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.