Degree of Alarm Fatigue and Mental Workload of Hospital Nurses in Intensive Care Units

Round 1

Reviewer 1 Report

This topic is globally relevant and applies to many critical units in hospitals, thus an important topic. The article is well written and raises awareness of the issue.  Alarm fatigue could be directly related to safety, which you discussed in the aspect of performace correlation to alarm fatigue.  The scientific methodology is fine.

The aspect of cultural considerations (related to Korean culture) was only mentioned in the limitations, and this could have been expanded upon in the introduction or discussion, to see if there are aspects unique or specific to that culture. 

In addition, it would be helpful to suggest areas of research that could lead more closely to answers for how to address the alarm fatigue. These are not major gaps, however it could influence generalizability and prompt further research to help the staff in coping with alarm fatigue. Overall, this is a well-prepared paper!

Author Response

See Attachment

Author Response File: Author Response.pdf

Reviewer 2 Report

I found an error in the data reporting:

Lines 229-230.

Why would mental workload be higher when caring for fewer patients? The authors wrote:

"The mental workload was higher when the number of patients cared for per person was two, versus when there were three or more (t = 2.001, p = .048; Table 3)."   I think the authors worded that incorrectly. There is a higher workload score (82.32) for those with >3 pts than for those with 2. You indicated "The higher the score, the higher the mental workload." when describing the tool. A score of 82 with >3 pts is certainly higher than a score of 73.9

What you wrote should be reworded to: "The mental workload was higher when the number of patients cared for per person was >3 versus when there were 2 (t = 2.001, p = .048; Table 3). 

Author Response

See Attachment

Author Response File: Author Response.pdf

Reviewer 3 Report

It was a pleasure reading your work. While the intent and merit exist, i found your writing style a little bland and lacking engagement and scholarly critique. Overall, the research shows rigour and underwhelming findings, yet, could be improved significantly regardless. Find below specific comments.

Introduction

 

 

I find your introduction lacking adequate information and literature review to engage readership with regards to the concepts and objectives you want to explore in your study. Making blanket statements about concepts is not enough to capture your readers if you don’t provide the significance/uniqueness of the problem, the gaps in research/practice and how your study will attempt to bridge these identified gaps.

 

 

“The alarm was designed to monitor the patient's condition in real-time and to rapidly identify”

 

“Alarm fatigue defined is the sensory overload and desensitization that make nurses respond to real threats”

 

Your definition of alarm fatigue is wrong and doesn’t eloquently and simply describe the phenomenon. The desensitization makes nurses not able to respond to real threats in a timely manner and not the other way around.

Also, if you have to explain a concept in many words shows you don’t fully comprehend the concept. The whole paragraph from Line 38 to 54 could be summarised in in tersely worded sentences and not an essay like description.

 

I didn’t quite catch your working definition for mental workload and only assumed it from the description. Can you provide a working definition for this and why, how it has been correlated with alarm fatigue in studies?

 

Methods

“Nurses in the general ward, delivery room, recovery room, and operating room were excluded from the study because the frequency of exposure to the alarm sound differed significantly from that of the ICU nurses.”

 

Differed in what direction? More or less exposure to alarms?

 

Discussion

 

“The participants in this study had a high overall alarm fatigue score; however, they showed low scores for these two items. That is, if the alarm fatigue score is high, nurses may not immediately respond to the alarm. Conversely, this study’s participants reported that they responded immediately.”

 

I find these sentences to be incoherent and conflicting. Can you explain it further or revise?

 

“This finding contradicts a study showing that 81% of nurses had a delayed response to the alarm sound or deactivated the alarm sound when they experienced alarm fatigue.” This is intuitive to numerous studies and I don’t find it contractive. My concern is why do nurses respond immediately  when the alarm fatigue score is high? What factors in the ICU influence this response. What could have biased the responses to this question. It would be interesting to know for future directions

 

Author Response

Please refer to the attached file

Author Response File: Author Response.pdf