Nurses' practices in optimizing the care environment in everyday living settings for children with medical complexity.

BACKGROUND

Children with medical complexity (CMC) often require highly individualized care environments in everyday living settings. Nurses play key roles in coordinating care and optimizing these environments; however, their specific practices have not been fully elucidated.

PURPOSE: This study aimed to clarify nursing practices for optimizing care environments for CMC in everyday living settings.

DESIGN AND

METHODS

A qualitative interpretive description study was conducted with nurses from hospitals, home-visit nursing agencies, and community-based services in Japan. Participants were recruited using purposive and snowball sampling between July 2023 and February 2024. Semi-structured interviews explored nurses' experiences of optimizing care environments for CMC. Data were analyzed using reflexive thematic analysis.

RESULTS

Seventeen female nurses with a mean of 16 years (SD = 5.4) of CMC-related care experience participated. Five themes were identified: (1) supporting autonomous decision-making by CMC and their families; (2) organizing daily living environments for safety, comfort, and holistic well-being; (3) fostering family empowerment; (4) preparing service environments to improve service quality and support; and (5) organizing community environments for safe and sustainable living.

PRACTICE IMPLICATIONS: Nurses play key coordinating roles in optimizing multidimensional care environments through collaboration with families and multidisciplinary teams. These practices may inform community-based nursing interventions, strengthen family empowerment and decision-making, and support integrated care systems that promote safe and sustainable living for CMC and their families.