Environmental Theory of Nursing

Florence Nightingale’s Environmental Theory of Nursing

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Florence Nightingale’s environmental theory of nursing is considered the origin of the modern nursing practice. The theory changed the face of nursing by incorporating the restoration of a patient’s normal health status into the process of healthcare delivery (Hegge, 2013). Derived from Nightingale’s observation of the relationship between human health and the environment, the theoryis based on the idea that the manipulation of the physical environment surrounding the patient is the major component of nursing care (Hegge, 2013). In this context, the theory argues that the physical aspects of the environment such as light, warmth, noise, cleanliness, nutrition, variety and bed are the major areas of the environment that should be under the control of the nursing care providers (Selanders, 2008).

Identification of the theorist

Florence Nightingale was an English religious enthusiast, social reformer and statistician born in 1820 in Florence, Italy (Hegge, 2013). She is the founder of documented and academic nursing practice. Nightingale’s major recognition started when she worked as a nurse in the Crimean War. Her dedication to work compelled her to make frequent visits to the patients at night holding a lamp, which earned her the title “The Lady with the Lamp” (Hegge, 2013). Nightingale realized that most cases of death did not result from bullet wounds. Rather, they resulted from infections obtained during nursing care. In her book “Notes on Nursing”, Nightingale states that nursing is an act of using and manipulating the environment of the patient in order to improve the recovery process(Selanders, 2008). She observed that environmental factors such as fresh air, pure water and cleanliness, light and effective drainage were the key factors that enhanced the recovery process(Selanders, 2008). Nightingale later established a school of nursing at St. Thomas Hospital and contributed to the foundation of the Royal Buckinghamshire Hospital in Eynesbury (Hegge, 2013).

The Environmental Theory of Nursing   

Nightingale’s observations, which she wrote in her book “Notes on Nursing”, became the foundations of her Environmental theory of nursing. They transformed nursing practice in the 20th century (Hegge, 2013). First, the theory states that the patient is a“client to the nurse”. There must be a state of balance in nursing care in which the nurse, the client and the environment are concepts that must always be in balance (Hegge, 2013). This means that the nurse can manipulate the environment in order to compensate the response of the client to the environmental conditions (Selanders, 2008).

Secondly, Nightingale’s theory defines major components in nursing. According to this theory, nursing is a concept that must signify the appropriate or proper use of the environmental factors and diet in order to give power to the patient and allow nature to act on him (Hegge, 2013). The term ‘people’ represents the client. It is expressed in terms of the relationship between patients and their environment. On the other hand, the environment is defined as the aspects that surround the patient. Moreover, health is not well defined in the Nightingale’s notes,although she believed that “…Health is the unmaking of what God has made diseases…” (Selanders, 2008). This means that the goal of the nurses is to ensure that the clients recover from a disease or condition in order to retain the normal status.

Thirdly, Nightingale’s environmental theory of nursing defines some“ten canons of nursing” attached to the concepts (Hegge, 2013). For instance, the concept of physical environment relates to the canons of ventilation and warmth, light, noise, room and wall cleanliness, beddings and bed and health of houses (Hegge, 2013). Similarly, chattering hopes and advices are canons attached to the concept of physiological environments while taking food is a canon attached to the concept of nutritional status (Hegge, 2013). Finally, management and/or observation are canons attached to the concept of nursing care plan and management (Hegge, 2013).

Reasons for selecting Nightingale’s theory

Nightingale’s environmental theory of nursing is the fundamental concept that brought forward the idea of the relationship between the right environmental conditions and human health (Hegge, 2013). Florence Nightingale observed that most people die from infection, contamination, poor handling, unsafe water, ineffective drainage and other conditions and not necessarily because of the disease or injury itself (Hegge, 2013). Her idea revolutionized nursing and medical care practice after realizing that the safety of the physical conditions, the appropriate psychological support, the right diet and proper nursing care and management should be maintained to reduce the chances of infection and enhance the process of recovery (Hegge, 2013). The increased reduction of the number of deaths due to hospital based infection, improved hygiene and the right diet, appropriate psychological and care plan contributed to the increased population in the world in the 20th century, thanks to Nightingale’s work (Hegge, 2013). Therefore, it is important to consider this theory as the foundation of the improved healthcare in the last century as well as the foundation of the other nursing theories (Hegge, 2013).

Application of Nightingale’s theory of nursing to personal nursing practice (RN nursing)

In the modern nursing practice, Nightingale’s theory can be applied in the development and establishment of the basic views of care planning and management. As a registered nurse (RN), I workin a telemetry Step-down unit in a health care facility, where I have been since graduating in 2003.

I find Nightingale’s environmental model important in my practice. Although the modern healthcare system in the US is highly developed and incomparable with the situations during the Victorian England, my work entails practices that fall within the five concepts developed by Florence Nightingale (Selanders, 2008). For instance, it is my role to ensure that the physical, psychological, nutritional environments and care plan and management are developed and provided to the clients in the right manner in order to enhance the healing process. First, registered nurses are required to provide the right directions and guidelines for the appropriate physical environment (Libster, 2011). For example, to avoid hospital-based infections, it is my role to ensure that the nursing room and other spaces for care are free from microorganisms, injuries and other hazards. This also applies to the home-based care(Libster, 2011). Secondly,I must ensure that dietary interventions are provided and in the right manner. In addition, Imust ensure that the right information about the correct dietary intervention is provided to the clients, their families and groups. Thirdly, the psychological support given to clients is a major requirement for registered nurses(Libster, 2011). It is my role to ensure that clients and their families are provided with the right psychological and spiritual support to improve recovery or improve the quality of life during the last days of terminally ill patients (Macrae, 2005). In fact, these are some of the issues that are highlighted in Nightingale’s canons and concepts.




Hegge, M. (2013). Nightingale’s environmental theory. Nursing science quarterly, 26(3), 211-219.

Libster, M. M. (2011).Elements of care: nursing environmental theory in historical context. Holistic nursing practice22(3), 160-170.

Macrae, J. (2005). Nightingale’s spiritual philosophy and its significance for modern nursing. Image: The Journal of Nursing Scholarship27(1), 8-10.

Selanders, L. C. (2008). The Power of Environmental Adaptation Florence Nightingale’s Original Theory for Nursing Practice. Journal of Holistic Nursing, 16(2), 247-263.

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