From Practice to Theory: Development of the Caring Agro-Ecosystem Model (CAEM) Through Qualitative Evidence Synthesis

Abstract Background: Despite growing integration of nature-based therapies in healthcare, a theoretical gap exists in structuring agricultural healing within nursing practice. Current models lack integration of ecological, cultural, and human caring dimensions. Methods: A qualitative evidence synthesis was conducted using thematic analysis of semi-structured interviews with 15 interdisciplinary stakeholders in East Java, Indonesia. Data were analyzed following Thomas and Harden’s approach, guided by PRISMA 2020 and COREQ guidelines. Results: Three core themes emerged: healing rooted in nature and culture, nurses as ecosystem facilitators, and the need for a unified framework. Findings reveal that agro-therapeutic practices are culturally legitimate and effective, yet fragmented due to absence of theoretical grounding. Conclusion: The Caring Agro-Ecosystem Model (CAEM) was developed as a novel, circular nursing framework that integrates Jean Watson’s Human Caring, Leininger’s Transcultural Nursing, and planetary health principles. CAEM redefines nurses as Caring Ecosystem Facilitators, positioning health as co-created through symbiotic human-agricultural relationships. This model offers a transformative, scalable approach to culturally grounded, sustainable care in vulnerable communities.