Table 3: Percent of nurse responses to competence on physiologic monitors use items organized by subscales and confidence level (N=30).

Item No. Assessment items by subscale Percent of nurses (%)
Confident Neutral Not confident Never used
1. Admit, Discharge, and Transfer Patient
1 Discharge patient from central and beside monitors 87 0 13 0
2 Admit patient to central and bedside monitors 87 3 10 0
3 Transfer patient from central and bedside monitors 53 20 23 4
4 Edit patient information after admission 50 20 23 7
5 Resolve patient information mismatch (e.g., between X2a and bedside monitor, or bedside and central monitors) 33 44 23 0
2. Hardware and Connectivity
6 Connect monitor cables 83 0 17 0
7 Identify monitors’ major hardware components and connectors (SpO2b, NBPc, etc.) 80 3 17 0
8 Report device malfunctions to service personnel 70 3 20 7
9 Identify battery's power status of X2a monitor from display color (green, yellow, or red) 57 13 17 13
10 Clean, sterilize and disinfect monitors and monitors accessories 57 20 17 6
11 Describe the functions of alarm lamps and front panel color indicators (or LEDsd) 17 36 10 37
3. Alarm Management
12 Pause alarms and cancel the pause 93 0 7 0
13 Silence alarms 83 0 10 7
14 Know different types of parameters’ display and the meaning of waves and information in the display (e.g., arrhythmia, SpO2b, Respiration, etc.) 80 10 10 0
15 View all active alarm messages easily 80 3 17 0
16 Change alarm volume easily 80 3 7 10
17 Choose and change the source (e.g., Systolic, Mean, Systolic and Mean) of an alarm appropriately (e.g., pressure alarms source, NBP c, etc.) 77 13 10 0
18 Change alarm limits safely and appropriately 73 10 17 0
19 Change alarm limits easily 73 10 17 0
20 Identify and differentiate the priority (e.g., from crisis to advisory) and meaning of all physiologic alarm messages, based on visual and audible alarm indicators 73 10 17 0
21 Acknowledge and correct alarm messages appropriately 73 17 10 0
22 Identify and differentiate the priority and meaning of technical alarm messages (e.g., Check Equipment), based on visual and audible alarm indicators 70 13 17 0
23 Differentiate the source of each alarm (e.g., HRe Low alarm is from ECGf settings) 70 20 10 0
24 Customize default settings to patient specific 67 13 20 0
25 Troubleshoot common technical alarm messages (e.g., !!Check Patient ID) 57 17 23 3
26 Eliminate redundant alarms when changing default settings (e.g., if STg and STEh are selected, STEh will be redundant alarms) 53 17 27 3
27 Understand the monitor logic behind displaying different types of alarms (e.g., if there is an active ventricular bigeminy alarm, a PVCi > 6/min will NOT be triggered because it is lower in the same priority chain) 53 23 17 7
28 Know when you need to contact service personnel to correct technical alarms vs. when you need to troubleshoot the problem 50 17 23 10
29 Extend alarm pause time 30 17 23 30
30 Differentiate the behaviors of latching (alarm automatically will turn off when the condition no longer exists) vs. non-latching alarms (require nurse to turn alarm off even if the condition no longer exists) 17 33 10 40
4. Appropriate Monitoring
31 Place electrodes appropriately 97 0 3 0
32 Understand best practices in electrode placement (frequency of changing electrodes, skin preparation) 97 0 3 0
33 Change the NBPc measurement interval 97 0 3 0
34 Select the appropriate NBPc measurement modes (manual, auto, sequence, stat) 90 3 7 0
35 Store and send the 12-lead ECGf to the central monitor 90 3 7 0
36 Zero the pressure transducer 90 0 7 3
37 Put monitor into Standby mode and resume from Standby monitoring 90 7 3 0
38 Select appropriate invasive pressure label for monitoring (e.g., ABPj, ICPk, PAPl, Aom) 87 6 7 0
39 Change the size of a waveform 83 0 17 0
40 Select optimal SpO2b measurement site 83 4 13 0
41 Recognize elements and purpose of using monitors’ Screen Keys: (1) The four permanent keys (Silence, Pause Alarms, Main Setup, Main Screen), (2) smart keys, and (3) pop-up keys 80 13 7 0
42 Pick best primary and secondary leads for paced and non-paced patients 77 3 17 3
43 Navigate the different monitors' screens easily 77 6 17 0
44 Check beats annotation and relearn arrhythmia analysis 73 10 10 7
45 Adjust speed of different kinds of waves 67 6 20 7
56 Pick the appropriate lead for STg monitoring 67 16 7 10
47 Freeze and unfreeze waves 63 10 20 7
48 Recognize when specific monitoring is needed for specific patient cases (e.g., STg-Segment monitoring, QTn monitoring) 63 14 20 3
49 Recognize patient cases when specific monitoring is NOT recommended or clinically insignificant (e.g., in cases of setting STg or QTn monitoring) 63 21 13 3
50 Review trended patient data using screen trends 60 16 7 17
51 Explain the information displayed in trend windows 60 10 10 20
52 Use shortcuts to navigate monitor screens and keys efficiently (e.g., Select Quick Admit Smart Key to quickly admit a patient) 43 27 13 17
53 Differentiate/print patient reports available within the monitor 40 20 23 17
54 Temporarily disable/re-enable monitor touchscreen operation 33 24 23 20
5. Advanced Functions
55 View hemodynamic, oxygenation, and ventilation calculations 50 13 17 20
56 Perform parameters calculations 37 26 10 27
57 Access/use the drug calculator from the monitor 20 20 17 43
58 Manually enter some data into the monitor (e.g., lab results) 7 29 17 47
59 Use sepsis protocol and its guidelines that are within the monitor 3 21 13 63

aX2: is the transport monitor.
bSpO2: peripheral capillary oxygen saturation.
cNBP: noninvasive blood pressure.
dLED: light-emitting diode.
eHR: heart rate.
fECG: electrocardiogram.
gST: ST segment in the electrocardiogram.
hSTE: ST elevation.
iPVC: premature ventricular contraction.
jABP: arterial blood pressure.
kICP: intracranial pressure.
lPAP: pulmonary artery pressure.
mAo: aortic pressure.
nQT: QT segment in the electrocardiogram.