Effect of Progressive Muscle Relaxation and Nature Sounds on Alarm Fatigue in Intensive Care Unit Nurses: A Randomized Clinical Trial

BACKGROUND: Intensive care unit (ICU) nurses are exposed to numerous alarms, many of which are unnecessary and lead to alarm fatigue. This phenomenon, caused by desensitization to alarm sounds, reduces nurses' responsiveness to critical alerts and threatens both their well-being and patient safety. Alarm fatigue has been linked to elevated stress, burnout and errors in patient care, underscoring the need for effective interventions. Progressive muscle relaxation involves the gradual and systematic contraction and relaxation of different muscle groups throughout the body and nature sounds use for decrease stress and alarm fatigue. AIM: This study aimed to evaluate the effectiveness of progressive muscle relaxation (PMR) and exposure to nature sounds in reducing alarm fatigue among ICU nurses. STUDY DESIGN: A three-arm, parallel, single-blinded randomized controlled trial was conducted. RESULTS: Ninety-six ICU nurses from three hospitals in southern Iran, were randomly assigned to one of three groups: PMR (n = 32), nature sounds (n = 32) or control (n = 32). Alarm fatigue was assessed using a validated alarm fatigue scale at baseline, immediately after the intervention and 2 months post-intervention. Both PMR and nature sound interventions significantly reduced alarm fatigue among ICU nurses (p < 0.001). Between-group comparisons showed significant differences between the PMR and control groups (p < 0.001) and between the nature sound and control groups (p < 0.001). No significant difference was observed between the PMR and nature sound groups (p = 0.650). CONCLUSION: PMR and exposure to nature sounds significantly reduced alarm fatigue among ICU nurses, as reflected in lower fatigue scores. These interventions improved nurses' capacity to manage stress and fatigue, thereby supporting better job performance and enhanced patient safety. Given their simplicity and accessibility, both approaches represent promising strategies for addressing alarm fatigue in critical care settings. RELEVANCE TO CLINICAL PRACTICE: Progressive muscle relaxation and nature sounds may offer practical, non-pharmacological approaches to managing alarm fatigue among intensive care unit nurses. These interventions could be incorporated into nurses' work routines, although further research is needed to confirm their effectiveness and long-term benefits.