Physiotherapists’ attitudes and practices towards physiologic monitor alarms in critical care: A single-centre pilot study

BACKGROUND: Desensitisation to alarms, or alarm fatigue, is a concern for healthcare staff. Little is known about how physiotherapists relate to, or are affected by clinical alarms. This pilot study aimed to explore physiotherapists’ attitudes and practices towards physiologic monitor alarms (PMA) in critical care. METHODS: An online survey of physiotherapists with critical care experience working at a Model 4 Irish Hospital. A sample of convenience was used with all eligible physiotherapists invited to complete the online survey via email (n = 33). Demographic information was captured, as well as information on experiences, practices, and barriers and facilitators to managing PMA. RESULTS: The response rate was 76% (25/33). All respondents worked on-call and weekends, with one respondent managing a current day-to-day critical care caseload. The majority of respondents (20/25, 80%) perceived all PMA as clinically important, but a workplace distraction (19/25, 76%). Negative emotions were commonly experienced by respondents on hearing PMA. All respondents (25/25, 100%) reported to notice their patient’s PMA, feeling they had a responsibility to respond. Respondents indicated varying levels of self-confidence in responding to PMA but commonly assessed the cause of the alarm (24/25, 96%) and checked the patient’s condition (24/25, 96%). Education and training was identified as a key barrier and facilitator for physiotherapists in terms of managing alarms in critical care. CONCLUSION: This study provides preliminary data on physiotherapists’ attitudes and practices towards PMA in critical care. Additional studies are necessary in order to verify the findings of this pilot study and further explore alarm fatigue amongst critical care physiotherapists.

Sleeping Soundlessly in the Intensive Care Unit

An estimated 70% of patients who have been in the Intensive Care Unit (ICU) experience some form of Post-Intensive Care Syndrome (PICS). As a stressful environment, the ICU can be traumatic for any patient; however, the disruption of sleep experienced by patients in ICU negatively impacts their mental status and recovery. One of the most significant contributors to sleep disruption is the constant blare of monitor alarms, many of which are false or redundant. Through multisensory approaches and procedural redesign, the hostile acoustic environment of the ICU that causes so many to suffer from PICS may be alleviated. In this paper, we present suggestions for improving the ICU acoustic environment to possibly reduce the incidence of post-ICU complications such as PICS.

Parental stress: a neglected entity

Background: Parents feel very stressed when their child is sick and in Intensive care unit. Objectives of study were to identify common parental stressors during their child’s critical illness and to examine its relationship with demographic variables.Methods: It’s a Cross-sectional questionnaire based study done in PICU & NICU of a tertiary care medical college hospital in Mumbai, 62 parents of children admitted to PICU and NICU for at least 24 hours were interviewed using the Parental Stress Scale. The demographic variables were also recorded.The data analyzed using Cluster Analysis, Kruskal Wallis test, Chi- square test and spearman correlation.Results: The main cause of parental stress was to witness the child’s sufferings (unresponsiveness/pain, procedures, tubes, monitors around child) (median of standardized score = 3.9, IQR = 0.5, p <0.005). The median of standardised stress score due to hospital environmental factors (monitor alarms, nurses, doctors around baby, other sick children) was 3.7 (IQR = 0.5) and that due to lack of intimacy with child was 3.6 (IQR =0.4). Age of parent inversely correlated with the level of stress (r = -0.638) and parents of infants were more stressed (p = 0.005). Number of children, socioeconomic status didn’t affect the stress levels.Conclusions: Young parents and parents of infants were more stressful. Socioeconomic status, residential area and parental sex didn’t affect stress. Few stress factors need remedial steps to meet parental needs. The clinician’s awareness about these stressors, may help to provide optimized family-directed care.