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Environmental Theory Critique

Environmental Theory Critique

Florence Nightingale is a renowned theorist in the field of nursing. She is credited as the first nursing theorist and founder of modern and scientific nursing. She is also widely known for the development of the Environmental Theory which changed the face of nursing practices in the era. Her observations of the correlation between patients’ death and their respective environmental conditions led to the birth of the theory. She laid a theoretical and conceptual framework for the development of the Environmental model of care that is still relevant in today’s nursing practices. The purpose of this paper is to analyze and evaluate Nightingale’s Environmental Theory in order to determine its past, current and potential contributions to scientific knowledge. The paper covers the theory’s meaning, origin, usefulness in nursing practices, testability, and overall evaluation. 


In her Environmental theory, Florence Nightingale focused on the environment and its contribution to human health. Person, environment, health and nursing are the four major paradigms of the theory.  The theorist perceived a person as the recipient of nursing care (Thompson, 2018). Environment involves both the internal and external aspects of a person. According to Nightingale, health is the ability to utilize every power we have well. She referred nursing as the caregiving activities that promote health. Nightingale believed the primary role of nursing to be to alter patient’s (person’s) environment to one that supports the healing process.

 The main concepts of the theory are pure fresh air, pure water, good ventilation, cleanliness, good diet, adequate lighting, bed and bedding, noise-free and warmth. The deficiency or absence of these health contributing environmental conditions leads to impaired functioning of a person’s life processes or a dis-ease. The scholar, however, put more emphasis on clean, pure and warm air. She believed that keeping the air in the clinical setting impure and chilled has negative effects on the healing process. According to her, unnecessary noise or commotions that create certain expectations on the patients’ mind hurt the patients. She described light, and especially natural light from the sun to contain an inherent healing property that would revive a person’s health (Soney, n.d.). Dietary intake and meal schedules play a key role in the patient’s recovery. A dirty surrounding is a source of infections that hinders the patient’s wellbeing. Nightingale asserted that proper hygiene practices such as proper handling of food, proper disposal of sewage and bodily excretions, and hand washing played a critical role in patient’s health. A comfortable bed with clean linens is also essential in the patient’s recuperation process.

Nightingale’s Environmental Nursing Theory has seven major assumptions to it. It focuses on ensuring the patient’s environment supports the healing process. She believed that natural laws were behind people’s health and illnesses. Anyone seeking perfection can reach it. The other assumption to the theory was that nursing was a calling to help others. It is also an art and a science that is achieved through environmental alteration. A specific educational base is crucial to ensure positive nursing outcomes. It is also a distinct field that is separate from medicine.

Origins of the Theory

Florence Nightingale developed the Environmental theory in England in the mid and late part of the nineteenth century. She developed writings on “Notes on nursing: what it is, what it is not” (1860) to differentiate nursing practices from other health practices and more so medicine. During the Crimean war, Nightingale presented her philosophy of nursing as a calling from God. She laid out her holistic approach to human health in an era when only the physiological aspects of a person’s health were considered in medicine (Awalkhan, and Muhammad, 2017). She considered nurses as the healing agents who facilitate their patient’s recovery process. The scholar emphasized the need to put the patient’s subjective feelings into consideration in the caregiving process since she believed it contributed to positive health outcomes.

Nursing wounded and recuperating British soldiers in the Crimean war is what motivated Nightingale to develop the concepts that led to the birth of the environmental theory. In this period, she learned and discovered what worked and what did not in the recovery process. Being the first nursing theorist, there were no other theories to refer to. Most of her ideas and concepts were thus abstract. However, her theory upheld certain societal values such as compassion and care that she believed are crucial in the nursing process.


The theoretical and conceptual knowledge from Nightingale’s Environmental Theory is still relevant and useful in today’s nursing practices. According to Medeiros et al. (2015), a majority of Florence Nightingale’s work was written for those caregivers who offered their services at home. It thus provides practical nursing methods and guidelines that are still applicable in the present time. She put emphasis on the critical thinking which she believed helps in assessing a patient’s health situation to determine the most relevant nursing care to offer. The theory was largely based on her experiences in the profession. As such, a majority of her ideas and concepts were not derived from theoretical but practical knowledge. Hand washing was one of her ideas that are still emphasized in today’s health practices. Her work has served as the basis of nursing education and research which has contributed to the development of nursing.

Awalkhan, and Muhammad (2017) cite a case study in which the Environmental theory could be applied. The scenario involves a Mrs. X who has a post-op colostomy. She had received an intestinal obstruction surgical operation whose etiology was unknown. The woman had been made a widow three years ago from the death of her husband in a war in Afghanistan. The woman’s skin was extremely pale and her colostomy bag was covered with a plastic bag. Her abdomen skin also appeared to be red. Her mother in law who had accompanied her to the hospital together with her three children told the nurse that they live in a small house with two other children and their cattle. They live in poverty surviving on less than a dollar in a day. Her medical records also showed a history of intestinal infestation as a result of taking impure and unclean water. In the scenario, Nightingale’s model of nursing is very relevant in the patient’s intervention and treatment since it is clear that her environmental conditions play a key role in her ill health and slow recovery.  Other than providing a comprehensive education on the effects of different environmental conditions on health, the patient’s attending nurse forwarded her details to the hospital’s administration to have her under free medical care considering her financial conditions. The nurse also arranged to have a non-governmental organization ease her financial burden. It is now upon the patient and her family to ensure they alter their environment to that that supports their well-being.


The variables and hypothesis in Nightingale’s Environmental theory help in the understanding and interpretation of propositions. The major concepts in the theory are the independent and dependent variables that determine a patient’s health outcome. Various propositions were also developed from the theory’s concepts. The prepositions are, cleanliness prevents morbidity, nutritious diet, good bed and clean bed linens are essential for health recovery; noise disturbs the patients’ need to rest and is harmful to their health; clean environments decreases the number of infection cases; the house in which the patients live and the people who come into contact with them and more so the caregivers make up the nursing care; windows should always be opened to allow circulation of clean air and light in the nursing facility; and that external environmental conditions can either prevent, suppress or contribute to illnesses and death. The theory has generated various researches in the field and used to develop other nursing theories and models that are relevant in today’s nursing practices. According to Soney (n.d), the theory has been used before on various studies one of them being the study of the environmental vulnerability of children exposed to HIV during birth.

Overall Evaluation

The Environmental nursing theory is comprehensive and specific to key details. Nightingale presents and explains the major paradigms in the theory which are person, health, environment and nursing in a way that she perceives them. The scholar also highlights what she believes to be the critical concepts to the theory and gives a comprehensive explanation of the relationship between them and how they interplay in a person’s health. Although no hierarchical order is made to the concepts, Nightingale perceives ventilation as the most crucial concept (Selanders, 2010). She also believed that sunlight has healing properties that can contribute to the quick recovery of a patient’s health. The underlying assumption to the theory is that with a healthy environment, people are bound to remain free from illnesses. She specifically stated that such patient’s conditions as being cold, feverish, faint, bed-sore or ill after a meal are entirely the nurse’s fault and should not be blamed on the disease. A nurse is thus a changing agent to the patient’s health. To ensure positive nursing outcomes, he/she must understand the patient’s health condition and the immediate environment. The environmental theory also has a broad scope that enhances its utilization in all nursing areas.

One of the major strength of the Environmental theory is that it is based on empirical observations and statistics rather than theoretical knowledge. Nightingale developed the theory from her own observations in the nursing career especially during the Crimean War (Selanders, 2010). The theory gives nurses an active role to ensure favourable environmental conditions in the caregiving process whilst encouraging people to take the initiative to ensure their wellbeing and adopt good practices that promote self-healing. The theory also promoted the view of nursing as a distinct discipline from medicine thus allowing for its expansion and development. Her theoretical and conceptual frameworks have proven to be relevant form their time of formation up to date. This means the theory is timeless and its significance does not fade out with time. However, the theory put too much emphasis on the physical factors assuming that diseases are always as a result of an environmental wrong. Her observations seem to have exclusively come from her experience with patients in the Crimean war which somewhat limits its scope.


The main purpose of Nightingale’s Environmental theory was to promote health and enhance the patients’ recovery process by maintaining an environment that supports wellbeing. She presented pure fresh air, pure water, good ventilation, cleanliness, good diet, adequate lighting, bed and bedding, noise-free and warmth as the main concepts of her theory. The presence or absence of the environmental conditions contributes to a patient’s wellbeing or ill-health respectively. Although faced with a few weaknesses, the strengths of the theory undoubtedly outweigh the weaknesses. Nightingale’s Environmental theory is a nursing theory that I would apply in my advanced nursing practices.

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