Recovery environments in places of daily living: a scoping review and conceptual analysis

Abstract

Background

Owing to advances in medical technology and the promotion of at-home medical care, patients are more frequently being treated in their places of daily living after discharge from acute care hospitals. As medical care and lifestyle are closely linked, the quality of life of the patient and their families therefore depends on the adequate preparation of the recovery environment. Hence, modifying this environment to ensure that the patient’s lifestyle and medical care are complementary is often vital. This study aimed to clarify the concept of recovery environments in places of daily living.

Methods

The literature search and selection of articles were based on a scoping review conducted in Scopus and PubMed, while data extraction and analysis were based on conceptual analysis. Thirty-two articles met the inclusion criteria.

Results

Our analysis of these articles allowed us to classify four types of recovery environments in places of daily living: physical environments appropriate to the health status of the recovering patient, collaborative environments in which intra-family roles are empowered, community environments in which recovering patients are accepted, and service environments in which the required services can be accessed. We also noted the main roles of medical professionals for building relationships with patients: providing decision-making support in places of daily living, creating an environment that empowers patients and their families, and modifying the service environment.

Conclusions

For patients, the main aims of recovery environments in places of daily living are to make them physically comfortable, maintain their identity, and improve their quality of life. Although this study is only a first step towards conceptualizing recovery environments in places of daily living and the final results are tentative, we are nonetheless confident that it will be important for advancing the field of home healthcare research.

Background

Advances in medical technology and the promotion of at-home medical care mean that patients of all ages, with various diseases and conditions, including chronic diseases, frailty, mental illness, and physical disabilities, are being transferred to their places of daily living to finish their recovery after acute-phase hospital treatment [1, 2]. The recovery of patients in their places of daily living is limited by scarce personnel (healthcare professionals, caregivers etc.), resources, and services. When patients’ places of daily living also become their recovery environment, significant changes occur, including with whom they are in contact and the services they can access [3]. This makes it essential to modify the recovery environment as appropriate. As medical care and lifestyle are closely linked, the quality of life of the patient and their families therefore depends on the adequate preparation of the recovery environment. Hence, modifying this environment to ensure that the patient’s lifestyle and medical care are complementary is often vital. In this study, a 'recovery environment' is defined as the environment in which individuals, after completing acute treatment, live their daily lives while receiving appropriate medical care, nursing, and psychological support. This environment includes managing illnesses and symptoms, maintaining or improving physical functions through appropriate treatment and rehabilitation based on the physician's instructions, all while coping with chronic diseases or disabilities.

Taylor stated that patients’ places of daily living must provide (i) a suitable physical environment, (ii) social activities (including entertainment, religious activities, work, and education), (iii) connections with the local community, and (iv) access to services and a support system [4]. The author also stated that the fundamental characteristics of one’s place of daily living include the physical environment of one’s home, the security of one’s education or employment, the people in one’s local community, and the social resources and support system that one can access. Florence Nightingale’s theory of nursing sees humans and their environment as one and the same [5]. Nightingale considered healthy environments as fundamental to healthcare and emphasized that in addition to providing the five aspects of the physical environment (i.e., clean air, water, basic hygiene, cleanli-ness, and light) [6], nursing is influenced by and dependent on place, space, and time [7]. Nurses can adjust the environment to restore patients’ health [8]. Peplau and Travelbee viewed the nursing profession as an important component of the interpersonal environ-ment [5]. Humans interact with each other within the surrounding environment. Hence, the relationships among recovering patients, their families, and medical professionals af-fect recovery environments and establishing these relationships is thus crucial to such en-vironments in places of daily living [4].

The ability to recover in one’s place of daily living is crucial to both patients and their families. Having patients finish their recovery in their place of daily living can reduce the re-hospitalization rate, hospitalization duration, emergency outpatient examination or treatment rate, and medical costs [9]. Additionally, enabling patients to enjoy daily life at their own pace increases satisfaction with at-home care and health-related quality of life, irrespective of their conditions [10]. Furthermore, introducing patient support programs for at-home care can help increase patients’ adherence to and persistence with the treat-ment methods included in at-home recovery regimens [11]. However, when patients re-covering in their daily living environments have multiple functional disorders, chronic diseases [12], or conditions that require high levels of medical care [13, 14], their activities of daily living (ADL) and instrumental activities of daily living (IADL) can be significantly hindered. Family caregivers are expected to gain medical knowledge and learn the tech-niques required to support the health of recovering patients, which increases the former’s physical and psychological burden [15–17], in addition to other problems, including the financial burden from potentially giving up work [18]. Resolving these concerns requires direct support for patients and their families, including organizing better places of daily living for them.

In developed countries, at-home medical care [19] is becoming increasingly wide-spread to support early discharge from hospitals and reduce hospitalization duration. Providing acute- and subacute-phase care at home to patients with conditions requiring hospitalization has now become possible [20]. However, the preparation of recovery envi-ronments in patients’ places of daily living has not been examined in previous studies. Hence, perspectives of their preparation, including how to better maintain patients’ and families’ lifestyles, require clarification. Therefore, the purpose of this study is to integrate a scoping review and conceptual analysis to design a conceptual framework for clarifying the structure of recovery environments in places of daily living.

Methods

Combining a scoping review and conceptual analysis

Scoping reviews and conceptual analysis have traditionally been used to elucidate and analyze hard-to-observe concepts, but each method has its strengths and weaknesses [21]. First, scoping reviews sit between narrative and systematic reviews [22]. Freytag et al. [23] define scoping reviews as “a quick summary of the key concepts underlying an area of research, the main sources of information, and the types of literature and information (evidence) available.” Their main goal is to identify gaps in research while providing an overview of a wide range of information to inform future research. However, scoping re-views often fail to report how the data were analyzed qualitatively [21, 24, 25].

Second, conceptual analysis such as Rodgers’ evolutionary conceptual analysis [26] is used to examine recovery environments in places of daily living, which are heavily influenced by historical, cultural, and ethical factors. Rodgers’ conceptual analysis involves collecting and analyzing a sample of at least 30 articles, or approximately 20% of the collected target literature. Each step of the analysis is repeated until the concepts become clear. This qualitative and inductive method clarifies the attributes, antecedents, and consequences of the concept under study by collecting a broad range of data. Specifically, attributes characterize the usefulness of the concept, antecedents occur before attributes arise, and consequences occur as a result of attributes arising. This method focuses on the characteristics and usage of the concept as an entity that evolves in response to a given context. However, as with many other methods of conceptual analysis, its systematic procedure for identifying and selecting appropriate papers in the review is unclear, and it is thus necessary to show the process that led to the identification of papers.

A literature search was conducted in Scopus and PubMed, which allow researchers to search for relevant articles. This approach was taken because it was considered to be a reliable analytical tool that provides quick access to relevant peer-reviewed articles.

Identifying the research question

The research question for this study is: ‘What are the attributes of the environment that enable patients to recover in everyday life settings?’.

Performing the scoping review

The scoping review was conducted in April 2023. A literature search was conducted in Scopus and PubMed, which allow researchers to search for relevant articles. This ap-proach was taken because it was considered to be a reliable analytical tool that provides quick access to relevant peer-reviewed articles. Data were collected on four academic dis-ciplines: nursing, medicine, sociology, and social work. After defining the search terms extracted from the Medical Subject Headings descriptors, the Boolean operators "AND" and "OR" were used to combine the terms in a logical representation. The final research expression used was [environment] AND [home] AND [care] AND [nursing]. Hyperacute disease, infectious disease, occupational environment, and work environment were ex-cluded. Those that did not describe recovery environments in places of daily living were excluded. Figure 1 shows the flowchart of the PRISMA Extension for Scoping Reviews (PRISMA-ScR) [27].

Fig. 1.

PRISMA-ScR flowchart for the study selection process

Selecting relevant publications

To explore the concept of recovery environments in places of daily living, this study targeted research published between 2012 and 2022. Buurtzorg, a non-profit organization offering comprehensive at-home care established in the Netherlands in 2007, provides home visits, care management, rehabilitation, and preventive care. Owing to rapidly in-creasing global interest in Buurtzorg as well as its high client satisfaction, its teams have expanded globally, including in Sweden in 2011 and in the United States in 2013 [28]. Germany established a medical care program centered on primary care in 2011 [29], while Japan introduced a comprehensive, community-based care system in 2012 [30]. Japan’s care system has shifted from institution-centered medical and nursing care to a system aimed at providing patients with access to services in their places of daily living, enabling them to follow their preferred ways of living without anxiety.

Thus, the study covered a period in which medical care in places of daily living be-came mainstream due to the promotion of home care. Articles for inclusion in the study were selected using inclusion and exclusion criteria. Articles that included descriptions of recovery environments in places of daily living and articles that were peer-reviewed and available were included in the study. The living arrangements addressed in this study in-cluded home and assisted living facilities, where the main purpose of living is to provide care. In the selection of articles, those that included the following as recovery environ-ments were chosen: physical environments such as natural surroundings, sanitation, residential conditions, and living environments, as well as social environments such as family dynamics, educational level, economic status, community environment, and ser-vice availability. Do not include during acute hospitalization, treatment for infectious diseases, or professional occupational environment, or workplace. This study did not in-clude factors related to the internal environment, such as the beliefs and values of the pa-tients themselves. From that list, we excluded papers published before 2012, papers not written in English, and papers that were literature reviews or opinion articles. We applied this criterion independently to all the titles and abstracts of the articles selected by two of the authors (YM and YS). If it was unclear whether a publication should be included, a full-text review was conducted by the three authors (YM, YS, and YF). The authors met regularly to discuss any uncertainties about the process. Any disagreements were dis-cussed and the inclusion/exclusion criteria were revisited until consensus was reached.

Performing the analysis

The analysis was refined by extracting raw data from the results of each paper on the attributes, antecedents, and consequences that might correspond to recovery environments in places of daily living as well as by creating a data extraction table. Following discussions by two of the authors (YM and YS), all three authors (YM, YS, and YF) labelled the data and created codes and subcategories. A series of meetings were then held to discuss the derived categories, culminating in the final concept reported herein.

Results

Sample selection

The literature search yielded 4255 hits. After removing duplicates, the literature was screened by title and abstract, leaving 886 articles. Following the process of selecting target articles in Fig. 1, the titles and abstracts of these 886 articles were reviewed again, re-sulting in 488 articles. Please refer to Fig. 1 in results section. Subsequently, those arti-cles that did not describe recovery environments in places of daily living were excluded, resulting in 32 articles being analyzed: 21 from Europe, 7 from North America, 2 from Oceania, and 1 each from the Middle East and Asia. The recovering patients in the places of daily living were older people (n = 16), home healthcare recipients (n = 8), children (n = 6), and cancer/terminally ill patients (n = 2) (Table 1).

Table 1.

Findings from the sampled papers

Author(s), year	Country	Target population/age	Conditions	Place of daily living	Study method	Findings on recovery environments in places of daily living
Elliane Irani, et al. (2021) [31]	USA	People receiving home care/Unknown	The housing conditions are not good. Due to the financial situation being inadequate, it is difficult to obtain medication	Homes	Qualitative descriptive study	The home care nurse refers the patient to the availability of social support in the local community as well as financial resources.
Catherine E. Dingley, et al. (2017) [32]	USA	Patients with advanced cancer/Unknown	Suffering from cancers such as lung cancer, prostate cancer, brain tumors, and breast cancer, and currently undergoing cancer treatment	Homes	Prospective observational study	Through caregiver-specific questions, open-ended questions and statements, and personal questions, nurses provide education, reassess the patient/care environment, and validate communication to activate caregivers.
Ying-Ling Jao, et al. (2021) [33]	USA	Older people with dementia/Average age of 84.2 ±8.7years	A condition with moderate to severe cognitive impairment	Nursing homes and assisted living facilities	Cross-sectional study	Older people with dementia were found to be significantly associated with having lower apathy, especially with an enhanced indoor environment.
Rachel Potter, et al. (2018) [34]	UK	Older people/Average age of 85 years (ranging from 68 to 95 years)	There are individuals exhibiting symptoms of depression	Care homes	Mixed method study	Access to outdoor spaces was reported to be limited in a variety of ways, including locked doors, uneven footing, steep stairs, and the need for permission or assistance to leave the building.
Sarah Wells, et al. (2021) [35]	USA	Hospitalized children with complex medical needs/The median age is 6 years.	Has multiple chronic conditions and requires medical care	Homes	Prospective study	Post-discharge problems identified by nurses include social/family problems (e.g., economic instability), durable medical equipment (e.g., inadequate supply or malfunction), and the child's home environment (e.g., unsafe sleeping quarters).
Laurene Aydon, et al. (2017) [36]	Australia	Preterm babies/Preterm infants born between 28 and 32 weeks of gestation	Has moved beyond the acute phase but requires continued management with medical devices or is in an immature state	Homes	Qualitative descriptive study	Preparing parents for the patient's discharge from the hospital requires improving the communication of information, facilitating contact between parents and the interdisciplinary team, listening to the father to understand his needs, and promoting parental involvement according to individual needs within the family.
David Edvardsson, et al. (2013) [37]	Sweden	Older people/Unknown	Some individuals may have decreased cognitive function or require care	Homes	Cross-sectional study	A person-centered climate includes a place in which people feel welcome and accepted, can be themselves, residents feel safe, and the atmosphere is institutional but feels like home for residents.
Jose Granero-Molina, et al. (2019) [38]	Spain	Mothers of extremely preterm infants/Infant	In a condition requiring medical management such as oxygen therapy, apnea monitoring, and tube feeding	Homes	Qualitative descriptive study	The process of discharge from the hospital and the first months at home are difficult. The delivery and care of extremely preterm infants affects not only the mother's quality of life, but also her family and social life.
Parisa Sabetsarvestani, et al. (2021) [39]	Iran	Patients recovering at home/Unknown	Medical care such as suctioning of phlegm is required, making home care services necessary. However, there is a lack of facilities, personnel, and systems to provide home care, resulting in inadequate care being received	Homes	Qualitative descriptive study	Barriers to the effective management of home care include a lack of protocols for assessing home care, a lack of organization, low caregiver performance, and a lack of organizations providing home care services.
Fiona Ecarnot, et al. (2022) [40]	France, Belgium, Germany, and Italy	Older people/Unknown	Dislikes going out, finds it tiring and difficult, and lacks motivation to participate in group activities, which makes it essential to maintain strong engagement with the community	Homes and nursing homes	Qualitative descriptive study	The "living area" of older people is defined by (i) a working definition of "one's living area" (a multidimensional concept that includes individual and collective aspects), (ii) the importance of the built environment (e.g. public transportation, sidewalks, benches, ramps), (iii) the interaction between the nursing home and the outside community (especially the need to maintain interactions with the local community), (iv) the sense of integration (through social contact, seniority in the community, perceived self-usefulness), (v) the use of new technologies (integration, social contact, access to culture). These were found to help integrate older adults into the fabric of the community.
Sabine Bjork, et al. (2018) [41]	Sweden	Older people/The average age is 85.5 years	Some individuals have cognitive impairments, but there are also those who maintain their independence with the support of staff	Nursing homes	Cross-sectional study	The psychosocial climate of older residents in nursing homes showed the strongest association with resident thriving among the environmental variables. Controlling for resident characteristics, having a favorable psychosocial climate in the unit, being able to read the newspaper, living in a special care unit, and living in an unlocked facility were significantly positively associated with resident thriving.
Agnete Nygaard, et al. (2020) [42]	Norway	People with dementia	Cognitive function has declined, but participation in activities such as walking outside, reading, listening to music, and playing games (activities prior to moving in) is maintained	Nursing homes	Thematic analysis	The analysis yielded one overarching theme, "the tension between the nursing home being a home and being an institution," and five themes: relationships between oneself and one's peers, creating individualized living spaces, personalized interior private rooms that enhance a sense of connection, transition between old and new homes, and significant activities that give meaning.
Kerry Kuluski, et al. (2017) [43]	Canada	Patients with complex needs and their families/Age groups of young adults, middle-aged individuals, and older adults (ages 29 to 80)	Has conditions such as intellectual and physical disabilities, infections, intoxications, traumatic brain injury, stroke, aphasia, diabetes, obesity, depression, hip fractures, arthritis, osteoporosis, and hypertension	Homes	Qualitative descriptive study	The supportive care needs of complex patients and their families included (i) relationships as a basis for care, (ii) processes and structures for desired care, and (iii) barriers and workarounds for desired care.
Sophie Emilia Huttmann, et al. (2018) [44]	Germany	Patients receiving invasive mechanical ventilation at home /The median age is 64 years	Requires long-term home mechanical ventilation and is heavily dependent on care for bathing, using the toilet, and assistance with meals	Homes	Cross-sectional study	Despite maximum patient care and enhanced technical assistance, both health-related quality of life and life satisfaction were found to be significantly impaired in many invasive home ventilator patients who failed to wean for extended periods.
Kristina Lamas, et al. (2020) [45]	Sweden	Older people/80s.	Although receiving home care services, participation and independence are maintained	Homes	Cross-sectional study	Adults living at home with the assistance of home care services had relatively high levels of prosperity, indicating that participation in social relationships and experiences of self-determination in activities inside and outside the home were associated with prosperity.
Charlotte T.M. van Corven, et al. (2021) [46]	Netherlands	Older people with dementia/Unknown	Suffering from Alzheimer's disease, vascular dementia, and other conditions, with decreased cognitive function	Homes and care homes	Qualitative descriptive study	Four themes were identified as important aspects of empowerment for older adults with dementia: (1) having a personal identity, (2) having a sense of choice and control, (3) having a sense of usefulness and need, and (4) retaining a sense of value.
Anastasia Silverglow, et al. (2021) [47]	Sweden	Frail older people/Average age of 82 years (ranging from 71 to 93 years)	In a condition of frailty and receiving home care	Homes	Qualitative descriptive study	The factors that constituted a sense of security at home for frail older people receiving home care were feeling safe, having an influence, and trusting the staff.
Astrid Fjell, et al. (2020) [48]	Norway	Older people/Ages 69 to 93	The health condition is stable, and the individual is able to live independently.	Homes	Qualitative descriptive study	Older adults found that being independent and being in a social context were important when growing older. Activity centers were an important social factor as they facilitated networking, provided a sense of usefulness, and provided structure to older adults' lives.
Bao-Huan, et al. (2018) [49]	Taiwan	Children with muscular dystrophy/Ages 8 to 13	Suffering from muscular dystrophy and requiring care such as suctioning of phlegm, respiratory support, rehabilitation, and nutrition	Homes	Phenomenological research	The partnership between families and healthcare providers consisted of feasible resources and detailed care information, the provision of integrated care across systems, family and home as key components of critical care, respect and care for family care requests, and feedback and support from the family.
Anette Hansen, et al. (2017) [50]	Norway	Older people with dementia/Unknown	Support is needed for personal hygiene, meals, medication management, and maintaining physical safety. Psychosocial needs are not adequately met	Homes	Qualitative descriptive study	Improving the competence and awareness of psychosocial needs and how to meet them is essential to providing quality holistic care that enables people with dementia to live at home as long as possible.
Una Molloy, et al. (2021) [51]	Ireland	Older people/Unknown	At the stage of palliative care and in need of daily living care and support	Long-term care facilities for older people	Qualitative descriptive study	Nursing home staff feel a deep attachment to their residents when providing palliative and end-of-life care.
Rebecca Baxter, et al. (2019) [52]	Sweden	Older people/Average age of 85.4 years (ranging from 72 to 92 years)	In a condition where, when necessary, the individual receives functional and physical care such as medication administration and assistance with dressing, while actively striving to maintain a sense of independence	Nursing homes	Qualitative descriptive study	Thriving in a nursing home means "striving to remain positive and accepting of being in a nursing home," "feeling support and care while maintaining independence," "balancing opportunities for solitude and companionship while living with others," and "feeling a sense of home while living in an institutional environment."
Sarah Hoare, et al. (2019) [53]	UK	Terminal patients	Desires to spend their final days at home. Completely physically dependent for daily activities	Homes	Qualitative descriptive study	End-of-life care at home depended on significant support from family and professional caregivers, both of whom did not have adequate resources. Medical staff considered hospitalization when the nursing system was inadequate or when family support was inadequate, even when family members were well supported.
Aleksandra Jarling, et al. (2018）[54]	Sweden	Older people/People aged 77 to 90	They have medical issues such as pain, diabetes, heart failure, cancer, stroke, and anxiety disorders, and are receiving various medical and social services	Homes	Qualitative descriptive study	Home care from the perspective of older people living alone was an adaptation to a culture of caregiving, high exposure, inability to influence care, and forced relationships. Overall themes revealed that older adults experience life-changing situations when receiving home care and become guests in their own homes.
Isabel Maria Fernandez-Medina, et al. (2021) [55]	Spain	Vulnerable patients/Unknown	The patient is frail, requires assistance with self-care, and needs medical care such as oxygen therapy and medication. Additionally, the family is unable to manage the care that the patient requires	Homes	Qualitative descriptive study	Several factors were found to limit the involvement of home care nurses in the care of vulnerable patients. The sociocultural level of the patients and their families, the absence of family and social support networks, and the presence of family conflicts complicate home care.
Margareta Johansson , et al .(2022) [56]	Sweden	Children and mothers/Infant	Postpartum mother and newborn baby	Homes	Descriptive cross-sectional qualitative study	Postpartum care at home was valued because it allows fathers to feel safe in their home environment and receive support from a midwife. Continuous care from the same midwife creates a sense of trust and individuality. Being in a home environment helped fathers support their partners and foster a father-child bond.
Sarah A. Sobotka, et al. (2020) [57]	USA	Children receiving mechanical ventilation/Unknown	Requires home mechanical ventilation, thus in a condition that requires home nursing care	Homes	Qualitative descriptive study	Healthcare providers consistently stated that in hypothetical scenarios regarding medical technology, children are given less nursing time than the healthcare provider's ideal practice; one-third described discharging patients without home nursing arrangements.
Anna Larsson Gerdin, et al. (2021) [58]	Sweden	Home care patients/Unknown	Patients requiring home medical care, such as those with dementia who exhibit symptoms like hallucinations	Homes	Phenomenological hermeneutic study	The meaning of the lived experience of nurses' encounters with patients in home care was accepting the other, coping with unpredictability, and managing frustration.
Sonja Šare, et al. (2021) [59]	Croatia	Older people/The average age is 80 years	A condition in which there is a potential for the development of depression, anxiety, and decreased self-esteem.	Nursing homes	Cross-sectional study	Compared with seniors living at home, seniors residing in nursing homes report lower self-esteem, higher levels of depression, and more anxiety.
Marta Muszalik, et al. (2021) [60]	Poland	Older people/aged 60 and over	frail condition	Homes and nursing homes	Cross-sectional study	The prevalence of frailty syndrome was found to be associated with place of residence, age, widowhood, poor economic status, level of basic education, living alone, longer duration of illness, comorbidities, more medications taken, hearing loss, cognitive impairment, depression, and lower quality of life.
Cedric Mabire, et al. (2019) [61]	Switzerland	Pre-discharge patients/Average age of 67 years (ranging from 19 to 97 years)	In a condition that requires support for self-care and symptom management	Homes	Secondary data analysis of a multicenter observational study	Higher nurse experience, better patient self-reported health status, and higher patient ratings of self-care and symptom management instruction were significantly associated with higher patient readiness for discharge.
Julia Limes, et al. (2021) [62]	USA	Post-acute patients/Unknown	Has moved beyond the acute phase and requires home medical care services	Post-acute care facilities	Cross-sectional study	This national survey of internal medicine residents revealed general knowledge gaps regarding post-acute care. These knowledge gaps did not improve throughout residency without intentional exposure to the post-acute care environment.

Attributes of recovery environments in places of daily living

The attributes of recovery environments in places of daily living were divided into four categories and 15 subcategories. The four categories were (i) physical environments appropriate to the health status of the recovering patient, (ii) collaborative environments in which intra-family roles are empowered, (iii) community environments in which recovering patients are accepted, and (iv) service environments in which the required services can be accessed (Table 2).

Table 2.

Attributes of recovery environments in places of daily living

Category	Subcategory	Article number(s)
Physical environments appropriate to the health status of the recovering patient	An environment in which recovering patients’ safety is ensured	[31–34]
	An environment equipped with the necessary materials, equipment, and communication modes	[31, 32, 35–39]
	An environment in which recovering patients can move around where they like	[34, 40–47]
Collaborative environments in which intra-family roles are empowered	An environment in which recovering patients can express their wishes and use their abilities	[33, 34, 38, 40–49]
	An environment in which recovering patients and their families can make decisions	[32, 36, 37, 42–44, 46, 47, 49–55]
	An environment in which their families can organize their own lives	[31, 32, 36, 38, 43, 47, 48, 50, 52–57]
	An environment in which families can provide care	[32, 35, 36, 38, 44, 49, 53, 55–57]
Community environments in which recovering patients are accepted	An environment in which the recovering patient feels happy living and is accepted by the people surrounding them	[37, 40, 42, 44, 46, 47, 51–54, 56, 58]
	An environment with which the recovering patient has connections and interactions and is supported by people in the local community	[34, 35, 37, 39, 40, 42, 44–46, 48, 50–52, 54, 59, 60]
Service environments in which the required services can be accessed	An environment in which recovering patients and their families can readily request services	[32, 36, 37, 39, 42, 43, 46, 47, 50, 51, 54–56, 58–61]
	An environment in which essential healthcare and social welfare services can be fully used	[31, 35, 36, 39, 40, 43, 48–51, 53, 55, 57]
	An environment in which medical backup is provided	[35, 44, 49, 55, 57]
	An environment in which comprehensive care is provided	[43]
	An environment in which specialist medical professionals respond to the needs of recovering patients and their families	[31, 32, 35, 36, 39, 40, 42–44, 46, 47, 50–56, 58, 62]
	An environment in which specialist medical professionals strive to increase care quality	[32, 35, 36, 38–40, 43, 48–51, 53, 55–58, 61, 62]

Physical environments

Physical environments included three categories: an environment in which recovering patients’ safety is ensured (PHY1), an environment equipped with the necessary materials, equipment, and communication modes (PHY2), and an environment in which recovering patients can move around where they like (PHY3).

PHY1 included four subcategories: an environment with a low risk of falls [31], an environment without risk of infection [31], an environment in which safety is ensured during recovery (e.g., a safe nursing environment with the room and furniture layouts altered and obstacles moved) [31, 32], and an environment appropriate to the patient’s physical functioning (e.g., one that reduces physical exertion) [33, 34].

PHY2 included four subcategories: an environment where appropriate drugs are (physically) obtained [31, 35], an environment in which care items are given immediately [36, 37], an environment in which the necessary medical devices are readily accessible [32, 35, 38, 39], and an environment in which the medical devices, care materials, and communication modes needed for patient recovery [40].

PHY3 included four subcategories: an environment that guarantees the patient can enter and leave their place of daily living [34, 41, 42], an environment that provides support for entering and leaving their place of daily living [40, 42], an environment in which the patient can engage in IADL independently when outside (e.g., reliable public transport for travel, public buildings having slopes, and wheelchairs being available for their rest) [40, 43], and an environment that ensures freedom of movement (through provisions such as technical auxiliary equipment for moving) [40, 44–47].

These three physical environments guarantee the safety of the recovering patient, secure the resources necessary for treatment, and allow patients to enjoy a social life while receiving care [31, 33, 34, 40, 42, 44, 45, 47, 48].

Collaborative environments

Collaborative environments included four categories: an environment in which recovering patients can express their wishes and use their abilities (COLL1), an environment in which recovering patients and their families can make decisions (COLL2), an environment in which their families can organize their own lives (COLL3), and an environment in which families can provide care (COLL4).

COLL1 included two subcategories: an environment that supports eliciting recovering patients’ abilities (stimulating their cognitive functions, wishes, and abilities) [33, 34, 38, 40, 43–49] and an environment that supports maintaining recovering patients’ activities and roles (e.g., participation in activities that enable them to express their full humanity and fulfillment of social roles) [41, 42, 45, 46, 48].

COLL2 included two subcategories: an environment in which medical professionals consider recovering patients’ wishes (e.g., their right to speak and communicate by means other than speech) [32, 37, 42–44, 50, 51] and an environment in which medical professionals support decision-making by the recovering patient and their family [32, 36, 43, 44, 46, 47, 49, 51–55].

COLL3 included two subcategories: an environment in which families can reestablish their lives (including living at their own pace and having secure employment) [31, 36, 38, 48, 50, 52, 54–56] and an environment in which families can access services that support their lifestyles (e.g., comprehensive support for their burdens and a system enabling them to consult medical professionals) [32, 43, 47, 53, 55, 57].

COLL4 included two subcategories: an environment in which families can provide the required support to recovering patients (i.e., they thoroughly understand the patient’s health status and required support and can respond appropriately when medical professionals are absent) [32, 35, 36, 44, 49, 53, 55, 56] and an environment in which medical professionals support families with the care techniques that recovering patients need (e.g., medical professionals being positive about families participating in care, educational systems provided, enabling families to learn care techniques) [32, 35, 36, 38, 53, 55, 57].

In these four collaborative environments, recovering patients and their families take the initiative in exercising their motives and abilities as well as maintaining their activities and roles. For example, they can continue to make decisions. Moreover, families’ lives can be organized and they can provide care proactively. Such collaborative environments are necessary for recovering patients and their families to take on social roles in addition to enjoy the social life made possible by the physical environments discussed earlier [32, 46, 49, 52, 54–56].

Community environments

Community environments included two categories: an environment in which the recovering patient feels happy living and is accepted by the people surrounding them (COMM1) and an environment with which the recovering patient has connections and interactions and is supported by people in the local community (COMM2).

COMM1 included three subcategories: an environment in which it feels good to live, with familiar spaces and a family-like atmosphere [37, 42, 46, 47, 52–54, 56, 58], an environment for spending time with loved ones (patients being together with close friends and relatives, irrespective of dependence on medical care and ensuring they can spend their time surrounded by loved ones at the end of their life) [37, 40, 44, 51, 53], and an environment in which people accept the recovering patient so they feel at home [37, 42, 46].

COMM2 included five subcategories: an environment in which consideration is given to the recovering patient maintaining self-respect (e.g., medical professionals consider their self-respect and privacy) [37, 39, 40, 46, 51, 59], an environment that considers their privacy [39, 42, 54], an environment associated with the local community (enabling interactions with local people) [34, 40, 42, 45, 46, 48, 50, 52, 59, 60], an environment linked to supportive people in the local community and with amiable and cooperative relationships [35, 50], and an environment in which the community understands about the recovering patient’s illness and can arrange appropriate services [44, 46].

Even if the recovering patient and their family are ready to take on their social roles, they cannot engage in social activities without the acceptance of the community. In other words, both a collaborative environment and a community environment must be in place for the recovering patient and their family to be able to take care of themselves in the community [35, 39, 43, 53, 57, 62].

Service environments

Service environments included six categories: an environment in which recovering patients and their families can readily request services (SERV1), an environment in which essential healthcare and social welfare services can be fully used (SERV2), an environment in which medical backup is provided (SERV3), an environment in which comprehensive care is provided (SERV4), an environment in which specialist medical professionals respond to the needs of recovering patients and their families (SERV5), and an environment in which specialist medical professionals strive to increase care quality (SERV6).

SERV1 included three subcategories: an environment in which there is good communication between the recovering patient, their families, and medical professionals (i.e., opportunities for consultation and discussion between them) [32, 36, 37, 39, 43, 46, 54, 55], an environment in which the recovering patient and their family can trust the involved medical professionals (i.e., medical professionals who try to build good relationships with them) [32, 36, 37, 39, 42, 43, 47, 50, 51, 54, 56, 58, 59], and an environment in which the recovering patient and their family can evaluate health statuses and symptoms (including support for empowerment and being able to request support when needed) [36, 42, 55, 56, 59–61].

SERV2 included three subcategories: an environment in which social resources relating to at-home care are available in the community (i.e., the systems using community-based services and social resources meeting the patient’s needs are familiar and can be used in the long term) [31, 35, 36, 39, 43, 49, 50, 53, 55, 57], an environment in which the recovering patient and their family have financial security (with financial support systems for at-home healthcare to avoid them experiencing financial hardship) [31, 35, 39, 43, 48, 50, 57], and an environment in which the various procedures for accessing services are not burdensome (i.e., the burden of examination and treatment at medical facilities is reduced and procedures for accessing at-home care are understandable) [40, 49, 51].

SERV3 included four subcategories: an environment in which access to home visits and outpatient medical care is available [44, 49], an environment in which there is a home-visit nursing organization [57], an environments where appropriate drug therapy is available [35], and an environment in which hospital readmission is possible [55].

SERV4 included two subcategories: an environment in which access to services is ensured irrespective of the recovering patient’s disease type, symptoms, age, and financial status [43] and an environment in which the patient’s place of daily living is as beneficial as possible (i.e. the mobilization of both health care services (such as nursing or home physiotherapy) and social care services (such as assistance with instrumental activities of daily living or making adaptations to the home environment) [43].

SERV5 included two subcategories: an environment in which medical professionals provide the support appropriate to the patient’s background and symptoms (e.g., services suitable to the needs and control of symptoms are provided) [31, 32, 35, 42–44, 46, 47, 50, 51, 53–56, 58, 62] and an environment in which medical professionals consider patients’ and families’ feelings, thoughts, and wishes (e.g., making efforts to understand the recovering patient’s suffering and hesitancy and giving importance to their previous life history) [32, 36, 39, 40, 42–44, 46, 47, 50–56, 58].

SERV6 included four subcategories: an environment in which there are good support networks between medical professionals and organizations) [32, 35, 36, 38, 39, 43, 48, 49, 51, 53, 55, 56, 62], an environment in which medical professionals can maintain and increase at-home care quality (including an evaluation mechanism) [32, 35, 36, 39, 43], an environment in which medical professionals with high clinical competence can provide recovering patients with high-quality at-home care (with access high-quality services irrespective of where they live) [35, 36, 39, 40, 50, 51, 55, 57, 58, 61], and an environment in which medical professionals strive to parallel medical progress (i.e., advances in medical technology) [44].

Based on the attributes identified in this study, a recovery environment in a place of daily living incorporates healthcare as part of daily life, accepts the patient as a member of the community, provides access to the services necessary for their recovery, and builds positive relationships with medical professionals. The core of this environment is a physical environment appropriate for the health status of the recovering patient and a collaborative environment in which intra-family roles are empowered to aid the patient’s recovery (Fig. 2).

Fig. 2.

Conceptual framework of recovery environments in places of daily living

Antecedents of recovery environments in places of daily living

Certain antecedent conditions were found to be necessary to create recovery environments in places of daily living. These conditions were broadly classified into three categories: decision-making of recovering patients and their families for transitioning to at-home care (ANT1), pre-discharge support (ANT2), and support for specialist medical professionals (ANT3) (Table 3).

Table 3.

Antecedents of recovery environments in places of daily living

Category	Subcategory	Article number(s)
Decision-making of recovering patients and their families for transitioning to at-home care	Recovering patients’ and their families’ choice of suitable recovery environments in places of daily living	[31, 36, 45, 47, 54, 56]
Pre-discharge support	Pre-discharge sharing of issues relating to recovery environments in places of daily living and other care between the involved people	[36, 43, 56, 61]
	The support from specialized medical professionals to ensure a smooth transition for recovering patients and their families toward daily living	[36, 57, 61]
Support for specialist medical professionals	Educational system for specialist medical professionals providing at-home care	[36, 39, 43, 61, 62]
	Organizational environment in which specialist medical professionals can work easily	39, 57]

ANT1 included the category of recovering patients and their families’ choice of suitable recovery environments in places of daily living. This included three subcategories: the recovering patient and their family’s desire for at-home care [47, 54], the recovering patient and their family’s attitudes and preparation before discharge from hospital [31, 36, 47, 56], and the recovering patient’s self-determination in their place of daily living [45, 47].

ANT2 included two categories. The first category was pre-discharge sharing of issues relating to recovery environments in places of daily living and other care between the involved people. This included three subcategories: pre-discharge provision of information appropriate to families’ needs [36], pre-discharge information sharing between families and medical professionals [36, 43], and pre-discharge provision of guidance to the recovering patient and their family [36, 56, 61]. The second category was the support from specialized medical professionals to ensure a smooth transition for recovering patients and their families toward daily living. This category included three subcategories based on the consideration of life after discharge, including families’ ability to participate in care during hospitalization [36], receipt of instructions about discharge [36, 61], and pre-discharge home-visit nursing [57].

ANT3 included two categories. The first category was educational system for specialist medical professionals providing at-home care, which included two subcategories: opportunities to educate medical professionals with accurate information when their knowledge or understanding is deficient [39, 43, 61, 62] and medical professionals’ ability at the institution in which the patient is hospitalized to form an accurate image of their life after discharge [36, 62]. The second category was ensuring an organizational environment in which specialist medical professionals can work easily, which included two subcategories: organization of an educational system for medical professionals (e.g., an organization supporting nurses involved in at-home care to use techniques with which they have had no previous experience) [57] and measures enabling home-visit nurses to work safely (e.g., organization of medical professionals’ occupational environments) [39, 57].

Consequences of recovery environments in places of daily living

For the consequences of recovery environments in places of daily living, we extracted two categories: well-being of recovering patients (CON1) and well-being of patients’ families (CON2) (Table 4).

Table 4.

Consequences of recovery environments in places of daily living

Category	Subcategory	Article number(s)
Well-being of recovering patients	Ease of recovering patients’ physical functioning	[44, 50, 60]
	Increasing recovering patients’ quality of life	[44, 48, 50, 56, 58]
	Maintaining recovering patients’ identity	[37, 40, 44, 46, 47, 50]
Well-being of patients’ families	Alleviating families’ stress	[42, 56]
	Reorganizing families’ lifestyles	[38, 56]

Three subcategories were extracted for CON1. First, ease of recovering patients’ physical functioning included a good nutritional state [50], ease of breathing [44], and ability to maintain physical functioning, such as preventing decrease in physical activity and reducing fatigue [60]. Second, increasing recovering patients’ quality of life included the recovering patient’s happiness [50, 56], building trusting relationships among the recovering patient, families, and medical professionals [56, 58], and the recovering patient’s enjoyment of hobbies and entertainment [44, 48]. Third, maintaining recovering patients’ identity included the recovering patient’s sense of adventure and curiosity [44, 47], protecting their status as a human [37, 40, 46, 50], and enabling them to have a sense of value in being alive [40, 46, 50].

CON2 consisted of two subcategories. First, alleviating families’ stress included enabling families to relax and work off their stress [56] and ensuring that families have sufficient sleep at night [42]. Second, reorganizing families’ lifestyles included stabilizing the recovering patient’s health status [38] and medical professionals viewing families as part of the care provision team [56].

Discussion

Characteristics of recovery environments in places of daily living

Using a scoping review and conceptual analysis, this study explored the evolution of recovery environments in places of daily living and proposed a tentative operational definition. Recovery environments in places of daily living were characterized by a comprehensive set of four components: a physical environment that responds to the health status of the recovering patient, a collaborative environment in which intra-family roles are empowered, a community environment that welcomes the recovering patient, and a service environment in which the necessary services are available. Thus, recovery environments in places of daily living are based on creating a physical environment that corresponds to the recovering patient’s health status and an environment that empowers inter-family roles, while being supported by connections with people in the community and incorporating support and services according to their needs. Such environments can meet the physical, emotional, and social needs of recovering patients and their families. The characteristics of these four environments are discussed more in detail below.

Physical environment

The physical environment in which the recovering patient and their family spend their time proactively is at the core of recovery environments in places of daily living for both a wide range of generations from children to the elderly and different conditions (i.e. those requiring advanced medical care and end-of-life care). Because recovering patients often have impaired sensory and cognitive functions, ADL, and IADL, or have daily difficulties due to their illness, it is fundamental to create a physical environment that can accommodate the health conditions of the recovering patient. Without a physical environment that can cope with the recovering patient’s state of health and appropriate care provision, it will be difficult to manage their symptoms. Furthermore, in the event of a disaster, if the environment (PHY2) with the necessary materials, equipment, and means of communication is disrupted, it will cause infection and endanger lives. Therefore, it is necessary to predict critical situations such as disasters, secure stock of goods, and construct a supply system for goods. Moreover, if their families are the main care providers, they will become exhausted both physically and mentally [63]. Therefore, support from the pre-discharge stage onward is essential. In order for the physical environment to be provided smoothly, it is necessary to introduce services. Furthermore, in order to improve or maintain the physical environment in accordance with the patient's condition, it is important to create an environment in which essential healthcare and social welfare services can be fully used (SERV2).

Recovering patients and caregivers must recognize that a central component of preparation for discharge is mobility [64], and must make adjustments to achieve an environment in which the recovering patient can move around where they like (PHY3). People with movement disorders are more likely than others to have difficulties with IADL and are less likely to participate in cultural and social activities [65]. Therefore, modifying the environment to ensure recovering patients can move around where they like must be linked to proactive recovery in places of daily living. By creating an environment in which recovering patients can move around where they like (PHY3), it will be possible for recovering patients to live not only at home but also in the community. However, barriers to walking in the physical environment are linked to an increased risk of falls [66], which could lead to concerns about fractures and other secondary disabilities; hence, an environment in which the recovering patient’s safety is ensured (PHY1) is essential.

Collaborative environment

An environment in which the recovering patient can express their wishes and make use of their abilities (COLL1) is essential for recovering patients and their families to live in a familiar place while they continue to their social roles. Empowered patients feel more confident about their abilities to express their wishes and manage their health status [67] and are thus more capable of the physical and psychological control necessary to maintain their social roles. Discussions and interactions among patients, their families, and medical professionals are crucial for making the best care decisions that meet all parties’ cultural and social expectations [68]. Therefore, for an environment in which recovering patients and their families can make decisions (COLL2), relationships with and support by medical professionals are critical. It is closely related to an environment in which specialist medical professionals respond to the needs of recovering patients and their families (SERV5).

For patients and their families in recovery environments in places of daily living, it is essential to prepare a collaborative environment to fulfil their appropriate roles and make use of their strengths cooperatively. Therefore, medical providers must aim to establish good relationships with recovering patients and their families, share knowledge about medical care and the healthcare system, and create an environment in which they and their families can express their wishes. For these reasons, efforts must be made to build both an environment in which families can provide care (COLL4) and an environment in which families can organize their own lives (COLL3).

Home-based family caregivers often desire to be part of the medical team [69] and need professional support to make the patient and family a central part of the patient's care. Patients and relatives emphasize that personal vigilance and assertiveness are essential to ensure that they receive the care they need [70]. To this end, it is important to create a collaborative environment in which patients and their families can express their wishes.

Community environment

The community environment included an environment in which recovering patients feel safe and happy because they are accepted by those around them (COMM1) and an environment in which recovering patients and their families feel connected to, interact with, and supported by people in the local community (COMM2). Recovering patients and their families are supported by a community environment that embraces them and leads to their continued participation in society. The results for these two categories are related to social capital, defined as the “characteristics of a social organization, such as trust, norms, and networks, that can improve the efficiency of society by promoting cooperative behavior” [71]. The local environment includes informal social resources provided by neighbors, friends, volunteers, and other community members as well as free support from community organizations. The enrichment of social capital, which is the connection between local residents, helps improve people’s health and quality of life [72]. Activated social capital promotes an environment in which recovering patients can express their wishes and use their abilities (COLL1).

Service environment

Coordination in the at-home healthcare field is complicated by the involvement of multiple professionals [73]. As patients’ backgrounds are diverse, the tailored coordination of the service environment appropriate to the situation of the patient and their family is required. By clarifying the kind of life a recovering patient would like to lead in their daily life, the recovering patient will be able to make adjustments to services themselves. Recovering patients are the main actors in coordinating services. Specialists play the role of coordinating services, taking into consideration the background of the recovering patient receiving treatment in their daily life. Therefore, it is necessary to create an environment in which recovering patients and their families can easily access the necessary medical and welfare services (SERV1 and SERV2) and medical backup (SERV3); hence, a comprehensive support environment (SERV4) provided by medical professionals is important. It is also necessary to create an environment in which the medical professionals who provide services are responsive to the needs of recovering patients and their families (SERV5) and an environment that aims to improve the quality of care (SERV6). The introduction of professional quality improvement programs will promote the development of professional activities, satisfaction, and job retention [74], thus improving the quality of medical professionals and the services they provide.

Roles of professionals who coordinate recovery environments in places of daily living

Furthermore, our study highlights three roles for medical professionals who coordinate recovery environments in places of daily living: (i) providing decision-making support in places of daily living, (ii) creating an environment that empowers patients and their families, and (iii) modifying the service environment.

Providing decision-making support in places of daily living

Preparing recovery environments in places of daily living before discharge is crucial. This includes the pre-discharge sharing of issues relating to sheltered and other care between the involved people and support for medical professionals working toward recovery environments in places of daily living. Therefore, it is essential to respect the feelings of the recovering patient and their family about whether they want to recover in their place of daily living. Additionally, it is important to confirm their status of their physical, psychological, and social preparation, support their choice of recovery environment, and modify and improve unsatisfactory environments before discharge to align with the hopes of the recovering patient and their family. To provide such support, medical professionals are recommended to establish relationships with the recovering patient and their family at an early stage, including face-to-face relationships, and continue such relation in the long run. Living in the community means that the recovering patients undergoing treatment must make self-determination. However, with the addition of medical treatment, patients will need to continue treatment according to changes in their condition, control symptoms, and support patients in making decisions from medical professionals while dealing with physical pain and mental anxiety. Building relationships with medical professionals is important for supporting decision-making by patients and their families. Communication between nurses and patients influences relationship building, but despite nurses' efforts to meet patients' needs, the focus is often on nursing routines and physical care[75]. Therefore, healthcare providers need to review their own practices and examine how they spend time with patients to see if there are any indifferent and avoidant behaviors that inhibit rapport building [76].

As recovering patients are undergoing medical treatment, an environment in which medical backup is available for recovery in a place of daily living (SERV3) is essential. Additionally, establishing an organization as a community resource can ensure that the patient receives the necessary medical backup, support if re-hospitalization is needed, and access to medical care and welfare services. Joint decisions among recovering patients, their families, and medical professionals can be made based on the types of medical backup feasible in the place of daily living. There may be occasions when the families of pediatric patients, patients with reduced cognitive function, and terminal patients make decisions as their representatives. This decision-making must remain participatory, cooperative, frank, open-minded, and respectful [77] to ensure that the appropriate people can support the decision-making process in consideration of patients’ thoughts and feelings [78]. Professionals must liaise with those people who fully understand and respect the recovering patient’s wishes.

Creating an environment that empowers patients and their families

To build collaborative environments in which recovering intra-family roles are empowered in their place of daily living, it is vital to empower them. The concept of empowerment is widely used in clinical practice. Regarding healthcare service users, the empowerment approach is strongly associated with being paternalistic and materially supportive [79]. Because the number of healthcare service users with complex needs is increasing, medical professionals must empower service users when providing high-quality care [79]. In places of daily living, building an environment in which the recovering patient can express their wishes and use their abilities (COLL1) and an environment in which the recovering patient and their families can make decisions (COLL2) enables them to cooperatively establish lifestyles that aid their recovery, resulting in their empowerment.

Preparing an environment in which the recovering patient can move around where they like (PHY3) is also empowering, as it can enable them to maintain independence and participate in appropriate activities to continue fulfilling their social roles. Further, preparing an environment in which the community accepts the recovering patient (COMM1) is important.

Instructing families on the daily medical care that recovering patients require can establish an environment in which families can provide care (COLL4), enabling them to fulfill their roles as caregivers. Technical guidance using the physical environments and resources in the places of daily living of recovering patients must be provided [80] [81] [82]. Moreover, importance must be placed on an environment in which families can organize their own lives (COLL3). It is essential to assess whether families’ physiological and social needs are being met, including education and employment. In some cases, respite care may be needed to ensure families are rested and enjoy a change of environment [83] [84] [85]. In this respect, establishing an environment in which families can organize their own lives (COLL3) is linked to the empowerment of families.

Modifying the service environment

It is vital to modify environments to ensure that services can be used, with multidisciplinary involvement often needed. Professionals must establish relationships with recovering patients and their families (as well as other medical professionals) to create an environment in which the appropriate services are accessible. For high-quality services, an environment in which medical professionals respond to the needs of the recovering patient and their family (SERV5) means providing medical backup in the place of daily living and incorporates medical care as a lifestyle component. The nurses at Buurtzorg consider the nurse–client relationship to be at the organization’s core for meeting patients’ physical, psychological, and social needs [28]. To build trusting relationships with recovering patients and their families as well as strive to meet their needs, medical professionals expected to play the role of service coordinators. It is important to create an environment in which the recovering patient and family can make decisions (COLL2) in order for the patient and family to take the lead in accessing services.

Strengths and weaknesses of the study

The strength of this study is that it clarifies the concept of recovery environments in places of daily living, which is commonly used in clinical practice. In particular, previous studies have not examined how and for whom the medical care environment in places of daily living should be comprehensively developed. Although this study is only a first step towards conceptualizing recovery environments in places of daily living and the final results are tentative, we are nonetheless confident that it will be important for advancing the field of home healthcare research. Another strength of this study is that it addresses the care environment in the living arrangements of caregivers with a variety of conditions, from children to older people.

A disadvantage is that this study should not be viewed as definitive. The literature on recovery environments in places of daily living is dominated by qualitative studies, which have identified the factors that influence the recovery environment in places of daily living, but few have shown relevance (as noted above).

Limitations and future research directions

Recovery environments in places of daily living change depending on national policies and past medical care and home care. However, this study clarified the overall concept of recovery environments in places of daily living and ignored differences in the concept by country. In addition, the exclusion of patients undergoing treatment for hyperacute and infectious diseases means that the recovery environment cannot be adapted to that of such subjects. Further, the presented results do not consider country-specific conditions such as safety, sanitary conditions, and economic base. Finally, as a search of the grey literature was not conducted in the conceptual analysis, some articles may have been missed. To use this concept in practice, it is thus necessary to clarify the culture and policies of each country as well as the characteristics of recovery environments in places of daily living (e.g. inpatient facilities). Since recovery environments in places of daily living must be developed in-depth, future research could aim to develop tools to provide a comprehensive medical care environment. Moreover, further research addressing how the care environment in places of daily living is conceptualized by clinicians and policymakers may help further clarify concepts in the home healthcare and home care environments.

Conclusions

Using a scoping review and conceptual analysis, this study provided an in-depth explanation of the evolution of the concept of recovery environments in places of daily living and proposed a tentative operational definition. The attributes of recovery environments in places of daily living include the following four areas: a physical environment corresponding to the health condition of the patient, a collaborative environment in which the patient receives their medical care, a community environment that supports the patient, and a service environment in which the patient and their family can receive the necessary services. The main aims of recovery environments in places of daily living are to make the patient physically comfortable, maintain their identity, and improve their quality of life as well as relieve family stress and allow the family to reorganize their own lives.

For recovering patients undergoing treatment in their daily lives, continuing to play a role in the family and local community leads to an independent life of treatment. Furthermore, ensuring that the family's life is reorganized will help preserve the family's ability to provide care and maintain a good relationship between the patient and the family. To this end, professionals need to coordinate medical care and welfare and create a recovery environment where patients and their families can take the lead in living.

Abbreviations

PHY1

An environment in which recovering patients’ safety is ensured

PHY2

An environment equipped with the necessary materials, equipment, and communication modes

PHY3

An environment in which recovering patients can move around where they like

COLL1

An environment in which recovering patients can express their wishes and use their abilities

COLL2

An environment in which recovering patients and their families can make decisions

COLL3

An environment in which their families can organize their own lives

COLL4

An environment in which families can provide care

COMM1

An environment in which the recovering patient feels happy living and is accepted by the people surrounding them

COMM2

An environment with which the recovering patient has connections and interactions and is supported by people in the local community

SERV1

An environment in which recovering patients and their families can readily request services

SERV2

An environment in which essential healthcare and social welfare services can be fully used

SERV3

An environment in which medical backup is provided

SERV4

An environment in which comprehensive care is provided

SERV5

An environment in which specialist medical professionals respond to the needs of recovering patients and their families

SERV6

An environment in which specialist medical professionals strive to increase care quality

ANT1

Decision-making of recovering patients and their families for transitioning to at-home care

ANT2

Pre-discharge support

ANT3

Support for specialist medical professionals

CON1

Well-being of recovering patients

CON2

Well-being of patients’ families

Authors’ contributions

Conceptualization, Y.M. and Y.S.; methodology, Y.M.; formal analysis, Y.M., Y.S. and Y.F.; writing—original draft preparation, Y.M.; review and editing, Y.M., Y.S., and Y.F; and funding acquisition, Y.M. All authors have read and agreed to the published version of the manuscript.All authors reviewed the manuscript.

Funding

This work was supported by JSPS KAKENHI, Grant Number JP20K02666. The funder had no role in study design, data collection, analysis, or writing.

Data availability

No new data were created or analysed in this study. Data sharing is not applicable to this article.

Declarations

Ethics approval and consent to participate

The study did not collect data directly from patients.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.