A Baccalaureate Community Health Nursing Course Grounded in Nightingale’s Environmental Action Theory of Nursing Practice

Community Health Nursing (CHN) has evolved from the era of Nightingale to the time of the Affordable Care Act. It has come from Wald’s public health nursing in the 1800s to in-patient hospital care in the 1900s and now back to community-based care. Today, there is a greater demand for health care provided in the community. As CHN practice and education continue to evolve, it is important that theory guides them. The lack of research in Community Health Nursing education is significant, as research is necessary to promote evidence-based nursing education and practice. Nightingale’s environmental theory is an excellent theory to frame nursing education in CHN. With its emphasis on the effect of the five points of light, water, air, cleanliness, and drainage on patients’ health, her theory could guide research and nursing education. These points are the major focus of “Notes on Nursing” (1860). Even though these points were written in the mid-19th century, their ideas are still relevant. Ever enduring, Nightingale’s Environmental Adaptation Theory of Nursing Practice (NEATNP) is applicable to today’s CHN practice. Since Nightingale’s era, nurse educators have recognized the importance of teaching students about the environmental influences on health and illness, but her theory has not been identified as providing the framework for a CHN course. Nightingale’s theory, with its emphasis on environmental effects on health, could guide CHN, and teaching her theory’s points in CHN courses could better prepare future nurses to provide care. The purpose of this study was to learn nursing students’ perceptions of using the Nightingale Environmental Adaptation Theory of Nursing Practice (NEATNP) in their community health nursing education experience, and how this helped them to understand the importance of theory in practice. The objective of this study was to develop, implement, and evaluate a baccalaureate level CHN course grounded in the Nightingale Environmental Adaptation of Nursing Practice. This was a first time pilot study exploring the results of students’ perceptions regarding the development of a CHN course grounded in the NEATNP. The researcher has developed and implemented the CHN course, including didactic and clinical instruction. The course was followed by an evaluation, a descriptive qualitative study design using focus groups for data collection. The Classic Analysis Strategy method, used for data analysis, revealed that the baccalaureate students had positive perceptions of this CHN course. They concurred that Nightingale is an appropriate theorist to guide a Community Health Nursing course, sharing that it was a good reminder of her theory and was a more holistic approach. A suggestion for the course in the future was to start teaching the NEATNP in the Nursing Fundamentals course and carry it throughout the curriculum. Their positive perceptions and the enthusiasm demonstrated in the focus groups confirmed the researcher’s belief that there is a need for theory, specifically the NEATNP, in baccalaureate nursing education. All of these results support the researcher’s assumptions that pertain to the connection between theory and CHN, the importance of CHN education, and NEATNP:

1. Community health nursing is an emerging and valid specialty, requiring a unique and specialized skill set.
2. Theory based education produces competence and confidence in students.
3. Nursing is both an art and science, dependent on compassion and common logic, and the utilizations of research (Selanders, 2005).
   1. Community health nursing education is optimized when based on research and grounded in a theoretical framework.
   2. Nightingale’s theory with its emphasis on the environment is well connected to CHN, where the goal of the nurse is to create an environment where a person can heal.
   3. Understanding its historical antecedents, which include Nightingale and her theory, enhances current nursing education.
   4. Nightingale’s essential concepts are salient, and CHN education programs would benefit from applying Nightingale’s theory to their clinical praxis.

The findings of this study contribute to the body of research regarding utilizing theory in a baccalaureate-nursing course, and provides a starting point for future research. Repeating this study in other schools of nursing is warranted to provide more generalizability. These studies should be conducted at a variety of baccalaureate level schools of nursing, which would also increase generalizability. For example, it could be repeated at a school of nursing located in a city, or one located in other part of the country. A future study relating to the use of the NEATNP in a Fundamentals of Nursing course would provide greater insight into the use of theory in nursing education. This could take place at the same school of nursing as this study to provide data to compare with these results. It also should be conducted at other schools in cities or other parts of the country to increase generalizability.