{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T06:08:51Z","timestamp":1790143731710,"version":"4.0.1"},"reference-count":36,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T00:00:00Z","timestamp":1790035200000},"content-version":"vor","delay-in-days":264,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["72174209"],"award-info":[{"award-number":["72174209"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["72174316"],"award-info":[{"award-number":["72174316"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of Nursing Management"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Understanding nurses\u2019 clinical alarm\u2013related behaviors is crucial for enhancing patient safety in critical care settings. These settings operate under significant constraints that profoundly influence how nurses prioritize and respond to alarms. While suboptimal alarm management has been extensively studied in well\u2010resourced settings, research remains scarce in resource\u2010constrained settings. This study aimed to evaluate nurses\u2019 clinical alarm\u2013related behaviors and their associated factors in critical care units within resource\u2010limited contexts.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      An analytical cross\u2010sectional study was conducted among 434 nurses recruited via multistage stratified random sampling from five hospitals in Malawi. Data were collected using validated scales for alarm behaviors, knowledge, attitudes, fatigue, burnout, and resilience measurements. Data were analyzed using descriptive statistics, Pearson\u2019s correlation, and multiple linear regression with backward elimination to identify independent factors influencing clinical alarm\u2013related behavioral scores, with statistical significance set at\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.05.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The mean clinical alarm\u2013related behavioral score was 68.89\u2009\u00b1\u20099.72 out of 85. Factors independently associated with higher behavioral scores included working in the ICU (\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u2009=\u20095.47, 95% CI: 0.61 to 10.33,\n                      <jats:italic>p<\/jats:italic>\n                      <jats:italic>\u2009=\u2009<\/jats:italic>\n                      0.027), resilience (\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u2009=\u20090.18, 95% CI: 0.07 to 0.29,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.001), positive attitude (\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u2009=\u20090.36, 95% CI: 0.21 to 0.51,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.001), implemented alarm management protocol (\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u2009=\u20094.54, 95% CI: 2.83 to 6.24,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), and having experienced alarm\u2013related adverse events in the last 2\u2009years (\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u2009=\u20092.02, 95% CI: 0.28 to 3.75,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.023). Conversely, greater years of nursing experience (\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u2009=\u2009\u22120.39, 95% CI: \u22120.75 to \u22120.03,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.032) and higher knowledge scores (\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u2009=\u2009\u22120.93, 95% CI: \u22121.47 to \u22120.38,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001) were associated with lower behavioral scores. The model explained a substantial proportion of the variance in alarm\u2010related behaviors (\n                      <jats:italic>R<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u20090.673).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>These results indicate that effective alarm\u2010related behaviors extend beyond technical knowledge and competence and require multifaceted support. Interventions may benefit from comprehensive, system\u2010level strategies that integrate standardized protocols, tailored training to bridge knowledge\u2010practice gaps, resilience\u2010building program, and efforts to foster positive attitudinal shifts among nurses. Such targeted approaches hold strong potential to optimize clinical alarm\u2013related behaviors, mitigate risks such as delayed responses, and ultimately enhance patient safety in resource\u2010limited critical care environments.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Implications for Nursing Management<\/jats:title>\n                    <jats:p>The findings of this study call for nurse managers and hospital administrators to consider implementing debriefing protocols following any alarm\u2010related incident. By reinforcing positive attitudes (through leadership, peer support, and recognition) and integrating resilience\u2010building programs, these strategies may enhance proactive alarm behaviors and ultimately improve patient safety in resource\u2010limited critical care settings.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1155\/jonm\/9349880","type":"journal-article","created":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T05:36:12Z","timestamp":1790141772000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Nurses\u2019 Clinical Alarm\u2013Related Behaviors and Their Associated Factors in Malawian Critical Care Units: A Cross\u2010Sectional Study"],"prefix":"10.1155","volume":"2026","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-3382-2455","authenticated-orcid":false,"given":"Chimwemwe 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