Florence Nightingale Environmental Theory


The origin of the theory

Florence Nightingale (born 1820) is known as the founder of modern nursing and based her ideas of nursing on germ theory and her experiences during the Crimean War and various hospitals. In 1853, she became superintendent at the Institute for the Care of Sick Gentlewomen. Florence treated wounded soldiers during the Crimean War. She was focused on improving the nutrition and conditions of the nurse. Apart from injuries, soldiers were dying of from typhoid, cholera, and dysentery. She made changes in the ward and this significantly reduced deaths from 42% to 2% (Petiprin, 2020). Nightingale believed that soldiers died because of poor nutrition, inadequate supplies, and overworking. She improved sanitation in hospitals. She established a nursing school, St. Thomas’ Hospital in London in 1860. Her work laid the foundation for modern nursing.  In 1859 she wrote notes on nursing for her school and schools. She worked “toward the establishment and development of nursing as a profession, paving the way for nursing in its current form” (Petiprin, 2020). Nightingale used inductive reasoning through observation and experiences to obtain laws of health, disease and nursing.

Meaning and scope

Before the conception of the nursing metaparadigms, she named them (human, environment, health, and nursing) through her writings about the impact of cleanliness on patient care. “Pure air, pure water, efficient drainage, cleanliness, and light” were five points essential to an environment conducive to healing (Nightingale 1860/1957/1969, p. 24). In addition to these, she noted several factors such as noise, personal cleanliness, and social contact as also essential. To Nightingale (1893/1954), nursing was a way to put patients “in the best possible conditions for nature to restore or to preserve health…” (p. 357). She was also noted for her work in proving the value of nursing through analysis of statistics and collecting evidence. This work contributed to reform in public health and foundations in nursing education

Logical adequacy

Nightingale was deeply involved in promoting nursing education both at community level and global level. Her legacy continues and many scientists and scholars use her work to enlighten nursing science.  The work continues to be used as effective guidelines for nursing.


Usefulness and simplicity

Her work remains useful and relevant today, especially in creating frameworks related to the concept of environment in relation to population health. Her ideals on human dignity and headstrong attitude in patient advocacy despite pushback from local and federal authorities and physicians continue to inform and inspire nurses today. This theory in practice is that it helps patients in sustaining their crucial capacity and meeting their needs through facilitating their health. It is practical and helpful to nursing so it offers the appreciation of career knowledge and its connection with nurses’ endeavors. Provision and balancing environmental factors contribute to the prediction of health outcomes. The clean environment directly correlates with the objective of the theory, meeting the needs of the patient to improve and restore health. Nightingale’s model of nursing offers guidance on role of environment in developing health interventions. The emphasis on the patient’s environment is especially crucial when providing nursing intervention to the vulnerable population (McEwen & Wills, 2019)


The Environmental Theory is comprehensive and also specific so that all the concepts are presented and elucidated in depth.  This theory is comprehensive because is addressed health, environment, diseases, and influence of the patients (McDonald, 2014). Environmental theory is specific because concepts are presented and elucidated in depth.


This theory is easily testable and has generated extensive research. It has resulted in countless clinical studies aimed at facilitating the recovery of patients. An example of a qualitive study carried out with the help of this theory in nursing research by Davoodvand, Abbaszadeh, & Ahmadi (2016), the need for patient advocacy. Effective patient advocacy results to improved healthcare. Patients should be protected from ethical and illegal acts. In addition, “nurses should support patients and their families in social environments such as economic, educational and research, healthcare delivery, and legislative environments” (Davoodland et al., 2016).  This study reviewed how internal and external risk affects the patient’s healthcare environment and how nurses help to reduce the risk of the patient. Patient cannot be able to defend themselves when they are ill so they need someone(nurse) to protect them from danger while they are hill. The study concluded that patient advocacy is a social issue and can be evaluated by the patient or individual.

Davoodvand, S., Abbaszadeh, A., & Ahmadi, F. (2016). Patient advocacy from the clinical nurses’ viewpoint: a qualitative study. Journal of medical ethics and history of medicine, 9, 5.

McEwen, M., & Wills, E. M. (2019). Theoretical Basis for Nursing. Philadelphia, PA: Wolters Kluwer.

Nightingale, F. (1893/1954). Sick-nursing and health-nursing. In A. Burdett-Clouts (Ed.), Women’s mission: A series of congress papers of the philanthropic work of women by eminent writers. New York, NY: Charles Scribner’s Sons. Reprinted in L. R. Seymer (Ed.). (1954). Selected writings of Florence

Nightingale, F. (1860/1957/1969). Notes on nursing: What it is and what it is not. New York, NY: Dover Publications.

Petiprin, A. P. (2020). Nightingale’s environment Theory. Nursing Theory. https://nursing-theory.org/theories-and-models/nightingale-environment-theory.php


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