JMIR Publications

ABSTRACT

Background:

Currently, older adults account for approximately two-thirds of hospital admissions, with up to 50% experiencing cognitive impairment, including dementia. These patients often struggle to adhere to care plans and maintain day/night cycles, posing challenges for nurses. Hospitals are generally unprepared for this patient population, resulting in increased nurse workload and specific challenges such as managing motor agitation, which can lead to falls and accidental removal of medical devices.

Objective:

This study aimed to (1) understand the effects of using an in-bed real-time motion monitoring system (IRMS) on nurses' perceptions of physical and mental stress, (2) assess the impact of the IRMS on the care process, (3) identify potential ethical implications such as patient autonomy and privacy, and (4) explore how nurses acquire knowledge about the technology and how this learning process influences their assessment of the IRMS.

Methods:

The system, which enables real-time motion monitoring as well as information on bed edge and bed exit information was used and evaluated in the geriatric ward of a University Medical Center. The research project was designed as a monocentric explorative evaluation study with a mixed methods approach. The study lasted 24 weeks and was divided into two phases. In phase 0, patients received standard care. For the intervention phase, the geriatric ward was equipped with the bed sensor system. Two group discussions, an interview, a survey and two participant observations during training sessions by the manufacturer were conducted to capture the nurses’ experience with the technology. Reporting of the study adheres to the GRAMMS checklist.

Results:

The initial training sessions revealed differing atmospheres and engagement levels, with the second session showing more optimism and interprofessional exchange. Survey results, taken after 20 weeks of use, indicated that nurses found the system beneficial for patient safety, care planning, and time management, despite some initial setup challenges. Focus group discussions highlighted the system's perceived reliability and its role in reducing anxiety related to fall prevention, though concerns about patient privacy and feelings of being monitored were noted. Overall, nurses expressed a willingness to continue using the IRMS, acknowledging its benefits while affirming their ability to provide care without it.

Conclusions:

The findings suggest that participants have a positive attitude towards a real-time, in-bed movement monitoring system, recognizing its benefits, especially for night-time monitoring. While its effectiveness in preventing falls is inconclusive, the system reduces nurses' fear of falls and enhances their response capability. The study emphasizes the broader impact of the system beyond fall prevention and the importance of thoughtful integration into healthcare practice. Clinical Trial: The study was registered in the German Register for Clinical Studies (ID: DRKS00027525). Date of Registration: 2022-02-25