Clinical Judgment of Home-Visit Nurses with an Extended Scope of Practice in Japan: A Qualitative Study

Background/Objectives: The super-aged society and shortening of hospital stays in Japan have increased the importance of the role of home-visit nurses. The 2015 Specific Medical Acts Training Program qualified registered nurses with an extended scope of practice (RNs-ESP) to perform specified medical procedures based on physician-prepared protocols. Although the procedural activities of RNs-ESP have been documented, their underlying clinical judgments remain unclear. This study aimed to clarify the clinical judgments of home-visit RNs-ESP in Japan. Methods: This qualitative, descriptive study used participant observation and semi-structured interviews. Five home-visit RNs-ESP with at least 2 years of post-training experience participated. Data were collected from 32 clinical cases during home visits and analyzed using Mayring's qualitative content analysis, utilizing Tanner's clinical judgment model as a conceptual framework for operational definition. Results: The clinical judgments of RNs-ESP were classified into five categories and 18 subcategories: "Interpretation of pathological conditions and prediction of changes", "Directing daily living assistance based on general conditions", "Construction of the home care system in anticipation of pathological changes", "Optimization of pharmacotherapy tailored to pathological conditions and daily life", and "Selection of medical procedures tailored to daily life". RNs-ESP integrated medical reasoning with patients' life perspectives to design and implement optimal, highly individualized care plans. Conclusions: The clinical judgments of RNs-ESP are characterized by the integration of pathological assessment and daily life needs, supported by autonomous intervention authority. These judgments are essential nursing practices that balance continuous safe medical treatment with patient dignity and quality of life in home care.