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Advances in Nursing Science

Vol. 29, No. 1, pp. 43–54

c 2006 Lippincott Williams & Wilkins, Inc.

Environment, Ecosystems, and

Ecological Behavior
A Dialogue Toward Developing
Nursing Ecological Theory
Gary Laustsen, PhD, APRN,BC

Current epistemological foundations of nursing theory incorporate minimal ecology theory.

The purpose of this article is to present a nursing ecological theory with a goal to broaden
current nursing perspectives by incorporating expanded concepts of global ecosystems, com-
munities, and interrelationships derived from ecological sciences. A theory derivation process
is utilized, and a nursing ecological model is proposed. Nurses face a challenge to translate
global environment concern and ecological beliefs into professional activities. Elucidating a
nursing ecological theory may guide our profession toward new directions in holistic care and
will be good for the care of our patients, profession, and the Earth. Key words: environment,
global ecology, nursing theory, theory derivation

All of us must aspire to develop global ecologic
skills if we are to endure.1(p291)
E COLOGY may be defined as the
study of the relationships of organ-
isms to their environment and to one
another.2 Humans, as with all living things,
are ecological entities that interrelate
with other organisms and with the en-
vironment. Human interactions with the
environment encompass both personal and
professional activities. Thus, it is proposed
that nurses exhibit ecological interactions
while performing their professional nursing
activities. Current epistemological founda-
tions of nursing theory incorporate minimal
ecology theory. Does the current nursing
domain of environment delimit nursing the-
ory? Is nursing cognizant of the relationships
between practice behaviors, ecosystem dam-
age, and public health? Do ecological laws
From the Loretto Heights Department of Nursing,
RHSHP, Regis University, Denver, Colo.
Corresponding author: Gary Laustsen, PhD, APRN,BC,
Loretto Heights Department of Nursing, RHSHP, Regis
University, Mail Code G-8, 3333 Regis Blvd, Denver,
CO 80221 (e-mail: glaustse@regis.edu).
apply to healthcare systems? The purpose of
this article is to address such questions and
present a dialogue and process toward the
development of a nursing ecological theory.
This article will begin with a brief histori-
cal review and identification of relevant con-
cepts. Theory derivation3 will be outlined and
utilized as the knowledge development pro-
cess. Application of this process will develop
a nursing ecological model, preliminary con-
cepts of a nursing ecological theory, and a
few examples explicating ecological laws and
nursing. Finally, the dialogue will offer some
concluding remarks.
BRIEF REVIEW AND CONCEPT
IDENTIFICATION
One of the great lessons of ecology is the interrelat-
edness of nature, and . . . for thinking of the ecosys-
tem as the foundational unit.2(p11)
The writings of many theorists from
Nightingale’s Notes on Nursing4 to Fawcett’s
metaparadigm5 identify the concept of
environment as a prominent domain within
the nursing discipline’s theoretical founda-
tions. However, the domain as conceived
43
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44 ADVANCES IN NURSING SCIENCE/JANUARY–MARCH 2006
by nursing theorists has historically focused
on a narrow perception of the environment.
Chopoorian,6 a proponent of the reconcep-
tualization of environmental concepts in
nursing, stated that nursing’s “rigid, static
concept [of the environment] does not
inform the nursing paradigm in a substan-
tive manner.”6(p41) Other nurse authors, for
example, Kleffel7 and Stevens,8 have also
suggested that nurses need to rethink and
reconceptualize our environmental domain.
Meleis has suggested that “several types of
theories related to environment need to be
developed.”9(p115)
The term environment originates within
the biological and ecological sciences and
refers to the surroundings or conditions
of an organism. Habitat is often used as a
concept equivalent to environment. In Smith,
environment is “the place where an organism
lives and its surroundings, both living and
nonliving.”10(p13) Thus, the biological concept
of environment generally refers to physical
entities.
Tomey and Alligood,11 in their exploration
of the work of nurse theorists, found that
the concept of environment has been ac-
corded a plethora of meanings. For example,
Nightingale’s “house” obliquely referred to
the environment as ventilation, warmth,
light, diet, cleanliness, and noise.4(p6) Watson
cited the “mental, physical, sociocultural,
and spiritual environment.”12(p81) Rogers
proposed the environmental field as an “irre-
ducible, pandimensional energy field.”13(p31)
Roy’s environment is “all the conditions, cir-
cumstances, and influences surrounding and
affecting persons or groups.”14(p22) Neuman
defined environment as “all the internal and
external factors that surround or interact with
man/client,”15(p2) and Parse cited the human-
universe diad that “interchange energy to
create what is in the world.”16(p27) Chopoorian
defined environment as “social, economic,
and political structures; . . . as human, social
relations;. . .as everyday life.”6(p47) A critical
review of these definitions identifies a consis-
tent view of the environment as an entity or
object and rarely alludes to the significance
of biotic and abiotic interrelationships,
or systems within the environment. Thus,
the current concept of environment within
nursing is vague, burdened with compet-
ing and transient definitions, and lacks
a consistent epistemology by nursing
professionals.
To address this issue of conceptual chaos, I
propose the term ecosystem as an alternative
to the concept of environment for the nurs-
ing discipline. Originally suggested in 1935 by
the biologist Tansley, ecosystem is described
as “the whole system, including not only the
organism-complex, but also the whole com-
plex of physical factors.”2(p334) Within ecolog-
ical science, the term ecosystem addresses the
dynamic, interacting, and relational nature of
organisms and their environment.
The essential activities of nursing also ad-
dress the dynamic relationships of clients in-
teracting within environments. In this article,
environment is defined as the conditions, cir-
cumstances, factors, or variables affecting the
individual, family, or community. Such con-
ditions may include physical factors, such as
the climatic effects on a community’s citizens.
Other nonphysical influences, such as eco-
nomic and political forces, are also considered
influential environmental aspects.
Some nurse theorists have included the
concept of interaction or relationship with
the environment. However, these concepts in
nursing theories typically present a linear, an-
thropocentric model in which the environ-
ment affects the client. The relationship and
interaction of humans with the environment
are generally not addressed in nursing theo-
ries. As Brewer states, “In the ecosystem, com-
munity and habitat are bound together by ac-
tion and reaction, the reciprocal effects of
physical environment on organism and organ-
ism on physical environment.”2(p334) Ecosys-
tem is a broader concept that embraces the
circularity of influence and causation, creat-
ing a web of interrelationships among and
between the environment and all of the in-
habiting organisms. However, because eco-
logical literacy is absent from the theoreti-
cal foundations of nursing, ecosystem is a
LWWJ194-04 January 28, 2006 4:42 Char Count= 0
Environment, Ecosystems, and Ecological Behavior
generally unknown concept in the discipline’s
epistemology.
The definition of ecosystem may be ex-
tended to the dynamic interactions and
interrelationships of humans and the health-
care system. Such a human health ecosys-
tem would be characterized by actions,
reactions, and coactions between the health-
care providers (eg, nurses and doctors), the
healthcare client, affiliates (eg, the client’s
family), and the healthcare environment. A
model for the proposed human health ecosys-
tem will be presented later.
The purpose of this article, as previously
stated, is to present a dialogue toward de-
veloping nursing ecological theory. That is,
I will suggest a framework that incorporates
the ecological relationships of healthcare par-
ticipants and recipients into the healthcare
ecosystem. A theory derivation process as
proposed by Walker and Avant3 will be em-
ployed as the method for developing and
informing a nursing ecological paradigm. I
propose that developing a nursing ecologi-
cal theory will promote a reconceptualiza-
tion of the environmental domain and sup-
port the inclusion of the expanded concept of
ecosystem.
Nursing theorists have historically and
consistently included the concept of environ-
ment within the domain of nursing’s profes-
sional discipline. Nurses have not only fo-
cused traditionally on discrete environmental
levels such as a hospital room or the commu-
nity, but they also participate in an intercon-
nected and dynamic relationship with both lo-
cal and global ecosystems. Thus, we need to
expand nursing’s worldview and our under-
standing of ecological relationships related to
the activities of the profession. Professional
activities and behaviors of nurses are inter-
twined with the Earth’s ecological systems.
The activities of nurses produce effects on the
local and global ecosystems, just as the envi-
ronmental components of ecosystems inter-
act with human populations.
The activities or behaviors of organisms
are an important aspect of ecological study.
General ecological behavior (of humans) can
45
be viewed as the “actions [that] contribute
towards environmental preservation and/or
conservation.”17(p153) Proenvironmental atti-
tude, concern, or consciousness, and eco-
friendly or “green” behaviors are concepts
congruent with general ecological behavior.
Many nurses exhibit general ecological behav-
ior in their concern for the environment and
seek ways to minimize their personal impact
on the Earth’s ecosystems. Some nurses, con-
cerned about the effects their professional
behaviors produce on ecosystems, have de-
veloped actions to ameliorate environmental
degradation. To address these activities, I pro-
pose to identify this phenomenon as nurs-
ing ecological behavior. Nursing ecological
behavior may be defined as the behaviors
nurses enact while performing their profes-
sional duties that contribute toward environ-
mental preservation or conservation or both.
As previously noted, nursing theories
demonstrate a consistent recognition of
the domain of environment within most
theoretical models. However, the concept of
ecosystem, implying functional relationships
of organisms within environments, was
not specifically identified in the nursing
theories reviewed. In addition, while the
phenomenon of nursing ecological behavior
is believed to exist, I find a conspicuous lack
of theoretical underpinnings to understand
or relate this concept to nursing theoretical
models. Therefore, with the development of
a nursing ecological theory, I will seek to illu-
minate nursing ecological behavior in relation
to the healthcare ecosystem. Using the theory
development process, I will explore current
ecologic theory and suggest a method for ap-
plying ecological concepts and models to de-
velop an analogous nursing ecological theory.
KNOWLEDGE DEVELOPMENT PROCESS
Theory derivation is the knowledge de-
velopment process used in this article to
promote an evolution toward a nursing eco-
logical theory. Theory derivation is the “pro-
cess of using analogy to obtain explanations
or predictions about a phenomenon in one
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46 ADVANCES IN NURSING SCIENCE/JANUARY–MARCH 2006
field from the explanations or predictions in
another field.”3(p171) Theory derivation is an
exercise in analogy that attempts to borrow
theoretical concepts from one field of study
to develop a theoretical grounding in a sec-
ond field of study. An ability to “see anal-
ogous dimensions of phenomenon in two
distinct fields” 3(p171) is prerequisite for the
theoretician.
The application of theory derivation to the
development of ecological theory within the
nursing discipline incorporates certain basic
steps. As proposed by Walker and Avant,3
the first step is to examine the literature
within the theory-deficient field related to the
phenomenon of interest. Thus, the nursing
literature would be thoroughly examined for
writings related to ecological theory. If a the-
oretical foundation for the topic of interest
is unrealized, the next step is to read widely
in fields expected to offer a suitable the-
oretical background. When developing the
phenomenon of nursing ecological theory,
readings within the literature of biology and
ecology would offer the theoretician proba-
ble sources for the explication of general eco-
logical theory.
Once the theoretical base is discovered
and explored, a “parent theory” is identified
from which a theoretical offspring within
the new discipline is conceived. A parent
theory should be chosen to promote new
and insightful explanations about the phe-
nomenon of interest in the theorist’s field.3 It
is not feasible or necessary to use the entire
theoretical structure and concepts from one
field to the other. The theorist’s next step is
to identify the content or structure from the
parent theory that supports the analogous
development of theory within his or her
own field. As Walker and Avant stated, “the
theorist is free to choose what best fits the
needs of the situation.”3(p174)
The final step represents the most chal-
lenging part of the theory derivation process:
concept redevelopment. Concepts and state-
ments from the parent theory are modified
from their original field to provide meaning-
ful concepts for the theorist’s field. The task
of concept redefinition offers an opportunity
for creative thinking in the development of
the new theory. Although the steps outlined
above have been presented in a sequential
order, theory derivation may not necessarily
proceed in such a linear fashion. The process
may more likely be iterative, with steps being
repeated nonsequentially and in an itinerant
order.
PROCESS APPLICATION
“Theory derivation is particularly useful
where no data are available or where new
insights are needed to inspire research and
testing.”3(p172) Intuitively, I believe that the
phenomenon of ecological behavior exists
among nurses. However, this concept is
poorly understood, and minimal nursing re-
search has been applied to elucidate the
meaning of nursing ecological behavior. Of
relevant concern to understanding ecological
behavior is the lack of an ecological theoreti-
cal perspective in the nursing discipline. The
following theory derivation steps offer a sug-
gested development toward a nursing ecolog-
ical theory.
Literature review
The initial step in the theory derivation
process is for the theorist to become famil-
iar with the state of the science within his or
her own field of interest. This step may be ac-
complished through a literature review, nurs-
ing practice review, and professional resource
review. A literature review is relatively easy
to conduct, using key word searches within
the healthcare databases such as the Cumu-
lative Index of Nursing and Allied Health Lit-
erature (CINAHL) or MEDLINE. Key words
such as ecology, environment, ecosystems,
theory, and nursing may be used to identify
nursing literature references relevant to the
phenomenon of nursing ecological theory.
A literature search using key words (singly
and in combinations), such as ecology, en-
vironment, knowledge, concern, awareness,
theory, nurses, and nursing, was conducted
in the CINAHL, the Education Resources
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Environment, Ecosystems, and Ecological Behavior
Information Center, Health and Psychosocial
Instruments, and MEDLINE databases. In re-
viewing the healthcare literature on ecolog-
ical theory and behavior, no research stud-
ies or discussions critically examining these
topics in nursing were found. However, disci-
plines such as environmental science and ed-
ucation, environmental biology, conservation
biology, and ecology were found to have many
studies addressing this topic.
The literature search produced no cita-
tions specific to nursing ecological theory
or behavior. As Shaner remarked, “Unfortu-
nately, environmental education is not a stan-
dard part of the curriculum for physicians,
nurses and other health professionals.”18(p3)
However, many authors19–36 have suggested
professional activities that imply develop-
ing ecological behaviors of nurses. Broad
categories, identified by these authors, that
reflect these activities include waste reduc-
tion, energy conservation, “green” product
use, and recycling. Yet, these suggested nurs-
ing ecological behaviors are promoted with-
out a guiding framework or theoretical foun-
dation. Some nurse scholars have, however,
suggested paradigms and concepts congruent
with developing an ecological theory base for
nursing.
Kleffel suggested an ecofeminist per-
spective for nursing: “looking for an en-
vironmental viewpoint within a feminist
framework.”7(p13) Her salient points were that
ecofeminism is antinaturist, antisexist, and
antiracist, has contextual ethics, is pluralistic
and inclusive, is not objective or unbiased,
and reconceives what it means to be human.7
Ecofeminism also sees the connections
between the domination of women and the
domination of nature.37
The ecocentric perspective, a paradigm
subsequently proposed by Kleffel,38 pro-
gressed beyond her previous ecofeminism
framework. To foster a new model in nurs-
ing that promotes an understanding of ecosys-
tems, she suggested a transition to the ecocen-
tric perspective based on Miller’s39 work. The
underlying assumptions about ecocentric the-
ory can be summarized as follows.
47
• The nature of human beings: Humans
remain one among many other species
and are interdependently involved in the
global ecosystem.
• Social causation: Human affairs are in-
fluenced not only by social and cultural
factors but also by intricate linkages of
cause, effect, and feedback in the web of
nature . . . human actions can have unin-
tended consequences.
• Human society: Humans live in and
are dependent on a finite biophysical
environment.
• Constraints on human behavior: Eco-
logical laws will always provide the
primary context for human and other
animal life.
• End goals: Unity, stability, diver-
sity, self-sustaining systems, demo-
cratic social systems, self-sustaining
resource systems, sustainable
development.39(paraphrased from Table 1.3)
Kleffel suggested that nursing scholars are
shifting to the ecocentric perspective be-
cause of a developing global community. This
paradigm is “grounded in the cosmos, and
the environment is considered whole, liv-
ing, and interconnected.”38(p1) The ecocentric
perspective draws its theoretical roots from
diverse traditions such as eastern philoso-
phies, contemporary western thought, Deep
Ecology theory, and traditional Native Amer-
ican ideas. Sarter40 suggested that nursing
theorists such as Rogers, Neuman, Watson,
and Parse are considered contemporary pro-
ponents of ecocentric nursing theory be-
cause of shared, common holistic themes.
According to Sarter, these themes include
“process, evolution of consciousness, self-
transcendence, open systems, harmony, rel-
ativity of space and time, pattern, and
holism.”38(p4)
Adopting the ecocentric viewpoint has “ex-
hilarating potential for transforming nursing
scholarship and practice beyond its tradi-
tional boundaries.”38(p5) Kleffel’s ecocentric
paradigm provides a relevant perspective, but
lacks the developed concepts and relational
statements to consider it a nursing ecological
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48 ADVANCES IN NURSING SCIENCE/JANUARY–MARCH 2006
theory. In addition, her ecocentric paradigm
relies on the use of nonacademic and less em-
pirically based writings and does not incorpo-
rate theoretical elements from the ecological
sciences.
Holistic nursing is another theoretical per-
spective relevant to nursing ecological the-
ory and was originally derived from Levine’s41
4 conservation principles. In his work, en-
vironment is “where we are constantly and
actively involved” and “the person and his
relationship to the environment is what
counts.”11(p197) Holistic nursing practice and
natural systems theory have promoted the
“interconnectedness of natural structures in
the universe.”42(p7) The Holistic nursing per-
spective recognizes that the well-being of the
planet’s ecosystem is a determinant of the
well-being of humans.
The concepts and proponents of holis-
tic nursing have blossomed into a well-
developed framework for the practice of nurs-
ing. Books and journals have expanded the
concepts of holistic nursing into a recognized
subculture of the nursing profession. Holis-
tic nursing, as a theoretical paradigm, offers
a substantial contribution to the foundations
and exploration of nursing ecological behav-
ior. However, similar to Kleffel’s ecocentric
paradigm, holistic nursing is a developing the-
ory with minimal influences from the ecolog-
ical sciences.
Originally, I suggested that the literature re-
view should also include a nursing practice re-
view and discussions with professional nurses
involved in nursing ecological behavior. How-
ever, the identification and professional ex-
pression of this concept is currently undevel-
oped. Therefore, the attempt to review this
phenomenon in nursing practice or through
discussion with other nursing professional re-
sources is not a tenable option at this time.
Exploration of relevant fields
After exploring the current state of the sci-
ence in nursing, the next step was to look
for suitable concepts or theories from other
disciplines. As the phenomenon of concern
is ecological theory and behavior, I explored
this topic within the biological sciences: the
parent discipline for ecology. To investigate
this topic within the ecological literature, it
was more germane to select scientific materi-
als of a general nature rather than of a specific
nature. Textbooks in general ecology or envi-
ronmental science were scanned as appropri-
ate media to begin the search for generic eco-
logical theory. Although a systematic search
may yield the desired material, utilizing imag-
ination, creativity, or intuition may lead to
serendipitous discoveries.3
To accomplish this step, I reviewed and
read library resources within the generic
content area of general biology and ecol-
ogy. Web-based courses in ecology were
also searched for theoretical concepts and
models that could offer analogies for the
development of nursing ecological theory.
A final activity was to solicit input from a
university colleague who has educational and
professional experience within the fields of
ecology and medicine.
The result of this search was the decision to
use concepts from 2 specific resources in the
derivation of a nursing ecological theory: The
Science of Ecology2 and The Closing Circle:
Nature, Man, and Technology.43
Parent theory selection
In the search outlined above, a parent the-
ory was successfully identified for use in
the derivation of a nursing ecological theory.
Choosing a parent theory is not necessarily
based on convenience or because it is the
most widely used in the parent field. A parent
theory should “offer a new and insightful way
of explaining or predicting a phenomenon
in the theorist’s field of interest.”3(p173) It
is not necessary to adopt the entire par-
ent theory, and only relevant concepts or
models may be brought over to the new
field. Brewer’s The Science of Ecology2 and
Commoner’s The Closing Circle: Nature,
Man, and Technology43 provide relevant the-
oretical models and concepts amenable to the
needs of deriving a nursing ecological theory.
The selection of these resources leads to the
next phase of theory development.
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Environment, Ecosystems, and Ecological Behavior 49

Relevant parent theory content

The fourth step in theory derivation
as suggested by Walker and Avant3 is the
identification of content, concepts, or struc-
ture that will be borrowed from the parent
theory. As previously mentioned, the par-
ent theory does not have to be used in its
entirety, and the theorist has the freedom
to choose the portions of the parent theory
suitable for transference to the new theory
development process. Conceptual models,
theoretical structure, and/or theoretical state-
ments may individually or in combination
provide the needed substance for new theory
derivation.
Barry Commoner in the classic treatise The
Closing Circle: Nature, Man, and Technol-
ogy proposed a distillation of classic ecolog-
ical theory into “four laws of ecology.” He de-
scribed ecology as “the science of planetary
housekeeping”43(p32) and his informal laws of
ecology were organized from generalizations
of the scientific knowledge and principles. Figure 1. Proposed nursing ecological model.
His 4 laws are as follows:
New theory development: A nursing
The First Law of Ecology: Everything is connected ecological model
to everything else. . .
“The hardest part of theory derivation, but
The Second Law of Ecology: Everything must go also the most fun”3(p174) is the task of creating
somewhere. . . a new theory within the theorist’s field of in-
terest using the concepts, models, and struc-
The Third Law of Ecology: Nature knows best. . . ture borrowed from the parent theory. The
goal of this step is to modify and adapt ma-
The Fourth Law of Ecology: There is no such thing terial from the parent theory into a meaning-
as a free lunch.43(pp33–45) ful, organized, and relevant metamorphosed
These 4 “laws” are the basic statements theory. I concede that the following is only a
chosen to derive and inform foundational preliminary attempt at constructing a nursing
concepts for a nursing ecological theory. Al- ecological theory.
though couched in the vernacular of lay lan-
guage, the 4 laws are supported by princi- Nursing ecological model
ples espoused in the scientific writings of A proposed Nursing Ecological Model is
ecology. For example, his fourth law is sup- presented in Figure 1. The model identifies 3
ported by the principle that “both the envi- major components (large circles) of a commu-
ronment and the amount of energy fixation nity that interact with the healthcare environ-
in any given ecosystem are limited.”10(p7) His ment, as well as having coactions among each
4 laws of ecology were chosen to guide the component. The unifying structure for these
developing nursing ecological theory because components is the human health ecosystem.
they convey the relevant principles of ecol- In this model, the healthcare client, the
ogy in a succinct and inclusive format. healthcare providers, and affiliates (eg, family
LWWJ194-04 January 28, 2006 4:42 Char Count= 0
50 ADVANCES IN NURSING SCIENCE/JANUARY–MARCH 2006
members) have coactions between each
other. These 3 components and their rela-
tional coactions comprise the community. Ad-
ditional components, such as workplaces or
physical geography, could also be included
within the community, but are excluded at
this time to maintain a more parsimonious
model. The community’s individual compo-
nents are acting on and reacting to the health-
care environment. The healthcare environ-
ment is the physical entity that coordinates
and provides health-related services in its in-
teractions with the community. This may be
a local hospital, a long-term care facility, or a
state health department.
The community components and health-
care environment together make up the
human health ecosystem. The lines enclos-
ing the community and the human health
ecosystem are interrupted indicating that
these are not rigid boundaries, but allow
for interchange and integration with other
communities or other ecosystems. It is also
possible for multiple communities to interact
with one healthcare environment, as might
occur if a single large hospital was assessable
to a variety of local and regionally discrete
communities.
The 3 components of the community iden-
tified in Figure 1 represent a few of the
relevant “inhabitants” in the human health
ecosystem. Additional components can also
have significant interactions with the health-
care environment but have not been currently
included in this preliminary, simplistic model.
Some of these important components might
include political stakeholders, legal and gov-
ernmental agencies, economic influences (eg,
insurance and reimbursement agents), cul-
tural and social forces, and suppliers of health-
care equipment and peripheral services. Just
as in biological ecosystems, the difficulty of
identifying and evaluating all relevant compo-
nents is a complex and ongoing task.
The following scenario illustrates an ex-
ample using the nursing ecological model.
A nurse (healthcare provider) suggests a
new antiseptic soap (action) to the hospital
(healthcare environment). The hospital de-
cides to “trial”the new hand-washing soap (re-
action). The use of the new antiseptic soap
significantly reduces the occurrence (coac-
tion with healthcare providers) of nosocomial
infections acquired by patients (healthcare
client) within the hospital. Hospital rates of
morbidity and mortality due to iatrogenic in-
fections are reduced (reaction with patients).
Patients are discharged from the hospital with
lower costs and improved health. The in-
tegrity (coaction) of patients and their family
(affiliate) is maintained, and further use (ac-
tion) of the hospital by the family is assured
because of the provision of a safe healing envi-
ronment. The example has been simplified for
demonstration purposes, and other aspects,
such as costs of the new soap and the effect of
soap on the local environment, would have to
be considered. Applications of this model to
other arenas of nursing such as public health
nursing, or advanced practice nursing are pos-
sible, but are beyond the current scope of this
article.
Ecological laws and nursing
Commoner’s43 4 laws of ecology may be
analogously used to develop a nursing eco-
logical theory and support the nursing eco-
logical model. The first law, “Everything is
connected to everything else,” reflects the
elaborate network of interconnections and
the progression of cyclical events that exist in
ecosystems.44 This principle may be applied
to the human health ecosystem. For example,
environmental air pollution created by burn-
ing hospital wastes in an incinerator releases
dioxin.45 Dioxin, a known carcinogen, may
lead to the development of cancers within the
local population.46 The population afflicted
with dioxin-related cancer then seeks care
within the same polluting hospital.
An important concept within the princi-
ple of interconnectedness is the circularity of
ecosystems.44 Typically, causation is viewed
as being linear, in that the burning of hospi-
tal waste results in cancer-causing pollution.
However, in ecological theory, causation is
circular, in that there is no beginning or end in
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Environment, Ecosystems, and Ecological Behavior
the chain of causation. Using our hypothetical
example from above, treating an increasing
number of local patients with cancer requires
the hiring of more nursing staff and the build-
ing of more patient rooms. Funds that could
have been invested in new technologies for
safer, nonpolluting disposal of hospital wastes
are now diverted toward hospital and staff ex-
pansion. The current method of waste incin-
eration and the release of carcinogenic dioxin
are thus continued.
The recognition of the concept of inter-
connectedness is important. However, to be
of value within the human health ecosystem,
identification and elucidation of the meanings
of these connections present significant chal-
lenges to researchers within the relevant sci-
ences. The emerging concept of nursing ecol-
ogy is beyond the traditional scope of nurs-
ing practice and requires intradisciplinary and
interdisciplinary communication. Thus, there
is a need for developing nurse scientists with
training in environmental sciences, especially
in areas that influence nursing practice.47,48
The second law of ecology,43 “Everything
must go somewhere,”is partially derived from
a basic tenet in physics that matter is not only
transformable but also indestructible. As ap-
plied to the science of ecology, this concept
emphasizes that in nature there is no such
thing as waste. For example, the expired car-
bon dioxide and excreted wastes of animals
are used by plants for growth, which subse-
quently expel oxygen for consumption by the
animals. A problem made apparent by this
principle is that substances created by hu-
mans but previously unknown in nature, such
as plastics, do not have the requisite organ-
isms to transform the materials into a useful
biological product. Thus, humans create sub-
stances that do not fit into the natural cycle of
producers and consumers.
Nursing ecological theory can incorporate
this law within the human health ecosystem.
When dealing with physical items, nurses
should always ask, “Where does it come from
and where does it go?” To illustrate this con-
cept, we can look at a battery, a common item
used in many patient care devices. Where did
51
it come from? One of the key elements in the
functioning of batteries is mercury. Mercury
mining may be responsible for significant en-
vironmental pollution on a local level that may
affect human populations.
After the battery is used and discarded,
where does it go? If the healthcare worker
inappropriately discards a battery, the incin-
eration of the battery or degradation at the
landfill releases mercury into the local envi-
ronment. Eventually, the mercury will enter
water systems via rainfall or landfill leaching,
where it is absorbed and bioaccumulated by
fish. Pregnant women may transmit the neuro-
logically toxic mercury to the fetus. Lactating
women eating mercury-ladened fish will con-
centrate the mercury into their breast milk.
A mother nursing her baby can pass on a po-
tentially toxic dose to it. The bioaccumulation
of mercury resulting in human health prob-
lems is a real and disconcerting example of
Commoner’s first and second laws of ecology
and illuminates a need for promoting a nurs-
ing ecological theoretical framework within
the human health ecosystem. The route that
a substance, such as mercury, travels through
the ecosystems may be called its ecological
path. Understanding the concept of ecologi-
cal paths in which “nothing goes away” and
“everything has to go somewhere” is impor-
tant if nursing is to study and adopt nurs-
ing ecological behaviors into its professional
paradigm.
The essential theme of Commoner’s third
law is that natural systems develop over a
long period of time and evolve survival re-
lationships. This concept challenges the an-
thropocentric view of the universe com-
monly held within the human ontology. Some
nursing scholars have also challenged this
prevailing view and proposed antianthro-
pocentric nursing paradigms incorporating
aspects of feminism, holism, ecofeminism,
and ecocentrism.39 The relationships in na-
ture function well unless disturbed by new,
radical forces. Human technology is often
cited as one such radical force. Technology
not only has been promoted as an enhancer
of human health but can also be seen as
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52 ADVANCES IN NURSING SCIENCE/JANUARY–MARCH 2006
creating new problems that detract from hu-
man health. What is an example of a new, radi-
cal force within the human health ecosystem?
The widespread use of antibiotics is one ex-
ample of a technological Pandora’s box. Ad-
vances in antibiotic therapy have provided
significant reductions in human morbidity
and mortality. However, the overuse and mis-
use of antibiotics have also promoted the de-
velopment of “superbugs”;strains of common
bacteria are now resistant to many antibiotics.
The antibiotics are an example of a radical
force developed by humans, which influence
human ecosystems. Unfortunately, the ecosys-
tem’s human members have not yet evolved
survival relationships with these new bacteria
strains, and untreatable infections are arising.
Understanding and adopting the concept
of “Nature knows best” within a nursing eco-
logical view would promote an expanded
view of our professional activities and the in-
teractions with natural ecosystems. An eco-
logical worldview would promote a more
egalitarian view of all life. Nursing practice
would also be challenged to use resources and
products that engage with natural processes.
Commoner’s43 fourth law of ecology,
“There is no such thing as a free lunch,”
is borrowed from economics and in some
ways embodies the previous 3 laws. Every
gain may also be said to create a loss; for
ecosystems are composed of intricate and in-
timate connections of relationships. Within a
nursing ecological theory, the realities of this
concept may be applied to the human health
ecosystem. For example, the oncology nurse
is aware that the health benefits of the toxic
medications administered in chemotherapy
also produce serious side effects. Another
case is the challenges of public health nurses
to equitably distribute their services within
the reality of finite resources: Should children
receive immunizations or should the elderly
be supported with drug reimbursements?
Adopting and promoting a better under-
standing of the “no free lunch”concept within
a nursing ecological framework may help the
profession in addressing the challenges of
costly technology and finite resources. Nurs-
ing research within an ecological paradigm
would reinforce the propositions of holistic
healthcare. Addressing both the total, not just
individual or economic, costs and benefits
of nursing activities will likely provoke prac-
tice dilemmas that challenge our role as care-
givers. In a nursing ecological paradigm, “no
free lunch” implies finite resources and chal-
lenges to choose professional practices that
balance the needs of the individual with the
benefits for the majority.
CONCLUSION
We must widen the focus of our scholarly attention.
Consequences of ecologic devastation threaten
peoples’ health on a global scale.49(p3)
Theory derivation is a process that may be
used to borrow concepts and models from
one field of study to develop new theories
within another field. In this article, this pro-
cess was used to explore concepts amenable
to developing a nursing ecological theory
from general ecological theory. Informed by
Walker and Avant’s derivation guidelines,3 the
current state of the phenomenon was ex-
amined, ideas were explored in other liter-
atures, and a parent theory from the eco-
logical sciences offered transferable concepts
and models. From these borrowed concepts,
a new nursing ecological model was pro-
posed and general ecological principles were
applied to examples from nursing and health-
care. The need still exists for further refine-
ment of the nursing ecological model and
theory. In addition, testing of a nursing eco-
logical theory provides a challenge for future
research and development within the nursing
discipline.
Research supporting an ecological
paradigm for nursing may encompass
both qualitative and quantitative methods.
The concept of nursing ecological behav-
ior is unexplored and needs qualitative
methodologies such as descriptive inquiry
and phenomenology to derive the underlying
themes and context of this phenomenon.
Questions of interest might include the
LWWJ194-04 January 28, 2006 4:42 Char Count= 0
Environment, Ecosystems, and Ecological Behavior
following: What are the behaviors or actions
nurses participate in that they believe are
environmentally friendly? Why is it important
to nurses to practice ecologically at work?
What are the ways in which nurses learn
about ecological behavior?
Quantitative experimental designs could
also be used to inform the theoretical foun-
dations for a nursing ecological framework.
Analysis and management of healthcare waste
streams using educational interventions in a
pretest-posttest design may help elucidate the
interventions that promote waste reduction
by nurses. The emerging nursing concepts of
the ecosystem and ecological behavior may
be beyond the traditional scope of nursing dis-
cipline. Adequate exploration and evaluation
of these areas of interest may also require in-
tradisciplinary and interdisciplinary research
and communication.
A challenge for the nursing profession is
to translate a concern for the global envi-
ronment and general ecological beliefs into
professional activities. Developing ecological
theory and behaviors in the nursing profes-
sion has implications for developing a more
environmentally “friendly” nursing practice.
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