Practical Experience in Home Care of Nursing Interns: A Qualitative Research

Purpose: To explore practical experience in home care of nursing interns. Methods: The phenomenological method for qualitative research was to interview 15 nursing interns in a semi-structured way, and then the collected data were analyzed and summarized by using the Colaizzi analysis method. Results: Interviewing results showed that there were five recurring themes, including: 1) personalized care; 2) health education; 3) humanistic care; 4) solid professional foundation and sense of responsibility; 5) expanded vision. Conclusion: Through home care practice, nursing interns deepened their cognitions of nursing connotation, stimulated their love for nursing and motivation of continuous learning, and improved their sense of identity to nursing career. In general, the practice of home care had a positive impact on nursing interns.


Introduction
Clinical practice stage is not only an important part of nursing career, but also the clinical starting point of nursing professional education. It affects nursing students' professional attitude, behavior skills, professional role formation and work responsibility [1]. Moreover, it is also the key period of transforming nursing knowledge into practical ability for nursing students [2]. Practice in different clinical placement departments may give different impression and motivation to nursing interns.
Home care provides medical care, disease care and life assistance to patients with impaired function, and the disabled patients or patients suffering from various diseases in their residences [3]. Home care development has been ma-

Procedures
All participants had a face-to-face semi-structured interview, which was conducted when their internship was done in Transitional Care Department. All interviews were performed face to face by the lead author in a quiet place. The time average of the interviews was about 30 minutes, ranging from 28 minutes to 46 minutes. The sample of information saturation was appropriate. Before the interview, the lead author would introduce the purpose and significance of the research to the interviewees, and obtain interviewees' consent on the recordings.
In order to protect the privacy of interns, all research contents were anonymous and interns' names were numbered instead.

Data Collection
Data were collected based on the phenomenological research method; and then a semi-structured interview outline was drawn up according to the purpose of the study, mainly including interns' practical experiences, their feelings and other aspects. The interview outline was as follows: 1) What do you think the difference between home care and clinical nursing in the hospital? 2) What requirements do you think nurses who provide home care should have? 3) What is the influence of home care on your professional attitude? 4) What do you learn from home care? Each question is followed by probing question such as "Please say more", "Can you take an example?". Interviewing skills were required, such as active listening and asking open-ended questions without hidden presumption.

Data Analysis
The data collection and analysis were carried out simultaneously. After each interview, two researchers transformed the interview recordings into texts within 24 hours, and then analyzed the data by using the 7-step phenomenological analysis method of Colaizzi [6], summarizing and refining the common parts of the data. Then two researchers analyzed, reviewed and corrected the research data to ensure the authenticity and objectivity of results.

Ethical Issues
The Ethical approval was obtained from Institutional Review Board of the author's hospital. Personal privacy may be involved in the study, so researcher adhered to the following rules when dealing with ethical issues: the purpose of the project was introduced by the researchers; recording could not be performed until the consent of the interviewees was obtained; the interviewees had the right to quit without prejudice consequences; and gratitude was showed to interviewees.

Participants
15 interviewees were included in this study. Interviewees were between 19 and 24 years of age, with an average of 21.80 ± 1.32 years old. There were 2 males and 13 females, with 9 junior college students (60%) and 6 undergraduate students (40%). The characteristics of interviewees were presented in Table 1.

Health Education
Health education is crucial for home-based patients, which helps patients improve their quality of life and health level [7]. Nursing interns thought that home care practice requires paying more attention to health education. P3 "Health education and guidance given by teachers are very detailed, which effectively solves patients' problems"; P4 "During delivering home care, we should be patient and careful to patients and their families, and seriously carry out health education for patients and their families"; P6 "Through the practice of home care, I realize the importance of health education for patients, and also understand that we should learn more knowledge to help patients"; P7 "Nurses in the wards focus more on specific nursing skills, while home visiting nurses pay more attention to health education"; P9 "Home care practice enables me to learn about how to carry out health education for patients".

Humanistic Care
Humanistic care ability is the core of nursing [8]. Effective humanistic care can promote patients' recovery, obtain patients' satisfaction and improve the relationship between medical staff and patients [9]. However, some nurses often neglect patients' psychology and social concerns in clinical nursing [10]. Nursing interns stated that they barely felt the humanistic care given to the patients during the clinical practice in the hospital, but they deeply felt it during home care service. P2 "What depressed me during home care practice is humanistic care, and my preceptor always warms patient's heart with words and actions"; P3 "During home care service, communication between my instructor and the patients ran through the whole process, and my instructor was very gentle and paid attention to many details"; P10 "My instructor treated patients and their families as friends, using vivid words to communicate with patients; I think it is worth to explore and learn"; P14 "My instructor always provide excellent nursing service for patients with her patience and love during home care service. In my future nursing career, I will adhere to this spirit and provide more humanistic care for patients".

Solid Professional Foundation and Sense of Responsibility
Most of the interns thought that home visiting nurses need to be equipped with solid professional foundation, rich clinical practical experience and a high sense of responsibility. They thought that they should study hard and improve their competency to serve patients in the future. P4 "To provide home care, we need to be self-skilled and have solid professional knowledge"; P8 "Nobody can be competent for delivering home care without several years of working experience"; P11 "Home visiting nurses are required to have solid medical and nursing knowledge and rich clinical experience, and they should constantly improve their professional skills"; P12 "I will treat nursing more serious in the future by improving my professional skills and enhancing my competency"; P15 "Home care is not as simple as you thought, and it is not as typical as it was written in textbooks. There are sometimes many unexpecting conditions that you need to handle independently during home care service period. You cannot provide excellent home care service for patients if you have no sense of responsibility".

Discussion
In China, each nurse in the hospital is responsible for 8 -10 patients [11], which is a heavy workload for nurses. All the interviewees who have practiced in clinical nursing units considered that clinical nursing service in hospital is trivial because nurses spend a lot of time on injection, drug delivery for patients and execution of doctor's orders. They do not have time to provide personalized nursing service for each patient such as health education and humanistic care which is consistent with Zheng et al. findings [12]. Based on the above situation of nursing, the connotation of nursing and the value of nurses could not be presented well. Furthermore, nurses do same things every day, making them lack of enthusiasm. As an extension of inpatient service mode, the characteristics of home care service are totally different from clinical nursing, which gives nursing students a sense of novelty, therefore it is welcomed by all nursing interns.
Home care service is a one-to-one nursing service at patients' home with relatively sufficient time, which is conducive to making and implementing persona- can present the value and connotation of nursing in a more excellent manner.
Through the practice of home care, nursing interns can fully master about the whole process of nursing services from discharge to home, and the extents and depths of nursing, so as to deepen the cognition and understanding of nursing connotation.
The professional values formed during the internship of nursing students have a crucial impact on their employment. It is an effective way to strengthen the positive guidance of nursing students' professional values for stabilizing the nursing team and reducing the loss of nursing staff [13]. During the internship of nursing students, the professional attitudes and enthusiasm of interns are affected by the clinical instructors' words and deeds [14]. Home care services are generally undertaken by advanced and capable practice nurses such as possessing solid professional foundation, comprehensive nursing skills, serious working attitudes and outstanding communication ability [15]. As an important source of knowledge and experience, instructors would set a role model for nursing interns. Influenced by these instructors, nursing interns will also have higher requirements for themselves [16]. Learning from the words and deeds from instructors, nursing interns will have a correct perspective on life and values, which will stimulate their enthusiasm, make them have a clearer understanding of nursing profession, and virtually improve their understanding of the connotation of nursing profession and their professional identification [17]. Therefore, nursing administrators of medical institutions should monitor the psychological condition of students in the course of clinical practice and take appropriate measures to regulate the negative emotions expressed by nursing students, and actively encourage them to enhance nursing students' sense of professional identity and professional self-confidence.

Limitation and Future Research
There are limitations in this study. The interview outline was limited in items and could not fully reflect the nursing interns' experience of home care practice.
In the future, we will develop a questionnaire using the Delphi method based on literatures to investigate the practical experience of nursing interns more comprehensively so as to provide theoretical basis for the education and training of nursing students.

Conclusion
The practice of home care allows nursing interns to learn about the modes and service contents of nursing from other perspectives, and thus deepen their understanding of nursing connotation. This is conducive for interns to forming ho-