Nursing Leadership and Management

BS NURSING / FOURTH YEAR

STUDENT ACTIVITY SHEET
Session # 8

LESSON TITLE: MORAL AND SPIRITUAL Materials:

RESPONSIBILITIES OF NURSES
Book, pen and notebook, and index card/class list
LEARNING OUTCOMES:
References:
Upon completion of this lesson, the nursing student can:
Lydia M. Venzon RN, MAN, FPCHA Ronald M.
1. Define the Good Samaritan Act; Venzon RN, MAN (2010), Professional Nursing In
2. Enumerate the Moral Principles; and, The Phillippines 11th Edition: C & E Publishing, Inc.
3. Recognize the spiritual commitment of nurses. 839 EDSA, South Triangle, Quezon City

LESSON PREVIEW/REVIEW
Based on the previous lesson, give the 5 Universal Principles of Biomedical Ethics and briefly define each:
1.

2.

3.

4.

5.

MAIN LESSON

NURSES, whatever their religion, must be God-loving and God-fearing. They must realize that the nursing profession is
a commitment both to God and people. They should emphasize the importance of providing spiritual care as a vital aspect of
nursing care. They must uphold the sanctity of human life.

MORAL PRINCIPLES
When a nurse is confronted with situations where moral judgment is necessary, the nurse may be guided by the
following principles or rules:
1. The Golden Rule. God said, "Do unto others what you would like others do unto you." Since nurses like others to
treat them kindly and with respect, they should be willing to do the same to others too.
2. The Two fold Effect. When a nurse is faced with a situation which may have both good and bad effects, how
should she choose which one to follow? The basis of action may be the following:
a. that the action must be morally good;
b. that the good effect must be willed and the bad effect merely allowed;
c. that the good effect must not come from an evil action but from the initial action itself directly; and
d. that the good effect must be greater than the bad effect
It is not morally good if a boy steals in order to alleviate his hunger because the action itself is already bad. On the
other hand, if a patient who has cancer of the uterus submits to hysterectomy she will not be able to bear a child.
If she doe, not have the operation, she will die. It is the gynecologist's intention to help the mother and not to harm
her. The surgeon's action is morally good since saving the mother's life is of primary importance. Also the doctor
himself did not will that the patient lose her child-bearing function.
3. The Principle of Totality. The whole is greater than any of its parts. Suppose a man's foot is gangrenous, should
he consent to an amputation? Since the amputation will save the patient's life and he can still walk through the aid
of crutches or artificial limbs, he can consent to an operation. The nurse can help the patient understand this.
4. Epikia. "Exception to the general rule." It is a reasonable presumption that the authority making the law will not
wish to bind a person in some particular case, even though the case is covered by the letter of the law. If a mental

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 patient went berserk and the doctor could not be contacted, the patient may be restrained by virtue of epikia.
Another example of this is allowing a relative to see a seriously ill patient who expresses the desire to see the
former although it is not yet visiting hours.
5. One who acts through an agent is himself responsible. For example, a patient wants to have an abortion and
asks a nurse if she can do it. The nurse refuses, but then recommends a doctor who is capable of performing an
abortion. The nurse becomes liable to such a crime, since he/she is an accomplice of the said doctor.
6. No one is obliged to betray himself/herself .In testifying before a court, no one can force any person to answer
a question if such will incriminate him/her.
7. The end does not justify the means. Giving a sleeping tablet to a chronically ill person so he/she can die in
peace is morally wrong.
A physician in the United States assisted a woman, diagnosed as having Alzheimer's disease, in committing
suicide. This is both legally and morally wrong.
8. Defects of nature may be corrected. Patients with a harelip or cleft palate may have their defects corrected by
plastic surgery.
What shall be the role of the nurse in a case in which parents of a severely deformed newborn child
(Down's Syndrome with intestinal atresia) refuse to feed and allow their child to starve to death?
Withholding nutrition can constitute nursing neglect and expose the nurse to criminal charges of
negligence or conspiracy to commit murder.
9. If one is willing to cooperate in the act, no injustice is done to him/her. Suppose a patient subjects
himself/herself willingly to an experimental drug and he/she has been told of the possible effects of the same, is of
right age, and is sane, there is no violation of human rights.
10. A little more or less does not change the substance of an act. If a nurse gets medicine from a hospital stock
without permission or without prescription, he/she will be guilty of theft even if he/she got only one tablet of the
same.
11. The greatest good for the greatest number. During an epidemic, immunization against communicable diseases
is administered to the people. Although there may be some who may have slight reactions to the vaccine, the
greater majority of the population shall be considered rather than the isolated few. This is called the utilitarian
principle.
12. No one is held to the impossible. To promise that a patient with heart transplant will live may be an impossibility.
Yet, such procedures are done in the hope of saving or prolonging a patient's life. The doctor or the nurse cannot
be held to the impossible if they have done their best to take care of the patient and the latter dies.
13. The morality of cooperation. Formal cooperation in an evil act is never allowed. Immoral operations such as
abortion shall not be participated upon by a nurse even if the doctor commands it.
14. Principle relating to the origin and destruction of life. one of God's commandments is "Thou shall not kill." If
God has given man a life, will it mean that God has already ceded his right to man? And if life contains with it a free
will for man to perform what he thinks is best for him and his environs, where, then, does the right of God begin?
Where does the right of man begin or end? Assuming that God gave life to man, who will know that God does
abhor a man who takes his own life? Man may appear only a puppet of God, if God will not let go of his
creation—man— to do what is best for him, i.e., including euthanasia.

Euthanasia is direct killing of people who may not have committed any crime deserving of death, but because of
mental or physical defects, are considered worthless to society. Mercy killing is not allowed because it will lessen the
incentive for medical research. It will also be possible to arrange for the death of an enemy or a wealthy relative. Many
patients surprise doctors by recovering from illness. In legalized euthanasia, they are already dead.
Giving of narcotics to a dying person shall be withheld if there is no physical pain. He must be left conscious for as
long as God does not take his consciousness away.
The state recognizes the sanctity of human life. It shall protect the life of the mother and the unborn from the time
of conception. Any direct attack on the life of a fetus for whatever cause is immoral. A fetus shall be buried in
consecrated grounds. If it is dead and came from a dead mother, it shall be buried with the mother.

SPIRITUAL COMMITMENT OF NURSES

When we speak of holistic care this means that the spiritual aspect is included as well.
The Code of Ethics' for Filipino nurses lists provision of spiritual environment as one of the responsibilities of the nurse
Christian nurses often refer to the Bible for inspirational passage that will enhance and strengthen their love and concern for
their fellowmen. Muslims find appropriate passages in their Quran.
St. Paul's message to the Colossians is very apt for nurses. He said, "You are the chosen people of God. He loves you
and chose you for His own. So then, clothe yourselves with compassion, kindness, humility, gentleness, and patience."
The nurse's ministry is reflected in God's two great commandments: "Love the Lord God with all your heart, and with all
your soul and with all your mind" and "Love your neighbors as yourself."

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 The role of nurses in providing non-prejudicial, non-discriminatory care can well be based on the story of the good
Samaritan. God has asked us to love one another as He loves us.
Jesus' healing ministry includes among others, enabling blind men to see' and the hemorrhaging woman to be healed as
she touched His garment.' He has exhorted us, "not to become tired of doing good, for if we do not give up, the time will
come when we will reap the harvest."
Doing one's duties with a cheerful heart does good like medicine but a broken spirit makes one sick.
God gave assurance that man will inherit the kingdom of God, "for whenever we feed the hungry, give water to the
thirsty, take in a stranger, and visit those in prison, we have done these to God."
Patients and families who are troubled with illness or anxiety will certainly look up to a compassionate nurse for
understanding and kindness. There are times, however, that the patient and/ or his family may need the assistance of a
nurse in calling a priest or minister of their faith. Many hospitals have resident priests or chaplains and addresses of
ministers or imams who can be called immediately upon request.
Stillbirths of Catholic parents are given emergency baptism by saying, "I baptize you (give the name), in the name of the
Father, and of the Son, and of the Holy Spirit."
If there is danger of death, Roman Catholic patients are obliged to receive the sacraments. Confession and communion
are recommended. If the patient is admitted to the hospital, he/ she must be informed of the availability of a priest to care for
his/her spiritual needs. The nurse is obliged to call the priest when needed.
When danger of death is remote, reference when priest is making rounds is sufficient. When a patient is receiving;
opiates, delay its administration until the priest arrives so that the patient can have the opportunity to express sorrow for
his/her sins and make his/her confession.
The non-Roman Catholic patient likewise looks up to his or her minister for spiritual guidance. A prudent nurse
anticipates this need of the patient and makes arrangements that the minister or imam is contacted. In the absence of one,
a nurse can read favorite passages from the Bible for the patient. The Lord's Prayer may be recited for or with the patient.
Muslim nurses provide comfort and prayers to patients of the same faith by quoting passages from the Quran. "Patients
are encouraged to put their trust in Allah for He is compassionate and merciful and shall relieve them of their burdens."
"Allah is the Lord of kindness to believers; He is their protector and the best of their helpers;" He loves those who put
their trust (in Him)" and He loves those who do good. In serving the sick and the dying, Allah assures that for those who keep
their duty to the Lord, for them are Gardens underneath which rivers flow, wherein they will be safe forever."
In general, it is the nurse who recognizes the spiritual needs of the patient and gives the latter peace of mind and comfort
to face what lies ahead of him/her.

THE GOOD SAMARITAN LAW

There are many persons who refuse to give emergency aid to victims of accidents due to liabilities they may incur later.
Although no one is legally compelled to do so, it will not be ethically and morally right to leave persons without aid especially
if one has the skill and the knowledge to save lives.
In the United States, the Good Samaritan Law has been passed to encourage on-the-spot volunteer first aid in
emergency situations by persons with the proper knowledge and skill. A nurse therefore who renders first aid or treatment at
the scene of an emergency and who does so within the standard of care, acting in good faith, is relieved of the
consequences of the act.
The Good Samaritan Act is based on the biblical story of a man who aided an injured person who was waylaid by
thieves and was left half-dead. The Samaritan took care of him with compassion, bound up his wounds, brought him to an
inn, and took care of him." Jesus told the story of the good Samaritan to illustrate how we can love our neighbors.

NURSES AND SUFFERING

Nurses observe human suffering everyday—patients in pain, others suffering emotionally, or may even be dying.
Nurses who have emotional and spiritual maturity are more able to assist patients who are depressed, fearful or confused
about the outcome of hospitalization or illness to them.
A Christian nurse's duty is not only to give physical care but to pray for or with them so that they may also have spiritual
healing and to make them feel that God is with them always. Psalm 23 says, "Ye though I walk through the valley of the
shadow of death, I shall fear no evil, for Thou art with me —Thy rod and Thy staff they comfort me." This will make them feel
that God cares for them so that they may find strength and encouragement in the midst of pain and suffering.'

LIFE IN GOD'S SERVICE

Nurses can use their different gifts in accordance with the grace that God has given them. If their gift is to speak God's
message, they should do it according to the faith that they have; if it is to serve, they should serve; if it is to teach, they should
teach; if it is to encourage others, they should do so. Whoever shares with others should do so generously; whoever has
authority should work hard; whoever shows kindness to others should do so cheerfully.

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CHECK FOR UNDERSTANDING
You will answer and rationalize this by yourself. This will be recorded as your quiz. One (1) point will be given to correct
answer and another one (1) point for the correct ratio. Superimpositions or erasures in you answer/ratio is not allowed. You
are given 20 minutes for this activity:

Multiple Choice

1. “Exception to the general rule” refers to what moral principle?

a. Epikia
b. The Golden Rule
c. The two-fold effect
d. The principle of totality
ANSWER: ________
RATIO:___________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________

2. God said, "Do unto others what you would like others do unto you." This moral principle is
a. Epikia
b. The Golden Rule
c. The two-fold effect
d. The principle of totality
ANSWER: ________
RATIO:___________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________

3. The whole is greater than any of its parts. Refers to

a. Epikia
b. The Golden Rule
c. The two-fold effect
d. The principle of totality
ANSWER: ________
RATIO:___________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________

4. When a nurse is faced with a situation which may have both good and bad effects, how should she choose which one to
follow? The basis of action may be the following: SATA
a. that the action must be morally good;
b. that the good effect must be merely allowed and willed the bad effect ;
c. that the good effect must not come from an evil action but from the initial action itself directly; and
d. that the good effect must be greater than the bad effect
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
_______________________________________________________________________________________________

5. Giving a sleeping tablet to a chronically ill person so he/she can die in peace is morally wrong. This is based on the
principle
a. One who acts through an agent is himself/herself responsible.
b. No one is obliged to betray himself/herself.
c. The end does not justify the means.
d. Defects of nature may be corrected.
ANSWER: ________
RATIO:___________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________

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6. Patients with a harelip or cleft palate may have their defects corrected by plastic surgery. This is stated in what moral
principle?
a. One who acts through an agent is himself/herself responsible.
b. No one is obliged to betray himself/herself.
c. The end does not justify the means.
d. Defects of nature may be corrected.
ANSWER: ________
RATIO:___________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________

7. In testifying before a court, no one can force any person to answer a question if such will incriminate him/her. This is
supported by the moral principle.
a. One who acts through an agent is himself/herself responsible.
b. No one is obliged to betray himself/herself.
c. The end does not justify the means.
d. Defects of nature may be corrected.
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________

8. During an epidemic, immunization against communicable diseases is administered to the people. This is based on the
moral principle
a. The greatest good for the greatest number.
b. A little more or less does not change the substance of an act.
c. The morality of cooperation
d. Principle relating to the origin and destruction of life.
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________

9. Immoral operations such as abortion shall not be participated upon by a nurse even if the doctor commands it. This is
stated on the moral principle
a. The greatest good for the greatest number.
b. A little more or less does not change the substance of an act.
c. The morality of cooperation
d. Principle relating to the origin and destruction of life.
ANSWER: ________
RATIO:___________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________

10. This is based on the biblical story of a man who aided an injured person who was waylaid by thieves and was left
half-dead.
a. Good Samaritan Act
b. Euthanasia
c. Dying patient’s bill of rights
d. Christian Nurse’s duty
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________

RATIONALIZATION ACTIVITY (THIS WILL BE DONE DURING THE FACE TO FACE INTERACTION)
The instructor will now rationalize the answers to the students. You can now ask questions and debate among yourselves.
Write the correct answer and correct/additional ratio in the space provided.

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1. ANSWER: ________
RATIO:_______________________________________________________________________________________
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2. ANSWER: ________
RATIO:_______________________________________________________________________________________
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3. ANSWER: ________
RATIO:_______________________________________________________________________________________
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4. ANSWER: ________
RATIO:_______________________________________________________________________________________
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5. ANSWER: ________
RATIO:_______________________________________________________________________________________
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6. ANSWER: ________
RATIO:_______________________________________________________________________________________
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7. ANSWER: ________
RATIO:_______________________________________________________________________________________
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8. ANSWER: ________
RATIO:_______________________________________________________________________________________
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9. ANSWER: ________
RATIO:_______________________________________________________________________________________
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10. ANSWER: ________
RATIO:_______________________________________________________________________________________
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LESSON WRAP-UP

You will now mark (encircle) the session you have finished today in the tracker below. This is simply a visual to help you
track how much work you have accomplished and how much work there is left to do.

You are done with the session! Let’s track your progress.

AL Strategy: One-Sentence Summary

This closure activity is to evaluate what you learned after the discussion and the activity.
Give one-sentence summary about The Good Samaritan Law.

_________________________________________________________________________________________________

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