*3.2. Context*

Palliative care in the Netherlands is considered a generalist service; every nurse or doctor is expected to be able to provide palliative care. There are dedicated hospice services in the Netherlands consisting of in-patient professional driven hospices, in-patient volunteer driven hospices, a small amount of palliative care units within other healthcare institutions and hospice teams working in the community.

This study took place in an in-patient professional-driven hospice facility, referred to in the Netherlands as a 'high care hospice'. To obtain access to this hospice was quite easy, for one of the involved researchers (M.T.) is affiliated with the hospice as spiritual caregiver. This hospice facility has its own staff of healthcare professionals consisting of nurses, elderly care physicians and a spiritual counsellor. In addition, there is a team of volunteers supporting the hospice staff. The hospice consists of 16 private apartments. The hospice is located in a small city in the Netherlands, in the middle of a residential area next to the city center. The building is less than ten years old and was specifically designed as a hospice. The hospice is subtly placed in its surroundings and the simple façade is positioned some distance away from the street. The rest of the building is tucked away behind surrounding buildings that belong to a care facility. Visitors have to ring the doorbell and announce who they are before getting access. Even though the building is located in the middle of a city and community, it does not feel part of it. From the street, the building is hardly recognizable as a hospice and only in specific circumstances do people have access. From the inside of the hospice, there is hardly any contact with public life going on outside its walls. Pretty much all the spaces have large floor-to-ceiling windows but they look out over landscaped courtyards or the large garden, not on the surrounding streets.

Patients and family members entering the hospice are taken into the specific atmosphere of the hospice. An atmosphere that is dedicated to the experience of a good dying process. The different spaces at the hospice offer possibilities for privacy, togetherness, relaxation and contemplation. The spaces are decorated with warm materials and colors, symbolically referring to the peace, tranquility and even the strength of nature, and although patients and their families were taken into the specific atmosphere and structures of the hospice, staff recognized that each patient goes through the dying process in his or her own way.
