Junko Honda

Family nursing in Japanese emergency and acute care settings is deeply influenced by cultural norms that emphasize familial involvement in patient care. However, institutional constraints often impede meaningful engagement, particularly in high-acuity and crisis contexts. The scoping review revealed that family nursing in emergency departments remains fragmented, primarily qualitative, and highly dependent on individual nurses' discretion. Postpandemic data indicated a decline in relational competencies, especially among senior nurses. To foster ethical, culturally responsive family nursing in emergency care, system-level investment is needed in structured protocols, measurable outcomes, interprofessional collaboration, and education that integrates emotional and ethical competencies.

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.