Factors Influencing NICU Nurses' Decision-Making Behaviour Regarding Monitor Alarms During Clinical Changes in High- Risk Neonates: A Multicentre Study

Background The global incidence of high-risk newborns is increasing. Decision-making by neonatal intensive care unit (NICU) nurses regarding monitoring alarms directly impacts neonatal outcomes. However, clinical studies indicate a low rate of correct alarm decisions, and the influencing factors have not been systematically investigated. Methods A multicentre cross-sectional study design was employed. Between January and March 2025, an online survey via the Wenshu Xing platform was conducted among 359 NICU nurses across 10 Chinese hospitals. The questionnaire comprised sections on nurse demographics, self-assessed knowledge of high-risk neonatal monitor alarms, decision-making behaviours during alarm events when neonatal conditions deteriorate, and items regarding the impact of frequent monitor alarms on nurses' daily work. Descriptive analysis, chi-square tests, analysis of variance, and multiple logistic regression were conducted via SPSS 26.0 software. Results A total of 359 valid questionnaires were retrieved, representing a 100% response rate. Nurses' decision-making behaviours during critical monitoring alerts were categorised as follows: 81.3% initiated immediate intervention, 6.7% sought peer assistance, and 12.0% opted for no intervention. Multivariate logistic regression analysis revealed that nurses seeking peer assistance were more likely to have lower educational attainment (OR = 0.294, 95% CI: 0.110–0.784) and lower scores in the vital signs knowledge dimension for emergency interventions (OR = 0.615, 95% CI: 0.399–0.947). Nurses who chose not to intervene were more likely to have lower educational attainment (OR = 0.455, 95% CI: 0.209–0.990), not combine clinical assessment with monitor alarms (OR = 0.376, 95% CI: 0.184–0.769), and have lower scores in the knowledge dimension of vital signs for emergency intervention (OR = 0.782, 95% CI: 0.625–0.978) and close observation (OR = 0.762, 95% CI: 0.602–0.963), with lower scores in the vital signs knowledge dimension (all P < 0.05). Conclusion NICU nurses' decision-making regarding alarms for high-risk neonates is influenced by educational background, clinical assessment capabilities, and knowledge levels. It is recommended that clinical decision-making quality be enhanced and that neonatal outcomes be improved through stratified training, the optimisation of alarm systems, and the incorporation of decision-making indicators into nursing quality management.