Rethinking Public Hospital Design in Low-Middle-Income Countries Through the Lens of Florence Nightingale's Environmental Theory: A Commentary Research.

Purpose of StudyTo examine the recurring environmental design problems in low-resource public hospitals including insufficient ventilation and daylight, overcrowding, a raised washroom, and their cumulative burden on nursing care through Florence Nightingale's environmental theory, and to connect these patterns to the established literature on infection risk, fall prevention, and the therapeutic environment as a core value of holistic nursing.Design of StudyClinical commentary based on composite field observation, guided by Nightingale's environmental theory and the five core values of the American Holistic Nurses Association.MethodObservations were gathered over approximately 2 years of clinical teaching and supervisory ward visits across several secondary-level public hospitals in low-resource settings. No formal audit tool was used; observations were synthesized into composite, illustrative patterns and read against current evidence-based design and holistic nursing literature.FindingsFour recurring patterns were identified: insufficient ventilation and natural light; overcrowding and inadequate bed spacing; a washroom accessible only by climbing several unmarked steps above the ward floor; and a cumulative burden on nursing workflow and patient experience. Each maps directly onto Nightingale's environmental canons and connects to established evidence on infection risk, recovery, and falls.ConclusionsThe physical environment is a dimension of whole-person care, not a backdrop to it. Nightingale's environmental theory, interpreted through contemporary holistic nursing scholarship, generates specific, low-cost obligations for environmental assessment, nurse advocacy, and leadership in settings where resources are limited.