Traditional nurse call systems used in residential care facilities rely on patients to summon assistance for routine or emergency needs. Wireless nurse call systems (WNCS) offer new affordances for persons unable to actively or consciously engage with the system, allowing detection of hazardous situations, prevention and timely treatment, as well as enhanced nurse workflows. This study aimed to explore facilitators and barriers of implementation of WNCSs in residential care facilities. Methods:

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... The study had a cross-sectional descriptive design. We collected data from care providers (n=98) based on the Measurement Instrument for Determinants of Innovation (MIDI) framework in five Norwegian residential care facilities during the first year of WNCS implementation. The self-reporting MIDI questionnaire was adapted to the contexts. Descriptive statistics were used to explore participant characteristics and MIDI item and determinant scores (D1-29). MIDI items to which ≥20% of participants disagreed/totally disagreed were regarded as barriers and items to which ≥80% of participants agreed/totally agreed were regarded as facilitators for implementation. Results: More facilitators (n=22) than barriers (n=6) were identified. The greatest facilitators, reported by 98% of the care providers, were the expected outcomes: the importance and probability of achieving prompt call responses and increased safety (D9 expected outcomes), and the normative belief of unit managers (D15 subjective norm). During the implementation process, 87% became familiar with the systems (D18 awareness of content), and 86% and 90%, respectively regarded themselves (D17 knowledge) and their colleagues (D14 descriptive norm) as competent users of the WNCS. The most salient barriers, reported by 37%, were their lack of prior knowledge (D17 knowledge) and that they found the WNCS difficult to learn (D8 personal drawback). No features of the technology were identified as barriers. Conclusions: Overall, the care providers gave a positive evaluation of the WNCS implementation. The barriers to implementation were addressed by training and practicing technological skills, facilitated by the influence and support by the manager and the colleagues within the residential care unit. WNCSs offer a range of advanced applications and services, and further research is needed as more WNCS functionalities are implemented into residential care services. Background Traditional nurse call systems (NCSs) used in residential care facilities rely on patients to summon assistance for routine or emergency needs. NCSs are light call-, care communication-, call-, paging-or patient call systems, and may constitute of a variety of features supporting the main nurse call function, which is to support patient safety and facilitate communication between the patient and the nursing staff. NCSs are well accepted health technologies (1), integrated in standards (e.g. the German DIN VDE 0834 standard) and recommendations (e.g. the British Health Technology Memorandum 08-03; the Norwegian State Housing Bank recommendation HB 8.C.8.) to ensure that the healthcare organizations apply statutory requirements. The importance of implementing a multifunctional NCS that addresses the users' needs and supports effective communication between patients, healthcare providers and management, is emphasized (2). Research on NCS has predominately been hospital-based and has primarily reflected the major driving forces of technical development, namely to enhance patient safety through reduced call response time and to eliminate alarm fatigue among healthcare providers (2-5). In the residential care sector, research on alarm fatigue and corresponding patient safety issues has been related to monitoring systems (6-9). As a part of the digital transformation of healthcare services and based on a recommendation from the Norwegian Directorate of Health in 2017, wireless nurse call systems (WNCSs)