The participants were six nurses. The inclusion criteria were followings; they worked at clinics which proposed visiting medical treatment, they accompanied a physician and visiting medical treatments, apart from the daily visiting nurse station, their nursing experience was over five years. The exclusion criteria was that the nurse who might feel burden to talk in the interview was excluded.

The researchers recruited nurses who worked at one of four home hospice clinics where visiting medical treatments were proposed and the nurses agreed with participation.

The research interviewers visited clinics, explained about the research again, and received informed consent after agreement for participation. There were three interviewers and all had counseling certification.

The interview lasted approximately 60 minutes and was only completed once. The questions were; “How do you care for a patient and a family member when you visit their home as a nurse with a physician?” and “How do you perceive home hospice? Each nurses’ narrative was recorded by an IC recorder after getting their permission. This study was approved by the ethical boards of St. Mary’s College (June, 2017).

For the narrative data, we employed “qualitative analysis” by Funashima [8] based on the work of Berelson [9] . In narratives, we separated sentences into each shortest sentence without losing meanings, which is called as code. The similar codes were integrated into subcategories. Then similar subcategories were integrated into one category. Categories are separated into some themes. To maintain reliability, the categorization and coding were validated independently by researchers. Inconsistencies were discussed and negotiated until agreement was reached.

We selected categories from narratives about importance, changes, and hopes. We show the subcategory as < > and category as “ ”. A “clinic” means a “clinic which proposed visiting medical treatment”.

About the contents of care by a nurse, we chose six categories (Table 1). The category “1) Understanding a patient as a living person” included subcategories such as . “2) Making an atmosphere where a patient and family talk to staff easily” included subcategories like . The category “3) Examining if a patient and caregiver live at ease” included subcategories like . “4) Support for caregivers to continue care at home” included subcategories like or . The category “5) Sharing information and cooperation with other professions” included subcategories like . The category “6) Caring for a caregiver to accept a loved one’s death and care at death” included subcategories like .

The nurse’s narratives were categorized into 11 groups of about four themes (Table 2).

About the theme [Environment of home hospice], there are three categories. The category “7) Time and space for listening carefully” included subcategories like . The Category “8) Enjoyment of freedom in home” included subcategories like . The category “9) Appearance of hope to live” included subcategories like .

About the theme [Care of nurses], there are four categories. The category “10) Feeling of responsibility and attractiveness of work” included subcategories like . The category “11) Thinking of a patient and a family completely and intimate relationships” included subcategories like . The category “12) Focus on mental care in home hospice” included subcategories like . The category “13) Adjustment of relationships between a visiting nurse station and a clinic” included subcategories like .

About the theme [Introduction to home hospice and continuation], there are two categories. The category “14) Hopes for home hospice by a patient and caregiver for introduction” included . The category “15) Economics and man-power to continue home care” included subcategories like .

About the theme [Relationships between a hospital and a clinic], there are two categories. The category “16) The different opinions of observation among a family, a hospital and a clinic” included subcategories like . The category “17) Requirement of connection between hospitals and home hospice clinic” included subcategories like

Nurses could understand patients including their lives as a person. They can make intimate relationships between a patient or a family and staff. Relationships at home hospice may be stronger than at general hospitals. It is a beneficial point for home hospice. The category “3) Examining it a patient and caregiver live at ease” showed that people were made to feel safe to contact nurses for help at any time. Shalev, et al. [10] showed that caregivers in home hospice needed more information, and the nurses in this study tried to communicate with each other. Also, nurses use communication skills well. Oliver, et al. [11] showed that hospice nurses appear to use basic validation techniques naturally, and they use higher-level of techniques on complex occasions. Nurses in home hospice may be required to use higher-level communication technique sometimes because the number of visiting nurse is limited.

In the observation categories, nurses tried to make intimate relationships by understanding a patient and caregiver, they supported choices to continue care at home, and supported the acceptance of a loved one’s death during the diseases progress. These nursing processes may offer support for family resilience. A patient and family are confronted with the stressful or traumatic event of death, however, they have power to go through recovery; that is resilience. Nurses supported a patient and caregiver in regaining resilience. Previous studies showed that resilience is related to the quality of life (QOL). McDonald et al. [12] investigated the quality of life of caregivers and showed the importance of “maintaining resilience”. Moreover Yuli, et al. [13] showed that the resilience of caregivers of cancer patients contributed QOL to the caregiver’s burden.

Recently, the places where a patient spends time are various. About the theme [Environment of home hospice], nurses perceived that a patient at home can enjoy their time freely and sometimes hope appears. The number of patients in home hospice is not high, the place may be important to realize a good death [1] .

About the theme [Care of nurses], nurses with visiting medical treatments worry about the mental health of a patient and caregiver, a visiting nurse proposes mental care. Kozlov, et al. [5] showed that home hospice patients experience moderate-to-severe symptoms of anxiety and depression in the last week of life. Since family caregivers worry about the physical and emotional symptoms at the very end of care, support for this point may be important. Reblin, et al. [7] described that communication demonstrating emotional expression between cancer spouse caregivers and nurses during home hospice may have implications for caregiver depression up to a year after a patient’s death. That is, expressing emotion promotes a caregiver’s mental health. In the future, various kinds of intervention will be needed for mental health, and measurement of its effects will be also needed for evidence-based practice about home hospice.

Related to the theme [Relation between a hospital and a clinic], the category “16) The different opinions of observation among a family, a hospital and a clinic” showed the differences in opinions about places of care or observation. Recently, a patient’s intention is important, therefore, advanced care planning also seems to be important [14] . Nurses have an important role of talking to patients. Moreover, moving from a hospital where a patient gets medical treatment to a clinic in home hospice sometimes does not go well. Smoother transitions may be required. Also, teamwork between a visiting medical treatment clinic and a visiting nurse station is required. Limardi, et al. [15] showed the importance of healthcare team communication.

There are some economical or man-power problems of care giving that will need to be addressed in the future.