UNIT 1 E PRINCIPLES OF

STEWARDSHIP:
THE ROLE OF THE NURSE AS STEWARDS
 Steward from Old English “stig” meaning house, +“weard”
=steward – meaning housekeeper, or guardian
a person whose job is to manage the land and property of another person

God has absolute dominion over His creation

Man given a limited dominion over creation and are
responsible for its care ( as caretakers)
The gifts of human life, its natural environment be used with
profound respect for their intrinsic ends
The gift of human creativity be used to cultivate nature and the
environment
To recognize the limitations of our actual knowledge and the
risks of destroying these gifts
 NURSES AS
STEWARDS…
Personal STEWARDSHIP:

• nurses engage with the development of self,

• develop and nurture a new generation of transformational nurses,
• refining of skills and improving competencies,
• become visible and sound role models within their institutions to
maintain the balance between self and professional fulfilment
STEWARDSHIP TO NURSING:

• to address the ever-changing nature of the work of a nurse,

• refine evidence that supports the essential and exclusive contributions
of the professional nurse in outcomes of care and prevention,
• to make practice environments more positive, healthy and engaging,
• to collaborate with regulatory boards to improve on standards of
practice, certification and accreditation, thus ensuring that standards
and regulations support the nurse of the future and new models of
care delivery, and remain true to a patient/population-centered health
care system
SOCIAL STEWARDSHIP:
Impacting the community in many ways by:

• Working closely with local communities to drive meaningful poverty alleviation

and improve quality of life.
• This is done through a range of programs that covers education, training and skills
upgrade, and healthcare.
• Program of education and empowerment:
• training centers focused on sustainable programs (ie. Farming)
• Development programs, designed to equip with training and support. (SME’s)
• Program of Healthcare:
• improve access to healthcare for communities in rural areas
• engage and educate communities on health, hygiene and nutrition.
• training of healthcare givers, raising the standard and quality of health check-ups
ECOLOGICAL (ENVIRONMENTAL)
STEWARDSHIP
• Meaning: refers to responsible use and protection of the natural environment through conservation
and sustainable practices. To ensure the conservation and preservation of natural resources and values
for the sake of future generations of human and other life on the planet.
• The main benefits of environmental stewardship are:
• conserving natural resources,
• combating pollution,
• and protecting biodiversity
• In more practical terms: Reduce, Reuse, Recycle
• Reduce the number of shopping bags or use reusable bags
• Reduce the water usage, repair leaking taps immediately, slow the flow of water
• Reduce the amount of fuel you use by choosing smaller, lighter vehicles. Carpool. Live close to where you work.
Use public transit if you can.
• Reduce waste!
• Live in such a way that your life, your needs and wants do not negatively influence the world around you.
BIOMEDICAL STEWARDSHIP:
• In health this is caring not destroying of man’s body in reproductive
technology and terminal illness;
• it is the correction of defects and not merely perceived body
improvements in reconstructive and cosmetic surgery (Extreme
makeover?)
• it is just budget allocations in public health policy to liberate all
from disease
• It is performing research that seeks good for mankind and protects
the human subject from harm
• It is providing education that develops intellect and character of the
healthcare provider to manage & steward finite resources
 CASE STUDY
• Donna Johnson is a 40-year-old woman who is the CEO of a small manufacturing company.
Her job is stressful and she has a long history of headaches, but recently she feels the
headaches are increasingly frequent despite her efforts to manage them with stress reduction.
She has a neighbor who recently was diagnosed with a malignant brain tumor who also had
headaches, and she is asking her family doctor, Dr. Hernandez, to order a computerized
tomography (CT) scan to be sure she does not have a tumor.
• Dr. Hernandez takes a detailed history and rules out any other neurologic symptoms. Her
complete physical examination, including a careful neurologic examination, is all normal. Dr.
Hernandez concludes that these are tension headaches and discusses this with the patient. Ms.
Johnson would like a CT scan just to be 100% sure, but Dr. Hernandez does not think it is
clinically indicated. Furthermore, the test is expensive, even though the patient has insurance
that would cover it. Dr. Hernandez thinks to herself that it is just easier to order the test than try
to explain the risks and benefits to a worried patient.
 PRINCIPLE OF TOTALITY & ITS
INTEGRITY
Meaning: The human body is an integral part of the human person and is therefore worthy of human
dignity. It must be kept whole. No body part should be removed, mangled or debilitated unless doing so
is necessary for the health of a more essential body part or the body of a whole (Tonsillectomy or
Appendectomy). An unessential or redundant body part may be removed for the good of another person
Explanation
• Human nature is an integration of body and spirit. These two dimensions can never be separated (in
fact, separation of the spirit from the body is the definition of death). The human body shares in the
dignity of the human person. To dismember the body or to otherwise deface it abuses that dignity by
treating the human person as a machine or as a thing to be used and discarded.
Applications
• Surgeries that needlessly remove body parts or organs are immoral (circumcision)
• Tattoos and piercings are not inherently immoral but they may be immoral if they deface the body by
quantity or content.
• Torture is a moral evil because it seeks to dis-integrate the body and the spirit
 PRINCIPLE OF TOTALITY AND ITS INTEGRITY
1. Ethico-moral responsibility of Nurses in Surgery:

• Check patient understanding regarding surgery with all its pros and cons
and alternative therapies which has been explained by the attending
physician and obtain written consent, mindful of patient autonomy

2. Sterilization/Mutilation

3. Preservation of Bodily Functional Integrity

4. Issues on Organ Donation

2. Sterilization/Mutilation
• Because permanent contraception (sterilization) is an
irreversible procedure requiring surgery, it is nurses’ duty to
counsel clients so they can give informed voluntary consent
to the procedure
• Female genital mutilation (FGM), which involves partial or
total removal of the external genitalia, or other injury to the
genital organs for non-medical reasons -it is nurses duty to
report cases, to protect young women from going through
this procedure
How Peru forced poor women to get sterilized
https://nypost.com/2019/12/07/how-peru-forced-poor-women-to-get-sterilized-and-robbed-one-mother-of-her-
life/

When a government team held a “ligation festival” to register women for sterilization in La
Legua, Peru, Celia Durand resisted. The 31-year-old mother of three was appalled at the
pressure tactics government health workers used to induce women to have tubal ligations, her
husband, Jaime, said. Not only did they go house-to-house to round up candidates, but they
paid repeated visits to those who refused to comply. A simple tubal ligation gone wrong sent
Celia early to the grave. In Peru, what was originally sold to the country as an altruistic
program aimed at helping poor women was, in fact, a targeted attack on the fertility of the
Quechua-speaking women who live in the high Andes. The goal, to put it bluntly, was fewer
indigenous children.
Female genital mutilation
By Charlotte Santry, Freelance health writer
Monday 13th June, 2016 https://www.nursinginpractice.com/female-genital-
mutilation

Thousands of women living in the UK have suffered genital mutilation, a practice

classed as 'torture' by the United Nations.

• Nurses have been given specific legal duties to help put a stop to the barbaric procedures
that can leave young girls with life-long pain, urinary problems, trauma, infections such
as HIV - and can even cause death.
• It has been mandatory for nurses to inform the police whenever they come across a
patient aged under 18 who has been subjected to female genital mutilation (FGM), which
involves partial or total removal of the external genitalia, or other injury to the genital
organs for non-medical reasons.
3. Preservation of Bodily Functional Integrity
- it is the right not to have your body touched or your body interfered with, without
your consent
• Bodily autonomy protects a person's capacity to make his or her own decisions in
relation to his or her body
• The right to bodily integrity is conceptually different. It provides for a person's
exclusive use and control over his or her body
• The right to bodily integrity is akin to a property right; the right to bodily integrity
“literally and figuratively provide the necessary walls” to separate oneself from others
• It is the healthcare providers (doctors/nurses) duty to provide information that is
relevant to a treatment decision to make an informed consent
• Examples: gender reassignment surgery, circumcision, FGM, sterilization
• "Respect for bodily integrity," states in part: "Except when performed for
strictly therapeutic medical reasons, directly
intended amputations, mutilations, and sterilizations performed on
innocent persons are against the moral law." The American Heritage
Dictionary defines amputate as "To cut off (a part of the body), esp. by
surgery," and it defines therapeutic as "Having healing or curative
powers." In 1999 the American Academy of Pediatrics described
circumcision as "amputation of the foreskin," and the American Medical
Association called elective circumcision "non-therapeutic" (Council on
Scientific Affairs 1999). Elective circumcisions are directly intended,
nontherapeutic amputations of healthy foreskins. As such, they do violate
the moral law.
• http://www.cirp.org/library/cultural/fadel2/
 Organ donation involves removing a healthy organ
Issues on Organ Donation from a donor and transplanting it into the body of a
recipient who has a diseased organ that has failed
The advent of organ transplantation was a irreversibly. The recipient’s survival often depends
landmark in the history of medicine. on getting an organ transplant.

• There is a large need for organs by people affected with end-stage ailments, like diseases of
the liver, lung, heart and kidney
• Some Issues on Organ Donation:
• there aren’t enough donated organs around the world
• There are also personal, religious and cultural barriers that make it hard for people to accept the idea of
organ donation
• Due to a lack of awareness of the donation procedure and its consequences, most people prefer receiving
organs from live, instead of recently deceased, donors.
• Ethical issue: a living donor has to undergo a major surgical procedure to donate an organ, and such
procedures carry their own risks
• Commercialization: it’s very easy to provide monetary incentives to the poor and convince them to
donate an organ in return, not as a result of free choice
• Willingness on the part of some recipients to accept high-risk organs often comes down to a life-or-death choice.
The case of two-year-old Sophia M. Hoffman is a clear example.
Declared brain dead, there was no hope she would recover. But if
doctors moved quickly, they could use her healthy organs to help as
many as eight other children.
There was a major complication, however. Authorities in rural
Clearfield County suspected foul play, and to prove it, they wanted
an autopsy of the child’s intact body to provide an official cause of
death.
It was the perfect showdown between two determined opponents
committed to their unique roles in the equally important missions
of saving lives, protecting the public and ensuring justice.
PRINCIPLE OF ORDINARY & EXTRAORDINARY MEANS
• Ordinary measures are those that are based on medication or treatment which is directly available and
can be applied without incurring severe pain, costs or other inconveniences, but which give the patient
in question justified hope for a commensurate improvement in his health. This is obligatory.
• Extraordinary measures are those that are based on medication or treatment which cannot be applied
without incurring severe pain, costs or other inconveniences. Their application, however, would not
give the patient any justified hope for a commensurate improvement in his health. Not morally
obligatory.
• Assessed from an ethical point of view, it is possible to distinguish between on the one hand life-
prolonging measures the application of which is morally obligatory (ordinary measures) - as they are
likely to help the patient - and on the other hand those measures which can be applied optionally
(extraordinary measures) as the benefit to the patient is not immediately obvious or subject to
considerable debate.
• In cases where a treatment is ethically extraordinary and simultaneously futile and the patient and/or
family demand such treatment, doctors and health care facilities are not legally or morally obligated to
provide such treatment.
 Case Studies
1. An infant is born with Down’s 2. A 50-year-old woman is
syndrome, indicating probable dying of cancer. She has
mental retardation. He needs very only a few days to live. She
low-risk surgery for an easily has severe anemia due to the
correctible intestinal defect. If cancer. Even though a blood
untreated the baby will not be able to transfusion is the usual
retain food and will die. The parents treatment for severe anemia,
refuse surgery, stating that the the decision is made not to
mental retardation will mean a less give it.
than meaningful life for the baby
 Must be a loving, bodily, pleasurable expression of the complementary, permanent self-
giving of a man and a woman to each other.

Laws or social attitudes that NORMS OF SEXUAL In the image of God, man is created
hinder human freedom to MORALITY for love see Genesis 1-3
Generally recognized values:
achieve these values in ways -Sex is a search for the completion of
1. Sex is a social necessity for the human person through an
the individual desires are the procreation of children and intimate personal union of love
unjust and oppressive their education in the family so expressed by bodily union.
1.Use sex purely for the sake of as to expand the human
pleasure apart from any relation to community and guarantee its
love or family future beyond the death of
individual members.
2. Use it to reproduce (making test-
tube babies) without any reference to 2.Teaches that God created
pleasure or love persons as male and female and
blessed their sexuality as a
great and good gift.

PRINCIPLE OF PERSONALIZED SEXUALITY

 THE GIFT OF SEXUALITY
For secular humanists, reasonable uses of sex:
1. Sex is a search for sensual pleasure and satisfaction, releasing physical and
psychic tensions. Must be used in keeping with its intrinsic, indivisible, specifically
human teleology. Is based on the understanding of sexuality as one of the basic
traits of the human person and must be developed in ways consistent with
enhancing human dignity
2. Sexual behavior, at least among consenting adults, is entirely a private matter to
be determined by personal choice, free from any moral guilt.
Sexuality is a complex aspect of our personality and 'self'. Our sexuality is defined
by sexual thoughts, desires and longings, erotic fantasies, turn-ons and experiences.
3. Expression of unselfish love, but without any relation to marriage or family.
SEX = SYMBOLIC MYSTERY
4. Symbolically, a sacramental mystery that stands for the creative love of God
for all creatures and their loving response