Makoto Tsukuda

ABSTRACT Aim To examine clinical nurses' attitudes towards and self‐reported experiences of family nursing in Japan following the relaxation of COVID‐19 visitation restrictions. Particular attention is paid to early career nurses whose formative training occurred during visitation bans. The study focused on nurses' negative perceptions and emotional burdens associated with family involvement. Design A quantitative‐dominant mixed‐methods cross‐sectional study reported in accordance with the STROBE guideline. Methods Using a convenience sampling approach, a self‐administered, paper‐based questionnaire was distributed to clinical nurses in four general hospitals in Japan between January and May 2024. The questionnaire consisted of four parts: demographic and professional background, learning methods related to family nursing, 17 items including negatively valenced statements adapted from the Families' Importance in Nursing Care–Nurses' Attitudes (FINC‐NA) scale, and one open‐ended question. Quantitative data were analysed using descriptive statistics and t ‐tests, and qualitative responses were thematically analysed. Results Of 1921 nurses invited, 957 responded (response rate: 49.8%), and data from 892 valid responses were analysed. Overall, the nurses demonstrated positive recognition of family nursing as a professional value but also reported lingering emotional burdens and practical challenges when interacting with families. Early‐career nurses who began practice during the pandemic showed greater uncertainty and lower affective engagement. Thematic analysis revealed five key themes: relational disruption, emotional stress, moral conflict, reappraisal of family engagement and ongoing barriers. Conclusion The findings underscore the need to structurally and educationally reintegrate families into nursing care. Simulation‐based training, clear institutional policies and hybrid communication models are essential to rebuild relational continuity and support nurses' emotional and ethical capacity for family nursing. Implications for the Profession and/or Patient Care The findings highlight the need to structurally and educationally reintegrate families into clinical care to address the emotional burden and ambivalence reported by nurses. Organisational support—such as clear visitation policies, simulation‐based education and reflective opportunities—can help rebuild nurses' relational competence and confidence in engaging with families. Creating supportive learning environments, including on‐the‐job mentoring and team‐based reflection, may further facilitate the restoration of family nursing. Impact This study addressed how prolonged COVID‐19 visitation restrictions disrupted family nursing practice in Japan, created generational differences in nurses' competencies, and shaped nurses' perceptions of family involvement. Nurses reported emotional strain, feelings of being monitored and lack of time when families were present. Early career nurses showed lower relational engagement, while experienced nurses expressed moral distress. ‘Latent indifference’ was also noted. The findings provide valuable insights for healthcare organisations, nurse educators and policymakers by informing strategies to reintegrate families into patient care, improve discharge planning and strengthen training models. Reporting Method The STROBE checklist. Patient or Public Contribution No patient or public contribution.

There exists an international consensus on the importance of family-centered care (FCC) in intensive care settings and the evaluation of collaboration between nurses and families; however, FCC is currently practiced blindly in Japan. In this study, we developed a Japanese version of the questionnaire, Factors that Influence Family Engagement (QFIFE-J) and examined its reliability and validity. A web-based survey was conducted with 250 nurses working in the intensive care unit (ICU). Exploratory and validatory factor analyses were used to ascertain factor validity. Criterion-related validity was tested using correlation analysis with the ICU Nurses’ Family Assistance Practice Scale. Internal consistency and reproducibility were verified for reliability. Following exploratory and confirmatory factor analyses, a 15-item measure emerged comprising four factors: “ICU environment”, “nurses’ attitudes”, “nurses’ workflow”, and “patient acuity”. Confirmatory factor analyses showed a generally good fit. Cronbach’s α for the overall scale was 0.78, indicating acceptable internal consistency. The intraclass coefficient for test–retest reliability was 0.80. It was found that the QFIFE-J was reliable and valid and may help determine the factors that promote or inhibit FCC. Additionally, this study has also clarified the current status and family support related issues in ICUs in Japan.

Stigma among healthcare workers during the coronavirus disease 2019 (COVID-19) pandemic is an issue that requires immediate attention, as it may otherwise lead to the collapse of healthcare systems. In this study, we developed the COVID-19-related stigma scale for healthcare workers (CSS-HCWs) and assessed its reliability and validity. Data were collected online from 500 participants, including physicians and nurses involved in COVID-19 care. The first item of the draft scale was developed based on a literature review and qualitative study. The draft scale consisted of 24 items, which were rated on a six-point Likert scale. Descriptive statistics were calculated and the data distribution was analyzed. To assess the scale’s validity and reliability, structural validity was evaluated through an exploratory factor analysis. Criterion-related validity was examined through a correlation analysis using the E16-COVID19-S, a COVID-19 scale developed for physicians in Egypt. Reliability was evaluated by examining the scale’s stability and internal consistency. The findings revealed that the stigma scale was a valid and reliable instrument. The final scale consisted of 18 items across three domains: personal stigma, concerns of disclosure and others, and family stigma. In conclusion, the scale is a valid and reliable instrument that can measure COVID-19-related stigma among healthcare workers.