Digital technologies promote innovation in health care and nursing [1]. Notably, a previous study categorized different applications of information and communication technology (ICT) in nursing practice into assessment, clinical intervention, health promotion, and service organization [2]. Regarding assessment, nurses have used electronic clinical recording systems [3] to assist in clinical decision-making for individual care [4], meet patients’ health needs [5], and reduce overwork time and medical care expenditure [6]. Meanwhile, ICT-based health promotion programs can improve community health [7]. ICT also ensures efficient staffing and supports health workers’ decision-making, communication, training, and health system management [1]. Therefore, digitalization and ICT promote effective and efficient care for individuals and communities. However, previous research has primarily focused on hospital- or clinic-based individual care [8]; little work has been done on the function of ICT in public health nursing [2].

Clinical terminology or taxonomy and its framework help visualize the classification of patients and nursing practice and improve health equity in multidisciplinary settings [9-14]. Nursing practices are based on nursing diagnosis systems [11] and interventions [12]. Focusing on patient outcomes is essential to improve nursing care and management quality [13,14]. However, while prior studies examine individual patients, knowledge about public health nursing is scarce. Under each country's different cultures, policies, and health care systems, public health nurses (PHNs) provide a wide range of lifelong care, support at the group level, and community-based activities. They also create policies, programs, projects, and health care systems that meet the needs of each community [15]. Individual care takes up most of a PHN’s time [16], making it difficult to perform community-based activities and assessments [17], which are the basis of developing needs-oriented projects. Although these projects are vital for improving health equity in the community [18], evaluating the necessity of these practices and their linkage depends on the PHN’s tacit knowledge. Therefore, in this field, assessment items core to clinical reasoning considering sociocultural backgrounds are required.

Given the rapidly changing health care needs that affect services, systems, and staffing [8], digitalization is still recent, especially in PHN [19]. The COVID-19 pandemic has accelerated the shortage of PHNs and digitalization in Japan [20]. Approximately 70% of PHNs in Japan work as prefectural or municipal public servants [21] and work in various departments. As Japan has the world’s oldest population and the lowest birth rate, the national government must encourage digitalization and reduce the number of civil servants by half by 2040 [22]. Therefore, the total number of PHNs will potentially be halved by 2040. To ensure the quality of public health nursing, Japan has a national license system for PHNs [23]. Additionally, supervisory PHNs must manage practices in each department [24] while assessing the workloads of their staff and developing their competencies. Owing to the lack of ICT systems, supervisory PHNs may be unable to understand the happenings in each department and the performance and competencies of each staff member. An ICT system is needed to support their management and human resource development.

Furthermore, electronic record systems collect data on nursing care and promote evidence-based management in hospitals [6,10-13,25,26]. The Omaha system also enhances such management for each patient in community settings [14]. In Japan, the national government conducts a public health nursing activities survey every 3 years [27]. To this end, randomly selected prefectural or municipal PHNs gather data on their daily activities and the required hours [27]. However, no study has applied these data to elucidate public health nursing care management. To encourage evidence-based practices and nursing management, PHNs require an electronic recording and management system that identifies health needs and suggests the best public health nursing practices. The system would help PHNs think about their daily activities and share information with their supervisors to improve the quality of care and competencies, thus ensuring health equity in the community.

This study will develop and validate an electronic recording and management system to evaluate the necessity of different public health nursing practices—including individual care, community-based activities, and project development—and to determine their best practices.

This study used an exploratory sequential design, which was conducted in Japan [28]. This design was suitable for exploring unknown questions using qualitative methods and developing a new instrument that can be validated by quantitative research analysis [28]. This study has 2 phases. Phase 1 will include a panel discussion to develop a structure for the electronic recording and management system. Phase 2 will confirm the validity of the proposed items through interviews with expert PHNs and a nationwide survey of PHNs.

The research team worked in public health nursing, home care nursing, public health, statistics, and computer sciences. This study is divided 2 phases. In phase 1, the research team conducted a literature review and a panel discussion that included 3 supervisors with experience working as prefectural or municipal government PHNs and 1 executive director of the Japan Nurse Association. The criteria for convening the expert panels meeting were to gather their opinions on the draft architectural framework—a hypothetical algorithm to determine the need for practice review; moreover, each item was developed by the research team.

In phase 2, the participants of interviews will be supervisory PHNs in prefectures or municipalities. Additionally, to ensure nationwide representation, we will include supervisory PHNs and midcareer PHNs with experience working in all local governments in Japan except those that completed the interviews. The inclusion criteria of midcareer PHNs have their cases and experience working for 6 to 20 years. The exclusion criteria for them are a managerial position.

In phase 1, the research team recruited a panel of experts using snowball sampling. In phase 2, they recruited 5 to 10 supervisory PHNs as participants, who worked in prefectures or municipalities to avoid bias in the functions and roles of public health centers. Before starting the nationwide survey, we sent letters, including the study description, to supervisory PHNs. We used a mailing list of all supervisory PHNs from the Ministry of Health, Labour and Welfare to announce the survey by email. We expect approximately 530 local governments to participate based on a collection rate of 30% in a previous study that used a similar survey methodology [29].

In the qualitative phase, 3 researchers will read the interview transcripts (confirmed by the interviewees) and classify the contents in terms of the survey items using the content analysis method [33]. We will combine expressions with similar meanings into a single concept, whereas contradictory data will be left as is. After consulting with the project’s supervisory PHNs, we will revise the survey items. The items for the nationwide survey will be finalized after all the project members confirm their validity.

The nationwide survey will be conducted through a descriptive analysis of the components of the system and the subjective necessity of PHN practices. In this survey, PHNs will answer based on 2 types of activities: (1) highly unnecessary and (2) highly essential. We want to compare these 2 categories and confirm whether the items will effectively work to help identify the differences between each activity in terms of necessity. We will use Cronbach α to measure the degree of agreement between the importance calculated when the responses were applied to the system developed in phase 1 and the subjective importance expressed by PHN interviewees. We will also perform a decision tree or random forest analysis with the PHN’s subjective sense of significance as the outcome and the system configuration items as explanatory variables. The model with the highest prediction accuracy will be compared with the system created in phase 1. Finally, the panels will verify the nationwide survey results to confirm the external validity and consider whether the system may be improved based on the findings.

This study will be conducted following the Declaration of Helsinki. Ethical approval for this study was obtained from the Research Ethics Committee of the Faculty of Medicine of the University of Tokyo, review number ID=2022114NI, 2022114NI-(1), 2022114NI-(2). We will explain the study’s purpose and methods to the interviewees and advise them that their privacy will be protected in written form. Informed consent will be obtained from each participant. For the nationwide survey, only those who agree to participate in the study will be asked to respond to the questionnaire.

This study was supported by the Ministry of Health, Labour and Welfare Japan research grant, which was acquired in April 2022. Interviews for supervisory PHNs were started in September 2022. Additionally, participants in the nationwide survey will be recruited in December 2022. The estimated date of the nationwide survey’s completion will be January 2023. The preliminary results will be submitted for publication in December 2023.

In phase 1, the panels agreed that the draft architectural framework and a hypothetical algorithm were reasonable. After meetings with them, we decided that the system should not be linked to electronic nursing records to protect the privacy of each individual case. Items from a cloud-based practice record system are depicted in Tables 1 and 2. The items were divided into 2 domains. The first was a daily record system regarding individual care, community activities, and developing needs-oriented projects, whereas the second was their termly review system. Based on the Omaha system framework [14], we added assessment items from the perspectives of the individual, the family, and the environment, especially for individual care. We used 9 categories regarding a national survey of public health nursing activities [27]: infectious disease, intractable disease, disability, mental health, maternal and child health, health promotion, aging and long-term care, occupational health, and child welfare.

After developing the parts of the system, the researchers entered the data using typical vignette cases based on the national examination level and modified the items based on the results. The expert panels also filled in the items. However, the vignette cases were more straightforward than the actual clients. Therefore, we will ask PHNs to answer each item in the nationwide survey based on their actual cases (see below for more information).

This study will develop and validate an electronic recording and management system to evaluate the necessity of different public health nursing practices and accordingly consider how public health nursing practices may be improved; specifically, the system will focus on practices that fall into the categories of individual care, community-based activities, and project development. This study has several strengths. Validated items will evaluate the necessity of different public health nursing practices, suggest the best ones, and show the clinical reasoning of PHNs. The system will enable PHNs to record their daily activities and share them with their supervisors to reflect on and improve their assessment and the quality of care to promote health equity in community settings.

This study focuses on the links between individual care, community-based activities, and project development to assess the need for continued care. Most studies showed the framework and items of nursing assessment, interventions, and outcomes for individual patients [10-14]. By contrast, PHNs promote health equity and individual, family, and community health through direct care and policy development [15]. However, PHNs are often too busy with individual care to assess community health needs and implement population-wide activities [17]. By offering new insights into PHNs’ tacit knowledge, this study can also inform the best practices for them. Additionally, senior and managerial PHNs play a vital role in bridging community needs assessment and grassroots projects in ways that support novice PHNs. Clarifying and translating PHNs’ tacit knowledge into explicit knowledge would be essential to developing health care systems [35].

The result of this study will show the required time and burden for PHNs regarding each activity. Health care organizations required help ensuring high-quality care, owing to limited staff and other resources [36]. In this context, it is necessary to optimize human resources in health care. Identifying benchmarks for and measuring staff performance is crucial for effective human resource management and person-centered care [37]. Therefore, supervisory PHNs need to be able to identify the performance of each staff member and the effectiveness of their activities. Our system will support supervisory PHNs in promoting evidence-based human resource development.

Moreover, because the system requires PHNs to record their daily activities, it will enable PHN directors and staff to reflect on their practice periodically. Sharing the results of their daily activities with tier supervisors can help PHNs improve their performance and provide appropriate care for individuals, families, aggregates, and communities. Therefore, this study will improve the quality of care and address community health inequities.

This study has some limitations. First, due to the ongoing COVID-19 pandemic, we can only interview a few participants; additionally, we expect the response rate for our nationwide survey to be low. Meanwhile, it is also notable that our study participants will likely be health care workers interested in the study. While we will work to ensure that our sample will be nationally representative by asking all local governments in Japan to participate, this study will still be subject to this selection bias. We will be sure to carefully analyze and interpret the data accordingly.

This exploratory sequential study will attempt to develop and validate an electronic recording and management system to evaluate the necessity of different public health nursing practices and determine best practices. The results will offer insights to develop a system that can help PHNs reflect on their daily routines and create benchmarks that can inform, thus improving on-the-job training by supervisory PHNs. This system will strengthen evidence-based public health nursing practices and management while improving the quality of care to enhance health equities in community settings.