From the data analysis, six major themes with 14 subthemes emerged, categorized into three areas: Patient-related perspectives on smart technology focusing on smart mattresses, nursing-related perspectives on smart technology focusing on smart mattresses, and Technology-related perspectives: General experiences and expectations. In relation to patients, the major themes encompassed ‘difficulties in meeting patients’ care needs’ and ‘identified areas for technology adoption based on patient care experiences.’ Concerning nursing, the major themes included ‘potentials of smart technology for nursing care’ and ‘increased time and workload due to new device usage.’ Finally, the major themes associated with technology were ‘previous experience with technology devices’ and ‘expectations for in-development devices.’ A detailed representation of the major themes and subthemes can be found in Table 2.
Patient-related perspectives on smart technology focusing on smart mattresses
Difficulties in meeting patients’ care needs
Nurses expressed shared concerns about the challenges of meeting the patients’ care needs. Specifically, they highlighted the difficulties in recognizing and promptly addressing various patient requirements. These challenges included the urgency required in responding to such needs and the critical role of smart technology in facilitating their timely identification.
Recognizing patients’ diverse care needs which need to be addressed simultaneously and urgently
Nurses discussed the challenges of recognizing and addressing a variety of needs, some of which may feel urgent to patients but appear minor or non-emergent from the nurses’ perspectives. For example, one nurse shared, “In the intensive care unit, I noticed a significant issue. From the patient’s standpoint, enduring a wet diaper without immediate attention can be extremely uncomfortable. The sensation on the skin is distressing, and wearing a diaper while fully alert is particularly challenging.” In practice, non-critical needs are often deprioritized in nursing care, potentially impacting to adverse consequences for patients’ overall well-being. One nurse reflected on this, “The primary focus tends to be solely on preventing pressure ulcers, to the extent that even patients who are sleeping well are woken up, disrupting their rest. I often wonder, ‘When can this patient get more than three hours of uninterrupted sleep?’ My perspective on providing quality patient care has evolved. I’ve come to realize that even if a patient has mild pressure ulcers, they may be in desperate need of rest.”
Perceiving the need for smart technology in patient care
The research participants recognized the necessity of utilizing smart technology to address the diverse and non-critical needs of patients, which are often challenging for nurses to manage promptly. One participant suggested, “I even thought about features that could automatically change a wet diaper. Alternatively, if a smart mattress were equipped with a sensor, it could trigger an alarm when a patient’s diaper becomes wet.” Another participant proposed, “I believe a smart device could help alleviate some of the back pain experienced by patients by supporting back flexion through the controlled application of air.” These insights underscore the growing demand for innovative technological solutions to better accommodate the multifaceted needs of patients.
Identified areas for technology adoption based on patient care experiences
During the interviews, the nurses identified areas where technology could be effectively applied based on their patient care experiences. Notably, they acknowledged technology’s potential to assist with patient repositioning in bed and prevent pressure ulcers, all while maintaining uninterrupted patient sleep. Additionally, they recognized opportunities for technology to improve both patient safety and comfort.
Changing patients’ positions and preventing pressure ulcer without disturbing their sleep
Nurses, particularly those working in intensive care units, often encounter situations where they must reposition patients to prevent pressure ulcers, sometimes at the cost of the patient’s sleep quality. The introduction of an automated position-changing function could significantly improve sleep quality by minimizing nurse interference. As one nurse stated, “If a smart mattress can automatically change the position of patients, I don’t think we’re doing anything wrong even if we don’t physically touch them at night. The presence of automated position support features could enhance patients’ sleep quality.”
Involving patients’ needs for comfort and safety
Nurses acknowledged that smart technology could contribute to improving patient safety indicators, particularly in addressing concerns such as falls and infections. One nurse shared, “Falls can still occur despite our best efforts, so having a smart device as a warning guide would be beneficial.” Another nurse stated, “If the bed is equipped with X-ray plates, I believe the frequency of plate cleaning could be reduced when caring for infected patients.” These insights highlight the potential of smart technology to enhance patient safety and reduce the incidence of falls and infections.
Nursing-related perspectives on smart technology focusing on smart mattresses
Potentials of smart technology for nursing care
Nurses highlighted the potential of smart technology to enhance their work efficiency and improve the quality of care.
Optimizing work efficiency
Given the characteristics of nursing, where healthcare professionals interact with numerous patients, there is strong interest in technologies that can minimize unnecessary tasks and optimize the use of their valuable nursing time. In particular, the integration of Electronic Medical Records (EMR) with measurement devices was seen as a way to maximize work efficiency. One nurse emphasized, “Automatically interlinking vital signs data increases work efficiency and offers convenience.” Furthermore, nurses working in general wards without beds equipped with weight-measurement functions stressed the need for such features to improve efficiency. One nurse remarked, “There is considerable interest in when the beds with weight-measurement functions will be introduced, as they are consistently needed in our ward.” Another nurse added, “Considering the significant energy consumption, I hope beds with weight measurement functions can be introduced to enhance work efficiency.”
Improving the quality of care
Nurses expressed optimism that the adoption of smart technology could alleviate the burden of nursing work and potentially enhance the quality of care, leading to an positive outcomes for patients. One nurse expressed, “I believe that these devices can improve the quality of nursing care by allowing us to focus on other aspects while reducing the physical strain on our backs.” Another nurse emphasized the potential benefits, stating, “Even if technology provides only modest assistance, it can still contribute to delivering higher-quality care.” These perspectives highlighted the potential synergy between smart technology and nursing care quality.
Increased time and workload due to new device usage
Nurses, who frequently interact with various medical devices and continually adapt to new technologies tailored to their workplace’s characteristics, acknowledged that the introduction of smart technology presents its own challenges alongside its advantages.
Responding to malfunction and incidents
Managing safety incidents caused by device malfunctions and inexperience with new smart devices emerged as the primary concern among nurses, in particular, expressed heightened apprehension about the risks of device malfunctions due to the potential for fatal outcomes in such high-stakes environments. An ICU nurses stated, “We are deeply concerned about the possibility of fatal consequences in the ICU if a machine malfunction occurs.” Meanwhile, nurses in general wards concerns about the challenges posed by the diverse range of smart devices from different manufacturers, which complicates maintaining strict supervision. One nurse in a general ward shared, “In general wards, some patients are good at using devices, but those who are not may struggle. This disparity in user proficiency increases the risk of device breakdowns or accidents when patients attempt to operate them.”
Learning numerous new functions
Introducing new smart devices also imposes additional responsibilities on nurses, with some expressing concerns about the burdens associated with adapting to new functionalities. One nurse remarked, “While the Electronic Medical Records (EMR) system is beneficial, I believe it adds to our workload due to its extensive functionality.” Another nurse elaborated, stating, “The abundance of features within smart devices create more tasks for us to manage.” These perspectives highlight that challenges that can arise when integrating new technologies into nursing practice.
Backing up which is often needed (e.g., when using IoT devices)
Another perspective raised was the potential increase in workload if the device’s accuracy is difficult to trust, requiring nurses to verify and ensure data correctness, essentially doubling their tasks. This viewpoint reflects a negative perception of the interlocking function, as one nurse explained, “Even if the machine takes a measurement, it becomes a double task when nurses need to independently validate and filter the data through monitoring.”
Addressing numerous questions from patients and caregivers
Nurses in general wards, where clear communication with patients and caregivers is essential, expressed concerns about the increasing workload associated with an addressing numerous inquiries prompted by the introduction of smart technology. One nurse shared their experience, stating, “The alarms keep ringing, and caregivers constantly ask about the purpose of each alarm and its associated function. To be honest, responding to these inquiries can be quite burdensome.” Another nurse added, “In the general ward, if all patients use smart mattresses, I think they’ll be ringing all the time…”.
Technology-related perspectives: general experiences and expectations
Previous experience with technology devices
Participants mentioned negative and positive experiences with smart technologies or devices that they had used in nursing work before the interview.
Experiencing frequent false alarms
Many nurses expressed negative perceptions about false alarms caused by accuracy issues with medical devices. One nurse noted, “The respiratory rate is often measured incorrectly, and the apnea alarm rings so frequently that I often find it necessary to turn it off.” Another added, “There have been numerous instances where the apnea alarm sounds falsely, even on the current monitors.”
Enhancing work efficiency and convenience due to the integration of smart technology
Despite the negative experiences associated with the introduction of smart technology, participants acknowledged both the convenience and ability to enhance work. One nurse remarked, “I haven’t experienced delays in my work because blood pressure and ECG are automatically measured and integrated with the EMR.” Notably, technology was recognized as a valuable complement to human actions, enhancing the accuracy of patient identification and significantly enhancing patient safety. A nurse elaborated, “It’s reassuring to have devices scan the patient label first to ensure the correct medication is administered to the right patient, reducing the risk of medication errors.”
Expectations for in-development devices
Participants expressed expectations for devices currently under development, viewing them as potential solutions to the limitations of existing devices on prior usage experience. In particular, issues related to the accuracy of existing measuring devices led to widespread anticipation for enhanced accuracy and measurement consistency in new devices, especially for weight- measuring systems.
Hoping for enhanced accuracy and precision
There was optimism that advancements in the accuracy of vital signs measurement could help alleviate the nursing workload. As one nurse noted, “Accurate measurements of apnea, cardiac arrest, sleep patterns, and vital signs can significantly reduce the workload.” Another nurse emphasized the need for improved accuracy, stating, “It’s challenging to respond to all of the questions from caregivers about vital sign alarms, so I hope the measurements are accurate to address this issue”.
Anticipating consistency in measurements
ICU Nurses with experience using beds equipped with weight-measuring capabilities expressed a desire for greater consistency in weight measurements. One nurse explained, “When discussing weight-related matters, we sometimes find ourselves trying to adjust the values to fit into our input/output (I/O) records.” Another nurse highlighted the challenges specific to the ICU, stating, “The most significant difficulty in the ICU is measuring weight, and the variability in patient’s weight, even under the same conditions, is quite pronounced.”
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