101 Barriers and Facilitators Associated with the Implementation of Technical Improvements in Medical Beds 4 Data collection For data collection the authors developed a Process Evaluation Tool (PET). The PET included questionnaires to explore patient and nurse experience, their use of specific functions, an observation checklist, and a topic list for interviews. The questions were selected based on literature [8] and expert opinion (DS, TK, MvD, EI), the observation checklist was based on expert opinion (DS, TK, MvD, EI, DS), hospital protocols and based on the specific functions. The topic list for the semi-structured interviews was guided by the TICD framework [13] and aimed to further explore barriers, facilitators, and contextual factors influencing implementation. The PET was piloted with 1 to 10 participants per data collection method. The pilot results were reviewed by the research team, and the final version was created after consensus. Data were collected one and four years after the introduction of the smart beds, 2020 and 2023 respectively, using the questionnaires and observation tools. For both timepoints, the target was to collect data from at least 50 patients, 100 nurses, and 150 bedside observations. At one year, TK and DS collected all data. At four years DS and nursing students collected the data. Questionnaires and observation lists were digitized and could be completed on an iPad or another preferred electronical device. Patients were given the option to complete the questionnaire themselves or with assistance from a data collector. Nurses were invited to complete the questionnaire by themselves during their shifts and were offered traditional Dutch cookies, “stroopwafels”, as a token of appreciation. At one-year, semi-structured interviews were conducted with stakeholders to deepen the understanding of the results from the questionnaires and observations. Stakeholders were selected based on criterion and purposive sampling [14]. Based on pre-determined criteria, stakeholders who were closely involved in the implementation of TIMBER were included, see table 2. Purposive sampling was then applied to select both the most active and less active key users, including sector managers, team managers, and nurses. The sampling focused on wards where TIMBER was expected to be successfully implemented as well as those where implementation was anticipated to be less optimal. Data analysis Quantitative data were analyzed using descriptive statistics and are presented as either mean (standard deviations) or median (interquartile range) for continuous variables, depending on whether the data were normally distributed or skewed. Categorical variables are summarized as percentages. Statistical analyses were performed using IBM SPSS Statistics for Windows, Version 28.0. Armonk, NY: IBM Corp.
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