102 Chapter 4 The semi-structured interviews were audio-recorded and transcribed verbatim. The transcriptions were anonymized where feasible, although this was challenging due to small size of most stakeholder groups. Data saturation was expected after 10 interviews and was reached by the ninth. The qualitative analysis was based on deductive content analysis as described by Elo and Kyngas [15], with the support of ATLAS.ti 22 software (ATLAS.ti Scientific Software GmbH, Version 22, 2021). Data from the open-ended responses from the questionnaires were also included in the analysis. Researchers (DS, TK) familiarized themselves with the data by reading and re-reading the transcripts. DS conducted a deductive coding process using the seven domains outlined by Flottorp et al. [13] supplemented with open coding if needed. Coding definitions and content were discussed and refined collaboratively with TK to ensure agreement. Illustrative quotes were selected by DS and translated into English by an experienced translator. Ethical considerations The Medical Ethics Committee of the Erasmus University Medical Center determined that this study did not fall under the scope of the Medical Research Involving Human Subjects Act (MEC-2020-0093). The research was conducted in accordance with the principles outlined in the declaration of Helsinki. Patients received a participant information letter and were asked to provide digital consent for completing the questionnaires and participating in observations, where feasible. Nurses provided digital consent for the questionnaires, while written consent was obtained from participants involved in the interviews. Results Participants During the two data collection periods, 445 observations were conducted, with 369 patients participating and 209 nurses completing the survey, including 26 key users. Demographic data are presented in table 1. The number of participants per ward ranged from 2 to 25. The nurses’ age ranged from 16 to 64 years, with a median age of 27 in 2020, and 29 in 2023. Most nurses were female, only 7%-17% of the nurses were students. The median of the weekly working hours was 32 (IQR 27-36). The key-users had a median age of 49.5 (IQR 32.5 - 59) years. Eleven stakeholders participated in a total of twelve interviews. The clinical advisor from the manufacturer was interviewed twice, with the second interview focusing specifically on the execution of the implementation plan. The interviews lasted 13 to
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