Alarm Fatigue Linked to Compassion Fatigue in Surgical ICUs 

• In ICU
• Tue, 14 Oct 2025

Intensive care units rely on dense constellations of monitors, ventilators and infusion devices that generate frequent alarms to protect patients. Persistent exposure to these sounds can desensitise clinicians and reduce responsiveness, a phenomenon described as alarm fatigue. In parallel, sustained emotional demands and exposure to suffering can erode the capacity for empathy, leading to compassion fatigue. Evidence from two hospitals examined the relationship between these pressures among surgical intensive care nurses. The analysis focused on quantifying alarm fatigue and compassion fatigue, exploring their association and assessing whether demographic or work pattern variables influenced outcomes. The findings highlight an independent link between alarm burden and emotional exhaustion, with implications for nurse well-being and patient safety in technologically intensive settings. 

Study Design and Measures 

A descriptive, cross-sectional correlational design was conducted in July–August 2024 across one university hospital and one state hospital in Türkiye. The target population comprised 189 nurses working in surgical intensive care units. Using a proportionally stratified consecutive approach, researchers approached on-duty nurses who met inclusion criteria of at least 12 months of cumulative experience in a surgical intensive care unit. Usable data were collected from 162 nurses, exceeding the minimum sample size of 151 calculated with finite-population correction to strengthen statistical power. 

Data collection was performed face to face, guided by ethics approvals and written informed consent. Three instruments were administered. A 14-item demographic and work characteristics form captured age, sex, marital status, education, unit type, intensive care tenure, overall professional experience, shift pattern, monthly hours, patient load, job satisfaction, distress from alarms and prior training in alarm systems. Alarm burden was measured with the 10-item Alarm Fatigue Scale (AFS), scored 0–4 per item to a total of 0–48, higher scores indicated greater alarm fatigue. Internal consistency for the AFS in this cohort was α = 0.77. Compassion fatigue was measured with the 13-item Compassion Fatigue Short Scale (CFSS), scored 1–10 per item to a total of 13–130, with subscales for secondary trauma and occupational burnout, internal consistency in this cohort was α = 0.91. 

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Analyses in SPSS 27 included descriptive statistics, normality testing via Kolmogorov–Smirnov and skewness/kurtosis thresholds, Pearson correlations and linear regression. Correlation strength thresholds classified coefficients as high (≥ 0.60), moderate (0.30–0.59) or weak (< 0.30). Significance was set at p < 0.05 with listwise deletion for minimal missingness. 

Work Patterns and Fatigue Levels 

Participants were predominantly 27–34 years of age (56.8 %), male (61.7 %) and married (53.1 %), with most holding a Bachelor’s degree (61.1 %). Intensive care tenure clustered at 1–4 years (53.7 %) and overall professional experience at 5–8 years (48.1 %). The vast majority worked both day and night (93.2 %), most on 24-hour shifts (84.0 %). Nearly half reported 160–208 hours per month (49.4 %) and a patient load of 1–2 patients (70.4 %). Just over half reported enjoying their job (51.9 %). Regarding alarms, 49.4 % were partially disturbed and 38.9 % reported feeling very uncomfortable. Most had not received alarm systems training (64.8 %). 

AFS scores indicated a below-median but notable burden: mean total 23.77 ± 7.26, with subscale means of 11.20 ± 2.73 for positive response and 12.56 ± 6.28 for negative reaction. CFSS scores reflected moderate compassion fatigue: total 62.82 ± 26.66, comprising 22.36 ± 10.93 for secondary trauma and 40.46 ± 17.52 for occupational burnout. Across demographic and work variables, no statistically significant correlations were identified with either alarm fatigue or compassion fatigue totals. 

Subscale relationships suggested divergent patterns between constructive and maladaptive alarm responses. Positive response behaviour demonstrated weak negative correlations with occupational burnout (r = −0.204, p < 0.05) and with total compassion fatigue (r = −0.158, p < 0.05), and no significant association with secondary trauma. In contrast, negative reaction behaviour correlated moderately and positively with secondary trauma (r = 0.419, p < 0.01), occupational burnout (r = 0.374, p < 0.01) and total compassion fatigue (r = 0.417, p < 0.01). These patterns indicate that how nurses interact with alarm systems may align with differences in emotional strain. 

Association Between Alarm and Compassion Fatigue 

The central relationship of interest—between overall alarm fatigue and overall compassion fatigue—showed a moderate positive correlation (r = 0.302, p < 0.01). Linear regression confirmed an independent association. Alarm fatigue exerted a positive, weakly significant effect on compassion fatigue, with an R² of 0.091 (F = 16.04; p < 0.05), indicating that approximately 9 % of the variance in compassion fatigue scores was explained by alarm fatigue levels. The standardised beta coefficient for alarm fatigue was 0.30 (p < 0.05), supporting the direction and strength of the association observed in correlations. 

Taken together, these findings situate alarm exposure not only as an operational stressor but also as a contributor to emotional depletion in surgical intensive care environments. The absence of significant relationships between fatigue measures and variables such as age, sex, education, shift type, tenure, monthly hours or patient load suggests that the association is not readily attributable to the measured demographics or scheduling factors in this sample. The subscale results reinforce the notion that negative patterns of alarm interaction align with higher secondary trauma and burnout scores, while positive response behaviours align with lower emotional strain. 

Nurses in surgical intensive care settings reported moderate compassion fatigue and a measurable burden of alarms below the median of the AFS scale, with no clear sociodemographic or scheduling correlates. Alarm fatigue correlated moderately with compassion fatigue and independently explained a modest proportion of its variance. Subscale patterns indicated that maladaptive alarm responses align with higher secondary trauma and burnout while constructive responses align with lower emotional strain. These results underline the relevance of alarm burden as a determinant of nurses’ emotional well-being in technologically dense environments. Healthcare organisations may consider prioritising alarm management training, optimisation of alarm settings and measures that support mental health to address the identified association and protect patient care quality. 

Source: BMC Nursing 

Image Credit: Freepik

References:

Katran HB, Özdere B, Eti Aslan F (2025) An investigation of the relationship between alarm and compassion fatigue in surgical intensive care nurses: a cross-sectional study. BMC Nurs; 24, 1226.