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F. Nightingale’s Environmental Nursing Theory


Florence Nightingale is regarded as a pioneer nursing theorist who established the environmental theory. While working as a nurse, Nightingale noticed that environmental conditions affected the rate at which patients died following injuries sustained during the Crimean War. Nightingale believed that the environment had a great influence on patients’ outcomes. She recognized the extent to which contaminated environmental conditions exposed patients to health hazards. Nightingale’s accomplishments include volunteering to offer care to wounded soldiers during the Crimean War and championing for reforms on hygiene-related problems facing hospitals as published in many of her books.

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Nightingale started her nursing career in 1844 when she enrolled at the Lutheran Hospital of Pastor Fliedner in Kaiserwerth, Germany. The climax of her profession was witnessed during the Crimean War when she assumed the position of a social worker who helped to reduce the death rates of injured police officers. She accomplished this goal by advocating for the improvement of environmental conditions in hospitals.

On her trips to Paris and Egypt, Nightingale observed that well-organized and disciplined nuns performed better compared to women in England, thereby influencing her research on quality care in nursing. According to Frello and Carraro (2013), Nightingale’s major accolades include the Royal Red Cross honor by Queen Victoria in 1883, the Order of Merit in 1907, and the Norwegian Red Cross badge of honor in 1910. This paper supports the implementation of Nightingale’s environmental supposition across all medical facilities due to its potential of enhancing patients’ recovery rates as stipulated in the theory’s core concepts.

Analysis of the Concepts and Major Relationships in the Environmental Theory

The central concepts presented in Nightingale’s environmental theory include the individual, surroundings, well-being, and nursing. Nightingale as the first nursing theorist developed at least 10 components, which include ventilation and warming, light and noise, hygiene, the status of living areas, the conditions of beds and beddings, personal cleanliness, variety, offering hope and advice, food, and observation (Karim, 2015). These components of the environmental theory depict it as a patient-centered care framework.

According to Mughal and Ali (2017), the concept of the individual emphasizes the need for availing holistic nursing care to patients. Furthermore, this theorist acknowledges the degree to which the patient is affected by the environment. This awareness informs her decision to encourage nursing professionals to ensure that the setting of various hospitals is conducive to patient-centered care. Moreover, this theory holds that patients have reparative powers that influence their well-being.

The concept of the environment in Nightingale’s theory consists of various components of the physical and psychosocial elements that affect patients’ outcomes. Major concepts of Nightingale’s theory underscore the significance of well-constructed hospital facilities in any given society (Mughal & Ali, 2017). This theory encourages nurses to get rid of unnecessary noise particularly when patients are sleeping.

Nightingale presents the cleanliness of the health facility as an important component of patient-oriented care nursing. This theorist expects nursing professionals to always maintain hygiene in all hospital rooms. Furthermore, as Mughal and Ali (2017) assert, Nightingale advises nurses to prioritize patients’ sanitation, for instance, by washing their hands frequently when attending to them. According to this theory, personal cleanliness is one of the major elements of quality service provision in the field of nursing.

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This theoretical framework advocates for the regular changing and airing of bedcovers, which is an important practice for providing patients with quality nursing care services. As Mughal and Ali (2017) reveal, Nightingale recommends the idea of nurses providing patients with a variety of small and balanced meals. Additionally, this theory requires nurses to refrain from administering services while patients are eating to avoid distraction.

Social and psychological components of the environment concept presented in the environmental theory entail variety, offering hope and advice, and observation (Mughal & Ali, 2017). Nightingale emphasizes the significance of providing a variety of services to patients to get rid of boredom in the healthcare environment. According to Karim (2015), items that can help in mitigating boredom may include books and flowers.

This theory requires caregivers to offer hope and advice to patients. Additionally, Mughal and Ali (2017) encourage nurses not to demonstrate any form of laxity when handling patients’ diverse illnesses. Instead, they should show commitment to offering them services that enhance their health. Moreover, Nightingale integrates the concept of observation into her theory to emphasize the need for considering the status of patients’ residential areas.

The health concept is also central in Nightingale’s nursing theory. Specifically, according to this theorist, patients’ well-being includes the ability to use their powers to boost recovery rates (Mughal & Ali, 2017). According to Nightingale, controlling the prevailing environmental factors is crucial for promoting patients’ health and recovery rates. Moreover, the nursing concept incorporates various components of the environmental theory. Nightingale describes nursing care as highly dependent on the composition of environmental elements that influence the health of a patient (Mughal & Ali, 2017). Hence, nurses need to provide patients with fresh air, cleanliness, warmth, quietness, and a good diet to streamline their reparative processes.

In an article titled Application of Nightingale’s Theory in Nursing Practice, Pirani (2016) presents a scenario that highlights his application of concepts presented in the environmental theory under investigation. According to Pirani (2016), nurses should ensure that patients’ cubicles have proper ventilation and clean air by getting rid of dust inside and outside all rooms. This practice improves patients’ health, especially those who are diagnosed with COPD.

Pirani (2016) holds that paying attention to sick people’s diet is helpful because it reduces their chances of dying from starvation. The application of the environmental theory allows nurses to understand literacy levels in the environment in which patients live, thus contemplating the community’s awareness of basic health precautions. Such efforts enhance patients’ recovery rates by gaining knowledge about their backgrounds.

In another article addressing the legacy of Florence Nightingale in nursing practice, Zborowsky (2014) reveals the extent to which concepts postulated by this first nursing theorist have been applied considerably to the modern nursing environment. In particular, the four concepts of the environmental theory, which include the person, the environment, well-being, and nursing, have been deployed in acute and intensive care environments to optimize the quality and safety of patient-centered care (Zborowsky, 2014).

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Similarly, according to Murray (2017), patients’ safety and the quality of care they receive are based on the knowledge area developed by Florence Nightingale through the environmental theory. Overall, nursing leadership and management in the modern healthcare environment focus on the importance of considering various environmental aspects that constitute patient-centered care.

The Relevance of Nightingale’s Theory

The environmental theory postulated by Nightingale is relevant in personal, healthcare, and research dimensions. This theoretical framework is applicable to Nightingale’s life since she came up with a model that fosters the delivery of quality nursing services to patients. According to Shetty (2016), by enhancing environmental factors in nursing practice, Nightingale informed the move by healthcare practitioners to deploy various physical and psychosocial components that reduce the rate at which patients died while receiving treatment during the Crimean War.

The theory is also applicable to the modern healthcare environment because it integrates pertinent environmental factors that influence the delivery of nursing care (Shetty, 2016; Karim, 2015). The environmental theory has become a core model of promoting quality care and patient safety in modern healthcare settings. Overall, according to Frello and Carraro (2013), the incorporation of Nightingale’s theory into the healthcare sector has resulted in major improvements as far as quality and safety are concerned.

The theory also acts as the basis for various research endeavors that seek to investigate the influence of the environment on patients’ outcomes. As revealed in the study by Frello and Carraro (2013), the area of focus in most present-day research endeavors has been on strategies and challenges associated with quality nursing care and patient safety. This pioneering nursing theory has paved the way for various researchers to deploy Nightingale’s components with the aim of providing evidence-based findings that can influence nursing practice.

Summary: Strengths and Limitations

Nightingale’s environmental theory has been deployed in many healthcare settings because of its strength of reducing the number of deaths caused by unhygienic environments (Karim, 2015). In addition, although some theories are only applicable to specific geographical locations, Nightingale’s environmental framework has the strength of being implemented in any medical facility regardless of where it is situated around the globe.

However, this theory has some limitations. For instance, scholars have condemned its idea of presenting the external environment as the only source of various diseases (Pirani, 2016). Nightingale’s framework also ignores the role of other elements inherent in people, including tension and depression, in determining their overall well-being. This theory also overlooks nurses’ responsibility of managing patients’ psychological and emotional conditions.


Frello, A. T., & Carraro, T. E. (2013). Florence Nightingale’s contributions: An integrative review of the literature. Escola Anna Nery, 17(3), 573-579. Web.

Karim, H. N. (2015). Clinical application of nightingale theory. International Journal of Innovative Research and Development, 4(11), 225-227.

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Mughal, F. B., & Ali, B. H. I. (2017). Enhancing patient well-being: Applying environmental theory in nursing practice. Annals of Nursing and Practice, 4(3), 1085-1087.

Murray, E. (2017). Nursing leadership and management: For patient safety and quality care. Philadelphia, PA: F. A. Davis Company.

Shetty, A. P. (2016). Florence Nightingale: The queen of nurses. Archives of Medicine and Health Sciences, 4(1), 144-148. Web.

Pirani, S. A. (2016). Application of Nightingale’s theory in nursing practice. Annals of Nursing and Practice, 3(1), 1040.

Zborowsky, T. (2014). The legacy of Florence Nightingale’s environmental theory: Nursing research focusing on the impact of healthcare environments. HERD: Health Environments Research & Design Journal, 7(4), 19-34. Web.

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