How did home care nurses support COVID-19 patients in Japan? A qualitative study.

Aim: Home care nurses support patients with COVID-19 with mild to moderate symptoms at home due to the lack of community-based support. Little is known about how nurses initiated and maintained support for patients with COVID-19. This study explored the experiences of home care nurses in supporting patients with COVID-19 at home.

Methods: Using snowball sampling, 21 home care nurses participated in semi-structured interviews conducted either in person or online between September 2021 and February 2023. A qualitative study using a grounded theory approach was conducted.

Results: Home care nurses faced a situation where "suffering patients are overflowing" due to inadequate support from public health centers and designated hospitals. Despite their anxiety, they acted as a "flexible safety net by quickly compensating for uncertain support systems" for patients, families, and local health workers. They "built tentative support systems immediately" and "updated tentative support systems, own knowledge, skills, and mindset." Home care nurses also "rushed to patient/family" to provide timely support and "avoided preventable death."

Conclusions: Home care nurses act as a flexible safety net, preventing patient deaths by quickly compensating for uncertain support systems before and after initiating care. Their efforts complemented the inadequacies of traditional infectious disease control systems, typically managed by public health centers. Strengthening secondary and tertiary prevention systems is essential for home care nurses to save lives while delivering individualized care during the COVID-19 pandemic.