Alarm fatigue is a growing concern in critical care units (CCUs), where frequent non-actionable alarms contribute to nurse desensitization, stress, and compromised patient safety. In Saudi Arabia's rapidly evolving healthcare system, understanding these dynamics is crucial for improving care quality and staff well-being.
Aim
This study aimed to assess the prevalence of alarm fatigue and perceived stress among critical care nurses in Saudi hospitals, explore their interrelationship, and evaluate their impact on perceptions of patient safety.
Methods
A descriptive correlational cross-sectional research design was adopted. Using a convenient sampling approach composed of 190 CCU nurses across seven Saudi hospitals. Three validated instruments including the Alarm Fatigue Scale, Perceived Stress Scale, and Safety Attitudes Questionnaire were used in this study. Data were analyzed using descriptive statistics, t-tests, analysis of variance, and Pearson's correlations.
Results
Findings revealed moderate alarm fatigue (mean = 24.34, SD = 8.56) and stress (mean = 16.75, SD = 9.43). Alarm fatigue correlated with stress (r = 0.286, p < 0.01) and negatively with safety climate (r = 0.377) and teamwork climate (r = 0.402).
Conclusion
Alarm fatigue significantly influences stress levels and safety perceptions among critical care nurses, underscoring the need for targeted, context-specific interventions. Standardized alarm management protocols, culturally relevant staff training, and the adoption of intelligent alarm filtering systems are recommended to reduce cognitive overload, enhance nurse well-being, and strengthen patient safety culture in Saudi CCUs.
AlabdullahAWhitingLLittlechildB, et al. (2022) Workplace stress in paediatric intensive care units in Saudi Arabia: A mixed-methods study. Journal of Nursing Education and Practice13(2): 44. Available at: https://doi.org/10.5430/jnep.v13n2p44 (Accessed: 29 May 2025).
2.
AlbanowskiKBurdickKJBonafideCP, et al. (2023) Ten years later, alarm fatigue is still a safety concern. AACN Advanced Critical Care34(3): 189–197. Available at: https://doi.org/10.4037/aacnacc2023662 (Accessed: 29 May 2025).
3.
AlkubatiSAlsaqriSAlrubaieeG, et al. (2024) Levels and factors of nurses’ alarm fatigue in critical care settings in Saudi Arabia: A multicenter cross-sectional study. Journal of Multidisciplinary Healthcare17: 793–803. Available at: https://doi.org/10.2147/jmdh.s452933 (Accessed: 29 May 2025).
4.
AlsadaanNJonesLKKimptonA, et al. (2021) Challenges facing the nursing profession in Saudi Arabia: An integrative review. Nursing Reports11(2): 395–403. Available at: https://doi.org/10.3390/nursrep11020038 (Accessed: 29 May 2025).
5.
AlsufyaniAMAlforihidiMAAlmalkiKE, et al. (2020) Linking the Saudi Arabian 2030 vision with nursing transformation in Saudi Arabia: Roadmap for nursing policies and strategies. International Journal of Africa Nursing Sciences13: 100256. Available at: https://doi.org/10.1016/j.ijans.2020.100256 (Accessed: 29 May 2025).
6.
AndersonCJSreetharanSLópezAEE, et al. (2023) Improving auditory alarms: Reducing perceived annoyance with musical timbre (a randomized trial). Perioperative Care and Operating Room Management32: 100332. Available at: https://doi.org/10.1016/j.pcorm.2023.100332 (Accessed: 29 May 2025).
7.
AwanHUroojSRafiqN (2023) Level of stress and associated factors among nurses working in critical care unit in public sector hospital Lahore Pakistan. Journal of Positive School Psychology7(7): 131–138.
8.
CaseySAvalosGDowlingM (2018) Critical care nurses’ knowledge of alarm fatigue and practices towards alarms: A multicentre study. Intensive Critical Care Nursing48: 36–41. Available at: https://doi.org/10.1016/j.iccn.2018.05.004 (Accessed: 29 May 2025).
9.
ChoOMKimHLeeYW, et al. (2016) Clinical alarms in intensive care units: Perceived obstacles of alarm management and alarm fatigue in nurses. Healthcare Informatics Research22(1): 46–53. Available at: https://doi.org/10.4258/hir.2016.22.1.46 (Accessed: 29 May 2025).
10.
ChristensenMDoddsASauerJ, et al. (2014) Alarm setting for the critically ill patient: A descriptive pilot survey of nurses’ perceptions of current practice in an Australian regional critical care unit. Intensive & Critical Care Nursing30(4): 204–210. Available at: https://doi.org/10.1016/j.iccn.2014.02.003 (Accessed: 29 May 2025).
11.
CohenSKamarckTMermelsteinR (1983) A global measure of perceived stress. Journal of Health and Social Behavior24(4): 385–396. Available at: https://doi.org/10.2307/2136404 (Accessed: 29 May 2025).
12.
De OliveiraAECMachadoABSantosEDD, et al. (2018) Alarm fatigue and the implications for patient safety. Revista Brasileira De Enfermagem71(6): 3035–3040. Available at: https://doi.org/10.1590/0034-7167-2017-0481 (Accessed: 29 May 2025).
13.
DingSHuangXSunR, et al. (2023) The relationship between alarm fatigue and burnout among critical care nurses: A cross-sectional study. Nursing in Critical Care28(6): 940–947. Available at: https://doi.org/10.1111/nicc.12899 (Accessed: 29 May 2025).
14.
DuXLiuXZhaoY, et al. (2023) Psychometric testing of the 10-item perceived stress scale for Chinese nurses. BMC Nursing22(1): 430. Available at: https://doi.org/10.1186/s12912-023-01602-4 (Accessed: 29 May 2025).
15.
ErÖSGülİ (2025) The impact of alarm fatigue on patient safety climate among nurses: the mediating role of moral courage. Nursing in Critical Care30(2): e70002. Available at: https://doi.org/10.1111/nicc.70002 (Accessed: 29 May 2025).
16.
EtikanI (2016) Comparison of convenience sampling and purposive sampling. American Journal of Theoretical and Applied Statistics5(1): 1. Available at: https://doi.org/10.11648/j.ajtas.20160501.11 (Accessed: 29 May 2025).
LewandowskaKWeisbrotMCieloszykA, et al. (2020) Impact of alarm fatigue on the work of nurses in an intensive care environment—A systematic review. International Journal of Environmental Research and Public Health17(22): 8409. Available at: https://doi.org/10.3390/ijerph17228409 (Accessed: 29 May 2025).
19.
LiMHeSPengM, et al. (2025) Experiences and challenges for critical care nurses in work related to medical device alarms. CIN: Computers, Informatics, Nursing43(3): e01214. Available at: https://doi.org/10.1097/cin.0000000000001214 (Accessed: 29 May 2025).
20.
LuSFKuoYWHungSH, et al. (2024) Coping strategies of intensive care units nurses in alarm management: a qualitative research study. BMC Nursing23(1): 713. Available at: https://doi.org/10.1186/s12912-024-02374-1 (Accessed: 29 May 2025).
21.
MovahediASadooghiaslAAhmadiF, et al. (2023) A grounded theory study of alarm fatigue among nurses in intensive care units. Australian Critical Care36(6): 980–988. Available at: https://doi.org/10.1016/j.aucc.2022.12.004 (Accessed: 29 May 2025).
22.
NusairHAFonbuenaMChewC, et al. (2025) Exploring staff perceptions regarding alarm fatigue and practices among nurses: A multicentre study in the Northern Emirates. International Emergency Nursing79: 101584. Available at: https://doi.org/10.1016/j.ienj.2025.101584 (Accessed: 29 May 2025).
23.
NyarkoBANieHYinZ, et al. (2022) The effect of educational interventions in managing nurses’ alarm fatigue: An integrative review. Journal of Clinical Nursing32(13–14): 2985–2997. Available at: https://doi.org/10.1111/jocn.16479 (Accessed: 29 May 2025).
24.
NyarkoBAYinZChaiX, et al. (2023) Nurses’ alarm fatigue, influencing factors, and its relationship with burnout in the critical care units: A cross-sectional study. Australian Critical Care37(2): 273–280. Available at: https://doi.org/10.1016/j.aucc.2023.06.010 (Accessed: 29 May 2025).
25.
RypiczŁRozensztrauchAFedorowiczO, et al. (2023) Polish adaptation of the alarm fatigue assessment questionnaire as an element of improving patient safety. International Journal of Environmental Research and Public Health20(3): 1734. Available at: https://doi.org/10.3390/ijerph20031734 (Accessed: 29 May 2025).
26.
SalamehBAbdallahJAlkubatiSA, et al. (2024) Alarm fatigue and perceived stress among critical care nurses in the intensive care units: Palestinian perspectives. BMC Nursing23(1): 261. Available at: https://doi.org/10.1186/s12912-024-01897-x (Accessed: 29 May 2025).
27.
SeungeiY (2024) Implementing effective patient safety measures in ICUs: Innovative approaches to ICU patient safety. Journal of Perioperative & Critical Intensive Care Nursing10(2): 1–2. Available at: https://doi.org/10.35248/2471-9870.24.10.254 (Accessed: 29 May 2025).
28.
SextonJBHelmreichRLNeilandsTB, et al. (2006) The safety attitudes questionnaire: Psychometric properties, benchmarking data, and emerging research. BMC Health Services Research6: 44. Available at: https://doi.org/10.1186/1472-6963-6-44 (Accessed: 29 May 2025).
29.
StormJChenH (2020) The relationships among alarm fatigue, compassion fatigue, burnout and compassion satisfaction in critical care and step-down nurses. Journal of Clinical Nursing30(3–4): 443–453. Available at: https://doi.org/10.1111/jocn.15555 (Accessed: 29 May 2025).
30.
TherouxP (2010) Acute Coronary Syndromes: A Companion to Braunwald’s Heart Disease E-Book. Philadelphia, PA: Elsevier Health Sciences.
31.
TorabizadehCYousefinyaAZandF, et al. (2017) A nurses’ alarm fatigue questionnaire: Development and psychometric properties. Journal of Clinical Monitoring and Computing31(6): 1305–1312. Available at: https://doi.org/10.1007/s10877-016-9958-x (Accessed: 29 May 2025).
32.
UçakACebeciFÇatalAT (2025) Nurses’ alarm fatigue levels in adult intensive care units and their strategies to reduce fatigue: a convergent parallel design. Journal of Clinical Nursing34(5): 1691–1703. Available at: https://doi.org/10.1111/jocn.17644 (Accessed: 29 May 2025).
33.
ZimmermannNKüngKSereikaSM, et al. (2013) Assessing the safety attitudes questionnaire (SAQ), German language version in Swiss university hospitals - a validation study. BMC Health Services Research13(1): 347. Available at: https://doi.org/10.1186/1472-6963-13-347 (Accessed: 29 May 2025).
