How Fatigued Are ICU Professional Nurses in Chinese Public Hospitals Due to Equipment Alarms? Cross-Section Study from Beijing’s Tertiary Hospital, China, 2022
and Ying Bian 1,3,5,*Round 1
Reviewer 1 Report
Comments and Suggestions for Authors
Dear Authors,
Congratulations on the choice of topic, which is highly relevant to nursing practice.
I am sharing my suggestions below.
The introduction provides a relevant overview of the issue of alarm fatigue in ICUs, highlighting its impact on nurses' performance and patient safety. The text effectively contextualizes the concept of alarm fatigue and its global relevance but could be more direct in certain parts. In this section, the study’s objective could be reinforced by emphasizing which gaps in the existing literature this work aims to address. This would help better connect the practical and academic significance of the research.
The methodology section is well-structured and provides a detailed description of the study design, participants, data collection instruments, and statistical analysis methods. However, we suggest reorganizing the subtitles for greater clarity. It would also be helpful to specify how the variables were operationalized, clearly indicating which were dependent and independent variables and how they were measured. The use of tools such as the electronic questionnaire is well explained, but the description of the data quality assurance measures could be expanded to highlight the methodological rigor.
The results are presented clearly, supported by tables and figures that effectively complement the text. The description of participants' demographic characteristics is detailed, but the analysis could be more explicitly connected to the study's objectives.
The discussion is one of the article's strengths, linking the study findings with existing literature. However, the text could be reorganized to improve readability. Dividing the discussion into subtopics such as "Individual Factors," "Organizational Factors," and "Recommendations for Clinical Practice" would make the content more accessible. The analysis of factors associated with alarm fatigue, such as work intensity and mental health, is relevant but lacks concrete examples from the results to support the interpretations. Recommendations for practice, such as interventions to improve alarm settings and strategies to manage workplace stress, could be further detailed, emphasizing how these actions can be implemented in ICUs.
The conclusion effectively synthesizes the study's main findings but could more explicitly highlight the contributions of the work to clinical practice and future research. It would be valuable to emphasize how the results can guide practical changes, such as nurse training or revisions to alarm systems. Additionally, including a reflection on how this study's findings align (or diverge) from international research could enhance the conclusion’s relevance. The inclusion of a brief suggestion for future research would also strengthen the section, highlighting, for example, the need to explore other regions or variables.
Author Response
Please see the attachment.
Author Response File: 
Author Response.pdf
Reviewer 2 Report
Comments and Suggestions for Authors
Dear Author,
Congratulations on the work you have developed, which is both highly interesting and important for nursing and intensive care. However, certain aspects of the manuscript could be improved to make it clearer and to enhance its practical impact and the scope of its conclusions:
- I believe the introduction could be enriched with greater contextualization from an international perspective.
- Regarding the limitations of the study, I suggest expanding on the issue of geographical restriction, which may limit the generalizability of the findings to other regions of China or international contexts. Additionally, the inherent limitation of relying on a single questionnaire as the sole data collection instrument could be discussed further, as it may constrain the depth of analysis.
- As for the practical recommendations, I suggest including a more detailed analysis of the economic feasibility or long-term impact of the proposed interventions.
Author Response
Please see the attachment.
Author Response File: Author Response.pdf
Reviewer 3 Report
Comments and Suggestions for Authors
Abstract: too broad and not written according to the guidelines for authors.
It is stated that 412 questionnaires were distributed and that the response was 100%, which is very rare, especially since the survey was conducted in one day, 21 May 2022. This data should be in the methodology section, not in the abstract.
Introduction: in part 1.1.1. Current status of ICU nurse alarm fatigue internationally - all listed references are older than 10 years, except one
In general, the introduction is sufficiently informative and relevant. However, in some parts, it is too extensive. For example, a long description of the history of alarm fatigue could be more concise, emphasizing the most important points to make it easier for the reader to understand the context.
1.1.2. Error! Reference source not found..??
The goal of the research is clearly set.
Methodology: well structured with enough information
In the research subject section, it is stated: Finally, 412 nurses currently working in the ICU of Beijing's public tertiary hospitals were selected as research subjects. Including emergency care unit, respiratory intensive care unit, circulatory intensive care unit, neonatal intensive care unit, etc., it is of typical significance for studying nurses’ occupational fatigue.
In the data collection section, it is stated that the alarm record form was recorded by the researcher in person with the consent of the hospital department, according to the content of the form.
The abstract stated that the research was conducted in one day.
How is it possible for a researcher to personally document in several departments at the same time?
Results:
3.1. Distribution of sample characteristics: too much text with a very clear table, SD and median values ​​can be tabulated
Table 2 and Figure 1 give the same results, only presented differently, which additionally burdens the text and makes it difficult to follow
Discussion
4.1. Characteristics of ICU nurses - here, the age, gender, and educational structure of the respondents are shown in detail, but it is not stated how the mentioned characteristics affect the topic of the research, and one gets the impression that this part of the discussion is redundant in this scope.
Citations are limited to a few sources, which may suggest that relevant studies or recent data from the field are not sufficiently considered. The small number of citations may suggest reliance on the subjective judgments of the authors, which may lead to bias. In academic writing, relying on the wider literature contributes to objectivity and allows the reader to better assess the validity of the claims made.
Author Response
Please see the attachment.
Author Response File: Author Response.pdf
Reviewer 4 Report
Comments and Suggestions for Authors
Dear authors,
your research highlights an important issue, addressing alarm fatigue among ICU nurses in Chinese tertiary hospitals, which is critical for patient safety and nurse well-being. The use of validated tools (e.g., Chinese version of ICU Nurse Alarm Fatigue Scale) enhances the reliability of the findings.
The abstract is comprehensive but could be more concise. For example, the objective could be summarized in one sentence rather than two. Specifically, it would be helpful to divide the objective section into primary and secondary objectives.
The study highlights the issue of alarm fatigue but does not thoroughly explore how organizational or systemic factors (e.g., staffing ratios, hospital policies, or national healthcare standards) might exacerbate or mitigate this problem. Including these perspectives could enhance the analysis and provide insights into structural interventions.
Although the study briefly references global data, a more detailed comparison with international studies could improve the context. For example:
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How do false alarm rates in Beijing compare to those in other countries?
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What lessons can be drawn from international best practices for reducing alarm fatigue (e.g., the use of AI-driven alarm systems or team-based alarm response protocols)?
The study reports that 56.36% of alarms were false alarms. While this is consistent with previous findings, the analysis could delve deeper into the root causes of these false alarms:
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Are they primarily caused by technical issues (e.g., sensitivity settings) or by user behavior (e.g., improper parameter configuration)?
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What specific types of false alarms occur most frequently, and how can they be addressed?
Comments on the Quality of English Language
The language is clear, but simplifying some sentences could improve readability. Grammatical issues are minimal but present, such as the inconsistent use of singular/plural forms (e.g., "alarm sounds make me nervous" vs. "alarms sounds"). A professional proofreading session is recommended to refine the text for publication.
Author Response
Please see the attachment.
Author Response File: Author Response.pdf
Round 2
Reviewer 1 Report
Comments and Suggestions for Authors
Dear all,
The manuscript has been improved with the corrections made.
It can be accepted in its current form.
Author Response
Dear Reviewer,
I am truly overjoyed and deeply grateful to receive your approval. Your feedback and guidance throughout the review process have been instrumental in shaping this manuscript into its current state. Your recognition of the improvements made means a great deal to me and the entire research team.
If there are any additional administrative steps or requirements for the publication process, please do not hesitate to let me know.
Thank you once again for your time, expertise, and support.
Reviewer 2 Report
Comments and Suggestions for Authors
Dear Authors,
Thank you very much for the opportunity to review your work. I believe that my suggestions and comments have been addressed, and the study is now clearer, more rigorous, and more objective.
Author Response
Dear Reviewer,
I am extremely grateful for your time and effort in reviewing our work. Your in - depth suggestions and comments have been of great value to us during the revision process.
We are delighted to hear that you think our study has become clearer, more rigorous, and more objective after addressing your concerns. Your positive feedback is highly encouraging and gives us a great sense of accomplishment.
We sincerely hope to have the opportunity to work with you again in the future. If you have any further insights or suggestions, please feel free to let us know. We are always open to learning and improving.
Reviewer 3 Report
Comments and Suggestions for Authors
The authors have worked diligently to correct the paper; however, the abstract remains uncorrected and exceeds 500 words. As previously suggested, I recommend revising the abstract since such extensive information is unnecessary.
As I understand it, the journal has clear guidelines stating that the abstract should be a maximum of about 200 words.
Author Response
Please see the attachment.
Author Response File: Author Response.pdf
Reviewer 4 Report
Comments and Suggestions for Authors
Dear authors, the responses are generally well-structured and adequately address the reviewers’ comments. Some responses could be more explicit in detailing the changes made to ensure clarity. The overall quality of the paper has improved and is now suitable for publication, particularly thanks to the international comparisons and systemic interventions that were included in this revision.
Author Response
I would like to express my sincere gratitude for your meticulous and professional feedback on our manuscript. It is truly gratifying to know that our responses are generally well - structured and have adequately addressed the issues you raised. We will also pay more attention to making more detailed and clear explanations in the reply process in the future.
The improvement in the overall quality of this manuscript would not have been possible without your careful guidance. Your specific mention of the international comparisons and systemic interventions included in this revision as key factors contributing to the manuscript's suitability for publication is extremely encouraging. We have always been committed to contributing valuable research to this field, and your recognition is undoubtedly a great affirmation of our efforts.
Thank you again for your valuable comments and suggestions. I look forward to the opportunity of receiving your guidance in the future. Please feel free to contact us if there is anything else needed.
