Four NHs and 1 acute geriatric community hospital (AGCH) located in a NH were invited to participate in this interview study. These organizations were previously approached during the recruitment phase of the PRIMA project, in which only one of the NHs and the AGCH participated. Hereafter, the term “NH client” refers to both NH residents and AGCH patients located in a NH. In this interview study, all 5 organizations agreed to participate and invited health care professionals within their organizations to take part in the interviews. The invitation was broadly distributed by email, explicitly requesting representation from different professional groups, including physicians, nurses, and certified nursing assistants. A contact person from each organization provided the researchers with the contact details of health care professionals who were interested in participation.

Participants were included if they provided written informed consent and spoke the Dutch language. Participants were not expected to have knowledge of the Healthdot. Participants were purposively selected to create variation in the client population they cared for (ie, individuals with somatic and psychogeriatric conditions, individuals in short-term residential care, individuals undergoing geriatric rehabilitation, and individuals receiving acute geriatric care).

A semistructured interview guide (Multimedia Appendix 1) was developed by the research team (LCG, MCP, CMPMH, LMK, JS, and LWvB) and addressed the following topics: demographics, current practices regarding ARIs, digital health technologies in NH care, and the Healthdot. Prior to the discussion of the topic “Healthdot,” participants received a short presentation explaining how the Healthdot is placed, how it is used for monitoring, and its intended use in nursing homes (ie, for early detection of ARIs and detection of clinical deterioration during an ongoing ARI). More information about the Healthdot can be found at the Philips smartQare website [14]. Formally trained PhD student LG performed a pilot interview with a nurse practitioner who was formerly employed in an NH. Adjustments were made to increase understandability, which were validated by the nurse practitioner.

Interviews were conducted by LG between May 2024 and December 2024 until data saturation was reached, defined as the point during data analysis at which no new information emerged. Depending on the participant’s preference, interviews were held either via Microsoft Teams or in person at the NH. All interviews were audio-recorded. Verbatim transcripts were made, accompanied by field notes that included contextual information such as the setting, the relationship with the participant, the behavior of the participant, and reflections. The transcripts of the first 3 interviews were reviewed by senior researcher LWvB, who provided feedback to enhance the quality and consistency of subsequent interviews.

Thematic analysis was used to analyze the data in accordance with the 6-phase approach described by Braun and Clarke [15]. Transcripts were read by researchers LG, MP, and LWvB themselves to familiarize with the data. Inductive coding was performed in MAXQDA 24 (VERBI Software) [16], using a bottom-up approach to allow themes to emerge directly from the data. Two researchers independently open coded nine interviews (LG and MP or LWvB), with an equal distribution of interviews with physicians and care staff. Discrepancies were discussed until agreement was reached, contributing to a shared understanding of coding and interpretation among the researchers. The remaining 11 interviews were open-coded by LG, guided by the coding decisions and interpretations agreed upon during the initial coding phase, after which the codes were reviewed and critically appraised by either MP or LWvB. Coding was conducted iteratively, with regular discussions between researchers LG, MP, and LWvB to review coding decisions, resolve uncertainties, and ensure consistency with earlier coding. Subsequently, axial coding was conducted to identify relationships between codes and organize them into categories. This process led to the identification of overarching themes that captured the main patterns in the data. Throughout the analysis, reflexive discussions among the research team (LG, MP, CH, JS, and LWvB) helped to validate interpretations. Illustrative verbatim quotes were translated by LG and subsequently reviewed and corrected by 2 native English speakers.

Upon review of the study protocol, the Medical Ethics Review Committee of the Amsterdam University Medical Center concluded that this study does not fall within the scope of the Medical Research Involving Human Subjects Act [17] (WMO; case 2024.0480). Participants provided written informed consent prior to the interview.

Regarding the use of the Healthdot for monitoring ARIs in NHs, 5 main themes were identified: alignment of Healthdot use and treatment policy, balancing safety and freedom, impact of the Healthdot on work processes, supporting rather than replacing care, and possible use during pandemics and in the future.

One important precondition stated was the usability of the Healthdot. Participants mentioned that the device should be easy to use, allow monitoring from devices they currently use, be integrated into the electronic health records of NH clients, and be able to measure additional vital signs (ie, temperature, oxygen saturation, and blood pressure). It also needs to be trustworthy, and the early warning signal must be adjustable so that receiving too many false signals can be avoided. Moreover, participants pointed out that the Healthdot is single-use, suggesting that more sustainable alternatives should be explored.

Participants emphasized that successful implementation of the Healthdot requires a support base among care staff. They stated that this can be established by including them during the implementation process and incorporating their feedback. Several participants stated that it is essential to have enough care staff who are knowledgeable and skilled in using the Healthdot, suggesting that a dedicated team member could take the lead. Additionally, adequate training and guidance during the use of the Healthdot were emphasized as important, ensuring confidence for care staff.

Another precondition mentioned by several participants was the need for clear communication with NH clients and their families about expectations regarding the use of the Healthdot. Physicians stressed that it is crucial to prevent unrealistic expectations, for example, regarding how frequently the physician will review the data. They mentioned that some relatives may, at times, demand more than is feasible or preferable. Therefore, several participants recommended limiting NH clients’ and relatives’ access to the Healthdot data:

Finally, a clear policy regarding the use of the Healthdot is needed, according to the participants. They noted that it should be clear for whom, when, and for what purpose using the Healthdot is appropriate. Moreover, clear instructions should be available that specify by whom early warning signals are followed up and which actions need to be taken. Participants also mentioned the need for clarifying roles and responsibilities, suggesting that care staff should be responsible for monitoring, while physicians provide clinical guidance and assess the progression of the infection.

This qualitative interview study provides valuable insights into health care professionals’ perspectives on the use of the Healthdot for monitoring ARIs in NHs. While care staff were generally positive about the Healthdot, physicians’ attitudes were mostly reserved, highlighting the need for careful consideration of the NH context and its associated complexities during potential implementation. Our findings show that implementing wearable continuous vital signs monitoring devices in this setting extends beyond clinical purposes and necessitates careful weighing of the NH client’s treatment goals, ethical considerations, the balance of safety and freedom, its impact on care processes, and the importance of supporting rather than replacing personalized care.

Although perspectives of health care professionals on wearable continuous vital signs monitoring have been studied before in hospital settings, to our knowledge, we are the first to study these perspectives in the NH setting. A previous study by Weenk et al [18] found that hospital-based health care professionals were generally positive about continuous vital signs monitoring, whereas more reserved attitudes toward this were identified in our study. This difference might be explained by the context of NHs, where health care professionals must balance clinical care with NH clients’ quality of life and a home-like environment. Participants raised ethical concerns regarding the use of the Healthdot, particularly in palliative care situations, as they expressed fears that the Healthdot might lead to life-prolonging care in these cases, instead of promoting comfort and well-being. Nevertheless, van der Steen et al. [19] emphasize that careful and timely recognition and management of symptoms are crucial for enhancing well-being in palliative care [19]. From this perspective, the Healthdot could potentially contribute to person-centered palliative care by supporting the timely recognition and relief of symptoms.

The balance between safety and freedom is a recurring topic in NH care that was also reflected in our findings. Participants noted that the Healthdot could enhance safety by enabling early detection of deterioration caused by ARIs and offering a sense of security, which is in line with findings from another study focusing on monitoring devices in NHs [20]. However, participants in our study also raised concerns about the impact of the Healthdot on NH clients’ freedom, including feelings of being watched, privacy intrusion, and restrictive infection control measures. The COVID-19 pandemic demonstrated how such measures affected NH clients’ autonomy and mental well-being [21]. Still, the relationship between freedom and care in NHs remains complex. It has been argued that some degree of intervention is always required in institutional care, making autonomy and freedom in this context not straightforward [22]. Haslam-Larmer et al [23] highlighted similar tensions in the context of location monitoring in dementia care, where privacy is often considered secondary to safety concerns [23]. Interestingly, participants also saw potential for the Healthdot to enhance NH clients’ sense of freedom by reducing the need for manual measurements and nighttime disruptions. This aligns with findings from Emilsson et al [24], where NH staff reported that camera surveillance monitoring reduced unnecessary night-time visits [24]. To effectively balance safety and freedom, it is essential to consider the individual needs of each NH client, as the value placed on safety or freedom may differ for everyone.

A potential consequence of reducing manual measurements is a decrease in contact moments, which both physicians and care staff in our study considered essential for maintaining clinical insight and relationships. This concern is widely recognized across studies on both surveillance and vital signs monitoring in several care settings [18,24-26]. For instance, it was reported that continuous vital sign monitoring in hospitals may reduce bedside contact and compromise clinical judgment, as such systems cannot assess subjective experiences like pain [18,25,26]. Similarly, research on surveillance monitoring in NHs highlights the irreplaceable value of physical presence for both clinical observation and emotional reassurance [24]. However, Niemeijer et al [22] suggest that monitoring technologies do not necessarily reduce human contact, as during their study on surveillance technologies in residential facilities, nurses continued their rounds and maintained strong relationships [22]. In our study, participants also expected contact to remain necessary, as the Healthdot does not measure all vital signs needed for monitoring of ARIs and manual measurements are still required when indicated by the early warning signal. Moreover, both our findings and previous research suggest that time saved through monitoring may be reinvested in client-related tasks [18,22]. Nevertheless, with the expected increase in older adults in NHs and staff shortages [2,3], there is a risk that any time gained will be used to manage higher caseloads, potentially limiting opportunities for personal interaction.

Despite expectations that the Healthdot could save time for person-centered care, physicians in our study raised concerns about a possible increase in workload. Similar concerns have been reported in studies conducted in hospital settings, where the high frequency of measurements was found to burden physicians [18]. In line with our findings, several studies identified false-positive alerts as a contributor to “alarm fatigue,” further adding to the workload [18,22]. Physicians in our study also expressed concerns about the increased burden of responsibility that comes with more measurements. NH clients and their relatives might have unrealistic expectations, assuming immediate intervention when measurements deviate. Previous research has shown that unrealistic demands from family members are a recurring challenge in NHs and can contribute to staff stress [27]. Managing expectations is, therefore, crucial for sustainable use.

Notably, our findings revealed differing perspectives between physicians and care staff regarding the use of the Healthdot. Across themes, we found that care staff were generally enthusiastic, viewing the device as a way to reduce workload, increase time for personal interaction, and enhance the freedom and well-being of NH clients. Physicians, however, expressed more critical views, raising concerns about the Healthdot’s impact on clinical management, increased workload and responsibility, and potential implications for person-centered care. These differences may be explained by the distinct roles and responsibilities that physicians and care staff have within interprofessional collaboration, as described by Schot et al [28]. Whereas physicians may see the Healthdot primarily as a diagnostic tool requiring clinical action and interpretation, nurses may view it mainly as a support system in their caregiving routine, evaluating it in terms of practicality, efficiency, and NH clients’ comfort. Recognizing these divergent perspectives is essential, as they may influence acceptance, integration into care routines, and overall effectiveness. This suggests that the successful implementation of the Healthdot will require clear communication, alignment on its intended purpose, shared understanding of its role in care practices, and active collaboration between health care professionals. Additionally, acceptance is influenced by the nursing home’s organizational culture and leadership supporting innovation [29].

One limitation of this study is that the Healthdot is not currently used for monitoring ARIs in NHs, meaning that participants had to speculate about its potential use. This hypothetical context limited the extent to which their responses reflect real-world experiences or challenges and led some participants to reflect on the general use of the Healthdot in NHs rather than specifically for monitoring ARIs. Nonetheless, a strength of this study lies in its early involvement of end users, reflecting a growing emphasis in implementation research [30] and providing early insights, considerations, and key prerequisites for potential implementation. Additionally, our participants stressed the importance of including their perspectives to enhance acceptance and practical relevance, which aligns with evidence that such engagement fosters organizational readiness through an innovative culture and shared commitment [31,32]. Although some participants did have prior experience with the Healthdot in a research context due to their participation in the quantitative PRIMA study, this experience was limited to the placement of the Healthdot and did not involve monitoring with the Healthdot. No differences in responses were observed between participants with and without this prior experience.

Our findings demonstrate that implementing continuous vital signs monitoring devices, such as the Healthdot in NHs, involves multiple considerations and conditions, shaped by the complexity of this care setting. A tailored assessment is essential for each NH client, taking into account factors such as treatment goals, safety, autonomy, and person-centered care. Clear communication and alignment between physicians and care staff, as well as between NH staff and relatives of NH clients are crucial, particularly regarding expectations about the Healthdot’s impact on care processes. Although this study focused on ARIs, many insights may be relevant to the broader application of monitoring devices in NHs. This study offers practical guidance and key considerations that may inform future implementation efforts of continuous vital signs monitoring devices in this setting.