Reply to comment on: Role of education in enhancing home care nurses' assessment skills: A closer look at key findings

We appreciate the insightful comments by Dr Al-Qahtani et al.¹ regarding our article.² We welcome this scholarly dialogue and offer our views on their concerns. They raised four points concerning our study: the absence of consideration of the long-term effects of detailed educational program content, the interpretation of our findings related to novice nurse education, the generalizability of our results, and the relationship between assessment and clinical outcomes. In this letter, we offer the following clarifications.

Al-Qahtani et al. rightly point to the importance of considering the details of educational program content and their long-term effects.¹ Our primary aim was to examine whether existing home care agencies' educational systems are associated with nurses' comprehensive assessments.² A detailed evaluation of the quality of specific educational programs was beyond the scope of our cross-sectional design, such as educator roles, resource allocation and the direct effects, including potential long-term effects, of these factors on clinical outcomes. Building on our finding that specific educational system components were associated with more comprehensive assessments, we will investigate these aspects in our future research. For instance, educator roles vary by agency: some focus on creating educational plans, whereas others are involved in carrying out post-home visit reflections or organizing periodic case conferences. In future studies, we would carry out a detailed examination of these diverse roles and varying levels of educator involvement to explore more thoroughly their associations with nurses' comprehensive assessment practices.

A statistically significant association was not observed between novice-specific education and comprehensive assessment practice in our study.² As we focused on agency-wide educational systems, it was difficult to examine the long-term or distinct effects of novice-specific training. The fact that most participants were experienced nurses (average experience 7.9 years) increased this difficulty. The impact of educational interventions specifically targeting at novices might have been less apparent in our sample, particularly when ongoing educational activities often involve both novice and experienced nurses. These findings do not deny the fundamental importance of training for novice nurses. Instead, they highlight the need for future research to examine the content and long-term impact of education in greater detail.

We also concur with Al-Qahtani et al. regarding the generalizability of our findings, given that our sample comprised 11 agencies that were, as noted, well-resourced.¹ This limitation was discussed in our article.² We agree that further research is essential across a broader spectrum of agencies, including those with varying resource levels, sizes and geographical settings, to enhance the applicability of findings in this field.

Al-Qahtani et al. also make a critical point regarding the utilization of assessment results, emphasizing that assessment is a process, and that subsequent interventions are vital for improving patient outcomes.¹ In the actual care process, nurses begin by assessing the patient's status, and then they conduct care and finally achieve patient outcomes, based on Tanner's clinical judgment model.³ That is why our study focused on the assessment phase, using education as an effective intervention.² Furthermore, it is important to note that this study's quality indicators for long-term care, which were developed as part of the Visualizing Effectiveness of NUrSing and Long-term Care (VENUS) project.^{4, 5} The VENUS project aims to improve the overall quality of long-term care by developing and utilizing a comprehensive set of quality indicators to examine the structure of care from assessment to processes to patient outcomes. Our study, as a part of the VENUS project, focused on the assessment phase and its related factors.²

In our future research, we will also explore the effectiveness of specific educational interventions, carrying out longitudinal studies on the impact of such educational interventions, and further investigate the education–assessment–outcome path. In the VENUS project, we will continue to explore the crucial links between comprehensive assessments, the care provided based on these assessments and client outcomes. We are committed to these ongoing research efforts to advance knowledge and improve practice in home care nursing.

This study was supported by a Health and Labour Sciences Research Grant (Grant Number: 20GA1005) from the Ministry of Health, Labour and Welfare, Japan.

The authors declare no conflict of interest.