JMIR Publications

ABSTRACT

Background:

ICUs are alarm-dense environments where continuous physiological monitoring structures high-acuity nursing work. Although alarm fatigue is widely treated as a patient-safety concern, its trauma-related consequences for nurses—particularly through screen-mediated witnessing of instability and death—remain underexplored.

Objective:

This study explored ICU nurses’ experiences of digital gaze and digitally mediated vicarious trauma within alarm-monitoring ecologies and identified implications for alarm governance and affective-aware monitoring design.

Methods:

We conducted a qualitative interview study in an integrated ICU of a tertiary hospital in Hangzhou, China. Using purposive maximum-variation sampling, we recruited 15 ICU nurses (12/15, 80% female; ICU experience 1–22 years; staff nurses 11/15, 73%; team leaders 3/15, 20%; ECMO team member 1/15, 7%) between November and December 2025. Semistructured interviews were conducted in Chinese (40–60 minutes) in a private meeting room within the ICU, audio-recorded, transcribed verbatim, and deidentified. Data were analyzed using reflexive thematic analysis supported by NVivo 15 and reported following COREQ.

Results:

Four themes described a technology-shaped pathway from alarm visibility to trauma-related residue. Digital gaze captured compulsory presence and hypervigilance, perceived surveillance-linked performance anxiety, and fragmented attention under alarm-driven rhythm disruption. Digitally mediated vicarious trauma emerged through mechanized witnessing of dying (eg, waveform collapse and alarm silencing), disillusionment when “good numbers” did not translate into survival, and moral distress tied to sustaining “acceptable” parameters under constrained agency. Spatiotemporal intrusion reflected sensory residue and intrusive replay after shifts, heightened vulnerability via biographical resonance (eg, illness or family hospitalization), and residual strain sustained by digital tethering to workplace messaging. Resilience reconstruction and systemic implications included procedural defensiveness, compartmentalization, individualized meaning rebuilding, and calls for redesign (eg, graded alarms, trend-based alerts, buffering modes after high-impact events).

Conclusions:

ICU alarm-monitoring ecologies may generate trauma-related burdens through digitally mediated witnessing, accountability, and sensory intrusion—not workload alone. Digital gaze and digitally mediated vicarious trauma offer a trauma-informed sociotechnical lens to guide sustainable alarm governance and the design of affective-aware monitoring systems.