BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic posed substantial challenges for public health nurses (PHNs) in delivering outreach services to vulnerable pregnant women and families requiring assistance. Despite restrictive measures, the importance of maintaining face-to-face support and implementing adaptive strategies was evident. OBJECTIVES: This study aimed to identify the key characteristics of outreach practices conducted by PHNs during the pandemic, the challenges they encountered, and the strategies needed to address these issues effectively. METHODS: A qualitative descriptive study was conducted using semi-structured interviews with 11 PHNs from seven Japanese municipalities of varying population sizes. Data were analyzed using thematic coding, focusing on outreach characteristics, challenges, and resource requirements. RESULTS: The outreach practices included maintaining face-to-face home visits, fostering trust through casual interactions and written correspondence, leveraging collaborative networks, and utilizing digital tools. Major challenges involved balancing infection control with face-to-face support, overcoming the limitations of online consultations, and ensuring service accessibility for families without internet connectivity. Participants advocated for integrated digital tools, flexible communication approaches, and robust data management systems. CONCLUSIONS: Our findings underscore the resilience and adaptability of PHNs in supporting vulnerable families during crises. Addressing these challenges can enhance outreach practices and provide valuable insights for responding to future pandemics or similar emergencies.