Toward a conceptual understanding of a positive living environment for residents in nursing homes

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BACKGROUND AND OBJECTIVES: As nursing homes are permanent residences for dependent older adults, creating positive living environments for them is essential. Themes like sense of home, quality of life, and person-centered care address parts of this, but an overarching view of what a positive living environment entails, is lacking. This study aimed to clarify this concept and identify its key elements. RESEARCH DESIGN AND METHODS: We combined a scoping review with concept analysis to determine the concept's uses, defining attributes, antecedents and consequences. 5 databases were searched for qualitative and mixed-method studies published between 2004 and May 2024. We identified 56 resident-perspective articles. Using purposive sampling, we synthesized 31 articles until reaching conceptual saturation. RESULTS: Preserving identity emerged as the core of a positive living environment, embedded within 7 interrelated defining attributes: continuity with life before the move, having meaningful relationships, receiving personalized care, balancing autonomy and support, engaging in meaningful activities, feeling connected with the outside community, and balancing privacy and having company. Antecedents were identified at 3 levels: residents need acceptance and a positive mindset; staff require professional, interpersonal, and ethical competence; and organizations should provide a functional yet homelike setting, have sufficient resources, and a culture valuing personalized care and flexibility. Together, these elements dynamically interact, leading to consequences such as feeling at home, belonging, safety, dignity, and overall well-being. DISCUSSION AND IMPLICATIONS: A positive living environment is a dynamic, co-created process requiring collaboration among residents, families, staff, and the broader organizational context to support identity preservation.

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