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The Potential uses of Smart Technology in Short-Stay Hospital Beds

Introduction

Short-Stay hospital beds are mainly associated with acute care. Acute care is a type of secondary care in which the patient obtains treatment for a very short time (Mitchell, McNair & Jones 1998). However, the whole period is characterized by active care. Patients who are admitted to the hospital for acute treatment are described as short-term patients and the period of time that such patients take is usually five days or less. Services delivered in such periods of time may vary from surgical procedures to general medical services, emergency treatment and ambulatory services. Other instances may include outpatient care. In all the inpatient cases of acute care for short term patients, the general objective of the medical specialists is to discharge such patients once they are considered stable (Mitchell, McNair & Jones 1998).

Specific care settings that are typically associated with short-stay patients may include coronary care, emergency departments, general intensive care, newborn intensive care and cardiology among others. The most common basis for a patient being of the short-stay variety is cases where he or she requires a degree of stabilization in the aftermath of an acute illness. Short-term patients account for more than 60% of all patients admitted into UK health facilities (Hurtig & Downey 2008). While the stay may seem short, it is pivotal and may even determine whether the patient survives. Additionally, the care delivered at this stage may also determine the success of other treatments that are done afterwards.

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Due to critical nature of short-stay patients, they are kept very close to nurses and effective communication between the two is needed. However, due to several factors in the medical care environment, it is practically impossible to always assign a nurse to each patient in a short-stay bed. Due to various factors, nurses might not be able to devote their entire attention to each particular patient. There is a need for such a patients to alert a nurse when it is urgent and, more so specify, ask for the help that they may need. This may include instances when the patients’ condition has worsened and when they need emergency care. Patients may also need to communicate to the relatives in order to relay important information. Such could include details of their progress and reminders (Dai 2004).

A mode of communication that has been availed to patients, including those in short-stay beds, has sometimes been incomprehensive and inefficient. For many years, such beds have only been equipped with a bell that alert the nurse when the patient is requesting services. This form of communication lacked incomprehensiveness and the range of information that could be relayed was narrow. This was followed by telephones that improved the communication channels and allowed patient to talk to the nurses in charge. However, not all patients have the physical ability to utilize phones or talk to nurses. Nonetheless, smart technology in hospital beds has not been utilized to any significant extent so far.

Smart technology holds great potential for enhancing communication between the patients in short-stay beds and nurses. Such technology can include improvements or a simplification of the advanced messaging technology that has been developed by some social media networks. This would have imagery and symbols with shared meanings that can make them easier to use. At the same time, this technology can allow patients to communicate to their families. This can be a great improvement, as some hospitals in the past have not provided for means through which patients can directly communicate to families.

Some organizations have attempted to utilize smart technology to enhance patients’ communication. One such organization includes the Nightingale Association, which has collaborated with SAS and Billing Jackson Designs and developed a communication gadget that would generally give patients a dignified stay in the hospitals, especially in times of distress. This device was named “BedPod.” The dignified stay would be achieved when a patient was able to communicate efficiently with nurses when he/she needed to urinate or make a bowel movement. The team reasoned that effective communication would help to make short-stay hospital beds cleaner, more hygienic and could ultimately reduce infections (Pan 2010).

Despite this device being useful in communication, its design and use around the bed space for short-stay patients should enhance a good poster for the patient. This is important and can make it even more useful. The improper design of attachment of such a design can render it less effective or altogether useless. Additionally, it may ultimately lead to injury if the user has to strain in order to use it. This makes the ergonomic part of such a design very crucial.

Goals and Objectives

This research will look into the potential uses of smart technology in short-stay hospital beds. The design and development of gadgets that support such uses by smart phone manufacturers and other firms that develop smart devices may not be a difficult task since similar devices have been developed and are being used in many spheres of life, especially in social media. Additionally, interfaces of such devices are user-friendly which make interaction through the social media very easy. However, for such devices to be utilized effectively in a healthcare setting, their features and the interface should be easy to use such that short-stay patients can utilize them effectively (Hurtig & Downey 2008). Additionally, they should be fitted in the bed space in a way that they are easily accessible to the patients.

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The research will find out and discuss the potential uses for such devices that could benefit patients, especially those in short-stay beds who are receiving acute treatment. The research will also explore the ways in which such devices can be used bearing in mind their ergonomic as well as hygienic aspects. For such devices to be easy-to-use, the users’ posture has to be taken into consideration. Patients should be able to reach these devices without straining and the interface should allow most efficient utilization such that the user is able to spend as little amount of time to pass the required information. Finally, hospitals have not put much emphasis in incorporating the means through which patients can talk to their families. Patients have had to use their own means or communicate through the hospitals staff. This research will look into how smart technology can enable patients to communicate with their families through smart devices attached to their beds or placed in their bed areas.

Literature Review

Various authors and researchers have written and compiled materials concerning communication between patients and nurses and other health care specialists in the acute care environment. Other research has been authored detailing the possible use of smart devices in various walks of life. However, only a handful of research has concentrated on the use of smart devices in communication between nurses and short-stay patients. This is seen as a new area where much is still to be done to tap into the flexibility and convenience that smart devices would provide.

According to Ohashi, Kurihara, Watanabe, Ohno-Machado, and Tanaka (2011), smart devices can be utilized in the healthcare environment to make it safer and also improve on other aspects of patient care. These authors researched on various applications that smart devices would have in an acute care environment. It is important to note that most of the acute care patients spend five days or fewer in hospitals, which is why they are termed short-stay patients. Their period in the hospitals is characterized by active care in which a wide range or specialists and machines are utilized. Patients spent a large percentage of this period on beds or stretchers. The authors proposed that this period would be safer and more comfortable for patients and nurses if the beds and stretchers were equipped with smart devices. These devices would have the ability to communicate with nurses and the control rooms on several aspects that may include patient’s posture, temperature, other vital signs and movements. Additionally, these devices would also be equipped with an application that worked with an interface with which the patient could communicate with the health care staff. Finally, this could also make it possible for the patient to speak with his or her family. With research and more development, these authors concluded that it was possible for such as device to be linked-temporarily or otherwise- with the wards control room or the patients family.

Methodology

The entire process through which patients are admitted, treated and discharged in the hospital environment is long and complex. Various specialists are directly or otherwise involved in various steps. Another party that is crucial in this process is the patients of the client. These are the ones who receive health care services from hospitals. The third party that is very crucial in the hospitals environment is the specialists who deal with various equipment and machines; these link with manufacturer in the development of such equipment so that they can better fit the purpose for which they are designed.

In the collection of data for this research, the above three categories of people will be important. As this research paper try to respond to the research question, information and sometimes the views of some people in the above groups will be sorted out. For this reason, the research will employ both primary and secondary sources of data. The primary data will be acquired through the use of an online questionnaire which will be administered to patients who left various hospitals. The questionnaire make it possible to gain insight into the experiences of these people who have previously been in short-stay hospital beds. The questionnaire will seek to capture the mode of communication that the hospitals provided for these patients to use. The questions will also seek to find how these former patients would compare such mode of communication with smartphone applications, especially the ones used for chatting and particularly in the social media. This would be important in finding out if these people would like such mode of smart communication to be made specifically for hospital short-stay hospital beds to enhance communication with healthcare professionals and the patients’ families.

The other part of this research will rely on secondary sources of data. This will focus mainly on obtaining information concerning the design of such smart equipment to be used in communication in hospital beds. Additionally, this section will also seek information in the area of ergonomics in order to ensure that such devices would be useful and easily accessible to patients. Materials such as books, articles and Internet resource will be used. The device made has to be easily accessible to patients either in a sleeping or sitting position as this is how most patients spend their time in wards.

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After collecting the primary data from questionnaires, textbooks, articles and Internet resources will be assessed in order to provide information such as the reach of an extended arm of a sleeping or sitting patient and the most common sleeping position for patients in short-stay beds. Additionally, information such as the best attachment to the bed or the bedside will be evaluated. Issues such as the shape and design of such a device will be sorted from various resources related to several of the companies that develop smart devices. Additionally, such materials will be used to identify how such devices can borrow from applications that are used for interaction in the social media. Finally, secondary sources of information will be used to identify steps that can be taken as well as the materials that can be employed in these devices in order to make them easy to sterilize and prevent the spread of infection to other patients, members of stuff as well as family members.
The questionnaires will be analyzed to find out what patients who were formally admitted on a short-stay basis would feel if smart devices were produced and customized for short-stay beds. Additionally, the questionnaires will also seek to identify issues that these patients have faced while using the current technology used for patients to communicate to the nurses. The limitations of such systems will be evaluated compared to smart devices available in the market, although not customized for use in the hospitals and therefore not used.

Questionnaire

Questionnaire used to collect information from people who had formally been admitted in various hospitals for acute treatment. The questionnaire will be administered to persons who were discharged after 2011 to ensure that the information provided is current. (The information collected through the use of this questionnaire will be used for this research only)

Respondent’s background information: Name, Age, Sex, Level of Education, Fixed Telephone

Questions:

  • What is the date of your most recent hospital visit?
  • What did you use to communicate to the nurse when the need arose?
  • Did you communicate with your family while undergoing treatment?(Yes/No)
  • If your answer above is yes, how did you communicate?
    -Through the hospital staff
    -Through personal phones
    -Through visit by family members
    -Did not communicate
  • Do you own or do you have access to a smart phone/device? Are you able to use a smart phone/device?
  • How do you compare the communication offered in the hospital and that through the smart phone/device?

-Hospital’s communication is superior
-Smartphone is superior
-There is no difference

  • How would you like a smart device developed specifically to be used for the patient to communicate with the nurses and family?

-Very much
-Somewhat
-Neutral
-Would not like
-No idea

  • As a short-stay patient, what would you use a smart communication device attached to your bed for?

-Communicating to the nurses
-Communicating to the family
-Communicating to nurses and family
-Setting reminders

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Results

Of all the respondents, 60% rang a bell or used fixed telephone when they needed to talk to the nurse. The remaining percentage did not experience a need to alert nurses over the short period they were admitted. 90% of the respondents communicated with family at home during the short period of time they had been admitted to various hospitals. The means of communicating back home that was most preferred was through visit by the family members (51%). Mobile phones (50%) was the second most popular response, as they were not always allowed in clinical areas of wards. Communicating through the hospital staff was also seen to be common as patients could tell nurses and other specialists in the hospital environment to relay information to family members back home. Over 80% of the respondents could access and even use smartphone or other smart devices, all of these respondents thought that smart devices provide a better and more convenient way of communicating than fixed line telephone provided by hospitals or ringing a bell. A large number of the 20% who could not access or use smartphones for various reasons could not establish the difference. Seventy percent of the respondents would very much like to have a smart device developed specifically to be used around the hospital beds, for short stay-patients, for communication. Over 70% of all the respondents said they would use such a smart device for communication. The respondents said they would preferentially use it to communicate to nurses followed by their families.

Additionally, it was noted that over 50% of the respondents said they would use such a device for setting reminders. This is despite the fact that nurses have the role of maintaining medication and treatment routines for patients. This was an indication that nurses would utilize such devices for setting reminders that would make their work easier.

Illustration of various bed positions Sources; (Ohashi, Kurihara, Watanabe, Ohno-Machado & Tanaka 2011)
In the illustration above of a hospital bed, sleeping position of many people suggests that devices can only be put either in Zone 1 or Zone 6. The rest of the zones are not accessible to patients and may require them to sit, stand or strain in order to reach them. The headboard also provides an area on which devices may be attached although it is not easily reachable to a patient. Other mechanisms may be needed in order to make such devices easily accessible to patients (Pan 2010).

Smartphone manufacturers have developed materials that are used to manufacture smart devices that can be applied in very many environments. For instance, unlike the old features’ phones and devices that had physical keyboards that make them hard to clean and sterilize, modern devices have virtual keypads inside their screens. Their screens are waterproof, which makes them very easy to wipe clean and sterilize. Material science has also enabled the production of very thin glasses that can be used to make the very slim, modern and flat devices that are very light and robust which can be used in safely in varying environments without getting damaged. Finally, programmers and other entrepreneurs have made smart devices that accept many applications. Applications in the area of communication and social media are continuously being made easier to use and interactive: social media networks, for instance Whatsapp and Facebook messenger, have significantly eased social interaction. They do not only provide for written communication but have provided very many simplified images that have shared meaning. While typing can be difficult and time consuming, the use of such symbols can convey information that would otherwise require a whole sentence. This makes the whole process of passing information remarkably convenient and time-saving.

The results above will be used to identify and discuss the potential uses of smart technology in short-stay hospital beds, as well as explore the design and placement of such devices bearing in mind their ergonomic aspects.

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Discussion

Since 2009, the UK has had a significant transformation in the health sector. The then-Minister for Health Ben Bradshaw gave a directive that patients should be allowed to use their mobile phones in non-clinical areas of health facilities. Afterwards, various hospitals have given directives and rectified their codes of conduct to comply with a varying degree. The minister’s directive was offered after it was realized that the bedside telephones used in hospital beds were expensive and could cost up to 49 pence per minute. Afterwards, it is only in some psychiatric wards that phones may not be allowed. Some hospitals have varying policies concerning phones with cameras. Generally, phones are now allowed in hospitals especially in communal areas such as wards, waiting rooms, receptions and dining areas. Treatment room, dialysis rooms, radiation rooms, consultation rooms and surgical theaters do not allow phones for patients and even for medical specialists to minimize distractions (Gardner, Varadan & Awadelkarim 2001).

In the light of the information given above, smart devices can be designed and be attached to hospital beds for short-stay patients. Such devices could have a range of potential uses. First, they can be used for interactive communication between the patients and the nurses. They can also be designed like a smart phone and be equipped with an application designed specifically for the hospital environment. It would have a large screen and would have coded images like the ones used in social media networks for chatting. Every option and potential message that the patient could have can be coded into various simple images that can be put in the home screen so that the patient only needs to select the image and send it. It should also allow the patient in a very simple way to select the contacts that the messages would be sent to. It can also be programmed such that whenever a new patient occupies the bed; their contact information is updated such that the device is put in one ‘group’ with the patient’s family as well as the hospital’s control room. Thus, the patient will only need to send a message once but the message will be delivered to all contacts.

Secondly, smart devices can be linked to the hospital beds and even stretchers, making them communicate directly to hospital control room. These devices can be equipped with blood sugar sensors and blood pressure sensors all of which can be linked to the hospital’s control room and also the family at home. At the beginning of 2015, Apple Inc. released a large number of wearable devices all of which are able to communicate with the body directly and can determine blood pressure, heart rate and blood sugar level among others (Rocha, Correia, Wilson & Stroetmann 2013). This technology can be incorporated into various sensors in the hospital beds for short-stay patients so that this information is recorded on smart devices and relayed to the control room. This means that the device communicates to the control room even when the patient cannot (Gardner, Varadan & Awadelkarim 2001). Giving short-stay patients a dignified stay in the hospital may mean that they receive all necessary help at the time of need. Recently, a “smart” garment has been designed for the hospital bed that has the ability to sense instances when the bed is wet due to various reasons. This garment can also be linked to the smart devices to relay such information to the control room for action to be taken.

The University of New Hampshire has developed a smart bed which has the ability to “care for the patient” by doing all the activities that nurses normally would do. For instance, the bed has the ability to sense the patients’ blood pressure and even record variations to the normal. It has also been designed to respond or prevent bedsores due to its ability to roll the patient such that one part of his or her body is not in contact with the bed for prolonged periods of time. The bed can also tilt according to various needs. However, the whole system is made to be very automatic in that it does not engage the patient. The bed was designed to be especially helpful for a patient who is in coma or too weak. The bed described above can be improved to incorporate the users’ control using smart devices. The patient can be assisted to participate in the ‘care’ given by this bed. The easiest way to achieve this would be through the use of smart technology where the patient is able to communicate with this bed, which should have an ‘autopilot’ form of control that takes over when the patient is not able to control it (Donchin & Gopher 2013).

While patients’ communication is very important, a smart device attached to the patients’ bed for short-stay patients can also be very helpful for nurse-to-nurse and nurse-to-other specialist communication. Information such as medication as well as various schedules for the patient can be loaded in this device. Additionally, a nurse finishing a shift can also leave notes specific to the patient in this bedside device such that the incoming nurse can access that information. This can make the process of nurse’s transition more efficient where the incoming nurse or other medical professional is able to get all the information needed.

Ideally, the formation and the arrangement of these smart devices can be made in a way that each bed has a smart communication device attached to it. This device should also be linked to the bed as well as the beddings to enable it to communicate with them and even control them. In addition, this device should be linked to the nurses’ room and the patients’ family and should relay the patients’ message to them. Additionally, it should also provide a platform for the patient to communicate with the bed as well as relay the same information to the nurses’ room. The nurses’ room can be the control room where nurses can monitor all these devices. In this way, he/she will be able to ‘see’ all the beds from the control room.

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The hygiene part of this smart device could be an issue of concern due to the fact that all the users are patients, and that it is used by one patient after another. There could be concerns of spread of bacteria and viruses through touching these devices’ surfaces. However, UK hospitals have had the tradition of using bedside telephones for their patients. These devices had come with the conventional keyboards and the conventional receivers and had many crevices for bacteria and fungi to remain hidden. However, hospitals know ways of sterilizing them and various sprays and wipes with disinfectants such as ethanol, hypochlorite compounds have been developed which reduced this risk of spreading of infections. Smart devices will make the sterilizing work very easy as they only have flat surfaces to be sterilized. Sterilizing them will be as easy as a sterilizing a bench, as they lack crevices and hidden places. The ‘gorilla glass’ which is the material used as the protective covering for many smart devices is tough and inert which makes cleaning and especially through wiping to be really easy. The material is also inert and does not react with many chemicals and would therefore not react with various chemicals used for sterilization.

Considering the ergonomic aspects of the patients, many variables need to be considered. It is important to design and fit such a smart device in a position where it can be most useful to most patients without causing straining. For this reason, sitting and sleeping positions for short-stay patients is important. If a patient can sit to use such a device, it becomes better altogether and any position in his or her reach is suitable. However, a patient may be unable to sit but still needs to use such a device. Evaluating sleeping positions and the average reach of the arm are among the important steps necessary. The supine sleeping position, though preferred by many is not recommended to patients. (Reilly & Greeves 2002). This position is associated with mild obstreperous sleep apnea and is said to cause and worsen this condition among patients. Additionally, it can also make the reach and use of any device attached to the short-stay bed or placed around the bed unreachable to a sleeping patient. Prone as a sleeping position is also discouraged, as it is also associated with several conditions as one is not able to obtain fresh air and may keep inhaling air rich in carbon dioxide. It is associated with the Sudden Infant Death Disorder among others. Other positions might include ‘semi spine’ which is viewed as a constructive way of taking a rest, However, only the stronger patients who can sit-if need be- are able to sleep in this position. Lateral sleeping position remains to be the most preferred in the short-stay beds unless otherwise advised by physicians. This position enables patients to avoid complications such as apnea, access fresh air and also be in a better position to use their hands while still sleeping. Since most people are right handed, the smart device can be most useful when placed on the left hand side of the bed. A patient sleeping in lateral position on the left side will be able to reach such a device. The question of the reach may be insignificant as hospital beds are designed and made to be narrow. The average hospital bed in the UK and the North American continent is around 39 inches (around 99cm). A person sleeping at the middle of such a bed has to stretch his/her hand for only 19.5 inches to reach a device attached at the side of the bed. This becomes easily manageable as the average stretch of human arm is 25 inches (Duffy 2011).

As discussed earlier, the device has to have an interface that makes communication easy for the Short-stay patients. The patient does not have to type and the interface has to have many images, each with shared meaning. Such has been used in Whatsapp messaging: a smartphone application which has very many images enabling people to communicate effectively without having to type. Such images may include a smiley face, a sad face and simplified images of washrooms among others. Sending such an image to a nurse and family can mean that the patient is feeling well, bad or needs to use washrooms respectively. Another group of such images may include simple graphical representation of various meals where sending a symbol of such meal may represent patients’ choice of food. Yet, another group of images may include images of tablets, injections or even surgical tools where a patient selecting and sending such may remind the nurses and the family of medication, injection or scheduled surgical procedure. Although the nurse may have such information and especially concerning medical procedures and schedules, a patient sending such information to the family can convey very significant information and may actually remind or alert the family members (Duffy 2011).

This is not forgetting that the smart devices can be programmable and the nurse may also update all the patient information in it including all the schedules and reminders for him/herself and any other specialist who might need such information. At the same time, the device will also be communicating to the bed or the stretcher that the patient is lying on. This will be important in helping the patient to recover fast and prevent issues such as bed sores. Additionally, when/ if the bed is equipped with various sensors, the device will act as the control center for these sensors and will continuously relay information to the nurses’ control room. As discussed earlier, the device should also provide a means of communication between the patient and his/her bed. It should also be programed ‘auto pilot’ itself and even communicate to the control room when the patient is not able to. Such information that may be relayed to the control room even without the patient being involved may include body temperature, blood pressure, heart rate, blood sugar. The device should also relay conditions, such as if the bed is wet or not among others.

Hospital environments have been filled with cables and pipes and the process of installing has been very expensive. In the use of bells and bedside telephones for short-stay beds, a lot of wiring and cabling is done to support this crucial equipment. Although changing these in already established hospitals may be expensive, the use of smart devices in hospital beds and especially for short-stay patients might not require such much cabling. This is because mobile smart devices may only use the available mobile networks. Like social media application, smart devices for hospital beds can use ordinary mobile network for communication. When used in the hospitals, Wi-Fi network can be used by such devices to send and receive information from the ordinary mobile network as conventional smartphones do. This means that such devices would only need to be connected to power sources to be used effectively. However, depending on hospitals needs and various conditions, they can also opt to interconnect such devices using cables or even opt to use wired Internet on them (Reilly & Greeves 2002).

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Whatever the means and designs discussed above, the desired result would be an environment with efficient communication between the patient, nurses, the bed or stretcher among others. All the design details described above can make such smart devices beneficial and also hygienic to use. Ergonomic considerations have also been discussed, as this ensures that the patient will be able to interact with these smart devices device well without straining. The interaction between the patient and this device should not lead to excess fatigue on the patients’ side or even injury. For this reason, easy reach considering sleeping positions, average length of the arm among others have been considered and discussed above. Hygiene is very crucial in the healthcare setting. Proper hygiene and sanitation ensure that diseases from one patient are not passed to either other patients or healthcare professionals. This is very important considering that patients with many diseases converge in hospitals. Their immune systems are also weakened in such periods of time; therefore, keeping their environment clean and sterilized is very important to help them. A smart communication device, resembling a smartphone or other smart devices’ may not present any serious cleaning challenge. Their surfaces are large and flat which makes them easy to wipe and sterilize with damp cloth. This is unlike earlier telephones which have very uneven surfaces with many crevices and hidden area, which complicates cleaning and sterilization.

Conclusion

The world today is driven by smart technology. Though introduced to enhance and refine communication, smart devices have found many other applications (Rocha, Correia, Wilson & Stroetmann 2013). They started as improved phones but their capabilities have been enhanced and refined to levels of supercomputers, carrying out functions that were never imagined before. Some of their roles in the real world have included tracking and controlling machinery. Smart devices have also enhanced communication between various machine systems and people and have provided an interface through which human can communicate with machines. These devices are also equipped with hardware intelligences that can be exploited by various software and programs to effectively regulate various machines. Smart devices have greatly enhanced communication and social interactions between people. However, for various reasons, smart devices and all their advantages have not been utilized in healthcare environment and even in the short-stay beds despite the numerous advantages that would accrue (Poslad 2009).

Despite the various issues that have prevented widespread use of smart devices for communication especially in short-stay hospital beds, these devices would be very useful. They would make communication more efficient and would provide patients with a more dignified and safer stay in hospital beds. Various uses that these smart devices can be used for include patient to patient-nurse communication, patient to family communication as well as nurse/ patient to bed/ stretcher communication. As discussed earlier, this technology can also enhance nurse-to-nurse or nurse-to-other specialist communication, hence making the process of transition from one nurse to another or from one nurse to the next specialist more efficient.

The patients’ environment can be safer in that these smart devices would be easier to clean and disinfect than any other. The nurses and other hospital staff members can disinfect these devices periodically or before the bed is occupied by the next user. Such aspects as patient’s dignity will be improved in that he/she can be able to communicate easily and in timely manner whenever there is a need to urinate or have a bowel movement. Another application of such a device is that if it is equipped with various sensors and receptors; it can continuously communicate with the hospital control room relaying information such as patients’ blood pressure, blood sugar and temperature among. This has a crucial potential to trigger corrective measures from the nurses when such readings show undesirable trend. The fact that these devices could be made to communicate even when the patient cannot becomes very important as seen in the previous statement is of chief importance. In addition, when equipped or connected to electric fabric, they can also communicate to the control room when the bed is wet due to various reasons, which can initiate timely corrective move to restore patients’ dignity and comfort.

The consideration of ergonomic factors is important to ensure that patients can interact with these devices well (Reilly & Greeves 2002). As seen in the discussion, close consideration should be given to patients in the sleeping position. The devices can be placed in a raised railing on left side of the bed such that the patient can access it from a sleeping position using the right arm. The railing should be raised only to a comfortable height of around one foot from the bed to compensate for the height of the mattress. The device should also be fixed in a way that it can be tilted either towards or away from the user to enhance clarity. It can also be fitted in a way that it can be folded back to avoid potential damage when not in use. The bed arrangement should be such that the nurse in charge as well as any other specialist who might need to access such a device can do so conveniently. This means that the arrangement of beds should allow such a device to be accessible to the second party. Additionally, considerations should be made to ensure that the device can be shifted to the other side should the patient be left-handed.