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Alarm Fatigue Concept Analysis and Florence Nightingale's Environmental Theory

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Alarm fatigue has emerged as a significant concern for the safety of the patients. Furthermore, it is acknowledged to be a contributor in the environs of the nurses and clinicians. It also interferes with the ability of the doctors to provide their services to the patients thus hindering patient care and safety issues. Besides, alarm fatigue is the focus of (NPSG) National Patient Safety Goal.

Alarm Fatigue has been chosen as one of the clinical problems that require effort. According to Winters, , Cvach, Bonafide, Hu, Konkani, connor and Kane-Gill (2018), there are two main categories of concepts used in many theories. There are those familiar concepts that can be easily understood and those that are referred to as specific concepts. The environmental theory is one of the methods developed by Florence Nightingale, and, it has its primary focus on the environment. It is interpreted that the situation is depicted as an external condition that influences the growth of an organism in the human body which can either prevent or cause a disease. Perhaps, Nightingale believed that a suitable environment results to a difference in recovery of the patient. Therefore, the concept of alarm fatigue in environmental theory is presented as part of the common ideas. Nurses should use all the powers they have to restore the health of an individual. In accord with this, the essay seeks to discuss the literature review and use of different cases that can be used to emphasize the data that was discovered during the review stage and the key words are alarm fatigue, alarm, fatigue, interruptions, and nursing.

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First, alarm according to Macmillan Publishers (2015), refers to sudden anxiety that something wrong is going to happen. Perhaps it is a device that makes a warning signal sound. However, fatigue on the other hand, is a state of being extremely tired.

Alarm fatigue refers to an overload in ones sensory. It occurs when a nurse or a doctor is exposed to quite frequent alarms which in most cases can result in desensitization to signals as well as missing other essential alarms. Patient deaths are some of the things that are characterized by alarm fatigue.

Interruption is referred to as an act of interrupting someone in the middle of an action. Perhaps in a health care facility, the doctor can be suspended during his consultation time with the patient for urgent surgery.

Nursing, on the other hand, refers to the glue that is holding the journey of the patient together. However, according to Ledoux (2015), alarm fatigue health is demonstrated as something that has been growing over the years, more so, when looking at the patient’s safety. Before developing any policies and strategies to solve a particular problem, there must be an understanding of the stated problem. If the patient is not feeling well, the physicians must first understand the issue at hand; the causes of the problem then eventually come up with a solution to the problem. Also, alarm fatigue can be well evaluated by using a method that identifies the attributes, antecedents, and consequences of alarm fatigue in individual’s health care.

A literature review is conducted with the aim of understanding alarm fatigue in  Florence Nightingale’s Environmental theory. Perhaps one of the issues the literature review covers is the facts about the concept of alarm fatigue in nursing in a multidimensional approach. According to De Souza, Wall, de Moraes and de Lima (2017), ECRI institute which is a non-profit organization is using scientific research to list hazards in the environment; ‘Alarm hazard’ is depicted as the top technology hazard. Inappropriate alarms and alarm fatigue are some of the high hazards in the atmosphere. Nonetheless, one of the issues addressed in this review of literature is facts about alarm fatigue as stated in various article reviews.

According to research and statistics, 65% of nurses are indicating that they have been impacted by alarm fatigue as stated by Wilson, Gettel, Walsh and Esquenazi (2016). In most cases, alarm fatigue causes stress and nurse burnout. The first fact about alarm fatigue is;

The burden of alarms in various health facilities is problematic and unsustainable. Regarding this, nurses are subjected to make four fields or more on alarms per minute. The clinicians are then forced to reduce the number of field alarms or hire more people to assist in field alarms.

Secondly, half of all the alarms signals in health facilities are not clinically relevant because there is the presence of non-actionable alarms. As a result, non-actionable alarms can be caused by patient’s manipulations or patient’s movements.

Thirdly, excess alarms cause a nuisance to the environment which is then harmful clinically. Perhaps, an environment that is characterized by intense signals can result in adverse outcomes such as deaths.

Fourthly, having a large number of false alarms is operationally inefficient, more so, in a health care facility. It is because as nurses respond to non-actionable alarms, a lot of time is consumable. Perhaps, the nurses could have done other tasks which could have improved operational performance clinically.

Lastly, there is a clear responsibility to improve the management of alarms. Joint Commission International (JSC) states that the technologies that are used in enhancing patient safety such as alarms can create hazards in hospitals if they are not carefully managed. Perhaps, ECRI Institute presents alarm as one of the top health hazards that require good operational management.

In the fourth step, there is the discussion on the attributes of alarm fatigue which is the selected concept of analysis. Attributes refer to the characteristics of a concept that keeps on recurring over and over again in a text or literature. According to Paine, Goel, Ely, Stave and Stemler (2016), these attributes are often associated with the concept hence allowing a vast insight. The concept of alarm fatigue has various qualities which include the following;

It is an environment such as the health care facility or an organization which has extreme and recurring situations. For instance, in a hospital, alarms are some of the signals that frequently occur because of the patient’s care and safety.

Secondly, it has a lessened motivation as well as interest in the surroundings. According to the literature review on facts about alarm fatigue, there are non-actionable signals that consumers nurse’s time. It is also a significant cause of nurse stress.

Thirdly, it has the characteristic of diminishing capacity for physical as well as any mental work. ECRI Institute ranks alarm signals as the top alarm hazard in the list because it causes interruptions and distractions during work. The doctors cannot concentrate on a patient because of non-actionable alarm signals.

Antecedents refer to the events that must occur before the concept manifestation. On the other hand, consequences refer to an event that occurs after or as a result of the concept of expression. Below are the antecedent and consequence of alarm fatigue. Antecedents are the ability to evaluate one’s feelings subjectively. There is also a patient environment which has stimuli in excess. Consequences include; there is a limited perception of the clinical importance of having an alarm signal because it is a significant cause of nurse stress and burnout. Perhaps, when a clinical event is ignored, it can lead to adverse situations which are harmful such as patient’s deaths.

Empirical referents are the categories of actual phenomena that portray the contextual framework of a concept. Perhaps, they are important because they present a way in which the researcher can observe a specific concept. Hence, the literature on alarm fatigue demonstrates the necessity of a multidimensional approach to the stated phenomenon.

Therefore, the empirical referents on alarm fatigue include; the effects of excessive alarm signals to patients and staff (Stolwijk, van Onna, Boonen and van Tubergen, (2016).)

Secondly is the response of the nurses to alarm signals in hospitals. The nurses’ response to non-actionable alarms consumes their time; instead, they could have performed other tasks that improve the clinical performance.

Jessica is a school nurse at a local school which has up to 400 children. Weekly there are over 45 children who regularly visit the clinic during the lunch break particularly for generic medication as well as first aid. Perhaps, Jessica finds it hard to concentrate because of the daily demand of her services to the children. For the first two weeks, one of the kindergartener James has been visiting her every day during lunch break for recess. James shared his playground injuries with Jessica every day, and everyday James was requesting for a bandage. One day, James got to the clinic and Jessica did not concentrate on him, she did not make any eye contact with James. Jessica went to the refrigerator to get her lunch and began taking her lunch. After one hour, she has a soft voice, “Can you kindly look at my shoulder now?”

The above case demonstrates three identified attributes of alarm fatigue as described previously. First, the school nurse is in an environment with recurring events from the same student who is James and unnecessary interruptions. After frequent visits, Jessica develops a decrease in awareness of the student’s presence; she goes to the refrigerator to take her lunch instead of attending to James hence altering her nursing response to the student’s fractured shoulder.

A borderline case is when one or two of the previously identified cases are missing for instance. The health facility has been continuously busy with influenza-like patients during the December holidays. There was a capacity limit of its patients. One is discharged, and another one with the same disease from the same community is admitted. The nurse’s staffs have been working tirelessly in shifts to curb the community flu-like disease. The nursing staff was tired and burnout because of the constant patients, but they managed to work together as a team and presented the patient care and safety required.

This case has presented only two attributes of alarm fatigue. First, there is the recurrent patient care of influenza-like that is community flu hence many patients from one community are admitted. Due to the overpopulation of patients, the nurses got tired and stressful which is the second attribute of alarm fatigue. Despite displaying physical fatigue, they developed a teamwork approach where they were working in shifts to curb the problem. This case did not demonstrate the other attribute of alarm fatigue because there was no reduction in nurse’s capacity to accomplish the started work.

This is the case created that depicts the opposite of the chosen nursing concepts. Perhaps, all the identified concepts are not present.

Jane is a school nurse who enjoys traveling to around ten or more schools within two weeks. Jane gives her services to many children with diverse characteristics regarding medical attention and age. Besides, Jane enjoys participating in a classroom discussion on matters related to health issues and collaborates with the teachers in health-related projects. She is always excited about her school nurse practice job and the events surrounding it.

In this case, there are none of the attributes of alarm fatigue. The school nurse is being exposed to different environments with diverse medical attention required as opposed to chronic medical care in alarm fatigue. Furthermore, Jane is excited about her work and motivated by creating extra job activities which are in contrast with the concept of fatigue and stress brought by excess work.

The main intention of this concept of analysis is to provide a clear concept of the environment and surroundings of alarm and fatigue. Perhaps, health care facilities and its employees need to understand the phenomenon concept so that in future, medical alarm technology can make some compliments on nurse work environment to provide efficient and safe patient care services. The overall impacts of alarm fatigue are stated to influence patient safety issues; hence nurses have an obligation of providing best service practices to the public. In contemporary society, alarm fatigue is causing a lack of concentration. The doctors and nurses are not providing the expected response. This concept of alarm fatigue applies to environmental theory because Florence Nightingale identified unnecessary noise as cruel care that is subjected to patients. Today, medical devices produce unwanted noise hence hindering the patients.

 

In conclusion, nurses are portrayed as essential beings in patient care and safety because they have a responsibility of influencing change in health policy through the development of theories such as the environmental theory. Nursing care is crucial because it ensures that there is a positive patient outcome. Healthcare organizations should establish nurse’s work environments which are conducive for patient care and safety.

 

 

 

Reference

  1. De Souza, M. A. R., Wall, M. L., de Moraes, A. C., de Almeida, B., & de Lima, D. M. (2017). The Vital Power and the Legacy of Florence Nightingale in the Health-disease Process: integrative review. Revista de Pesquisa Cuidado é Fundamental Online, 9(1), 297-301.
  2. Ledoux, K. (2015). Understanding compassion fatigue: understanding compassion. Journal of Advanced Nursing, 71(9), 2041-2050.
  3. Macmillan Publishers. (2015). Macmillan Dictionary. Retrieved from macmillandictionary.com
  4. Macmillan Thesaurus
  5. Paine, C. W., Goel, V. V., Ely, E., Stave, C. D., Stemler, S., Zander, M., & Bonafide, C. P. (2016). Systematic review of physiologic monitor alarm characteristics and pragmatic interventions to reduce alarm frequency. Journal of Hospital Medicine, 11(2), 136-144.
  6. Stolwijk, C., van Onna, M., Boonen, A., & van Tubergen, A. (2016). Global Prevalence of Spondyloarthritis: A Systematic Review and Meta‐Regression Analysis. Arthritis care & research, 68(9), 1320-133.
  7. Wilson, M., Gettel, V., Walsh, J., & Esquenazi, S. (2016). Caring Compassionately for Hospitalized Patients: Can Nurse-Delivered Massage Address Compassion Fatigue? International Journal for Human Caring, 20(3), 146-154.
  8. Winters, B. D., Cvach, M. M., Bonafide, C. P., Hu, X., Konkani, A., O’connor, M. F., … & Kane-Gill, S. L. (2018). Technological distractions (part 2): A Summary of Approaches to Manage Clinical Alarms with Intent to Reduce Alarm Fatigue. Critical care medicine, 46(1), 130-137.

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