Learn it. Try it. Use one small step.

Flourishing Nursing, made simple 🌱

You do not have to learn a whole theory at once. Start with one person, one priority, and one practical support.

A short, self-paced introduction for the whole nursing team. No sign-in. No patient information is needed. Choices stay in this page’s memory and clear when you reload.

1. The big idea

Ask what matters. Make the next step possible. Come back with support.

Flourishing can mean more comfort, independence, connection, or meaning—even when someone lives with illness or disability.

Instead of stopping at “Here is a healthy recipe,” ask:

“Would preparing a meal help with something that matters to you? What would make it easier?”

What does “theory” mean here?

A proposed way to organize nursing care and describe relationships we want to study. The integrated model and original tools are still developing and have not been validated or peer reviewed.

✝️ How does the Bible ground this approach?

Nathanael’s guiding ideal: holistic nursing grounded in biblical love is our gold standard for Flourishing Nursing.

Love your neighbor. Notice the whole person. Respond with practical compassion. The King James Bible is the founder’s spiritual foundation; clinical care also follows evidence and each person’s informed preferences.

People of every faith and none are welcome. Spiritual discussion is optional. This is our founding ideal, not a claim of proven clinical superiority.

🍲 Explore the Culinary CNA vision · 🤲 LPN / LVN learning pathway

2. Explore the Nine Gardens

Gardens are areas of life to explore, not nine tasks to assign. Tap one to see a plain-language question and possible support.

🥦 Nutrition: Food skills and access

Ask: “What makes a nourishing meal possible in your daily life?”

Consider together: Adapt one familiar meal and connect practical food support.

🚶 Movement: Movement that fits

Ask: “What movement feels possible and meaningful for you?”

Consider together: Explore a manageable activity and appropriate adaptations.

🌙 Sleep: Rest and restoration

Ask: “What interrupts your chance to rest?”

Consider together: Consider schedules, caregiving, the environment, and appropriate support.

🧘 Mindfulness: Attention and coping

Ask: “What helps you feel steadier when life is demanding?”

Consider together: Offer a wanted, manageable coping practice and relevant support.

🫂 Relationships: Connection and boundaries

Ask: “Who supports you, and what support feels welcome?”

Consider together: Explore a wanted connection, communication need, or boundary.

🎯 Purpose: What gives life meaning

Ask: “What would you like to be well enough to do?”

Consider together: Connect a practical step with a personally valued activity.

🏘️ Community: Belonging and resources

Ask: “Which local people or resources could make this easier?”

Consider together: Name a useful connection and who will follow through.

🌍 Global Impact: Environment and stewardship

Ask: “What conditions around you affect daily life?”

Consider together: Consider a feasible individual or collective change without assigning blame.

🕊️ Faith & Compassion: Meaning on the person’s terms

Ask: “Would you like to discuss beliefs, values, or sources of hope?”

Consider together: Follow their wishes, including secular meaning or no spiritual discussion.

Choose with the person. Adapt to their wishes, clinical needs, and your role. You can use their own words instead of Garden names.

3. Soil and Cup, without the jargon

🌱 Soil = what makes change possible

Think access, time, money, safety, culture, energy, support, and working conditions. Ask: “What helps, and what gets in the way?”

For nurses, Soil also includes staffing, schedules, leadership, and time to provide care.

☕ Cup = the person’s experience and priorities

Ask: “What sustains you? What drains you? What matters most today?” An optional 0–10 reflection can help a conversation, but numbers are not necessary.

There are no established diagnostic cutoffs or validated total scores. A person may decline the conversation or rating.

A simple distinction

“I want to make dinner myself” is a priority. “I cannot stand for long and groceries cost too much” describes barriers. Support must respond to both.

4. Try a situation

A fictional learning example: Sam wants to prepare dinner more independently. Standing is tiring, groceries feel expensive, and Sam enjoys a familiar bean dish.

Choose a useful first conversation. These are learning choices, not a patient assessment or a graded test.

Each starting point can open a useful conversation when it respects Sam’s wishes. A recipe alone may leave access barriers unresolved. Pair the chosen action with support and a return visit or contact.

See one possible shared plan

Sam chooses one familiar meal adapted to their abilities and budget. The team agrees who will explore ingredient access and appropriate preparation support, and when to follow up. At review, ask whether the meal was manageable, affordable, enjoyable, and worth repeating. No clinical result is predicted.

5. Your take-to-work reminder

This is a learning takeaway, not a patient record, certificate, or evidence of clinical competence.

Start with the person

“What would you like to be well enough to do?”

Your Garden to explore

Nutrition: food skills and access. Choose any relevant Garden with the person.

Look at the Soil

What makes the next step easier or harder?

Agree together

One manageable action, one promised support, one task owner, and a plan to return.

Follow up

What was useful, difficult, or worth changing?

Open the four-page printable toolkit · Find a patient resource · Suggest an improvement

Educational prototype by Flourishing Nurse Ninja Nathanael Elijah Smith, FNP-C, DipACLM. Use appropriate clinical assessment and established measures. Every role retains its own scope.

Developing framework, not yet peer reviewed or validated. Learning version 0.3 · October 30, 2026. Prefer reading? The full public overview continues below. If interactive controls are unavailable, all five lessons remain readable.

🌿 The Flourishing Nurse formula

Lifestyle Nursing education
+ American Holistic Nurses Credentialing Corporation holistic nursing board certification
+ American Holistic Nurses Credentialing Corporation nurse coach board certification
+ Integrative Nurse Coach® Academy Functional Nursing course completion (fourth and final item)
= the foundation for Official Flourishing Nurse recognition within our initiative.

Defined by founder Nathanael Elijah Smith, October 30, 2026. This is our initiative’s recognition pathway, not a new national board certification, license, or postnominal credential. Recognition requires verification of the requirements below; this website does not automatically award it.

Start with Lifestyle Nursing, then combine preparation where useful

Prerequisite: current, unrestricted RN/APRN licensure and applicable eligibility requirements.

1. Complete Dr. Karen Laing’s Lifestyle Nursing course through Integrative Nurse Coach® Academy.
2. Earn and maintain an applicable American Holistic Nurses Credentialing Corporation holistic nursing board certification.
3. Earn and maintain American Holistic Nurses Credentialing Corporation nurse-coach board certification.
4. Final completion item: complete Integrative Nurse Coach® Academy’s Functional Nursing: A Functional Medicine Framework for Nurses. Taught by Elizabeth Sult, BSN, RN, NC-BC, and Thomas Sult, MD, IFMCP. Keep documentation of successful completion for recognition review.

All four completion items plus the licensure prerequisite must be verified for Official Flourishing Nurse recognition within this initiative. Existing qualifying coursework and active certifications do not need to be repeated. 🙏 See the nurses and educators we thank for each item.

Your personal pathway checklist

Use this to organize your next step. It is not a certification application or credential verification. No documents or patient details are requested. Checks clear when the page reloads.

Current, unrestricted RN or APRN licensure
Meet the relevant certifying body’s requirements, including its international equivalency pathway where applicable. Dr. Karen Laing’s Lifestyle Nursing course completed
Keep the course completion documentation. Active holistic nursing board certification
Hold the applicable American Holistic Nurses Credentialing Corporation credential: HN-BC, HNB-BC, AHN-BC, or APHN-BC. One appropriate level is required, not all four. Active nurse coach board certification
Hold American Holistic Nurses Credentialing Corporation NC-BC, or the HWNC-BC designation when eligible as a holder of both active holistic nursing and nurse coach certifications. Fourth and final completion item: Integrative Nurse Coach® Academy Functional Nursing course completed
Keep the course completion documentation for review.

Review the licensure prerequisite and four completion items and identify your next step.

How do the board credentials fit together?

American Holistic Nurses Credentialing Corporation awards holistic nursing credentials at different levels. These are alternatives matched to eligibility, not a requirement to collect every level. American Holistic Nurses Credentialing Corporation explains that HWNC-BC is a nurse coach designation used instead of NC-BC when both certifications are active; it does not replace the separate holistic nursing credential.

Lifestyle medicine certification can be an additional professional goal where eligible. It has separate requirements and is not automatically awarded by the Lifestyle Nursing course or required in this initial founder-defined formula.

What does “official” mean here?

It means recognition by the Flourishing Nursing initiative after the required credentials and course completion have been verified. It does not mean American Holistic Nurses Credentialing Corporation, the American Holistic Nurses Association, Integrative Nurse Coach® Academy, a nursing board, or another organization endorses or issues a Flourishing Nurse credential. No automatic approval, certification examination, or accredited Flourishing Nursing credential is offered here. Do not add invented certification letters after your name.

To ask about a future recognition review, use our general contact page. Please do not upload licenses, identification documents, or confidential records to a public message. A secure verification process must be arranged before collecting credential documents.

Everyone can begin learning. Nursing assistants, LPNs/LVNs, students, and other team members remain welcome to learn and contribute within their roles. This RN/APRN board-certification pathway does not make someone a licensed nurse or make noneligible learners eligible for American Holistic Nurses Credentialing Corporation certification.

Our founder’s biblical foundation inspires compassionate whole-person care. Professional certification requirements belong to the certifying organizations; a religious profession is not added to their requirements. People of every faith and none are welcome.

Official-source pathway information checked October 30, 2026. Confirm current eligibility and accepted education directly with American Holistic Nurses Credentialing Corporation and the course provider before enrolling. Existing qualifying certifications do not need to be repeated solely to follow this suggested learning order.

🌿 The guiding conceptual foundation of FlourishingNursing.org. Developed by Flourishing Nurse Ninja Nathanael Elijah Smith, FNP-C, DipACLM, Flourishing Nursing Theory™ brings together compassionate whole-person nursing, practical lifestyle support, nurse coaching, and coordinated care to help each person flourish by their own definition, while nurses flourish too. This page is a public overview of a developing framework, not the full publication manuscript. The integrated model has not yet been peer reviewed or validated.

🧭 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 could be evaluated: a proposed development pathway

A website does not validate a theory. These milestones are a proposed path; not every nursing theory needs every step, and the order may change.

Proposed milestone	Status as of October 29, 2026
1. Clear definitions of the theory’s concepts	Drafted (version 0.1, this page)
2. Explicit proposed relationships	Drafted (official mind map)
3. Review by nursing and clinical experts	Not started
4. Patient and community input	Not started
5. Feasibility testing	Not started
6. Intervention specification (manual, training, dose)	Not started
7. Selection of outcome measures	Started: proposed scorecard on the research page
8. Pilot evaluation	Proposed below; not started
9. Comparative effectiveness evaluation	Not started
10. Replication in other settings	Not started
11. Peer-reviewed reporting	Not started
12. Revision based on findings	Ongoing as evidence is reviewed

💡 A conceptual framework can still be useful while its effects are being evaluated: it gives teams a shared language, a way to organize assessment and coaching, and clear questions for research.

🧫 Pilot proposal (not yet started)

Element	Proposal
🎯 Why this population	Older adults going home after a hospital stay for heart failure. Readmission is common, meaningful and measurable in this group, and nurse-led transitional care has been tested here before.
👥 Target population	Adults aged 65 and older, admitted for heart failure and discharged to their own home, living in the partner’s service area.
✅ Inclusion	Principal reason for admission is heart failure; discharged home; consent from the person or their legally authorized representative; reachable by phone or visit.
⛔ Exclusion	Discharged to hospice, a skilled nursing facility or another facility; already enrolled in another transitional care program; living outside the service area. People with memory problems are included with a caregiver.
🙋 Patient priorities	Enrollment begins with “What matters most to you?” and a person-chosen starting garden; reflection tools are used only as conversation aids.
📣 Recruitment	Discharge planners refer all consecutive eligible patients; materials in the person’s language; refusals and reasons recorded.
👥 Staff roles	Nurse practitioner or clinical nurse specialist lead; registered nurses, including a nurse coach; licensed practical or vocational nurse; nursing assistant or home health aide; medication aide where state law allows; pharmacist consultation; the patient’s physician or prescriber.
🎓 Training and supervision	Transitional care protocol, motivational interviewing, lifestyle medicine basics, delegation and scope of practice, safety escalation; weekly case review supervised by the lead clinician.
⏱️ Protected time	Caseload limits and protected coaching time agreed with the partner before enrollment (to be set).
📞 Coaching and visit frequency	To be specified in the protocol, informed by the tested model: a home visit soon after discharge, regular home visits and telephone availability seven days a week for about three months.
🥦 Lifestyle support	Nutrition, activity, sleep and stress support that follows the person’s heart failure plan from their clinicians. Kitchen Monk™ recipes may be offered as optional practical help; no single diet is required.
🌿 Holistic assessment	Symptoms, function, emotions, relationships, meaning, culture, caregiving and practical needs; spiritual support only if wanted.
🚨 Clinical escalation	Clear symptom thresholds from the person’s heart failure plan trigger same-day contact with the responsible clinician; a 24-hour pathway for urgent concerns.
💊 Medication coordination	Medication reconciliation at the first visit, pharmacist review, and all changes made by the prescriber.
🔀 Referral pathways	Cardiology, palliative care, social work, home care, community services and food programs.
🥫 Food and transportation	Screen for social needs; connect to food assistance and transportation to appointments.
🗣️ Language and disability	Interpreters, large print, accessible formats, phone or in-person options, and caregiver involvement.
📐 Fidelity	A checklist of components delivered at each contact; dose (visits, calls, minutes) recorded.
🏁 Primary outcome	All-cause unplanned hospital readmission within 30 days of discharge, per person (any readmission), counted at any hospital where data allow.
📊 Secondary outcomes	Readmission or death within 90 days; emergency visits; days alive and out of hospital; total readmission events at 6 and 12 months; goal attainment; a validated heart-failure quality-of-life measure; self-efficacy; patient experience; caregiver strain; staff well-being and turnover; costs.
🛡️ Safety measures	Adverse events, falls, low blood pressure, kidney or electrolyte problems from medicine changes, and all deaths reviewed.
⚖️ Comparison	A pragmatic randomized comparison with usual transitional care if feasible; otherwise a stepped-wedge or matched concurrent comparison, with its limits stated.
📆 Follow-up	About three months of intervention; outcomes followed to 12 months.
🔒 Data handling	Minimum necessary data, secure storage, de-identified analysis, and compliance with the Health Insurance Portability and Accountability Act.
🧩 Missing data	Intention-to-treat analysis; missing data reported by group; a pre-specified sensitivity analysis.
💵 Costs and resources	Staff time, training, travel and food-access support, budgeted with the partner (to be set).
🧮 Sample size	Calculated by a statistician from the partner’s own baseline readmission rate (to be set).
🏛️ Institutional review	Approval by an institutional review board before enrollment, and public trial registration before the first participant.

📝 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.
• Version 0.2 · October 30, 2026: established the theory as the site’s guiding conceptual foundation; connected eight key learning and care pages; added a practical teaching example, visual overview, printable four-page starter toolkit, permanent Our Foundation menu link, and structured feedback invitation. The model and tools remain unvalidated and not yet peer reviewed. This update records content development, not a new evidence review or clinical outcome finding.

Learning experience version 0.3 · October 30, 2026: added a five-step interactive introduction, role-specific reminders, a Nine Gardens explorer, a fictional practice situation with explanatory feedback, a personalized printable takeaway, reset and show-all controls, and readable content when scripting is unavailable. Added homepage and Start Here learning links. This is an educational interface update; the conceptual overview and PDF toolkit remain version 0.2, with no new validation or outcome claims.

“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 Flourishing Nurse Ninja Nathanael Elijah Smith, FNP-C, DipACLM. Free to share with credit to Kitchen Monk™ and Flourishing Nursing™. Educational information, not medical advice.