Nightingale’s Environment Theory and Application

Florence Nightingale’s Environment Theory

Florence Nightingale’s Environment theory was selected as one of the most appropriate theories in my field of practice. This theory was selected not only because it is the founder of modern nursing, but also the fact that it has stood the test of time (Steadman, 2014). Developed in the 1860s, this theory has remained relevant in modern society despite the significant changes witnessed in the field of nursing as knowledge and technology keeps developing. It is one of the widely used nursing theories and as Kim (2015) states it has defined the face of modern nursing practice. The focus of this paper is to analyze major concepts of this theory, its assumptions, and its application in the modern nursing environment.

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Theorist’s Background and Experiences

Florence Nightingale was born on May 12, 1820, in Florence, Italy to an upper-class British family. At a tender age, she traveled to various parts of Europe with her sister and her parents. During the trips, she met Mary Clarke who had significant influence in her life. During her time, women were expected to be respectful wives, not actively involved in economic activities. However, Clerk convinced her that women were also capable of playing major roles in transforming society other than simply being housewives. Her strong desire to serve people drove her to the field of nursing. Given that her rich father was opposed to the idea of her becoming a nurse, she had to teach herself the art and science of nursing. Her commitment saw her start working at institutions of healthcare as a nurse. The experiences that Nightingale had in Crimea during the Crimean War informed the nursing concepts that she developed, especially the Environment Theory. During the war, she and many other nurses and Catholic nuns went to the battlefield to help the wounded and the sick. Some of her patients died while many others survived. She noticed that the environment to which these patients were exposed affected them significantly. She was committed to finding ways of minimizing the deaths of patients under the care of nurses, and that is why she developed this theory to help nurses when offering care to patients.

Crucial References for the Original Work of the Theorist

The Environment Theory developed by Nightingale is widely considered the founder of modern nursing (Capolongo, Bottero, Buffoli, & Lettieri, 2015). It is one of the earliest theories and was primarily developed based on the experience of the theorist. When developing this theory, Nightingale’s primary reference was the personal experiences she had with the patients. She never had the opportunity to go through normal nursing classes as the modern nurses and as such, most of her concepts were based on what she experienced as a person while caring for the patients. Steadman (2014) argues that the fact that Nightingale’s concepts were developed based on real-life experiences they have remained relevant despite the changes witnessed in the field of nursing. The theory has been referenced by many scholars since it was developed. Some of the fundamental concepts of nursing in use today were developed based on this theory.

Problem Addressed by the Theory

Environmental Theory was developed to address the problem nursing environment. A patient admitted to an institution of healthcare needs a certain environment to heal and be discharged, according to this theory. Ventilation and warming are some of the primary factors defined by this theory. Patients must be kept warm and the wards must be properly ventilated to avoid infections and re-infections. Cleanliness of the area, proper lighting, and controlled noise are also identified as important factors. Other critical factors that nurses must take into consideration include personal cleanliness, clean bed and beddings, proper nutrition, close observation, and offering patients hope and advice as may be necessary. This theory also reminds nurses that nursing is a calling and one must be ready to serve. It prepared nurses psychologically, making it easy to deliver on their mandate without complaints.

Theory Description

Inductive Reasoning

Environment Theory is based on inductive reasoning. It is based on the premise that several factors within a patient’s environment would enable them to get better or may worsen their condition (Yoost & Crawford, 2015). A patient who is in a clean environment cared for by nurses who are hygienic, offered the right nutrition and medicine, and offered advice and inspiration are likely to get better at a faster rate than those who lack these benefits. This theory reasons that a series of environmental factors when present would make a patient get better. The processes undertaken by the nurses to create the desired environment results in a conclusion that can be positive or negative based on what was presented.

Major Concepts of the Theory

Environment Theory is based on four major concepts. The first concept in nursing. Nightingale argues nursing, as practiced by nurses, entails putting the patients in the best conditions to enable nature to act upon them. Nurses will try to influence nature by providing favorable conditions needed for the healing. Cleanliness, light, warmth, fresh air, and quiet are some of the basics of nursing. The second concept defined in this theory is human beings. Nightingale defines human beings about their environment. She argues that human beings are dependent on their environment, especially when they are sick. The third concept is the environment. This theory emphasizes on the need to create an enabling environment for patients. The theorists emphasize on the physical environment and the responsibility of nurses in ensuring that it is supportive of the patient. According to Smith and Parker (2015), patients undergoing different medications may require different environments within the hospitals. However, the ten environmental factors identified by Nightingale are universal to all patients. In her experience, she and her colleagues were forced to take care of wounded soldiers and civilians in makeshift tents. However, even in such extreme conditions, she noted that the basics such as warmth, ventilation, cleanliness, and quite are very critical when caring for a patient. The fourth concept is health. In this theory, Nightingale argues that it is the responsibility of nurses to ensure that the sick are helped to be healthy and the healthy maintain their good health. For the sick, nurses should do everything within their powers to help them recover. For the healthy, nurses should help them remain healthy by making them informed. The theory held that organizing promotional campaigns to help people know about causes and preventive measures against common diseases, especially communicable diseases, is critical.

Interpreting How the Concepts are Defined

The concepts in Environment Theory are defined explicitly. Nightingale is very explicit when defining the concept. Her concepts are simple and straightforward, leaving no room for uncertainties and guesses (Maville & Huerta, 2013). For instance, in defining the concept of environment, she clearly states what is meant by the environment in the context of nursing and what nurses are expected to do to ensure that they create a sustainable environment for their patients. The nature of the environment that patients need is outlined in simple but very clear terms. In defining the concept of health, the role of nurses is outlined in very clear terms and how they need to hand their patients to ensure that they recover from their conditions within the shortest time possible.

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The relationship among the Major Concepts

All the four major concepts defined in this theory are closely related to one another. The concepts are defined in a way that shows they work closely to achieve the desired results. Nursing as an art and science of caring for the patient and an enabling environment makes it possible for a patient to gain back his or her health. When a nurse offers care to the patient by providing the needed medication in time but the environment is not suitable, then achieving success may be a challenge. These factors must be aligned. The concept of a human being is also defined in the context of how it is affected by the environment, a sign that the theorist was keen on intertwining these concepts to help in achieving the desired results.


Explicit and Implicit Assumptions

Environment Theory was based on some assumptions, some of which are explicit while others are implicit. The theory explicitly assumes that to have a healthful house, five factors of pure air, cleanliness, pure water, proper lighting, and efficient drainage are sufficient. Once these factors are provided, then nature is allowed to help the patient gain full health. The theorist also assumes that nature alone cures in the presence of the right conditions. This is an assumption that she stated explicitly when explaining the environmental factors needed to ensure that nature can be allowed to cure patients. Nightingale also assumes that nursing is an art, very distinct from the science of medicine. She argues that nurses must work based on the directives of physicians who understand the science of the human body. Under this assumption, the theorist states that nurses should be loyal to medical plans (Snowden, Donnell, & Duffy, 2014). The theory has an explicit assumption that even with the best medical care it is not easy for patients to achieve good health in an unhygienic environment that lacks the ten basic requirements of an enabling environment.

Concepts of Nursing Metaparadigm

The four concepts of nursing metaparadigm (people, place, nursing, and environment) are all present in this theory and are clearly explained (Gottlieb & Gottlieb, 2012). The first concept is the people. The theory defines human beings as people who need healthcare services, whether they are sick or not. For those who are sick, the theory explains the kind of environment that they should be provided to enable them to get better. For those in good health, the theory explains that they need to be empowered through awareness creation to ensure that they can avoid common diseases. The concept of place is defined as an area where the nursing service is needed. In most of the cases, it is within the wards where the patients are admitted. However, sometimes it may be in tents away from medical facilities. The third concept in nursing. It is the responsibility of nursing practitioners to offer nursing to patients. Nursing in the context of this theory is defined as offering patients an enabling environment and following physicians’ directives to help patients achieve good health. The fourth concept is the environment. The theory itself is based on this fourth element of the nursing metaparadigm. It explains the nature of the environment that should be provided for the patients, irrespective of the place, to ensure that they regain their good health. It discussed the role of the environment in enabling patients to combat their conditions.

Clarity of the Theory

Environmental Theory is a clear and simple theory that describes what nurses should do to create an enabling environment for their patients. It has lucidness and consistency when explaining various concepts that nurses should understand. It is very practical, a fact that Kim (2015) attributes to the belief that Nightingale developed it while in the field offering help to patients. It is not a theory that was developed in a classroom context. It was developed in the nursing field, which is why its concepts are explicitly explained to help nurses apply them in their practical context. Each of the ten environmental factors is clearly stated to ensure that any possible cases of confusion are eliminated.


How the Theory Would Guide Nursing Actions

The Environment Theory would guide nursing actions. The theory clearly defines the relationship between a nurse and a medical doctor. It holds that nursing is more of an art of caring for patients while the medicine is a science. As such, nurses must follow the guidelines of doctors who understand the science of the body. The theory guides the actions of nurses by insisting that nurses should not take medical actions without directives from the physicians. The theory then provides a comprehensive analysis of the nature of the environment that nurses must provide for their patients. One factor that comes out clearly in this environmental analysis is hygiene. The theory insists that irrespective of the place where nurses offer their care, it is their fundamental responsibility to maintain a high level of hygiene. The theory also stipulates the nature of the place that is conducive for caring for a patient. Nurses can, therefore, advise the administrators of improvements needed in the wards from time to time.

How the Theory Can Be Used in My Area

In my area of nursing, Environmental Theory as proposed by Florence Nightingale is of great use. A registered nurse should know his or her relationship with other nurses and most importantly with the medical doctors. This theory clearly outlines the difference between doctors and nurses, making it easy for a registered nurse to know how to relate with the nurses. In practice, this theory helps in understanding the nature of the environment needed in the hospital wards. As a registered nurse, it is easy to understand why a high degree of cleanliness, quietness, good ventilation, and proper nutrition is important for patients. The theory explains how and why registered nurses should engage in public awareness campaigns to empower them medically. It justifies the need for nurses to spend time with the healthy members of the public explaining to them how they can remain healthy.


Capolongo, S., Bottero, M., Buffoli, M., & Lettieri, E. (2015). Improving sustainability during hospital design and operation: A multidisciplinary evaluation tool. Oxford, UK: Oxford Publishers.

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Gottlieb, L., & Gottlieb, B. (2012). Strengths-based nursing care: Health and healing for person and family. New York, NY: Springer Publishing Company.

Kim, H. S. (2015). The essence of nursing practice: Philosophy and perspective. Hoboken, NJ: Wiley & Sons.

Maville, J. A., & Huerta, C. G. (2013). Health promotion in nursing. Clifton Park, NY: Cengage Learning.

Smith, M. C., & Parker, M. E. (2015). Nursing theories & nursing practice. London, UK: McMillan.

Snowden, A., Donnell, A., & Duffy, T. (2014). Pioneering theories in nursing. New York, NY: Springer.

Steadman, P. (2014). Building types and built forms. Hoboken, NJ: John Wiley & Sons Publishers.

Yoost, B. L., & Crawford, L. R. (2015). Fundamentals of nursing: Active learning for collaborative practice. New York, NY: Cengage.

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