The number of people requiring home care was 170,000 in 2011, and is expected to increase to 290,000 by 2025 [1]. In addition, the number of visiting nurse stations, which was 5,731 in 2011, has increased to 10,418 as of 2019, nearly doubling in eight years. With the shortening of hospital stays, there is a shift in emphasis from medical facilities to home care. Against this backdrop, nurses are expected to build community-based comprehensive care systems that meet regional characteristics and demonstrate their nursing expertise as members of the home care team [2]. The place of employment for nurses will shift from hospitals to the community and home, and they are expected to provide appropriate comprehensive health, medical, and welfare services in collaboration with multiple professions in a variety of settings, not limited to medical institutions, and curriculum revision for basic nursing education in 2022 is being discussed [3]. Home nursing theory, which is an integrated subject of basic nursing education, has been taught and practical training has been promoted focusing on home nursing for home care patients, but nursing small-scale multifunctional in-home care and regular patrol/as-needed home nursing care have been established as community-based services. In addition, the activities of nurses have expanded to include consultation activities close to people's lives, such as "health centers for daily life. For this reason, the guideline for the operation of training institutes for nurses proposed that home nursing theory be revised to "community and home nursing theory," in which students learn the basics of nursing by understanding local people and their families in a variety of settings in the community [3]. Home health care nursing theory is not a facility-centered practical training, but rather a way to understand people living in the community and people living with disabilities and their families, and to acquire nursing care for people receiving treatment at home [4]. The practical training in home health care nursing at our university is a first semester course for fourth-year students. With the practical training objective of "understanding how to provide nursing care for the health and life issues of home care patients and their families, and learning about the cooperation of multiple professions and the role of home health care nurses in home care," the practical training focuses on visiting with home health care nurses at home health care nursing stations. The training focuses on visiting with visiting nurses at home nursing stations.In order to examine the design of home health care nursing practice to understand local people and their families and learn the basics of nursing in diverse settings in the community, it is necessary to clarify the content of students' learning in the current home health care nursing practice.Japan is expected to increase the number of home health care nurses as it is required to improve the community health care and nursing care delivery system in anticipation of the medical and nursing care needs of 2025. Currently, 80% of nurses are placed in clinical nursing settings, most of which are medical institutions, say hospitals and clinics [5]. It is expected that this will shift to home nursing in the future, but many of Japan's home nursing stations are short of nurses and are in a difficult situation, with only a minimum number of nurses to cover daily tasks. Many nursing students enter the clinical field after graduation, but few of them find employment in home health care nursing stations immediately after graduation. After working as a nurse at a university hospital or general hospital for a number of years, they may decide to work at a home health care agency when their lifestyles change or their careers take a turn. However, the current curriculum of nursing schools in Japan does not lead to working as a home health care nurse immediately after graduation, and the scope of home health care nursing is limited in the subjects of the national nursing examination. Large-scale home health care nursing stations in urban centers in Japan have introduced systems and structures that allow students to find jobs and work immediately after graduating from nursing school. However, few home health care nursing stations have the personnel and environment to mentor new nurses. In the future, it will be necessary for visiting nurse stations in Japan to improve the education content for new nurses. In addition to improving the educational content for new nurses, it is also necessary to improve the guidance system for nursing students. In order to improve the education system for nursing students and new nurses, it is essential to improve the environment and shortage of manpower at home nursing stations. In response to these problems of home health care nursing stations in Japan, we thought it necessary to clarify the problems of facilities that accept nursing students for practical training. Our university offers two weeks of practical training at a home health care nursing station as part of its home health care nursing training program. With the establishment of new nursing schools and the increase in the number of nursing students, it has recently become difficult to find facilities for practical training. The average number of nurses in a home health care nursing station is 3 to 5, which is the highest at 32.9% of the total (Ministry of Health, Labor and Welfare, 2020).This year, three new facilities have agreed to accept students as home health care nursing practice facilities, all of which have never accepted students as home health care nursing practice facilities before. All three facilities have never accepted students for practical training in home health care nursing before, and the nurses at the facilities have voiced their concerns about what kind of practical training they should provide to the students. Therefore, in this study, we will clarify the problems and issues of acceptance by the practice facilities in order to obtain suggestions on how the faculty and practice facilities should prepare a practice system for the practice facilities that accept students for the first time for a fulfilling practice.

To clarify the problems and issues faced by facilities receiving students for the first time, in order to obtain suggestions on how teachers and facilities should prepare a practical training system.

This is a qualitative inductive descriptive study using semi-structured interviews

Research Object

Student supervisors and administrators of three home health care nursing stations (hereinafter referred to as "A, B, and C") that will newly accept students as practice facilities for home health care nursing in 2019.Facility A: Female nurse in her 40s, more than 20 years of clinical experience, 3 years of experience as a visiting nurse, student supervisorFacility B: Nurse (female) in her 30s, more than 10 years of clinical experience, 3 years of experience as a home health aide, managerFacility C: Nurse in her 50s (female), over 30 years of clinical experience, 10 years of experience as a home visiting nurse, manager, student supervisor.

Research Method

The interviews will be conducted during the review meeting between the faculty and the facilities after the completion of the home health care nursing practice. The interview will take about 20-30 minutes. Semi-structured interviews will be conducted based on the interview guide. Interview guide.

• How was it for you to accept the students for the first time? Please tell us your impressions.
• Compared to your usual work, was there anything that changed with the presence of students? What was it like?
• Did you have any difficulties in teaching students? What kind of problems did you encounter?
• Please tell us what you are thinking about for the next practical training.
• The interview should be conducted with permission to record or transcribe, and the content of the interview should be recorded verbatim. To ensure the truthfulness of the transcribed verbatim record, have the interviewee confirm the contents

Ethical considerations

At the review meeting between the faculty and the facility after the practical training, when we visited the facility, we explained the outline of the research orally using written documents, and obtained consent by signing the "consent form". While asking for their impressions of accepting students for the first time and their opinions on the next year's practical training, we explained that they could decline the training for the next year. I also explained that the institution would not be disadvantaged by the refusal of the practical training as well as the research. Furthermore, it was explained that even after consent was given, it was possible to withdraw interview responses or decline to cooperate in the study at any time. This study was approved for ethical review by the Nihon Institute of Medical Science.

Results of Interviews at three Facilities. The following is a discussion of the interview results.

Nurse at Visiting Nursing Station-A

"I have been teaching nursing students in wards, but this was my first time teaching students in home nursing practice. This is my first time to accept students as a practice facility, and they are fresh."-The nurses at Facility A seemed to be accustomed to teaching students. The nurses at Facility A seemed to be accustomed to teaching students, and the fact that they described the students as "fresh" suggests that they find fulfillment and enjoyment in teaching students. “It would have been easier to teach the students if they could have imagined in advance the perspective of home nursing, which is different from hospital practice. When examining patients, we cannot ignore their life at home. It is necessary to consider what kind of life and background the patient has at home. I think it will be useful when I work as a nurse if I can think about the connection between life at home and life in the hospital.-A nurse at a facility had some unique points to say. With her long clinical experience and experience in teaching students, it was clear that she was thinking about what students should learn and how they should learn it as home nursing practice. It can be said that she is applying her teaching experience in the hospital practice to the home health care nursing practice. "It is easier for the teachers to teach if they have a clear idea of what the students need to learn. I think the university and facility administrators need to clarify what the students want to see and what they want them to learn in home health care nursing practice."-This was an important part of the purpose of the practical training, and it expressed the desire to help students learn with a purpose. As a supervisor of students, he remarks that it is easier to provide guidance to students if the purpose is clear. As a request from the facility side to the university side, I think this must be utilized in future practical training. "The first step is to observe, but the second step is to experience. It is important to start by observing, and then to actually touch. It is up to the students themselves to figure out how to develop themselves during the practical training. There is no point in just observing the practice."-The nurse from Facility A also expressed her own theory about practical training. In addition, a nurse from Facility A expressed her own opinion about practical training, which seemed to include her opinion not only from the standpoint of a student leader but also from the standpoint of nurse development. Home health care nursing practice tends to be thought of as a strong element of observation practice because there are few situations in which students proactively provide nursing skills. However, she said that even within the context of practical training, students can experience all kinds of things by setting up an environment that allows them to independently perform nursing skills. This shows the strong desire of the student leaders to let the students experience learning that cannot be obtained by just observing. “The students were nervous about the unfamiliar environment of the training. I thought it was important for the nurses to talk to the students. Nurses need to be considerate in order to create an environment where students can learn easily. If possible, have the students observe during the first visit. On the second visit to the same place, the nurse must play the role of encouraging the student to take the initiative to measure the vital signs of the patient."-Facility A nurse, referring not only to the university's requirements, but also to the considerations of visiting nurses at Facility A. She says that visiting nurses need to be considerate of students and that students can learn better when nurses at the practice facility are considerate of students. It is true that students do not know what to do when they visit the homes of the recuperators, such as how to stand at home or how to talk to the recuperators. In practical training, students are in an environment where they cannot stretch out and practice due to tension. The fact that she understands this and is able to put herself in the students' shoes is something I think we should all learn from."The knowledge and skills of nursing can be acquired later. The knowledge and skills of nursing can be acquired later, but the passion for nursing is different. I believe that if students have the desire, they can manage. Even a single touch to a patient makes a difference if the student has a desire for nursing and a desire for the patient. Even if the technique that the student implements fails, if the student has a desire for nursing and a desire for the patient, it will be conveyed to the other person. I want them to be interested."-I think this is a message from a nurse at Facility A to nursing students. This is a message from the nurse at Facility A to the nursing students. She hopes that the nursing students of today, who will be active nurses in the future, will have strong feelings anyway. As a nursing student, the desire to nurse the patient in front of you with purpose, even if you are not confident in your skills and knowledge, is not something that can be acquired later. I thought this was an important message that I wanted to convey directly to the nursing students who were able to practice. the nurses at Facility A were enthusiastic about guiding the students and had a heart for them. I felt reassured that in home health care nursing practice, there are instructors who are always thinking of ways to help students grow.

Nurses from Home Nursing Rehabilitation Station-B

This is my first time accepting students. I don't have any experience in student teaching, so I wondered if that was the right orientation for the practical training. There were no nurses who had taught students in the hospital practice, so I was worried whether I could learn as well as other visiting nurse stations. It was the first time for me to accept trainees, so I was worried if I could lead them well. I still have doubts about whether the students were able to learn the reality of home nursing."-The nurse at Facility B is the manager of a home nursing station, but she has no experience in teaching students. The nurse at Facility B seemed to have a lot of anxiety about teaching students in the practical training. They cited other facilities and seemed to be unable to fully evaluate whether their involvement with the students was correct or not. Nurses who have experience in teaching students in hospital practice seem to be able to understand how to interact with students and the purpose of practice. However, like the nurses at Facility B, they seemed to lack confidence in all aspects of their interactions with students. "There were many nurses who visited the homes of the patients with the students, and each nurse had a different perspective. There was a lack of uniformity among the nurses in terms of student guidance and practice. The students may have been confused during the training. At the patient's home, the students did not behave rudely. The staff was relieved when the practice was over.-I could see that the nurses at the home nursing station were anxious about how to interact with the students. In order to be able to provide consistent guidance to the students, the facility must have nurses with a lot of experience in teaching students. I can say that the burden on the nurses who had to teach the students the actual practice of home health care nursing was beyond their imagination. The nurses at Facility B were relieved when they said that they were relieved to have finished the practical training, and their relief at being freed from their anxiety could be felt. The nurses at Facility B did not respond to any questions other than what they were worried or anxious about accepting the practical training and how relieved they were after the training was over.

Nurse At Home Nursing Station-C

"This was my first time teaching at this facility, but I have experience teaching students at other facilities. I am teaching a class on home nursing to nursing students. The rest of the staff may have been confused at first."-The nurse at Facility C was experienced in both student teaching and nursing education, and she herself seemed to have no problem accepting the training, but she was informed that the other nurses at Facility C were confused. However, it was reported that other nurses at Facility C were confused. The other nurses did not have any experience in teaching students, and it was thought that they were overwhelmed during the period when the students were in training." It was very busy during the training period. Change the schedule of staff visits when students are present. We have to make a schedule considering where the students will visit. What the students want to learn, the characteristics of the patients, and the nurses who will take the students are all taken into consideration when making the schedule. There is a prep period before the practical training begins. However, after seeing the students' faces, talking with them, and seeing the type of students they are, the schedule may be changed to determine the places to visit. In the practical training, we had to think about arrangements, time coordination, and who would take the students. I had to be considerate of the students."-Before the practical training, they started to prepare for the practical training, and during the practical training, they were busy. Unlike the hospital practice, the style in which the visiting nurses visit the homes of the patients one by one, with the students following them, also affects the coordination of the entire visiting nursing station. Nevertheless, we found out that they wanted the students to learn as much as possible and were willing to sacrifice themselves to coordinate the practice for the students. "The users are happy. The patients are happy, and some of the patients and their families feel that they have to cooperate with the students who will become nurses in the future. When young students come to the hospital, the patients try to stand up straight and welcome them. The students are a stimulus for the patients. The presence of the students gave us an opportunity to review the facility's manual. The students have been a stimulus not only for the patients but also for the nurses. It also sped up our work. I learned to answer questions from the students, and the quality of the entire visiting nursing station improved."-A nurse at Facility C talked about the positive effects of the students' practice. The nurses at Facility C talked about the positive aspects of the students' practice, including the patients, the nurse staff, and the work environment at the facility. Although accepting the students for practical training was a burden, they decided to improve their own level and obtain a better environment. The students proved to be both refreshing and stimulating for the care givers and nurses. "Hospitals are all about treatment, and you may not get to see people as deeply. In home nursing, we have a deep relationship. It is a long term relationship. Home nursing is a place where people spend their lives, and some people are involved for more than four to five years. Some people are involved for more than 4-5 years. Deep education is also necessary. You will grow not only as a nurse but also as a person. You have to experience what you experience. It is important to have a wide range of humanity.-She talked about what home nursing is and what a nurse is. From this interview, I thought that the nurses at Facility C were looking to the future of nursing students and hoped that they would grow as nurses. It was a message to the students from an experienced nurse who had worked as a nurse for a long time, and it expressed the nurse's desire for the students to think about various things and grow through home nursing practice. "The nurses expressed their desire for students to think about various things and grow through home nursing practice. The nurses wash the patients' towels and wash their hands. This is a great way to communicate with patients. It would be great if they could see the difference between a hospital and a patient's home. Visiting nurses have to support the patient's life. It would be great if people could see that this is what home care is all about. In a hospital, there are many clean aspects, but at home, you have to look at the dirty parts as well. Visiting nurses do a lot of dirty work. They buy things that the patient's house needs. If you say that shopping is not a nurse's job, nothing will get done."-She talked about the difference between home nursing and hospital nursing. She also talked about the difference between home nursing and hospital nursing, and that it is not all pretty work so that the students can understand home nursing. I thought she hoped that students would understand a little bit about the role of home health care nurses. Working as a nurse is not all pretty work, you also have to do some dirty things. I thought that if the students could experience what it means to be a nurse in home health care nursing practice, it would give them an opportunity to think about many things.

Comparing the Interviews from Each Facility

The backgrounds of the nurses at the three facilities were as follows: two were nurses with experience in student teaching; the administrator at Facility B did not have any experience in student teaching. In the interviews, it was the nurses from Facility A and Facility B with student teaching experience who responded to the interviews, considering their feelings toward the students and the process of growing as nurses. They talked not only about the rigors of home nursing and how to grow as a nurse, but also about how to grow as a human being. We also learned that accepting the practicum was interfering with their original duties and placing an excessive burden on the staff of the home nursing station. I thought that home health care nurses would be exhausted by accepting the practical training, but I learned from the interviews that more than being exhausted, these nurses are also very resilient, as they find joy in teaching and are inspired by the students to step up their game. Nursing students need nursing knowledge and skills in order to become future nurses. In the interview, a nurse who has experience in teaching students said that knowledge and skills can be acquired later, but thoughts about nursing, thoughts about patients, and human skills cannot be acquired just by trying to acquire them. Through the practical training, I realized that there are many things I want to convey to the students. In the interviews with the nurses from the three facilities, each of them talked about their issues for the future practice. 1) Clarify what the students want to learn in the practical training. 2) Clarify what and to what extent students will do. 3) Ask students what they don't understand. 4) Find out what they can do in the limited time of practical training. 5)To grow as human beings. These were the five issues that were raised. The university needs to make a plan so that the dexterous opinions of the facility side can be utilized in future practice. Some studies have clarified issues in home health care nursing practice by listening to the opinions of the practice facility side [6-9]. It is hoped that the opinions of the training facilities will change home health care nursing practice for the better in the future. After all, it is the role of university faculty to value the voices from the field and create an environment where students can learn easily [10-13].

Unlike practical training in a hospital, practical training in a home health care nursing station places a heavy burden on the nurses. It is important to plan practical training that gives students a variety of experiences, taking into consideration the differences from practical training in hospitals. It is important for the faculty at the university and the nurses at the facility to collaborate and coordinate so that the students can learn a lot from the practical training by referring to the opinions from the facility side.

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