The Conceptualization of the Natural Environment in Healthcare Facilities: A Scoping Review

To identify how the natural environment (NE) in healthcare has been conceptualized.

The NE appears to afford significant therapeutic benefits. A clear concept of the NE in healthcare affords a shared understanding from which to advance science to facilitate comparisons across contexts. In this article, the various meanings of the NE were brought together into one framework by which to map its themes and their relationships.

A scoping review was conducted using database searches in MEDLINE, EMBASE, PsycINFO, CINAHL, and Cochrane for articles published up to July 2018. The bibliography of the included articles were manually searched for published books.

This review includes 137 peer-reviewed articles and research-based books from 27 countries. A conceptual framework was developed to identify five themes that conceptualize the NE in healthcare: (1) definitions of the NE in healthcare, (2) processes of the NE in healthcare, (3) usages of the NE in healthcare, (4) opinions about the NE in healthcare, and (5) NE's impacts on health and work outcomes in healthcare. These themes are filtered by the NE's physical and programmatic designs; changes in one affect the others. Definitions of the NE are described as human-made space, located in the indoors and outdoors, containing elements of nature and designed with the purpose to positively influence humans. Processes are described as the participatory approach in NE's development and its therapeutic goals. Usages are categorized into nature contact, frequency of usage, and accessibility. Opinions are accounted for by perceptions, preference, and satisfaction. Outcomes are related to physical health, mental health and well-being and work.

This framework contributes to the conceptual discussion and emphasizes NE's complementarity to the biomedical healthcare system.