Annoyance by Alarms in the ICU: A Cognitive Approach to the Role of Interruptions by Patient Monitoring Alarms

Nurses rely on patient monitoring systems for care delivery in ICUs. Monitoring systems communicate information to nurses and alert them through audiovisual alarms. However, excessive numbers of alarms often interrupt nurses in their tasks, and desensitize them to alarms. The affective consequence of this problem is that nurses are annoyed and feel frustration towards monitoring alarms. This situation leads to stress on nurses and threatens patient safety. Literature on sound annoyance distinguishes between annoyance induced by bottom-up (perceptual) and top-down (cognitive) processing. Extensive research on perceptual annoyance informs us on how to alleviate the problem by better sound design. However, addressing the cognitive aspect requires a broader understanding of annoyance as a construct. To this end, in this paper we distinguish between the annoyance induced by sensory unpleasantness of alarm sounds, and annoyance induced by frequent task interruptions. We present a conceptual framework in which we can interpret nurses’ annoyance by monitoring alarms. We further present descriptive analysis of the occurrence frequency of patient monitoring alarms in a neonatal ICU to illustrate the current state with regards to alarms. We aim to support nurses’ organizational well- being by providing an alternative hypothesis to explaining nurses’ affective states caused by auditory alarms. Future research can benefit from this paper through understanding of the context and familiarizing with the cognitive processes relevant to processing of patient monitoring alarms.