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Nursing Theories and Conceptual Models Essay

Nursing Theories and Conceptual Models Essay

Florence Nightingale was a fecund writer whose books, diaries, letters, pamphlets and monographs on different topics communicated of her ideas, values and beliefs. Although she did not formally develop a nursing theory, reviewers of her works credit her as the first nursing theorist. Nightingale was the first to explore nursing as a different discipline from medicine yet related. She also emphasized professionalism in the field something most people regard her as the founder of modern nursing for. Her philosophy paved way for the development of other nursing theories. Although she had great ideas on various topics, Florence Nightingale’s legacy in the field of nursing is mainly from the development of the environmental model of nursing care which later became the Environmental Nursing Theory. While the concepts of Nightingale’s model of nursing care are easy to comprehend, it is important for nurses to critically analyze and evaluate the model to enhance ease of application into nursing care and researches. This paper critiques the meaning, usefulness, testability and provides an overall evaluation of the Environmental Nursing theory from Nightingale’s environmental model of nursing care.


The environmental theory of nursing primarily emphasizes the essence of environment in health. In her notes on nursing, Nightingale describes various concepts which she believed formed the foundation of nursing practices. According to her, a nurse’s main job is to control different environmental factors to ensure they support and enhance the patient’s wellbeing. She believes in that nature cures and can be manipulated to achieve the best possible health outcome. The major concepts of her model were light, ventilation, cleanliness, noise, diet, and bed and beddings. The lack or poor condition of one or more of these concepts is a threat to human health and could delay or inhibit the recovery process.

Light, particularly natural light from the sun contains healing properties that patients should not be deprived of. The ventilation in the nursing setting should enhance clean, warm and fresh air.  Nightingale proposed the opening of windows, the use of good fire and putting the patient in the right position of the room to ensure the air they inhale is clean, warm and fresh (Alligood and Tomey, 2010). Cleanliness is an environmental factor that can hinder, slow down, enhance or even accelerate a patient’s recovery process depending on its level. Patients’ personal cleanliness, the caregivers’ cleanliness and clinical handling practices and the cleanliness of the surroundings play a major part in a human recovery process. A dirty environment and poor handling practices offer a source and a means of spreading infections that worsen the patients’ health conditions. She also laid emphasis on hand washing between patient’s care. Nightingale believed that a noisy environment could harm patients and negatively affects the healing process.  Not only did the theorist emphasize good dietary intake but also the assessment of meal schedules and their influence on patients’ health. A good bed with clean and warm beddings also plays a major role in facilitating human health and wellbeing.

The environmental theory of nursing care is based on various assumptions. The assumptions emphasize the manipulation of a patient’s environment to achieve the desired health outcomes. The theory assumes that natural laws determine people’s health and human beings can achieve perfection if they understand them and manipulate their environments well. Besides being an art and a science, nursing is a calling that calls for dedication and commitment to people’s health and wellbeing. The theory also assumes that human health and wellbeing can only be achieved through environmental alteration and more so of those factors contributing to the dis-ease or hindering recovery. Nursing is a distinct discipline separate from medicine and it requires specific education to equip the practitioners with the knowledge and skills necessary to ensure the success of the caregiving process.

Origin of the theory

The Environmental theory of nursing care originated in the second half of the nineteenth century in England. The theory originated from Florence Nightingale’s Nursing Notes which she detailed what she believed nursing was and what it was not and Notes on hospital all developed in 1859(Nightingale, 1992). In this era, nursing was hardly recognized as a profession and a discipline. Nightingale in her notes, therefore, shed light of what nursing entailed and what it did not. It was also an era when too much emphasis was put on the physiological aspect of human health and little on external factors that could also influence human health. The theorist, therefore, introduced a holistic approach to nursing and described how various environmental factors contribute to human health. In her documents, Nightingale presented her philosophical assumptions, values and beliefs of the key elements in nursing meta-paradigms which are human, environment, nursing and health.

Throughout her life, Nightingale was immensely dedicated to helping humanity and believed God “called” to help humanity. Though faced by her wealthy parents’ opposition, she studied nursing and committed her life to serve others. Her works involved but were not restricted to the British Army. However, experiencing the state of the Crimean War, Nightingale developed nursing concepts which gave birth to the Environmental model of nursing care and later the environmental theory. During the war, Nightingale presented her nursing philosophy and applied it in caring for the wounded British Soldiers.    Being the first person to document on nursing as a distinct discipline from medicine, the theorist did not have other theories to cite from. Her ideas and concepts were therefore abstract or obtained from her own observations in the profession. She applied a deductive approach in developing the Environmental model of nursing care.


Although Nightingale’s environmental theory was pioneering at the time of its development, its principles are timeless. Most of Nightingale’s works were developed to offer nursing guidance to home caregivers who sometimes lacked professional background (Medeiros et al., 2015). As such, she ensured her principles were easy to comprehend and apply. The major concepts of her theory which are light, ventilation, cleanliness, noise, diet, and bed and beddings are relatable and important factors for nurses to consider regardless of the generation. It contributes to the understanding of nursing as a separate discipline from medicine through the study of various canons in the theory. Through an efficient manipulation of the canons, nurses can predict the outcomes of their caregiving process.

Pirani (2016) provides a case study where the Environmental theory could be applied. The scenario involves a sixty years old man diagnosed with exacerbation of Chronic Obstructive Pulmonary disease (COPD). The patient also had dyspnea. The patient lived in the remote areas in Sindh and worked in an agricultural field. The patient is also a smoker and could smoke up to two packs in a day although did not smoke in the hospital. The windows to his room had to be closed since the dust from the surrounding exacerbated his condition. His surrounding was also very untidy. The patient later complained of shortness of breath and was put in the intensive care unit. I, however, believe that the patient’s condition would not have been as bad if his environment was clean and he received fresh air. His smoking history could have unpurified his breathing air worsening his condition. Dust and pollen from his farm would have also played a part in his illness.


The effectiveness and applicability of Nightingale’s environmental theory are testable. A nurse can determine the outcomes of a caregiving process depending on how well he/she has manipulated the various canons in the theory. The major concepts in the theory act as the independent variables whereas the patients’ outcomes are the dependent variables. Various propositions have also emerged from the concepts. Some of the prepositions are; a healthy environment is critical to healing; opening of windows allows entry of light and fresh air; dressing properly depending on the weather enhances warm; noise disturbs patients’ need to rest and can be harmful; nursing involves the house in which the patient is housed and those in contact with him and more so the caregivers; clean environment prevents infections and morbidity; nutritious food, good bed with clean linens and hygiene are essential (Medeiros et al., 2015). The theory has generated various scientific researches since its development. One example is the study of the effects of “intentional comfort touch in the management of tinea pedis in vulnerable populations” (Howett et al., 2010).

Overall Evaluation

Nightingale’s theory is clear and easy to comprehend and apply. The theory revolves around nursing meta-paradigms and concepts and how they interplay to enhance human health. It is also comprehensive and specific to key details. However, it covers a wide area of the environment’s contribution to human health providing nurses with a practical framework to work with. It also provides a nursing foundation that would help me in conducting advanced practice since the concepts are relevant regardless of the kind of nursing practice being undertaken. The theory also contains various strengths and weaknesses. The major weakness of the theory is its assumption that diseases are always directly caused by the environment (Nightingale, 1859). While the environment plays a major role in diseases, other factors such as genetics also play a role. Most of her writings were also based on her observations in the Crimean War hence limiting her scope.

Although the theory has a few weaknesses, its strengths outweigh them. Most of its strength comes from the fact that Nightingale developed her theory from empirical observations in her work, especially during the Crimean War when there was a high necessity for caregivers. This means that the theory is evidence-based and applicable in nursing practices.  The concepts and principles in the theory are timeless and applicable in any part of the world (Bunkers, 2008). Her nursing meta-paradigms also form the basis for other nursing models and theories (Tourville and Ingalls, 2003).


Although not faultless, Nightingale’s Environmental model of nursing care revolutionized the nursing profession. It identified nursing as a separate discipline from medicine and emphasized professionalism to ensure competence. Nightingale described light, ventilation, cleanliness, noise, diet, and bed and beddings as the major concepts in her theory and explained how they affect each other to facilitate human health. She emphasized on nurses’ role in manipulating and controlling their nursing surroundings to provide an environment that supports and enhances their patients’ health. The model was later reviewed and used to develop Environmental nursing Theory. Although she did not formally develop a nursing theory, Nightingale is widely considered as the first nursing theorist and the founder of modern nursing for her indispensable contribution in the field.  

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