Developing a Comprehensive Public Health Nursing Practice Model for Promoting Social Inclusion Among Populations Experiencing Social Exclusion: A Qualitative Study

AIMS: To develop a comprehensive practice model delineating public health nursing practices that promote social inclusion and illustrate their outcomes in Japan. DESIGN: Qualitative descriptive research design. METHODS: Semi-structured interviews were conducted with 12 public health nurses from municipalities, ordinance-designated cities, and prefectures in Japan. Transcripts were analysed using the framework method structured by a logic model and secondary inductive analysis, deriving the model. RESULTS: Public health nurses recognized community friction and isolation as signs of social exclusion and intervened by establishing trust with individuals and families facing social exclusion, improving their daily lives, and empowering them. They also developed support networks and empowered community residents. Although some practices yielded positive outcomes, others required reassessment and adaptation. This iterative process advanced a more inclusive social system. All practices were consistently grounded in five core values and implemented using eight basic skills. CONCLUSION: We develop a model empirically demonstrating the logical pathways through which public health nursing promotes social inclusion. The model provides a framework that flexibly addresses diverse and emerging forms of social exclusion. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: Public health nurses should recognize that routine practices are key to facilitating social inclusion. The model can serve as a communication tool to explain these practices to non-professional staff, fostering organizational environments that support inclusive public health nursing practices. IMPACT: This study addresses the lack of an explicit framework for operationalizing social inclusion in community settings. The findings reveal an empirical pathway connecting individual/family support to system-level change. The model supports public health nurses' competency development and assists in creating environments that enable proactive, inclusive public health nursing practices. REPORTING METHOD: The study was reported following the COREQ checklist. PATIENT OR PUBLIC CONTRIBUTION: This study did not include patient or public involvement in its design, conduct, or reporting.