4.4 | Deputy director nurse and above: yes = 1, no = 0 | |
| Education | X5 | |
| X5.1 | Secondary or tertiary school: yes = 1, no = 0 (control) | |
| X5.2 | Undergraduate=: yes = 1, no = 0 | |
| X5.3 | Master's degree or above: yes = 1, no = 0 | |
| Have you received alarm-related education and training? | X6 | Yes = 1, no = 0 (control) |
| Are you willing to take part in alarm-related training? | X7 | Willingness = 1, unwillingness = 0 (control) |
| Has the department implemented the alarm management improvement project in the past 3 years? | X8 | Yes = 1, No = 0 (control) |
| Does the department or hospital in which it is located formulate relevant systems or norms for alarm management? | X9 | |
| Have received alarm-related training or not. | X10 | |
| Willing to attend alarm-related training or not (from willing to unwilling) | X11 | Yes = 1, no = 0 (control) |
| Have experienced alarm-related adverse events over the last 2 years or not | X12 | |
| Have used auxiliary technology to improve alarm management? | X13 | |
| Department or hospital have an alarm management system or not. | X14 | |
| Alarm knowledge score | X15 | |
| Alarm attitude score | X16 | |
| Alarm behavior score | Y |
General demographic data of surveyed nurses (n = 2368)_
| Items | Frequency (n) | Constituent ratio (%) |
|---|---|---|
| Department has implemented the alarm management improvement project in the past 3 years | ||
| Yes | 1751 | 73.9 |
| No | 617 | 26.1 |
| Department has used assistive technology to improve alarm management | ||
| Yes | 1095 | 46.2 |
| No | 1273 | 53.8 |
| Have received education and training related to clinical alarm | ||
| Yes | 1877 | 79.3 |
| No | 491 | 20.7 |
| Willingness to participate in alarm related training | ||
| Willing | 2226 | 94.0 |
| Not sure | 24 | 1.0 |
| Not willing | 118 | 5.0 |
| Have experienced alarm-related adverse events during the last 2 years | ||
| Yes | 165 | 7.0 |
| No | 2203 | 93.0 |
Clinical alarm behavior scores and demographic data of surveyed nurses (n = 2368)_
| Items | n | Constituent ratio (%) | Alarm settings | Alarm notifications | Alarm recognitions | Alarm responses | Alarm learning | Total behavior score | |
|---|---|---|---|---|---|---|---|---|---|
| Score | Comparison | ||||||||
| Gender | t=0.112 P=0.911 | ||||||||
| Male | 62 | 2.6 | 20.06 ±4.26 | 5.94 ±2.25 | 7.98 ±1.80 | 27.05 ±4.09* | 4.00 ±0.83 | 65.03 ±8.40 | |
| Female | 2306 | 97.4 | 19.22 ±3.87 | 6.26 ±1.83 | 7.62 ±1.67 | 28.02 ±3.62 | 4.02 ±0.85 | 65.15 ±7.94 | |
| Age (years) | F=4.619 P=0.000 | ||||||||
| 20–25 | 623 | 26.3 | 19.29 ±4.08 | 6.10 ±1.90* | 7.50 ±1.75 | 27.83 ±3.76* | 3.99 ±0.89* | 64.70 ±8.35 | |
| 26–30 | 1043 | 44.1 | 19.01 ±3.94 | 6.26 ±1.84 | 7.66 ±1.66 | 27.76 ±3.62 | 3.97 ±0.87 | 64.66 ±8.05 | |
| 31–35 | 360 | 15.2 | 19.41 ±3.58 | 6.47 ±1.76 | 7.70 ±1.63 | 28.11 ±3.57 | 4.06 ±0.81 | 65.75 ±7.32 | |
| 36–40 | 188 | 7.9 | 19.53 ±3.64 | 6.36 ±1.89 | 7.73 ±1.61 | 28.97 ±3.41 | 4.20 ±0.75 | 66.79 ±7.59 | |
| 41–45 | 112 | 4.7 | 19.68 ±3.52 | 6.10 ±1.70 | 7.65 ±1.79 | 29.00 ±3.38 | 4.21 ±0.71 | 66.63 ±7.17 | |
| 46–55 | 42 | 1.8 | 20.38 ±3.46 | 6.45 ±1.69 | 7.88 ±1.44 | 28.26 ±3.60 | 4.26 ±0.83 | 67.24 ±5.99 | |
| Nursing stint (years) | F = 9.564 P=0.000 | ||||||||
| ≤5 | 1044 | 44.1 | 19.23 ±4.05* | 6.09 ±1.84* | 7.57 ±1.67 | 27.80 ±3.63* | 4.01 ±0.87* | 64.70 ±8.05 | |
| 6–10 | 755 | 31.9 | 19.00 ±3.83 | 6.37 ±1.86 | 7.65 ±1.71 | 27.83 ±3.72 | 3.95 ±0.89 | 64.81 ±8.23 | |
| ≤11 | 569 | 24.0 | 19.59 ±3.60 | 6.40 ±1.79 | 7.71 ±1.66 | 28.57 ±3.49 | 4.14 ±0.77 | 66.41 ±7.22 | |
| Hospital class | t = 2.705 P=0.007 | ||||||||
| Class III | 1582 | 66.8 | 19.52 ±3.78* | 6.25 ±1.88 | 7.70 ±1.66* | 27.95 ±3.63 | 4.03 ±0.85 | 65.45 ±7.93 | |
| Class II | 786 | 33.2 | 18.69 ±4.02 | 6.26 ±1.77 | 7.49 ±1.70 | 28.08 ±3.66 | 4.01 ±0.87 | 64.52 ±7.96 | |
| Hospital Affiliated to College or not | t=2.278P=0.023 | ||||||||
| Yes | 1777 | 75.0 | 19.39 ±3.88* | 6.26 ± 1.87 | 7.71 ±1.66* | 27.97 ± 3.69 | 4.03 ±0.85 | 65.36 ±8.06 | |
| No | 591 | 25.0 | 18.80 ± 3.84 | 6.23 ±1.76 | 7.40 ±1.71 | 28.07 ±3.48 | 3.99 ±0.86 | 64.50 ±7.57 | |
| Title | F = 4.425P= 0.004 | ||||||||
| Nurse | 595 | 25.1 | 19.23 ± 4.13 | 6.16 ± 1.91 | 7.46 ± 1.79* | 27.99 ± 3.77* | 4.00 ± 0.89* | 64.85 ± 8.40 | |
| Nurse practitioner | 1186 | 50.1 | 19.12 ± 3.90 | 6.31 ± 1.84 | 7.66 ± 1.65 | 27.75 ± 3.64 | 3.98 ± 0.87 | 64.82 ± 8.06 | |
| Nurse-in-charge | 507 | 21.4 | 19.55 ± 3.58 | 6.26 ± 1.79 | 7.77 ± 1.62 | 28.57 ± 3.49 | 4.13 ± 0.78 | 66.28 ± 7.17 | |
| Associate director nurse and above | 80 | 3.4 | 19.15 ± 3.50 | 6.09 ± 1.59 | 7.56 ± 1.57 | 27.96 ± 3.20 | 4.19 ± 0.71 | 64.95 ± 6.80 | |
| Education | F = 0.129P=0.879 | ||||||||
| Secondary/tertiary schools | 615 | 26.0 | 19.18 ±3.99 | 6.30 ±1.85 | 7.53 ±1.69 | 27.98 ±3.61 | 4.03 ±0.87 | 65.01 ±8.05 | |
| Undergraduate | 1678 | 70.9 | 19.26 ±3.85 | 6.25 ±1.85 | 7.67 ±1.67 | 28.00 ±3.65 | 4.01 ±0.85 | 65.20 ±7.92 | |
| Master's and above | 75 | 3.2 | 19.29 ±3.70 | 5.99 ±1.59 | 7.60 ±1.68 | 28.00 ±3.60 | 4.17 ±0.80 | 65.05 ±7.89 | |
| Marital status | |||||||||
| Married | 1456 | 61.5 | 19.26 ±3.79 | 6.28 ±1.83 | 7.66 ±1.68 | 28.05 ±3.63 | 4.04 ±0.84 | 65.29 ±7.84 | F = 0.750 |
| Unmarried | 889 | 37.5 | 19.23 ±4.04 | 6.19 ±1.88 | 7.60 ±1.67 | 27.90 ±3.65 | 3.99 ±0.88 | 64.92 ±8.15 | P=0.473 |
| Divorced | 23 | 1.0 | 18.43 ±3.54 | 6.74 ±1.48 | 7.09 ±1.54 | 28.00 ±3.78 | 4.04 ±0.83 | 64.30 ±7.22 | |
| Have child | 1253 | 52.9 | 19.29 ±3.75 | 6.30 ±1.83 | 7.67 ±1.68 | 28.09 ±3.60 | 4.06 ±0.82* | 65.42 ±7.74 | t=1.773 |
| Not have child | 1115 | 47.1 | 19.19 ±4.02 | 6.20 ±1.85 | 7.59 ±1.68 | 27.88 ±3.68 | 3.98 ±0.88 | 64.84 ±8.16 | P = 0.076 |
| Administrative duties | t=0.336P=0.737 | ||||||||
| Nurse | 2165 | 91.4 | 19.23 ±3.92 | 6.27 ±1.86 | 7.65 ±1.68 | 27.96 ±3.66 | 4.01 ±0.86* | 65.13 ±8.02 | |
| Head nurse and above | 203 | 8.6 | 19.26 ±3.43 | 6.10 ±1.63 | 7.49 ±1.71 | 28.32 ±3.37 | 4.14 ±0.75 | 65.31 ±7.10 | |
| Ranking attribute | F = 1.907 P=0.149 | ||||||||
| Formal | 1241 | 52.4 | 19.38 ±3.77 | 6.26 ±1.82 | 7.70 ±1.64 | 28.03 ±3.64 | 4.04 ±0.83 | 65.41 ±7.65 | |
| Contracting system | 1049 | 44.3 | 19.07 ±4.02 | 6.25 ±1.87 | 7.55 ±1.73 | 27.93 ±3.66 | 4.00 ±0.88 | 64.79 ±8.33 | |
| Temporary employment | 78 | 3.3 | 19.46 ±3.58 | 6.12 ±1.89 | 7.68 ±1.57 | 28.31 ±3.34 | 4.09 ±0.72 | 65.65 ±7.20 | |
| Department | F = 9.166 P=0.000 | ||||||||
| ICU | 294 | 12.4 | 20.41 ±3.47** | 6.62 ±2.11** | 8.34 ±1.33** | 28.43 ±3.35** | 4.11 ±0.78** | 67.90 ±7.40 | |
| Surgery | 835 | 35.3 | 19.08 ±3.97 | 6.17 ±1.82 | 7.44 ±1.80 | 27.70 ±3.91 | 3.99 ±0.90 | 64.38 ±8.43 | |
| Internal medicine | 700 | 29.5 | 19.10 ±3.87 | 6.08 ±1.74 | 7.55 ±1.67 | 27.94 ±3.49 | 4.04 ±0.83 | 64.72 ±7.72 | |
| Pediatrics | 196 | 8.3 | 18.69 ±3.92 | 6.35 ± 1.87 | 7.49 ± 1.56 | 28.08 ± 3.83 | 3.91 ± 0.82 | 64.52 ± 7.85 | |
| Emergency medicine | 132 | 5.6 | 19.28 ± 3.71 | 6.13 ± 1.63 | 7.57 ± 1.47 | 27.67 ± 3.12 | 4.11 ± 0.77 | 64.76 ± 6.77 | |
| Anesthesia | 104 | 4.4 | 19.28 ± 4.20 | 7.02 ± 1.81 | 7.81 ± 1.46 | 28.84 ± 3.27 | 3.98 ± 0.89 | 66.92 ± 7.41 | |
| Others | 107 | 4.5 | 19.13 ± 3.68 | 6.33 ± 1.83 | 7.81 ± 1.74 | 28.87 ± 3.48 | 4.07 ± 0.86 | 66.21 ± 7.11 | |