Nurses’ clinical alarm-related behaviors and influencing factors in China

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
Items	n	Constituent ratio (%)	Alarm settings	Alarm notifications	Alarm recognitions	Alarm responses	Alarm learning	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

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Nurses’ clinical alarm-related behaviors and influencing factors in China†

Article Category: Original Article

Published Online: Aug 03, 2022

Page range: 173 - 186

Received: Nov 11, 2021

Accepted: Jan 22, 2022

DOI: https://doi.org/10.2478/fon-2022-0023

Keywordsbehavior, clinical alarm, factors, nurses, patient safety

© 2022 Zhu-Jun Liao et al., published by Sciendo

This work is licensed under the Creative Commons Attribution 4.0 International License.

Clinical alarm-related behavior scores of nurses (n = 2368).

Multivariate linear regression analysis of alarm behaviors and related.

Factors that influence nurses’ clinical alarm behavior.

General demographic data of surveyed nurses (n = 2368).

Clinical alarm behavior scores and demographic data of surveyed nurses (n = 2368).

Nurses’ clinical alarm-related behaviors and influencing factors in China^†

Keywords
behavior, clinical alarm, factors, nurses, patient safety