Learning Outcomes

At the end of lesson, the students will be able to:

Apply the Principles of stewardship in nursing practice;
Compare and contrast ordinary from extraordinary care;
and
Interpret understanding of the concept of body integrity.

CONTENT:
Principles of stewardship
(Principles of stewardship requires us to respect the two gifts that
a sensible and loving God has given the earth with all the natural
sources and our personal human nature, with its organic
psychological social and spiritual capacities.)

This principle is grounded in the presupposition that God has

absolute dominion over creation, and that, in so far as human
beings are made in God's image and likeness, we have been
given a confined dominion over creation and are
accountable for its care.

Stewardship - refers to the expression of one's responsibility to

take care nurture and cultivate the has been entrusted to him.

Healthcare practice stewardship - refers to the execution of

responsibility of the healthcare practitioner to look after, furnish
fundamental health care services, and promote the health
and life of those entrusted to their care.

Traditional definition of stewardship - The parable of talents in

the new testament describes another factor of stewardship in
which a master divides his worldly items between his three
servants. The moral portrayed in this parable is that when one
entrusted with something of value there is an obligation to
enhance on it.
State oriented definition of stewardship - The broad definition
of state-oriented stewardship is that the feature of government
is responsible for the welfare and interest of the population
mainly the trust and legitimacy with which its activities seen by
the widespread public.

The metaphor of a steward - In the eleventh century the English

phrase steward was develop from the term “stigwaerd”
meaning the warden of the house.

Stewardship - is a role that man or woman adapt to ward some

other. It also stresses that to be a steward is to dedicate a
significant proportion of one's ideas and efforts to keeping or
enhancing the condition of some things or individual and not
mainly for one's own sake. It suggests that stewards are
motivated to act as they strengthen character disposition
which includes self-control and courage.

Conceptualization of stewardship can also be applicable to

nursing leadership at the factor of service.

There are recognized two frameworks of stewardship: the

dominant and the keeping - as a capability to interpret the
actions of a steward in relation to the environment.
o Domination framework - In natural resource
management as well as in theology the domination of
framework is premised on the faith that the earth exists
to serve the needs of the human beings it is an instrument
for human purposes.
▪ John Patterson (2003), a theorist, contends that
the hierarchy exist between humans and non-
human in which the former has the higher rank
that the latter who serves the former. Within the
domination form work stewardship targets to
enhance natural sources for economic benefits.
o Keeping framework - Patterson argues that exploitation
and depletion of the environment has given upward
push to the keeping framework which is premised the
belief that surroundings has an intrinsic value, as well the
idea that human and non-human are interconnected.
 ▪ In Patterson’s terms, stewards till and keep the
surroundings or as he explains the stewards serve
and maintain the environment. Patterson stresses
that all folks are jointly accountable for the well-
being of the surroundings and that serving the
surroundings not only entails sacrifice however
embraces a balance between the pride of self-
interest and the need of the environment.

Nurse leaders as stewards

- Stewards as well practicing nurses who are looking for to preserve
and promote value at a point of provider may have an effect on
managers in their decisions about who ought to get hold of what
provider and how, and therefore impact change in healthcare
organizations.
- Nurse leaders are to have interaction others and work
collaboratively to establish and acquire a vision and motive that
impacts the well-being of a system or organization as an
alternative than promote their self-interest.
Leaders are either:

• Oriented to self - reflects the value of individualism (leaders

perceive themselves as the decision maker and others as
implementers.)
Oriented to the company or system - displays the value of
collectivism (holds as their precedence the well-being of the
agency exhibit respect to all its members. The system-oriented
leaders in healthcare organizations a point of provider as their
precedence and seek the input of nurses in setting collective
values)
In order for nurses to influence decision-making at the point of service
there is a need to invigorate nursing leadership.
Role of nurses as stewards
✓ The steward to self -to reach the realms of health and nursing
stewardship, it is important that nurse leaders participate in self-
development. Succession of preparing to grow and cultivate
and a new generation of innovative nurse leaders could be the
only way to do this.
✓ In order to meet the idea of Lifelong Learning Nurse Leaders or
stewards, mentors and personal trainers would need to be
used to assist them in developing abilities and improving skills.
Healthy nurse leaders will thus become visible and sound role
 models within their institutions to maintain a balance between
self-fulfillment and professional achievement.

1. Personal
Virtue Ethics of Stewardship

➢ Mcintyre, a communitarian theorist, believes that an individual

is a conceptual self that seeks meaning or good for itself
through the perception of everyday experiences.
➢ Virtues are important because they influence interpretation
decisions on what is important in experience. A virtue is
characterized as a quality in which a person can move
towards the accomplishment of a specific human goal.
➢ Character or reputation is established as virtues are typically
practiced. In creating a character, a person acts without
determining the proper outcome of his or her actions, rather
than acting in the expectation that the action is worthwhile.
➢ It can be claimed that personality influences the protection
and promotion of what is objectively important in one's
experience as a result of perceptual decision.
➢ When the character affects his exercise of judgment when he
obtains a discerning insight into the goods or their values and
thereby supports his value preferences.
Virtue Ethics in Personal Stewardship

➢ A nurse who demonstrates stewardship at the point of delivery

in compliance with Mcintyre's Theory of Ethics would make it
easier for nurses to explain their common ethical goals within
professional frameworks such as the Canadian Nurses
Association Code of Ethics.
➢ As a result, stewards and nurses will maintain and encourage
what is fundamentally important in patient care. It may also be
argued that, in order to enable nurses' discernment of
embedded values, nurses will progressively balance self-
interest with service to others.
2. Social

Social role of nurses as stewards.

➢ Health care has been listed as the number one public priority
in Canada-and nurses play a vital role in the healthcare
system. Nurses advocate for health promotion educating
patients and the public on disease and injury prevention,
providing treatment and helping to restore health, and
 providing support. No other health care provider has such a
wide and far-reaching role to play.
➢ Nurses help families learn to be healthy by helping to
understand the variety of emotional physical, mental and
cultural interactions they encounter during health and illness.
➢ Nurses do far more than care for people. They always have
always been at the forefront of innovation in healthcare and
public health.
➢ Nurses innovate. Florence nightingale known as the founder of
modern nursing is remembered as the lady with the lamp - but
she also collected evidence to determine that the key caused
of casualties in the Crimean war was not enemy weapon
infections due to insufficient sanitation - was a pioneering
statistician, perhaps the first person in history to use graphics
and charts to force lawmakers to act. Today 's university
educated nurses learn to trust their own first-hand findings in
order to produce valuable research information on important
topics.

3. Ecological

Ecological role of nurses in stewardship

➢ The nursing profession is well equipped to solve the problems of
reducing waste within medical systems.
➢ The health sector produces a large amount of waste that leads
to environmental problems such as air pollution and water
pollution.
➢ By uniting and engaging workers through shared governance,
nursing frameworks will decrease and overhead costs
associated with waste management.
➢ Nurses have the potential to use their trustworthy skills to guide
the way to more healthier communities and societies in which
they work.
-the emerging methods of waste management in healthcare.
-the nurses form the largest group in the health sector and are
skilled at informing research and eliminating waste.

4. Biomedical
Biomedical role of nurses in stewardship
Bioethics (Greek words bios means life and ethos means
behavior) is a branch of applied ethics that refers the discipline
dealing with the ethical consequences of biological science
 and application particularly in medicine. It includes questions
related to the beginning and end of human life.

Principle of totality and its integrity.

o The principle of totality implies that all decisions in the field of
medical ethics must give priority to the welfare of the whole
person, considering physical and spiritual factors. This principle
was derived from the works of St. Thomas Aquinas, a medieval
philosopher who synthesizes Aristotle 's philosophy with
theology. The principle of totality is being used as an ethical
standard by Catholic health institutions.
o According to the philosopher Thomas Aquinas, all organs as
well as other parts of the body exist for the sake of the whole
individual. Because the intent of the part is to serve the whole,
any intervention that damages or prevents a part of the body
from achieving its objectives, infringes the natural order and is
morally wrong. This is called the principle of totality. However,
a single part may be chosen to sacrifice if the loss is essential
for the benefit of the whole person. For instance, the principle
of totality would justify the amputation of a gangrene limb
because the person could perish if the gangrene spreads.

A. Ethico-moral Responsibility of Nurses in Surgery

✓ Codes of ethics for the nursing profession tend to
concentrate on professional conduct and to ensure that
decision-making is as patient-driven as possible.

o Respect for other people

▪ The nurse must respect the dignity and
value of patients and colleagues and treat
all persons equally regardless of personal
characteristics or health problem. Related
to this is the obligation to always respect the
patient's right to self-determination in
medical care.
o Commitment to Patient
▪ One of the key ethical duties of the nurse is
to collaborate with the patient in order to
provide treatment that will optimize the
physical, mental and social well-being of
the patient. The nurse is also responsible for
 preserving and facilitating patient safety
and rights, in particular in terms of
maintaining the highest standards of
privacy and confidentiality in compliance
with the law.
o Honesty and Self-Integrity
▪ Nurses also have an ethical responsibility to
be honest with patients and colleagues,
and to maintain self-integrity and high
personal moral standards. By the same
token, nurses have a personal responsibility
to maintain professional competence and
strive towards personal and professional
growth so as to provide the best possible
care to patients.
o Professional Responsibilities
▪ The nurse also has a variety of ethical
obligations related to the nursing profession
and its specialization. A central obligation is
always to aim to change both the health
care system and the conditions of workers in
order to optimize the efficiency of health
care delivery.

B. Sterilization
o Sterilization may be described as any medical or surgical
intervention which renders a patient woman or a man
incapable of procreation naturally or operationally temporarily
or permanently.
Classifications:

o Sterilization may be classified according to different methods

employed. These include both surgical and non-surgical
methods.
o The surgical methods were the earliest employed. They involve
the inhibition of the reproductive organs male or female by
operating on any of the various parts.
For example, the surgical method used in females includes:
▪ Oophorectomy or removal of the ovaries that produce
germ cells.
▪ Salpingectomy ligation or destruction of the fallopian
tubes
▪ Hysterectomy or removals of the uterus.
 For men:

▪ Castration or removal of the testicles.

▪ Vasectomy or ligation or removal of the vas deferens
▪ Emasculation or suppression of the male genital organ

o Some of these interventions are brutal and outdated. However,

tubal ligation and vasectomy are still common today. Four
chosen birth control programs are considered in developing
countries. These methods have limited adverse effects. Even
after depletion of reproductive ability, they do not affect
sexual appetite.
o The non-surgical approach involves preventing the maturation
of the ovum through the use of pharmacological agents.

o A different classification is used from a legal point of view. The

reasons for sterilization, rather than the procedure, are
considered. Sterilization is classified as:
▪ Eugenic sterilization-to prevent the birth of a deficient
or deceased offspring. The law of eugenic sterilization
had first been approved in Indiana USA in 1907. Many
who suffer from presenile dementia epilepsy and
manic-depressive disorder become eligible for this
form of sterilization.
▪ Therapeutic sterilization: the removal of a defective
reproductive organ that endangers the health of the
patient. This is exemplified by the removal of the
cancerous uterus.
▪ Contraceptive sterilization: whether organic or
mechanical, it consists of suppressing ovulation in a
female that makes her sterile.
Ethical evaluation
o Before we discuss various ethical problems related to
sterilization, it is important to differentiate between direct and
indirect sterilization.
a. Indirect or therapeutic sterilization is what is not itself sought.
It is the result of a therapeutic treatment of a deceased
organ demanded by the health or life of the person. The
treatment is not geared towards sterilization, but sterility is
the product of comprehensive removal of pathological
tissues.
 o The morality of these actions is based on the concept of
totality, inasmuch as reproductive organs are like other
organs, i.e. essential parts that must serve the greater
good.
b. Direct sterilization by its very nature has only one immediate
effect: rendering procreation impossible. This involves so-
called preventive sterilization. Pregnancy, according to its
proponents, can aggravate some of the diseases

o Sterilization is immoral, despite good intentions to avoid

potential pregnancy-related illnesses. Obstetrics has
advanced so much today that these severe issues of high-risk
pregnancy are well handled in modern hospitals.
o In summary, researchers conclude that it is only necessary to
conduct indirect sterilization, i.e. that which results from the
therapeutic means used to cure a disease person. This can be
achieved either through operation, the removal of the
defective organ of the ovary, uterus, testicles, or through
pharmacological agents that have developed secondary
sterility. Other approaches, such as eugenic sterilization,
preventive or punitive sterilization, are all religiously illegal.

C. Preservation of Bodily Functional Integrity.

o The human body is an integral part of the human being and thus
deserving of human dignity. It must be kept whole. No body part
should be removed mutilated or incapacitated unless doing so is
appropriate for the wellbeing of a more important body part or
the body as a whole. An unessential or redundant body part can
be removed for the benefit of person.
o Human nature is a convergence of body and spirit. These two
dimensions can never be separated. The human body retains the
dignity of the individual being. To decapitate the body or
otherwise, human dignity is violated by treating the human being
as a machine or as an object to be used and discarded.
1. There is no morality whatsoever involved in cutting down
the mere anatomical completeness of the body.
2. It is immoral to lessen the functional perfection and
comprehensiveness of the body when such a factor is not
needed for the sustainability of the health and life of the
whole body.
 3. Since the whole is greater and more important than any
of its parts, it is morally permissible to reduce the functional
completeness of the body when it is the only efficient way
of ensuring a person's health or life.

o The principle of totality validates a series of surgical procedures

done in daily clinical practice. Particular operations to not in
present moral problems if surgical ablation involves these diseased
organs such as the appendix, gallbladder, kidneys, lungs, and
other organs. Difficulties are encountered in cases of cosmetic
procedures, organ transplantation and, above all, for sterilization.

D. Organ transplants and donation

o Transplant can be defined as the transfer of an organ or a major
or minor portion of the tissue from one area of the body to another
or from one organism to another. It should be noted that the
development and advancement of the transplantation
technique is part of the medicine during 20th century.
o In clinical practice alongside blood transfusion, the foregoing
have been ordinary: Corneal transplant, bone transplant, skin
grafting, heart valve transplant and other transplants. The first
successful kidney transplant between monozygotic twins was
performed in 1954. Since then, thousands of patients have
survived by kidney transplants all over the world. Several other
transplants have indeed been performed, including heart
transplantation, liver transplantation, lung, pancreas, and so on.
o Terminology transplants can be classified as:
1. Auto transplant (autografts or autoplastic grafts): the
donor and the recipient are the same person. The
transition is from one part of the body to another, like a
piece of the skin or bone.
2. Heterologous transplants: the donor and the recipient
are two separate people. In certain situations, the donor
is an animal, more often it is just any human being. The
latter is often referred to as homo transplantation
(homograft) homoplastic grafts or homologous
transplantation. Within the subtype of human to human
organ transplantation, there are two possibilities
from either living the person or from a dead body.

o Ethical evaluation
 ✓ Auto transplantation is generally considered to be lawful for
the same purpose as ordinary surgery). Hetero transplants
involving animal donors are now deemed to be legal.
✓ Likewise, the transplantation of organs collected from
cadavers is legal if it is carried out in compliance with civil
law. Natural law forbids the handling of a human cadaver
literally as a product or as an animal. If there is no law on
transplantation, the donor's permission must be obtained
before he or she dies; otherwise, the family must give
the authorization.
✓ Homologous transplants between two living individuals
became the subject of many arguments between the
ethicist and the moralist. Some have dismissed this as a form
of mutilation. However, these transplants are today justified
by the so-called Principle of Finality: "A healthy individual
may willingly donate any part of his body that is not essential
to his life without contradicting nature for the benefit of a
sick neighbor." Done out of kindness, which is often the
case, his gestures are not only validated, and therefore
also meritorious. Organ donation is fostered among
Christians today as a way to imitate Jesus Christ, who gave
his life for many. (Mark 10:45 a.m.)

o Certain requirements govern transplants between two living

people, which tend to be completely rational. In order to make it
moral, the following requirements are needed
➢ On the part of the donor: That the organ is purely non-
essential to life, that the donation is willing, not forced or
pressured even by family, that it is done for noble reasons
and that the donor clearly understands the risk involved.
➢ On the part of the recipient: That the transplant is absolutely
important for his or her wellbeing.
➢ On the part of the procedure: that the procedure has a fair
chance of success and that the gain to the recipient and
the expense to the donor is proportionate.

o Criteria on donation
➢ There have been a lot of discussions in the past about organ
donation. The medical requirements for patients eligible for
organ donation must be strictly observed once a diagnosis of
death has been identified.
➢ Relevant requirements are further suggested for potential
kidney donors, the most often transplanted organs. The
specifications shall include:
 • 18 to 55 years of age , for example, and
• No current nephropathy, malignant phase (except for
brain tumors), diabetes mellitus communicable or
infectious disease with serum-positive hepatitis syphilis.

o Key legal issues concerning transplantation:

➢ Confirmation of the exact date of death of the donor before
continuing with the extraction of organs and
➢ The legal existence of the cadaver: who has the authority or
control over it, who may decide on its use for medicinal
research purposes, etc.

Principles of ordinary and extraordinary means

➢ Ordinary interventions are those that are based on medications or
services that are readily available and can be administered
without incurring significant discomfort, expense or other
inconvenience, but which offer the patient in question a
reasonable hope for an effective improvement in his or her health.
➢ Extraordinary measures are those focused on medicine or therapy
that cannot be used without incurring serious discomfort, expense
or other inconvenience. However, their application would not
give the patient a fair chance for a significant change in his
health.
➢ When judged from an ethical point of view, it is important to
differentiate between, on the one hand, life-longing interventions,
the implementation of which is morally necessary (ordinary
measures)-as they are likely to improve the patient-and, on the
other hand, those interventions that can be applied optionally
(extraordinary measures) as the benefit to the patient is not
immediately apparent or open to consideration.
➢ These limitations were already illustrated in 1957 by Pope Pius XII,
who pointed out that life, health and earthly acts are entrusted,
and therefore subordinated, to spiritual ends.
➢ Death is seen as an integral part of life, because, according to
Christian teachings, death is not the end, but the transition to a
new life.

The principle of personalized sexuality

➢ The gift of sexuality must be used in accordance with human
teleology. Personalized sexuality is based on the concept of
sexuality as one of the essential characteristics of an individual
 and must be established in a way that is compatible with the
enhancement of human dignity.

➢ The Catholic Church is fascinated with sexual morality. The

explanation for the emphasis on sexual morality in the teaching of
the Church is that this aspect of human character too frequently
leads to a lack of integrity and an unwillingness to fulfill the real
purpose of human life.

➢ In the Jewish Christian tradition, which is based on the first chapters

of the genesis of human sexuality, the family is often seen as the
basic community in which we are born and educated and on
which the larger society is founded. Sexuality is also not just a
private matter, although it includes the most personal of
relationships. It also affects the general good of society and
acquires its public support and protection at the heart of the
social organization.
➢ The principle of personalized sexuality can be described as
follows. The gift of human sexuality must be used in marriage, in
accordance with its inherent indivisible, explicitly human
teleology, as a caring, physical, satisfying expression of a man's
and a woman's complementary, permanent self-giving to one
another, which is also a fruitful perpetuation and extension of that
personal communion through the family they engender and
teach.

➢ Norms of sexuality
▪ 1 Laws or social attitudes that impede human freedom to
accomplish these values in the way that individual desires are
unjust and oppressive.
▪ 2 Sexual behavior, at least among responsible adults, is
essentially a private matter to be decided by personal choice,
free from any moral guilt.