Eco-Conscious Nursing Is Not a Checklist: Climate Crisis, Assemblage Thinking, and Justice-Oriented Care
Article information
Cleofas, J. V. (2026). Assembling eco-conscious, justice-oriented nursing in the face of climate crisis. Nursing Philosophy, 27(1), e70061. https://doi.org/10.1111/nup.70061.
What this paper is about
Climate change is changing what nursing is called to do. Nurses are no longer expected only to care for individual patients in hospitals or clinics. They are also being asked to respond to heat, storms, floods, displacement, disease outbreaks, damaged infrastructure, environmental injustice, and the health effects of ecological crisis.
This paper asks: How can we think about nursing in a world where climate change keeps disrupting health, care, and communities?
The author argues that we can understand eco-conscious nursing through assemblage thinking. This means seeing nursing not as one fixed identity or set of tasks, but as a changing arrangement of many elements: nurses, patients, communities, policies, health centers, technologies, cultural values, disasters, ecosystems, and justice struggles.
In simple terms: nursing changes when the world changes.
What is an assemblage?
An assemblage is a dynamic network of things that come together and shape each other. In nursing, an assemblage can include people, tools, institutions, ideas, documents, places, technologies, routines, and values.
The paper explains four important concepts.
First, an abstract machine is the organizing logic behind practice. For example, the biomedical model, evidence-based practice, interprofessional collaboration, sustainable development, and planetary health can all shape what nursing is expected to do.
Second, concrete assemblages are the actual materials, spaces, tools, and practices through which nursing happens: health centers, medical supplies, digital platforms, documentation systems, green technologies, waste management routines, and community health programs.
Third, personae are the agents within the assemblage. These include registered nurses, nursing assistants, community health workers, environmental experts, patients, families, and other actors who make care possible.
Fourth, deterritorialization and reterritorialization explain change. Deterritorialization happens when a crisis disrupts established roles and routines. Reterritorialization happens when new routines, roles, and systems form in response. Telenursing during COVID-19 is one example: care moved from physical clinical spaces into digital spaces, then became stabilized through new protocols and practices.
How nursing’s relationship with the environment has changed
1) Before Nightingale: health and environment were already connected
The paper reminds readers that environmental awareness did not begin with modern professional nursing. Many healing traditions long recognized the link between health and nature. Ancient Greek medicine, Traditional Chinese Medicine, Ayurveda, Indigenous healing practices, monastic care, midwifery, and women’s healing work all included environmental understandings of health.
This matters because nursing history is often told through a Western professional lens. The paper pushes us to see that eco-conscious care has many roots.
2) Nightingale and the hygienist nursing assemblage
Florence Nightingale helped formalize environmental thinking in modern nursing through attention to clean air, fresh water, sanitation, light, and the patient’s surroundings. This produced the image of the nurse as a hygienist nurse: someone responsible not only for bedside care, but also for managing the healing environment.
Here, the environment was mainly understood as the immediate physical surroundings of the patient.
3) Public health and community nursing
From the late 1800s to the mid-1900s, nursing expanded into homes, schools, neighborhoods, and communities. Nurses addressed sanitation, nutrition, communicable disease, maternal and child health, and the living conditions that shaped health.
This shifted nursing from the bedside to the community. The environment was no longer only the patient’s room. It became the home, the neighborhood, and the wider social environment.
4) Environmental health movements
From the 1960s to the 1980s, environmental movements helped nursing pay more attention to pollution, toxins, lead exposure, water safety, and ecological hazards. Nurses became environmental educators, advocates, and public health actors.
This period made clearer that health is shaped by ecological harm and social inequality.
5) Global health and climate change
From the 1990s to the 2010s, climate change increasingly became a global health concern. Nursing began to engage with global health, environmental stewardship, “green” healthcare, sustainability, and health equity.
This expanded nursing’s environmental concern beyond local sanitation toward global health systems and transnational ecological risks.
6) Eco-conscious nursing in the era of climate urgency
From the 2010s to the present, climate change has become an urgent public health crisis. Nursing has increasingly taken up planetary health, climate adaptation, mitigation, sustainability, disaster preparedness, telehealth, data analytics, climate advocacy, and environmental justice.
In this period, nurses are positioned not only as caregivers, but also as climate health advocates, planetary health protectors, and actors in climate resilience and health policy.
The Philippine case: typhoon-vigilant nursing
The paper’s most grounded example is the Philippines, a country highly exposed to typhoons and climate-related disaster risk. In ordinary conditions, the barangay health center functions as a local public health space where public health nurses and barangay health workers provide services like immunization, health education, and maternal care.
But when a super typhoon hits, this normal health center assemblage is disrupted. Buildings may be damaged. Power may be lost. Communication may fail. Nurses may have to care for patients while worrying about their own families. Work and personal life collapse into the same crisis.
This is deterritorialization: the usual territory of nursing is broken open.
But new forms of nursing also emerge. Nurses join mobile clinic teams, provide emergency care, support disaster response, deliver psychosocial support, coordinate with other actors, and help recreate care networks under crisis conditions. Filipino values such as bayanihan and pakikipagkapwa become part of the response, helping build solidarity and mutual aid.
This is reterritorialization: nursing becomes reassembled as typhoon-vigilant nursing.
Why climate justice matters here
The paper argues that climate vulnerability in the Philippines is not only natural. It is shaped by injustice: class inequality, coloniality, neoliberal globalization, uneven development, heteropatriarchy, weak infrastructure, and limited political will.
This means nursing cannot respond to climate change only through technical disaster preparedness. Nurses also need climate justice consciousness: the ability to see how climate harms are unevenly distributed and how vulnerable communities often face the worst consequences despite having the fewest resources.
Bottom line
This paper shows that eco-conscious nursing is not a universal template. It is a living, changing, justice-oriented practice that must be assembled differently depending on local realities. In the Philippine typhoon context, eco-conscious nursing means working with communities, responding creatively to immediate needs, and challenging the broader systems that make some groups more vulnerable to climate crisis.
The core message is clear: nursing in the climate crisis must be ecological, relational, adaptive, and justice-oriented.
Policy/practice recommendations
- Teach eco-conscious nursing as situated practice
Nursing education should not only teach generic climate competencies. It should help students analyze how climate change affects specific communities, places, infrastructures, and health systems. - Use assemblage thinking in nursing education
Students can map the people, policies, tools, spaces, technologies, values, and inequities that shape climate-related nursing practice. - Prepare nurses for climate-related ruptures
Disaster nursing education should include how care changes when health centers are damaged, communication fails, electricity is lost, and nurses themselves are affected. - Center climate justice in nursing response
Nurses should be trained to ask: Who is most exposed? Who has the fewest resources? Whose knowledge is ignored? Which systems make this community more vulnerable? - Strengthen community-based climate response
Barangay health centers, public health nurses, barangay health workers, local governments, and community organizations should be supported as climate-health response networks. - Recognize cultural values as care resources
Values such as bayanihan and pakikipagkapwa can support disaster response, solidarity, and community resilience when used with critical attention to equity and sustainability. - Study local eco-conscious nursing assemblages
Future research can examine how nurses in different communities respond to heat, floods, typhoons, displacement, food insecurity, and environmental degradation.
Glossary of key terms
- Eco-conscious nursing — Nursing practice that recognizes the links among human health, environmental conditions, sustainability, and ecological justice.
- Justice-oriented nursing — Nursing that not only provides care but also responds to inequity, marginalization, and structural causes of suffering.
- Assemblage — A dynamic arrangement of people, objects, spaces, ideas, policies, technologies, and forces that come together and shape practice.
- Assemblage thinking — A way of understanding reality as changing, relational, and made through connections among human and non-human elements.
- Abstract machine — The organizing logic or framework that shapes an assemblage, such as biomedical thinking, planetary health, or sustainable development.
- Concrete assemblage — The actual materials, spaces, technologies, routines, and practices through which an abstract logic becomes real.
- Personae — The actors or agents within an assemblage, such as nurses, patients, community health workers, policymakers, and allied professionals.
- Territorialization — The process by which roles, routines, boundaries, and identities become stabilized.
- Deterritorialization — The disruption of existing roles, routines, spaces, and identities, often caused by crisis or rupture.
- Reterritorialization — The formation of new roles, routines, spaces, and identities after disruption.
- Environmental rupture — A major environmental event or shift that disrupts existing care systems, such as epidemics, pollution, disasters, or climate change.
- Climate crisis — The escalating ecological and health emergency produced by global climate change.
- Planetary health — A field focused on the interdependence of human health, ecological systems, and the Earth’s life-support systems.
- Climate justice — An approach that recognizes that climate harms and responsibilities are unevenly distributed across communities, countries, and social groups.
- Climate injustice — The unequal exposure of marginalized communities to climate harms due to social, political, economic, and historical inequalities.
- Typhoon-vigilant nursing — The paper’s Philippine example of nursing practice reassembled in response to recurrent typhoon threats and climate vulnerability.
- Barangay health center / BHC — A local public health facility in the Philippines that provides basic primary healthcare services.
- Barangay health worker / BHW — A community-based health worker who supports local public health services in the Philippines.
- Bayanihan — A Filipino value of mutual help and collective cooperation during need.
- Pakikipagkapwa — A Filipino relational value rooted in shared identity, concern, and fellow humanity.
- Climate justice consciousness — Awareness of how climate change is tied to inequity, and commitment to equitable, sustainable, and culturally relevant responses.
- Lines of flight — In Deleuzean thinking, openings for movement, transformation, or becoming otherwise.
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