J Clin Monit Comput (2017) 31:1305–1312
DOI 10.1007/s10877-016-9958-x
ORIGINAL RESEARCH
A nurses’ alarm fatigue questionnaire: development
and psychometric properties
Camellia Torabizadeh1 • Amirhossein Yousefinya1 • Farid Zand2 • Mahnaz Rakhshan1
Mohammad Fararooei3
Received: 13 June 2016 / Accepted: 8 November 2016 / Published online: 15 November 2016
Ó Springer Science+Business Media Dordrecht 2016
Abstract Alarm fatigue can adversely affect nurses’ effi-
ciency and concentration on their tasks, which is a threat to
patients’ safety. The purpose of the present study was to
develop and test the psychometric accuracy of an alarm
fatigue questionnaire for nurses. This study was conducted in
two stages: in stage one, in order to establish the different
aspects of the concept of alarm fatigue, the researchers
reviewed the available literature—articles and books—on
alarm fatigue, and then consulted several experts in a
meeting to define alarm fatigue and develop statements for
the questionnaire. In stage two, after the final draft had been
approved, the validity of the instrument was measured using
the two methods of face validity (the quantitative and
qualitative approaches) and content validity (the qualitative
and quantitative approaches). Test–retest, Cronbach’s alpha,
and Principal Component Analysis were used for item
reduction and reliability analysis. Based on the results of
& Mahnaz Rakhshan
mzrakhshan@gmail.com
Camellia Torabizadeh
torabik@sums.ac.ir
Amirhossein Yousefinya
ah.yousefinya@yahoo.com
Farid Zand
zandf@sums.ac.ir
Mohammad Fararooei
fararooei@gmail.com
1
Department of Nursing, School of Nursing and Midwifery,
Shiraz University of Medical Sciences, Shiraz, Iran
2
Department of Anesthesiology, Shiraz University of Medical
Sciences, Shiraz, Iran
3
Department of Epidemiology, Shiraz University of Medical
Sciences, Shiraz, Iran
•
stage one, the researchers extracted 30 statements based on a
5-point Likert scale. In stage two, after the face and content
validity of the questionnaire had been established, 19 state-
ments were left in the instrument. Based on factor loadings
of the items and ‘‘alpha if item deleted’’ and after the second
round of consultation with the expert panel, six items were
removed from the scale. The test of the reliability of nurses’
alarm fatigue questionnaire based on the internal homo-
geneity and retest methods yielded the following results:
test–retest correlation coefficient = 0.99; Guttman split-
half correlation coefficient = 0.79; Cronbach’s alpha =
0.91. Regarding the importance of recognizing alarm fatigue
in nurses, there is need for an instrument to measure the
phenomenon. The results of the study show that the devel-
oped questionnaire is valid and reliable enough for mea-
suring alarm fatigue in nurses.
Keywords Alarm fatigue
Nurses
Questionnaire
development
Psychometrics
1 Introduction
The Emergency Care Research Institute (ECRI) defines
alarm fatigue as the emotional pressure care-providers
experience when they are exposed to too many alarm
sounds. In other words, alarm fatigue is a phenomenon that
occurs when nurses work in a clinical environment where
alarm sounds are heard frequently [1–3]. Humans are able
to distinguish between five to seven categories of sound
[4]. In many hospitals, noise levels are above the limits
recommended by World Health Organization (WHO), i.e.
30 decibels in the ward rooms [5]. What type of alarm
sound should be used in hospitals is a controversial issue:
some studies suggest that at busy times, nurses may not be
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able to recognize melodies as alarms and respond to them
[6]. In their study of alarm sound-making equipment in
hospitals, Hirose et al. [7] conclude that the level of alarm
sounds should be set based on the usual level of sounds in
the environment; they also recommend that such equip-
ment be set in such a way that the maximum level of alarm
sound is automatically activated whenever the equipment is
turned on. This recommendation is not consistent with the
results of the study of Ryherd et al. [8]: they conclude that,
since loud noises can increase stress, fatigue and tension
headaches in medical staff and make concentrating more
difficult, visual and vibrating alarm systems deserve to be
studied in more depth by other researchers. It is necessary
that other forms of alarm notification devices be available
to guarantee the sound alarm is audible [9].
The psychological pressure caused by frequent exposure
to alarm sounds can desensitize nurses to alarm signals,
which can in turn lead to negligence of important clinical
alarms. As a result of alarm fatigue, nurses may not only
become dilatory in responding to clinical alarms, but they
may readjust the alarms and adopt settings that are not safe
for patients and practically turn the alarm systems silent or
off [1]. If doctors or nurses deactivate the alarm sounds, put
them on silent, or ignore them, patients’ safety is potentially
threatened [3, 10]. False alarms can have many negative
consequences: they can turn into a cry wolf (a lie) and make
nurses ignore the alarm systems or respond slowly to repet-
itive alarms. Moreover, false alarms can interfere with nur-
ses’ efficient planning and performance and distract them
[3]. A growing problem, alarm fatigue is so serious that ECRI
has declared it as threat number one on its list of 10 important
threats of technology in the area of health from 2012 to 2015
[11]. Alarm fatigue is considered a kind of human error; and
according to a report released by the Institute of Medicine in
1999, human errors are among the leading causes of death in
hospitals. The American Food and Drug Administration has
reported that 237 deaths from 2002 to 2004 were caused by
disregard for clinical alarms [12]. Due to hundreds of alarm-
related deaths over the past five years, the Joint Commission
set the 2014 National Patient Safety Goals to improve the
safety of alarm systems [13, 14]. Many of the alarm-related
incidents investigated by ECRI were found to have been
caused by alarm fatigue. Information from databases shows
that frequently alarms that have gone off as a result of a
patient’s serious conditions are either not heard by clinical
employees or responded to too late. In other cases, alarm
sounds are heard by the staff but are turned off due to their
annoying noise [15]. It is essential that healthcare equipment
manufacturers and operators and hospital authorities take
steps to eliminate unnecessary alarms.
In view of the importance of recognizing alarm fatigue as
a potentially dangerous phenomenon, there is need for valid,
reliable, and transferable instruments to measure alarm
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fatigue in nurses. A review of the articles in the databases of
PubMed (MEDLINE), CINAHL, Scopus, and Web of Sci-
ence showed that a comprehensive and valid instrument for
measuring nurses’ alarm fatigue had not been designed yet.
Graham and Cvach [16] designed a 5-item questionnaire to
survey medical staff solely about how to improve the safety
of patients with regard to monitor alarm sounds; Baillargeon
[2] developed a 6-item instrument to collect information
about patient monitoring equipment alarms—type of alarm,
alarm description, the number of times an alarm goes off,
alarm response time, personalizing alarm parameters, and
explanation—which had to be completed by a researcher in a
clinical environment. In an online survey in 2006, Healthcare
Technology Foundation (HTF) had 1300 technicians, engi-
neers and hospital managers complete a questionnaire on
clinical alarms. The results of the study showed that most of
the respondents believed that nuisance alarms happened
frequently and adversely affected the performance of care-
givers, sometimes leading caregivers to deactivate them.
Interestingly enough, a similar survey conducted in 2011
yielded similar results. In both cases, repeated false alarms
were considered as the most serious problem with alarm
signals in clinical environments [17].
In their study of nurses’ attitude toward clinical alarms in
intensive care units (ICU), Cho et al. [18] report that alarm
sounds from clinical equipment sometimes make nurses
impatient and compromise their competence as care-providers.
Though a number of interventions have been suggested
to reduce the number of false alarms, there is need for more
thorough research that addresses the possible negative
consequences of such interventions. Based on the results of
several studies in the fields of alarm fatigue and alarm
management in the U.S., a variety of measures have been
suggested to lessen alarm fatigue in that country since 2010
[2, 3, 10, 12, 16, 17]. However, in Iran, little research has
been conducted on medical device alarms and alarm fati-
gue is a new concept. There are not any comprehensive
instruments exclusively designed for measuring alarm
fatigue in nurses, thus the need for a valid and reliable
alarm fatigue questionnaire. Accordingly, the present study
is an attempt at developing a nurses’ alarm fatigue ques-
tionnaire and testing its validity and reliability in the hope
of improving the quality of clinical care and services.
2 Methods
2.1 Design, setting, and subjects
This is a cross-sectional study with the purpose of
designing a questionnaire for evaluating alarm fatigue in
nurses and subsequently analyzing its validity and relia-
bility. In the present study, the researchers addressed audio
J Clin Monit Comput (2017) 31:1305–1312
alarms: the alarm sounds made by patient cardiac monitors,
infusion pumps, pulse oximeters, syringe pumps, and
mechanical ventilators.
In order to develop and analyze items, the researchers
initially provided a practical definition of ‘‘Nurses’ Alarm
Fatigue’’ and set the specific objectives of the study based on
that definition. As there is not a standard definition of alarm
fatigue, after reviewing the available literature, the
researchers used the following definition to explain the
concept of alarm fatigue: having to respond to too many
alarm signals at work reduces one’s sensitivity to clinical
alarms, which can, in turn, result in alarm sounds being
missed or responded to with delay. Next, a blue print was
made and the significance of each objective was measured
according to the comments of experts and professors who
were familiar with the concept and psychometrics. Each
item was or was not incorporated into the questionnaire
based on the results of the review of literature, the experts’
comments and the item’s significance and relevance to the
objectives of the instrument. The remaining items were
examined several times and the repeats (items that were
similar in content) were eliminated. Eventually, after the
final draft had been approved, the validity of the instrument
was measured using the two methods of face validity (the
quantitative and qualitative approaches) and content validity
(the qualitative and quantitative approaches). Test–retest
reliability, Cronbach’s alpha, and Principal Component
Analysis (PCA) were used to assess the stability and con-
sistency of the instrument.
2.2 Data analysis
2.2.1 Validity
To verify the validity of the questionnaire, the researchers
had the questionnaire analyzed by several professors in the
fields of anesthesiology, intensive care, and nursing, as well
as some experienced head nurses and nurses in intensive care
units, all of whom were familiar with the concept in question;
based on the suggested revisions, certain items were
removed or added. To verify the validity of the question-
naire, both the face validity and content validity of the
questionnaire were tested.
2.2.2 Face validity
To confirm the qualitative face validity, the researchers
interviewed ten nurses face-to-face and asked for their opinion
about the difficulty level (difficulty of comprehending the
sentences), relevancy (relevance of the sentences to different
aspects of the questionnaire), and ambiguity (chances of
misinterpreting the sentences) of the questions. The
researchers also ascertained that the sentences were
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grammatically correct and coherent by double-checking the
items and having two language experts examine them.
2.2.3 Content validity
The content validity of the questionnaire was confirmed
both qualitatively and quantitatively. Ten experts were
asked to evaluate the content validity of the questionnaire:
the experts, who were authorities on questionnaire devel-
opment, medicine, epidemiology, and nursing, were asked
to evaluate the qualitative content validity based on
grammatical structures, choice of words, and order of the
sentences. To evaluate the quantitative content validity of
the questionnaire, its Content Validity Ratio (CVR) and
Content Validity Index (CVI) were examined.
To determine the CVR of the questionnaire, the experts
were asked to rate each item on a three-part scale: neces-
sary, helpful but unnecessary, and unnecessary. Based on
Lawshe Table, to determine the least value of content
validity ratio, the items whose CVR was judged to be
above 0.62 by the experts were considered significant
(p value \0.05) and were maintained [19]. Subsequently,
the content validity index of the questionnaire was ana-
lyzed based on Waltz and Bausell’s method [20]: the
experts were asked to evaluate the relevancy, clarity,
simplicity and specificity of each item based on a 5-point
Likert scale. The CVI score of each item was calculated by
dividing the number of experts who had selected scores 3
or 4 for that item by the total number of experts [21].
Hyrkas et al. [22] recommend the score 0.79 and above for
accepting the CVI of an item. Finally, the average content
validity index of the questionnaire (S-CVI/Ave) was cal-
culated based on the mean of the CVI scores of the entire
items. Polit and Beck [21] recommend the score 0.90 and
above for accepting the S-CVI/Ave of a questionnaire.
2.2.4 Reliability
The reliability of the questionnaire was verified based on
the analysis of its internal homogeneity and consistency in
102 ICU nurses. The Cronbach’s alpha of the questionnaire
was calculated to measure its internal homogeneity. It is
believed that the internal homogeneity of a questionnaire is
satisfactory when its Cronbach’s alpha is between 0.7 and
0.8 [23]. To measure the consistency of the questionnaire,
the researchers used the test–retest approach. The key point
about this approach is the time interval between the tests;
according to Fowler [24], the interval should be long
enough for the respondents to forget the items on the
questionnaire to a certain extent, but should not be too long
for the phenomenon being measured to change. Burns and
Grove [25] suggest that the length of the interval be from
2 weeks to 1 month. Thus, the retest was given 14 days
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after the initial test. The correlation between the scores Table 1 Personal characteristics of the participants in the reliability
obtained from the pre- and posttests was analyzed. Prin- section of the study
cipal Component Analysis (PCA) was used to define the Variable Absolute Relative
organizing principle of the instrument. Factor loading and distribution distribution (%)
‘‘alpha if item deleted’’ were used to measure the contri-
Age
bution of items to the instrument and the scale’s reliability
Under 25 23 22.6
and to reduce the number of items if necessary. SPSS v. 21
25–30 35 34.3
was used for analyzing the collected data which included
30–35 14 13.7
descriptive and analytical statistics.
35–40 19 18.6
Above 40 11 10.8
Gender
3 Results
Male 41 40.2
Female 61 59.8
3.1 Participant demographics
Education
In the quantitative part of the present study, in order to B. S. 78 76.5
evaluate the reliability of the designed questionnaire, 102 M. S. 24 23.5
nurses with an average age of 32.64 ± 4.81 and length of Employment status
experience of 7.12 ± 6.34 years were tested. Table 1 Permanent 18 17.6
shows the distribution of the participants based on gender, Contractual 28 27.5
education, and employment status. Periodical 19 18.6
Trainee 37 36.3
3.2 Validity Length of experience (years)
1–5 48 47.1
Based on the results from stage one of the study, alarm 5–10 36 35.3
fatigue can be defined as lacking the full capacity and Above 10 18 17.6
ability for identifying and prioritizing clinical alarms,
which leads to inefficient response to alarm sounds. In
stage one, 16 statements were composed, which were 3.5 Item reduction in the scale
scored on a 5-point Likert scale: never, rarely, occasion-
ally, usually, and always. Based on factor loadings of the items and ‘‘alpha if item
deleted’’, six items were suggested to be removed from the
3.3 Face validity scale. As a result, after the second round of consultation
with the expert panel, the items were removed from the
For evaluating the face validity of the questionnaire, the scale. The results of PCA on the revised scale suggested
experts and nurses’ opinions were considered and the possible existence of two underlying factors according to
necessary revisions were made. the factor loadings of the remained items (Table 4). The
final scale and its underlying structure and a summary of
3.4 Content validity item and scale analyses are presented in Tables 2 and 3.

Based on the results of the content validity evaluation, the
following changes were made: item 7 was revised in
compliance with the experts’ documented comments; 3
items were removed based on Waltz and Bausell’s content
validity index and the experts’ documented comments
(Table 2); 5 new items were added to the questionnaire
based on the experts and research team’s documented
comments. Eventually, the nurses’ alarm fatigue ques-
tionnaire ended up consisting of 19 items and was tested
for item reduction and reliability analysis (Table 3). It
should be noted that the average content validity index of
the questionnaire (S-CVI/Ave) was found to be 0.92.
3.6 Reliability
3.6.1 Internal homogeneity reliability
The Cronbach’s alpha coefficient for the internal homo-
geneity of the final version of the questionnaire was found
to be very good (Cronbach’s alpha = 0.91).
3.6.2 Test–retest reliability
Moreover, to verify the consistency of the retest, the researchers
calculated the Spearman–Brown coefficient of the statements,

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Table 2 Evaluation results of the content validity index (CVI) of the questionnaire
No. Phrase Relevancy Clarity Simplicity Specificity

1 I raise the limits of the alarms at the beginning of every shift 1 0.9 0.9 0.8
2 When a patient returns from a clinical procedure, I change the limits of their monitoring 0.9 0.8 0.8 0.8
alarm
3 I regularly readjust the limits of alarms based on the clinical symptoms of patients 0.9 0.9 0.8 0.8
4 Generally, I hear a certain amount of noise in the ward 0.8 0.9 0.9 0.8
5 I believe much of the noise in the ward is from the alarms of the monitoring equipment 0.9 0.9 0.9 0.9
6 I pay more attention to the alarms in certain shifts 1 1 1 1
7 In which shifts does the heavy workload in the ward prevent quick response to alarms? 0.7 0.9 1 0.7
8 When alarms go off repeatedly, I become indifferent to them 1 1 1 0.9
9 In the night shift, I deactivate the alarms for patients to have peace 1 1 1 0.9
10 As soon as I hear an alarm, I check the patient 1 1 1 1
11 The alarms make me nervous 0.8 0.9 0.9 0.8
12 I react differently to the low-volume (yellow) and high-volume (red) alarms of the 0.8 0.9 0.9 0.8
ventilator
13 I respond immediately only to constant red alarms 1 1 1 1
14 In your opinion, which of these alarms are more important in terms of patient safety in 0.7 0.7 0.5 0.6
ICU? Arrange 5 alarms from most important to least important
15 How do you usually react to the alarms you listed above (previous question)? 0.5 0.6 0.5 0.6
16 Based on your experience with monitoring alarms, what steps can be taken to improve 0.5 0.5 0.6 0.5
clinical care?

Table 3 Results of the retest and internal homogeneity of the ICU nurses’ alarm fatigue questionnaire
No. Statement Factor 1 Factor 2

2 I regularly readjust the limits of alarms based on the clinical symptoms of patients
5 I turn off the alarms at the beginning of every shift
6 Generally, I hear a certain amount of noise in the ward
7 I believe much of the noise in the ward is from the alarms of the monitoring equipment
8 I pay more attention to the alarms in certain shifts
9 In some shifts the heavy workload in the ward prevents my quick response to alarms
10 When alarms go off repeatedly, I become indifferent to them
12 Alarm sounds make me nervous
14 I react differently to the low-volume (yellow) and high-volume (red) alarms of the ventilator
16 When I’m upset and nervous, I’m more responsive to alarm sounds
17 When alarms go off repeatedly and continuously, I lose my patience
18 Alarm sounds prevent me from focusing on my professional duties
19 At visiting hours, I pay less attention to the alarms of the equipment
Kaiser–Meyer–Olkin measure of sampling adequacy = 0.747; Bartlett’s test of sphericity = 1523.845, P \ 0.0001; test–retest correlation
coefficient = 0.99; Guttman split-half correlation coefficient = 0.79; Cronbach’s alpha = 0.91

which was found to be very good (Spearman–Brown coeffi-
cient = 0.99) for the entire scale (Table 3).
4 Discussion
In view of the importance of recognizing alarm fatigue in
nurses and its consequences for nurses and patients alike,
and considering the lack of a proper instrument for
measuring alarm fatigue, the present study aimed to
develop an ICU nurses’ alarm fatigue questionnaire. The
face validity and content validity (quantitative and quali-
tative validity), internal homogeneity (Cronbach’s alpha),
and consistency (test–retest) of the questionnaire were
confirmed. PCA was used for item reduction and reliability
analysis of the instrument.
So far, there have not been any instruments exclusively
designed for measuring alarm fatigue, and the available

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Table 4 Rotated Factor Matrix
Factor
1 2
Q2 before 0.842
Q5 before 0.679
Q6 before 0.996
Q7 before 0.624
Q8 before 0.816
Q9 before 0.849
Q10 before 0.831
Q12 before 0.652
Q14 before 0.435
Q16 before 0.765
Q17 before 0.730
Q18 before 0.573
Q19 before 0.750
instruments are intended for collecting data from patients’
monitoring alarms and improving patients’ alarm-related
safety. Moreover, the validity and reliability of the avail-
able instruments have not been tested, and the instruments
have been designed for use in certain hospital wards and
are not transferable to all wards where patient monitoring
devices are used. One of the instruments which has been
designed for collecting data from patients’ monitoring
equipment alarms consists of only 6 items which address
type of alarm, alarm description, the number of times an
alarm goes off, alarm response time, personalizing alarm
parameters, and explanation, and does not deal with alarm
fatigue [2]. Another questionnaire which is intended for
surveying hospital staff in order to improve alarm-related
patient safety consists of 5 questions: question 1 is a yes/no
question and deals with adjusting the limits of alarms; in
question 2, nurses are asked to rank the amount of noise in
the ward and the contribution of alarms to the noise from 1
(least) to 5(most); in question 3, nurses are asked to list five
alarms which they believe are most important; in question
4, nurses should describe their usual response to the alarms
they listed in the previous question; and the last question,
which is optional, asks for nurses’ suggestions about alarm
management [16]. The questionnaire used by HTF con-
sisted of several items and the participants’ responses
reflected to what extent they agreed with each statement.
The initial part consists of 19 general statements about
clinical alarms. The last section contains 9 items about
issues that inhibit effective management of clinical alarms.
No information is provided about the reliability and
validity of the instrument [17]. The instrument used by Cho
et al. is a two-part questionnaire. Part one, which consists
of 14 items about the respondent’s knowledge of alarms
made by clinical equipment, is based on the questionnaire
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J Clin Monit Comput (2017) 31:1305–1312
of Healthcare Technology Foundation (HTF) translated
into Korean. Part two consists of 9 items about barriers to
handling alarms effectively which are extracted from two
other sources in the literature [18]. The validity and relia-
bility of the instrument are assessed only based on the
content validity index and Cronbach’s alpha coefficient
respectively.
It is evident that the above-mentioned instruments lack
exclusivity for measuring alarm fatigue. The questionnaire
developed in the present study, however, exclusively
addresses alarm fatigue. In addition to evaluating nurses’
attitude, the instrument used by Sowan et al. [26] includes
a few items about nurses’ performance with regard to new
cardiac monitors; however, the face validity of the
instrument has been examined by only 4 expert ICU
nurses and the other monitoring devices in the ICU are
not dealt with.
Though a number of studies have addressed ICU nurses’
attitudes and practices related to clinical alarms, in none of
them is a reliable and valid instrument used. Most of these
studies use the instrument developed by HTF whose reli-
ability and validity have not been verified. In the present
study, to perform a psychometric analysis of the instru-
ment, the researchers used two methods of face validity
(the quantitative and qualitative approaches), content
validity (CVI and CVR), test–retest reliability, Cronbach’s
alpha, and Principal Component Analysis (PCA); also, the
instrument addresses all monitoring audible clinical
devices.
Moreover, the Likert scale used in the commonly-used
instruments ranges between ‘‘agree’’ and ‘‘disagree’’; the
problem with this is that a respondent may agree with an
item but not actually act as stated in the item, which can
prevent the results from being a reflection of the real sit-
uation. This may account for the fact that there is not a
significant difference between the results of the two sur-
veys conducted by Funk et al. (HTF). In the instrument
developed in the present study, however, the Likert scale
used assesses the respondents’ performances rather than
their attitudes.
Even though some of the above-mentioned studies have
used very large sample sizes, the instruments used to
measure alarm fatigue in nurses have not been accurately
tested for reliability and validity.
Validity is the extent to which a method or instrument is
accurate in measuring a certain characteristic. In the pre-
sent study, the researchers evaluated both the face validity
and content validity (CVR and CVI) of the designed
questionnaire, which resulted in the deletion of 3 state-
ments and revision of one. The average content validity
index (S-CVI/Ave) of the questionnaire was found to be
0.92, which is a satisfactory value (according to Polit and
Beck, values of 0.90 and above are acceptable for S-CVI/
J Clin Monit Comput (2017) 31:1305–1312
Ave) [27]. Thus, in terms of content validity, the ICU
nurses’ alarm fatigue questionnaire developed in the preset
study is valid.
Reliability is defined as the homogeneity of respon-
dents’ scores for a set of items as obtained in two separate
situations or based on two equivalent instruments. In the
present study, the researchers evaluated the internal
homogeneity (Cronbach’s alpha), consistency (test–retest),
and item reduction of the developed questionnaire. The
Cronbach’s alpha coefficient of the questionnaire was
found to be 0.91, which shows that the items of the ques-
tionnaire have high internal homogeneity. Thus, the relia-
bility of the ICU nurses’ alarm fatigue questionnaire was
confirmed. The consistency of the questionnaire was tested
based on the test–retest method: the results of the two tests
with a 14-day interval were found to be very good
(Spearman–Brown coefficient = 0.99), and the question-
naire was found to be consistent.
The score range of the developed questionnaire is
between 8 (minimum) and 44 (maximum), with higher
scores indicating a greater impact of alarm fatigue on
nurses’ performance. Each item on the questionnaire is
scored from 0 (‘‘never’’) to 4 (‘‘always’’), except items 2,
and 14 which are scored reversely.
As this is the first attempt at developing and evaluating
the psychometric characteristics of an ICU nurses’ alarm
fatigue questionnaire, the present research project is inno-
vative in Iran. The fact that the present study was con-
ducted on the ICU nurses in Iran limits the transferability
of the results: the results cannot be applied to all nurses.
Therefore, the researchers suggest that further studies be
conducted with larger numbers of participants and across
different countries.
The designed questionnaire, in its final form, consists of
13 items on the 5-point Liker scale (never, rarely, occa-
sionally, usually, and always). The questionnaire is inten-
ded for measuring ICU nurses’ alarm fatigue, and has been
designed based on an extensive literature review and sev-
eral experts and nurses’ comments.
5 Conclusion
In the present study, a questionnaire was designed in Iran
for measuring nurses’ alarm fatigue. The results of the
study show that the validity and reliability of the ques-
tionnaire are satisfactory. It should be noted that this
questionnaire is easy to use and can be completed in about
10 min. Therefore, this psychometric questionnaire is
efficient enough for measuring nurses’ alarm fatigue and
can be used in the development of programs for reducing
alarm fatigue-related problems and issues.
1311
Acknowledgements The present article was extracted from the M.S.
thesis of the second author. The thesis has been approved by the
committee of ethics at Shiraz University of Medical Sciences, Shiraz,
Iran (Registration No. 93-7362) and recorded at the Iranian Registry
of Clinical Trials under the code: IRCT2014080818734N1. The
authors would like to thank all the nurses who voluntarily participated
in this study. The authors would like to thank Mr. Mohammadreza
Gheisari for translating the text into English.
Compliance with ethical standards
Conflict of interest The authors declare that they have no conflict of
interest.
Ethical approval All procedures performed in studies involving
human participants were in accordance with the ethical standards of
the institutional and/or national research committee and with the 1964
Helsinki declaration and its later amendments or comparable ethical
standards.
Human and animal rights This article does not contain any studies
with animals performed by any of the authors.
Informed consent Informed consent was obtained from all individ-
ual participants included in the study.
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