Becoming the family’s last piece of driftwood: a narrative inquiry into professional identity formation among home-based hospice nurses

Abstract Background Home-based hospice care extends palliative care into patients’ homes and requires nurses to provide clinical, emotional, practical, and existential support within family contexts. Although home-based hospice nurses play a central role in this model of care, little is known about how they develop professional identity and sustain commitment while managing the emotional and relational demands of end-of-life care. This study explored how home-based hospice nurses developed professional identity and sustained commitment across their career journeys while negotiating the emotional and relational responsibilities of end-of-life care. Methods This qualitative narrative inquiry adopted a life-course perspective. Between November 2021 and March 2022, in-depth interviews were conducted with 10 certified home-based hospice nurses in Taiwan who were recruited through purposive and snowball sampling. Interviews lasted 50–195 min and were analyzed using Polkinghorne’s narrative analysis, supported by Kelly and Howie’s procedures for narrative organization and cross-case interpretation. Results Participants’ career stories revealed a developmental journey from entering nursing and searching for professional direction to becoming trusted relational caregivers within patients’ homes and family contexts. Four themes were identified: searching for a place in nursing; finding meaning beyond clinical tasks; walking through the valley with patients and families; and sustaining self while caring for others. Relationships with patients and families were central to participants’ professional identity formation and sustained commitment over time. Two participants used driftwood imagery, including one who described being the family’s “last piece of driftwood,” reflecting a broader pattern of emotional responsibility, family trust, and boundary negotiation across the narratives. Conclusions Professional identity in home-based hospice nursing is shaped through relational caregiving, repeated encounters with suffering and death, reflective practice, team support, and lifelong learning. These findings highlight the importance of educational and workforce support strategies that strengthen emotional boundary-setting, communication, relational ethics, and interprofessional collaboration to sustain the home-based hospice nursing workforce.