🌿 A gentle, whole-person way for nurses and caregivers to help you flourish, the way you define it.

💚 In plain words

• 🙋 You lead. You decide what a good life looks like for you, and where to start.
• 🌱 Start small. Pick one garden, like a ten-minute walk or one new bean recipe. You never have to do everything at once.
• 👥 A whole team can help. Aides, nursing assistants, nurses, nurse coaches and nurse practitioners each help in their own way.
• 💊 Your clinician stays in the loop. Changes in eating or activity can change what medicine you need, so the person who prescribes it makes any changes.
• 🕊️ No blame. Living with illness is not a failure. Comfort, dignity and connection count, even when a cure is not possible.
• 🧪 Still being tested. This is a new, proposed way of caring. We share what research shows about its parts, and what it does not yet show.

🧭 What this theory is, and is not

• 🧭 A proposed nursing theory, or conceptual framework. It organizes how a nursing team can support each person’s own flourishing.
• 🔗 It brings together evidence-based lifestyle medicine, holistic nursing, nurse coaching and coordinated clinical care.
• 🙋 It is built around patient-defined flourishing: the person decides what matters most and where to begin.
• 📚 It is informed by existing research on specific parts, such as intensive lifestyle programs, nurse coaching and nurse-led transitional care.
• 🧪 It still needs evaluation. Its complete structure, how it is put into practice, and its outcomes have not yet been tested together.
• 🚫 It is not validated, peer reviewed, accredited, or endorsed by any institution, agency, university, professional association or nursing board. Studies of individual interventions do not validate the whole framework.
• ™ The ™ symbol is a branding designation only. It does not mean the name is registered or legally exclusive.

🌼 What “flourishing” means here

In this framework, flourishing is defined by the person. It can include their:

• 💪 Physical health, as the person experiences it
• 🦽 Functional ability: doing the everyday things that matter to them
• 💛 Emotional well-being
• 🫂 Relationships with family, friends and caregivers
• 🎯 Meaning and purpose
• 🏘️ Community connection
• 🧾 Practical circumstances: money, housing, food, transportation, work and caregiving
• 🗺️ Personal goals, chosen by the person
• 🕊️ Dignity and agency: being respected and having a real say

🗺️ The official mind map

Read top to bottom. On a phone, scroll; every box is text, so screen readers and printers read it fully.

⬇️ shares priorities with

⬇️ helps the person choose a starting point among

⬇️ supported by the nursing team through

⬇️ proposed to influence

🔁 Feedback and reassessment: outcomes return to step 2, and the person chooses the next step.

How to read this map: ⬇️ arrows with words are proposed relationships that we intend to test, not proven effects. Boxes are groupings that make no claim on their own. 🔁 marks feedback over time.

🎯 Mission

What that means in practice:

• 🩺 Whole-person nursing: we look at the whole person, not only a diagnosis.
• 🥦 Evidence-based lifestyle support: nutrition, movement, sleep, stress, connection and avoiding risky substances, matched to each person.
• 🧭 Patient-centered coaching: goals chosen by the person, with follow-up over time.
• 📚 Practical education: clear, free resources such as recipes, videos and plain-language guides.
• 🤝 Coordinated clinical care: lifestyle support works alongside medicines, monitoring and referrals, within each professional’s scope.
• 🚪 Accessible resources: free, public, no registration, with attention to cost, language and disability.
• 📏 Meaningful outcomes: we measure what matters to the person and report results honestly.

🔭 Vision

• 👥 Nursing teams, from aides to advanced practice nurses, equipped and supported to help people flourish.
• 🔄 Prevention and treatment working together instead of in separate silos.
• 🏥 Compassionate care that follows people across settings: home, clinic, hospital and community.
• 🥕 Healthy living made more accessible and affordable.
• ⏳ Patients supported over time, not only during a single visit.
• 📏 Outcomes measured honestly, including results that disappoint us.
• 🪔 Nursing professionals supported in their own well-being. Who nurses the nurse?

Universal access and global flourishing are aspirations we work toward. They have not been achieved, and we do not claim otherwise.

💎 Values

🕊️ This work grows from Nathanael’s Christian faith and compassion. People of every faith and of no faith are equally welcome. Spiritual support is offered only when a person wants it, follows their own beliefs and preferences, and requires their consent.

Value	What it means	What it changes in practice
💗 Compassion	Noticing suffering and responding with kindness, for patients and colleagues alike.	A nurse asks what feels hardest today before teaching anything.
🕊️ Human dignity	Every person has equal worth, whatever their health, income, faith or choices.	Care plans and conversations never blame a person for being ill.
🙋 Patient agency	The person decides what flourishing means for them and where to start.	Plans begin from the person’s own goals, and saying “not now” is respected.
🔬 Evidence and intellectual honesty	We say what is proven, what is promising and what is unknown, and we keep null results visible.	Projections are labeled as scenarios, and a trial that found no benefit stays on our research page.
⚖️ Equity and accessibility	Care and learning should reach people regardless of money, language, disability or location.	Free public resources, plain language, interpreters and options that do not require the internet.
🌍 Cultural humility	Learning from each person’s culture and beliefs rather than assuming.	Meal ideas start from foods the person already loves.
🪑 Connection and belonging	There is always room at the table. Pull up a chair.	Nursing assistants and aides take part in team decisions.
🌱 Stewardship	Careful use of people’s time, money and energy, and of the earth’s resources.	Low-cost options come first, and no product purchase is ever required.
📏 Professional accountability	Learn widely. Practice within your role.	Medication changes go to the responsible prescriber, and delegation follows state rules.
🤝 Collaboration	Every hand heals: the whole nursing team, the person, their family and other professions.	One shared plan, clear handoffs and a known escalation pathway.
🌅 Hope	Some improvement in comfort, connection or function is often possible, even when cure is not.	A palliative goal that is met counts as success.
🎯 Meaning and purpose	Care connects to what makes life worth living for the person.	Every plan starts with “What matters most to you?”

🧭 Goals

Each goal has a broad aspiration and a proposed measurable commitment. These commitments are proposals for discussion, not previously adopted organizational targets, and no numerical targets or deadlines have been set.

🙋 Patient goals

• Aspiration: People define and pursue their own flourishing goals, with support that continues over time.
• Proposed measurable commitment: In any pilot, every participant has a documented, person-chosen goal and starting garden at enrollment, reviewed at each follow-up.
• Why we propose it: Patient agency; easy to check in records.

👥 Workforce goals

• Aspiration: Every nursing role, from aides to advanced practice nurses, has training, protected time and a voice.
• Proposed measurable commitment: Before any pilot enrolls patients, staff complete defined training and receive protected coaching time; staff well-being and turnover are measured at the start and the end.
• Why we propose it: A pragmatic coaching trial delivered far fewer sessions than planned (see research page), so delivery must be resourced and measured.

🏛️ Organizational goals

• Aspiration: Transparent, independent and free public resources.
• Proposed measurable commitment: Theory, evidence and calculation pages stay free with no registration, and every substantive change is recorded in a public change log.
• Why we propose it: Our standing commitment that everything on both sites is free and public.

🏘️ Community goals

• Aspiration: Partnerships with public health services, congregations of every faith, food programs and other local resources.
• Proposed measurable commitment: Before any pilot, map local resources with community members and document referral pathways.
• Why we propose it: The neighborhood-network principle of Buurtzorg-style teams (see below).

🔬 Research and evaluation goals

• Aspiration: Test the theory honestly and share what we learn.
• Proposed measurable commitment: Publish a pilot protocol with a pre-specified primary outcome before enrolling anyone, and report all results, including null and unfavorable findings.
• Why we propose it: Common research-integrity standards.

🌿 The Nine Gardens of Flourishing™ in this theory

The Nine Gardens of Flourishing™ are a way to organize conversations and choices. They are not nine independently proven treatments, and nobody is asked to work on all nine at once. Most people start with one. The Garden Soil Assessment™ and Cup of Flourishing™ are engagement and reflection tools that help a person choose a manageable starting point; they are not validated clinical instruments.

🥦 1. Nutrition

• What it means: Eating patterns that nourish. Kitchen Monk™ recipes are whole-food plant-based and free of added salt, oil and sugar.
• A person might choose: “Add one bean-based lunch a week.”
• Possible nursing contribution: Teach one simple recipe; link to food assistance; tell the prescriber when eating changes may affect medicines.
• Common barrier: Cost, time, food access, cooking equipment
• Measure to use: Process: servings of vegetables, fruits and legumes. Outcome where relevant: blood pressure or hemoglobin A1c.

🚶 2. Movement

• What it means: Physical activity that fits the person’s body and abilities.
• A person might choose: “Walk ten minutes after dinner,” or seated exercises.
• Possible nursing contribution: Check safety and fall risk; adapt for disability and symptoms.
• Common barrier: Pain, disability, unsafe streets, time
• Measure to use: Process: active minutes per week. Outcome: a function measure.

😴 3. Sleep

• What it means: Restorative sleep.
• A person might choose: “Same bedtime five nights a week.”
• Possible nursing contribution: Screen for sleep problems; review medicines; refer when needed.
• Common barrier: Shift work, caregiving, pain, housing
• Measure to use: Outcome: self-reported sleep quality.

🧘 4. Mindfulness

• What it means: Practices that ease stress and bring calm.
• A person might choose: “One minute of slow breathing before bed.”
• Possible nursing contribution: Teach a brief practice; screen for depression and anxiety and refer.
• Common barrier: Time, heavy stress, trauma history
• Measure to use: Outcome: a perceived-stress measure. Process: practice days per week.

🫂 5. Relationships

• What it means: Supportive connection with others.
• A person might choose: “Call my sister every Sunday.”
• Possible nursing contribution: Map who helps; teach caregivers a practical skill.
• Common barrier: Isolation, caregiver strain
• Measure to use: Outcome: loneliness and caregiver-strain measures.

🎯 6. Purpose

• What it means: What gives life meaning.
• A person might choose: “Keep volunteering at the library.”
• Possible nursing contribution: Ask what matters most and shape the plan around it.
• Common barrier: Illness that disrupts roles and routines
• Measure to use: Outcome: goal attainment.

🏘️ 7. Community

• What it means: Belonging and access to local help.
• A person might choose: “Join a community walking group.”
• Possible nursing contribution: Refer to community programs and public health services.
• Common barrier: Transportation, language, cost
• Measure to use: Process: referrals completed.

🌍 8. Global Impact

• What it means: Caring for the wider world, including healthier environments.
• A person might choose: “Share a favorite recipe with a neighbor.”
• Possible nursing contribution: Advocate for healthier environments; share what works with other nurses.
• Common barrier: Limited energy and resources
• Measure to use: Process: optional participation, never required.

🕊️ 9. Faith & Compassion

• What it means: Spiritual life and compassion, as the person defines them, including no faith.
• A person might choose: “Return to my congregation,” or “practice gratitude.”
• Possible nursing contribution: Offer a spiritual-care referral only if wanted and consented.
• Common barrier: Fear of judgment
• Measure to use: Outcome: spiritual well-being, only if the person chooses to measure it.

🔄 The proposed care process

1. 👂 Listen first. Ask what matters most and what the person hopes for.
2. 🩺 Assess the whole person. Body, function, emotions, relationships, meaning, practical circumstances and safety.
3. 🌱 Choose one starting garden together. Reflection tools can help; the person decides.
4. 📝 Co-create a small plan. One step the person feels confident about, with a way to check in.
5. 🤝 Deliver it as a team. Lifestyle support, holistic nursing, coaching and coordinated treatment, each role within its scope.
6. 🧱 Address access and conditions. Food, money, transportation, language, disability and caregiving.
7. 🛡️ Keep it safe. Monitor when medicines may need adjusting; escalate symptoms to the responsible clinician.
8. 🔁 Measure and reassess. Review what helped, adjust the plan, and choose the next step.

👥 Every hand on the team

The theory welcomes the whole nursing and direct-care family: home health and personal care aides, nursing assistants, medication aides and patient care technicians, licensed practical and vocational nurses, registered nurses, public health and school nurses, nurse coaches, clinical nurse specialists, nurse practitioners, nurse-midwives, nurse anesthetists and nurse educators. Every role is equal in dignity and voice, and distinct in scope and accountability: Learn widely. Practice within your role.

Aides and nursing assistants are essential team members but are not licensed nurses; licensed nurses assess, teach, coordinate and coach within their scope; authorized prescribers manage diagnosis and medication changes.

🏡 An inspiration: neighborhood nursing teams

Buurtzorg (Dutch for “neighborhood care”) is a home-care organization founded in the Netherlands in 2006. Small, self-managing teams of nurses and nurse assistants care for people in one neighborhood, starting with what the person and their own network can do, then adding the team, then formal services. Its approach inspired the neighborhood-team and inside-out ideas in this theory.

• 🧾 A study commissioned by the Dutch Ministry of Health (KPMG, January 2015) found Buurtzorg used about 108 hours of home care per client per year, compared with 168 at other providers. Its hourly cost was higher, but home-care cost per client was lower (Commonwealth Fund case study; Dutch parliamentary letter).
• ⚖️ Total cost per client, including follow-on doctor and hospital care, was only slightly below average (about €15,357 versus €15,856), because Buurtzorg clients’ follow-on costs were higher. The analysis had acknowledged statistical limits.
• 🇬🇧 An English pilot of an adapted team found it feasible and acceptable to patients, carers and general practitioners, but did not measure clinical outcomes, costs or readmissions (Drennan and colleagues, 2018).
• 🌍 A scoping review of 25 publications from outside the Netherlands found person-centered care and high satisfaction, but inconclusive cost evidence and rarely measured outcomes; workplace culture, staffing and national policy were common barriers (Hegedüs and colleagues, 2022).

Buurtzorg has not reviewed, endorsed or partnered with this work. Its experience in the Netherlands shows a way of organizing care; it does not show what our combined approach would achieve.

🔬 Research basis

Each item links to the original study. Full study-by-study details, effect sizes and limitations are on the patient-outcomes research page, which is the single source of truth for every calculation.

• Intensive lifestyle programs can prevent or delay type 2 diabetes in high-risk adults (trial)
  🔬 Randomized trial · New diabetes cut by 58% over about three years; the difference was smaller but still present at 15 years.
  Limit for our model: Intensive program, not nurse coaching, and not a test of a diet free of added salt, oil and sugar.
• Nurse coaching can modestly help some people with diabetes (Belgian trial; null trial)
  🔬 Randomized trials and reviews · Small benefits in some trials (hemoglobin A1c about 0.2 percentage points lower); one pragmatic trial found no difference when far fewer sessions were delivered than planned.
  Limit for our model: Effects are modest and depend on delivery, training and protected time.
• Better risk factors do not automatically mean fewer heart attacks or strokes (trial)
  🔬 Randomized trial (null) · Lifestyle intervention improved weight and hemoglobin A1c but did not reduce major cardiovascular events; the trial was stopped early for futility.
  Limit for our model: We measure the outcome we claim.
• Nurse-led transitional care can reduce hospital readmissions for some older adults (2004 trial; 1999 trial)
  🔬 Randomized trials · Older adults with heart failure had fewer total readmissions over a year (104 versus 162) and lower costs; the share readmitted at least once did not differ significantly.
  Limit for our model: Tested advanced-practice-nurse transitional care, not lifestyle medicine or coaching; results apply to similar patients.
• Neighborhood self-managing nurse teams are workable (case study; review)
  🏛️ Organizational reports and case studies · Fewer home-care hours per client in the Netherlands; feasibility and satisfaction elsewhere.
  Limit for our model: Not randomized; total cost savings small and uncertain; few outcomes measured.
• The combined framework improves flourishing
  🧭 Our proposed framework · Not yet tested.
  Limit for our model: This is the question a pilot must answer.

🧭 The theory as a whole has not been tested. Evidence for transitional care, intensive lifestyle programs or coaching supports individual parts; it does not prove the full framework, and effects of multicomponent programs are not attributed to lifestyle medicine or coaching alone. Our recipes are offered as practical support; the cited trials did not test them or a diet free of added salt, oil and sugar.

🧮 Outcome projections: what we publish and what we hold

• ✅ Published: workforce reach scenarios and a diabetes-prevention scenario, with every assumption shown, on the research page.
• ⏸️ Held: a national estimate of hospital readmissions avoided. We checked an earlier draft model and found it did not meet our standard, so we are not publishing a number. See why.
• 🧱 Workforce numbers show who is available to help. They do not show that any intervention works.

⚠️ Limitations

• 🧪 The full framework has not been tested as one program, and no outcomes have been measured.
• 🔗 Evidence comes from studies of separate parts, in specific populations and settings; results may not transfer.
• 🧩 The Nine Gardens are an organizing tool, not nine proven treatments.
• 📋 The Garden Soil Assessment™ and Cup of Flourishing™ are reflection tools, not validated instruments.
• 🌐 Workforce counts are jobs, not people, and show availability, not effectiveness.
• 🏛️ United States scope-of-practice and payment rules differ from the Netherlands and vary by state.
• 👤 The theory was developed by one founder and has not yet had independent expert or community review.

🧪 How the theory will be tested

A website does not prove a theory. The next steps are expert review, input from patients and communities, a small feasibility test, then a carefully measured pilot.

🧫 A proposed first test

We have written a proposal for testing the framework with older adults going home from the hospital after heart failure, where coming back to the hospital is a meaningful and measurable outcome. No pilot has taken place, and no patient data exist.

📝 Version history and change log

• Version 0.1 · October 29, 2026: first public draft. Defines flourishing, mission, vision, values and goals; official overview map; Nine Gardens; proposed care process; research basis; development pathway; pilot proposal. An early draft readmission projection was reviewed and held (see research page). Evidence reviewed October 29, 2026.

“Reviewed” means we re-checked the sources; “revised” means the content changed. We only advance the version when the content changes.

Nathanael’s Flourishing Nursing Theory™ is a proposed framework by Nathanael Elijah Smith, MSN, APRN, FNP-C, DipACLM. Free to share with credit to Kitchen Monk™ and Flourishing Nursing™. Educational information, not medical advice.