112 Chapter 4 Context Several contextual factors might have substantially influenced the implementation of TIMBER and the primary outcomes. After moving to the new hospital in May 2018, many nurses felt disappointed, as their high expectations for the promised ‘smart hospital’ were not met. The hospital emphasized sustainability and technological integration. For example, bedpan washers were replaced with shredders capable of processing almost all waste – from regular disposables, to drains to special bedpans - but these frequently required technical maintenance. On top of this, nurses were already frustrated by the loss of a space where they could retreat. Additionally, nurses transitioned from caring for patients in fourperson rooms to single rooms. Initially, this caused feelings of uncertainty, as nurses had less immediate overview of all their patients. Previously, entering a room meant seeing four patients at once, which also provided a form of social control. Now, nurses had to check four separate rooms to get an overview of four patients. They needed to build trust in this new work environment. Promises were made that fall-risk patients could be monitored with the smart functions in the beds, but the smart beds arrived 1 year after the move. All these factors did not contribute to quickly accepting and embracing new innovations, but resulted in a feeling of frustration among nurses, as they were disappointed in the new ‘smart hospital’. After the introduction of the beds, connectivity issues emerged. While a Wi-Ficonnection was expected to be implemented shortly after the beds were introduced, it proved more challenging than anticipated, partly because the IT department had not been involved from the start. During both measurement periods, connectivity to the nursing call system could only be achieved with a 16-pin communication cable. However, observations revealed that the beds were rarely equipped with this cable. Even when a communication cable was available, the connector was often damaged. As a result, features such as the fall-detection alarm frequently only functioned in the patient’s room, rather than integrating with the nurses' call system. Nursing is inherently a multitasking profession, and obtaining a reliable weight measurement can be challenging when combined with other tasks, such as taking vital signs and engaging with the patient. The bed’s weighing function not only measures the patient's weight but also account for everything on the mattress, including side rails, and the footboard. To ensure accurate calibration, it was agreed that the bed should contain only one pillow, one blanket, and one sheet. The weighing function is calibrated upon the bed’s arrival in the patient’s room. During the observations, only 26 beds (13%) in 2020 and 92 beds (37%) in 2023 had only one pillow, one blanket, and
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