Intensive Care Unit Nurses' Perceptions and Experiences of Clinical Alarms: A Systematic Review of Qualitative Evidence Using Meta‐Aggregation

BACKGROUND: Clinical alarm management is a critical patient safety challenge in intensive care units (ICUs). The high frequency of non-actionable alarms paradoxically undermines safety by contributing to alarm fatigue, increased cognitive load and delayed responses among nurses. AIM: To systematically synthesise and appraise qualitative evidence on ICU nurses' experiences, perceptions and coping behaviours regarding clinical alarms. STUDY DESIGN: A systematic review of qualitative evidence using meta-aggregation was conducted. A comprehensive search of eight databases (PubMed, Web of Science, Embase, CINAHL, CNKI, Wanfang, VIP and CBM) was undertaken from inception to December 2024. Included qualitative and mixed method studies were critically appraised using the Joanna Briggs Institute's Critical Appraisal Checklist. Data were synthesised using the meta-aggregation approach, and the confidence in the synthesised findings was assessed using the ConQual approach. RESULTS: Fourteen studies were included in the synthesis. The meta-aggregation produced four synthesised findings: (1) The Perceptual Paradox: Alarms as an Essential Safety Mechanism and a Clinical Burden; (2) Nurses' Alarm Response as an Evolving Practice of Situated Clinical judgement; (3) A Multi-level System of Nurses' Alarm Response: Individual, Contextual and organisational Factors; and (4) ICU Nurses' Expectations for Clinical Alarms: Intelligent Support, Practical Training and Sustained Autonomy. CONCLUSIONS: Effective alarm management is fundamentally a socio-technical challenge, rooted in a core perceptual paradox. Nurses navigate this paradox through situated clinical judgement, a process shaped by a multi-level system in which unit safety culture is pivotal. Therefore, sustainable solutions must integrate technological optimisation to reduce cognitive load, cultivate positive unit safety cultures and augment clinical expertise-thereby repositioning nurses from passive alarm responders into empowered clinical decision makers. RELEVANCE TO CLINICAL PRACTICE: The synthesised evidence suggests that interventions should prioritise competency-based, situational training to bridge the recognition-intervention gap, foster a non-punitive unit alarm safety culture to mitigate responder isolation and adopt a human-centred design paradigm for future technologies to reduce cognitive load and support, rather than replace, clinical expertise.