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. 2025 Mar;30(2):e70002.
doi: 10.1111/nicc.70002.

The impact of alarm fatigue on patient safety climate among nurses: The mediating role of moral courage

Özlem Soyer Er  1 , İsa Gül  2
Affiliations

The impact of alarm fatigue on patient safety climate among nurses: The mediating role of moral courage

Özlem Soyer Er et al. Nurs Crit Care. 2025 Mar.

Abstract

Background: Alarm fatigue negatively impacts nurse well-being and patient safety. Exposure to many alarms causes nurses to become unresponsive to alarms. However, nurses with moral courage are expected to take alarms seriously and maintain patient safety despite challenging circumstances.

Aim: This study aimed to determine the mediating role of moral courage in the relationship between alarm fatigue and patient safety climate among surgical ICU and OR nurses.

Study design: This was a cross-sectional study. The study sample consisted of 268 nurses who had worked in hospital surgical ICUs and ORs for at least 6 months, volunteered to participate in the study. Data were collected between April and May 2024, using the Alarm Fatigue Questionnaire, the Nurses' Moral Courage Scale, and the Patient Safety Climate Questionnaire. Data were analysed using descriptive statistics, correlation, and mediation analyses. The study adhered to the STROBE checklist.

Results: Nurses' alarm fatigue score was 15.45 ± 6.20, moral courage score was 4.11 ± 0.56, and patient safety climate score was 3.69 ± 0.60. Scale scores significantly differed between surgical ICU nurses and OR nurses. Alarm fatigue negatively affected both moral courage and patient safety climate. Moral courage positively affected patient safety climate. The study confirmed the mediating effect of moral courage on the relationship between alarm fatigue and patient safety climate.

Conclusions: Alarm fatigue among ICU and OR nurses is a risk factor that threatens the patient safety climate. Moral courage can reduce the negative impact of alarm fatigue on the patient safety climate. This courage makes nursing practice safer and raises the standard of care.

Relevance to clinical practice: Moral courage was found to contribute positively to the relationship between alarm fatigue and patient safety climate. It is recommended that nurse managers focus their efforts on reducing alarm fatigue and increasing moral courage at the unit level to improve patient safety climate.

Keywords: alarm fatigue; intensive care; moral courage; operating room; patient safety climate.

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References

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