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“[Jesus is] our nurse . . . our healer.”

Epistle to Diognetus 9.6, in Richardson, 1953, p. 221

The Aim and Structure of this Book

The aim of this book is to show how the religious and moral teachings of the Christian Bible compare, contrast and correlate with the ethical standards of modern nursing, as stated in the Code of Ethics for Nurses with Interpretive Statements (hereinafter referred to as the Code; American Nurses Association [ANA], 2015). We intend it to be used as a textbook for courses in nursing ethics at Christian colleges and universities, and it is likely that many of our readers are themselves Christians, who have devoted their lives to caring for the sick, the injured, the elderly, the disabled and the dying as a way of living out their commitment to Jesus Christ. Such readers will presumably have a deep personal interest in knowing how closely the teachings of the Bible match the provisions of the ANA Code. But we recognize that many nursing students at Christian educational institutions belong to other religious traditions—or to none at all. We cherish the hope that this book will be useful to these readers as well. For we hope that they at least feel an interest in the general question of the relationship between “religion” and “health care,” even if they feel no need to reconcile the provisions of the Code with the norms of Christian discipleship mapped out in the Bible.

To accomplish our aim, we distinguish four main types or “strands” of moral discourse in the Bible—law, holiness, wisdom and prophecy—and correlate each of these strands with two or more of the nine provisions spelled out in the Code (ANA, 2015), as shown in Table 0.1 below. The left column lists the four strands and offers a “theme verse” for each strand. The theme verse for each strand is taken from one of the scriptural passages that will represent that strand later in the book. The relevance of the four theme verses to nursing practice may not be immediately obvious at first glance but will become clear as we proceed. The right column lists the nine provisions of the ANA Code, arranged in four groups, with each group bearing a general thematic correspondence with one of the four strands of biblical moral discourse.

Table 0.1. The Four Strands and the Nine Provisions
The Four Strands	The Nine Provisions
Strand 1: Law: “Keep the commandments . . . for your own well-being” (Deut 10:13).	Provision 1: The nurse practices with compassion and respect for the inherent dignity, worth, and unique attributes of every person.Provision 2: The nurse’s primary commitment is to the patient, whether an individual, family, group, community, or population.Provision 3: The nurse promotes, advocates for, and protects the rights, health, and safety of the patient.
Strand 2: Holiness: “Be holy, for I am holy” (Lev 19:2; cf. Matt 5:48; 1 Pet 1:16).	Provision 5: The nurse owes the same duties to self as to others, including the responsibility to promote health and safety, preserve wholeness of character and integrity, maintain competence, and continue personal and professional growth.Provision 6: The nurse, through individual and collective effort, establishes, maintains, and improves the ethical environment of the work setting and conditions of employment that are conducive to safe, quality health care.
Strand 3: Wisdom: “God’s works will never be finished; and from him health spreads over all the earth” (Sirach 38:8b).	Provision 4: The nurse has authority, accountability, and responsibility for nursing practice; makes decisions; and takes action consistent with the obligation to promote health and to provide optimal care.Provision 7: The nurse, in all roles and settings, advances the profession through research and scholarly inquiry, professional standards development, and the generation of both nursing and health policy.
Strand 4: Prophecy: “No prophet is accepted in the prophet’s hometown” (Luke 4:24).	Provision 8: The nurse collaborates with other health professionals and the public to protect human rights, promote health diplomacy, and reduce health disparities.Provision 9: The profession of nursing, collectively through its professional organizations, must articulate nursing values, maintain the integrity of the profession, and integrate principles of social justice into nursing and health policy.

We recognize that the Bible says little if anything about many of the specific activities performed by modern registered nurses (RNs) and that many of the activities performed by persons named in the Bible as “nurses” would rarely, if ever, be performed by modern RNs. When the word nurse appears in the Bible as a verb (Hebrew: yānaq; Greek: anatrephō = nurture; thēlazō = give suck; trephō = feed), it often refers to breastfeeding, either by a child’s mother or wet nurse (Gen 21:7; Exod 2:7, 9; 1 Sam 1:23; 1 Kgs 3:21; Song 8:1; Isa 66:11; Wis 7:4; Luke 11:27; 23:29). In one remarkable instance, God himself enables his people, wandering in the wilderness, to “suck” nourishment from their surroundings: “he nursed [them] with honey from the crags, with oil from flinty rock; curds from the herd, and milk from the flock . . .” (Deut 32:13b–14a). As a noun (Hebrew: yôneq; Greek trophos), “nurse” usually refers to a woman who cares for another’s child as a wet nurse or nursemaid during the child’s infancy (Num 11:12; Ruth 4:16; 2 Sam 4:4; 2 Kgs 11:2; 2 Chr 22:11; Isa 60:4), though she might stay on as a chambermaid after her charge grows up (Gen 24:59; 35:8). Saint Paul once uses the word in this sense, when he likens his apostolic work to that of “a nurse tenderly caring for her own children” (1 Thess 2:7).1 And the Epistle to Diognetus, an anonymous Christian writing of the second century, exhorts the reader to regard Jesus himself “as Nurse [trophos], Father, Teacher, Counselor, Healer [iatros], Mind, Light, Honor, Glory, Might, Life” (Richardson, 1953, p. 221). It is noteworthy that “nurse” heads this list, and that “healer” (or “doctor”) is included as well.2

Figure 0.1. Anonymous, Salome and midwife bathing the infant Jesus [fresco]. (Twelfth century). Dark Church, Open Air Museum, Goreme, Cappadocia. This fresco illustrates a scene from the Proto-Gospel of James, chapters 19–20 (Ehrman, 2003, pp. 69–70). The Proto-Gospel of James is a mid-second-century apocryphal writing that was crucial in the development of Christian Mariology; this particular scene became a popular subject in Eastern Christian art.

We also recognize that the Code (ANA, 2015) in its current form is a thoroughly secular or “nontheistic” document. That is, it makes no claims about the existence or nature of God. That does not mean that it directly denies or expresses doubts about the existence of God. It simply brackets out the question of God and assumes that the validity of the ethical standards it upholds does not depend on the validity of any given system of religious beliefs and practices.

Thus, we cannot read the Bible as a manual of nursing (cf. Verhey, 2003, pp. 32–67), nor do we find any explicitly “religious” content in the Code (ANA, 2015). Nevertheless, we argue that the Bible’s ways of structuring the character and conduct of Christian individuals and communities can richly inform the way nurses and healthcare facilities (or at least Christian nurses and church-affiliated healthcare facilities) do their business. We argue further that the nine provisions of the Code are in many respects congruent with the moral and religious values of Christian Scripture, and stipulate qualities of a nurse’s personal character and professional practice that resonate closely with the complex account of godliness found in the Bible. Indeed, as Marsha Fowler (2015) argues, several of the Code’s key concepts, such as compassion and human dignity, have their roots in one or more of the world’s great religions and reflect the Christian convictions of Florence Nightingale and other founders of modern nursing (pp. 1–3, 41–42).

The book contains five chapters. Chapters 1–4 follow the pattern shown in Table 1 above. Chapter 5 discusses their interrelationships.

Chapter 1, “The Nurse as Citizen, Professional, and Public Servant,” examines the legal strand of Scripture, with special attention to the Ten Commandments of Moses and the so-called Love Commandment of Jesus. It then correlates these texts to Provisions 1–3 in the Code (ANA, 2015), which deal with human dignity and patient rights. This analysis is followed by a discussion of the theme of law in the theological writings of Florence Nightingale (1992, 2002).

Chapter 2, “The Nurse as Healing Presence,” relates the biblical theme of holiness, as delineated in the Levitical Holiness Code and Jesus’ Sermon on the Mount, with Provisions 5 and 6 in the Code (ANA, 2015), which deal with the personal and professional virtues required for skillful and ethical nursing practice.

Chapter 3, “The Nurse as Savvy Problem-Solver,” looks at the wisdom strand in Scripture, as exemplified in passages on healing from the book of Sirach and the letter of James. It then compares these texts with Provisions 4 and 7 in the Code (ANA, 2015), which focus on professionalism in nursing and the skills required for effective problem-solving and decision-making in clinical situations.

Chapter 4, “The Nurse as Patient Advocate and Social Critic,” focuses on the prophetic strand of biblical moral discourse. This strand is exemplified by Jesus’ programmatic sermon in the synagogue of Nazareth, and by two stories that Jesus mentions in that sermon about healings performed by Old Testament prophets. These prophetic texts are then correlated with Provisions 8 and 9 in the Code (ANA, 2015), which pertain to human rights, social justice, health diplomacy and health policy.

Chapter 5, “Moral Maturity in Christian Nursing,” summarizes and synthesizes what we have learned in chapters 1–4 about the congruence between faithful Christian discipleship, as delineated in Christian Scripture, and the vocation of nursing, as normed by the Code (ANA, 2015).

Six Points of Clarification

We must clarify several matters before we proceed. First, the translation of the Bible that we use throughout this book is the New Revised Standard Version with the Apocrypha. Some readers may be unfamiliar with the Apocrypha, or suspicious of them, so a few words about them are in order. The Apocrypha are a group of sixteen books written between the fourth century BC and the first century AD, that is, after most or all of the books of the Old Testament (OT) had been composed, but before most of the books of the New Testament (NT) had been composed. Their authors were Jewish (like the authors of the OT), who wrote in Greek (like the authors of the NT) and concerned themselves with the problems faced by Jews living in the heavily Hellenized culture of that period. The Apocrypha certainly provide indispensable information about the historical, religious and political background of the NT—but do they belong in the Bible itself? Should they, in other words, be regarded as “canonical”? The term canon refers to the list of books that a particular church body accepts as its scripture. The problem is that different church bodies have somewhat different canons. Virtually all churches accept the thirty-nine books of the OT and the twenty-seven books of the NT as canonical, but opinions differ on the Apocrypha. Roman Catholic and Eastern Orthodox Christians generally accept them as sacred Scripture but often regard their religious authority as inferior to that of the original Hebrew Bible. Their secondary (“deuterocanonical”) status is disguised a bit in Catholic and Orthodox Bibles, however, because they are interspersed throughout the OT—apocryphal history books with canonical history books, apocryphal wisdom books with canonical wisdom books. In sharp contrast to Catholic and Orthodox practice, many Protestants and Evangelicals reject the canonicity of the Apocrypha altogether and exclude them from their published editions of the Bible. The New Revised Standard Version takes a middle way between these extremes. Reflecting contemporary ecumenical sensibilities, it includes the Apocrypha, but represents their deuterocanonical status by placing them together in a separate section between the Old and New Testaments. One of the OT Apocrypha, the book of Sirach, features prominently in chapter 3 below, and we will treat it as deuterocanonical Scripture.

A second important clarification pertains to the relationship between the books of the Bible and the strands of biblical moral discourse. In the OT and the OT Apocrypha, the relationship is quite close. For example, Strand 1 predominates in the five books of the Law, namely, Genesis, Exodus, Leviticus, Numbers and Deuteronomy. There are no OT books in which Strand 2 is dominant, but there is a long block of holiness material, known as the Holiness Code, found in chapters 17–26 of Leviticus. Strand 3 comes to the fore in a cluster of books known as the OT Writings, which include Job, several of the Psalms, Proverbs, Ecclesiastes and the Song of Solomon, as well as the apocryphal books of the Wisdom of Solomon and Sirach. Strand 4 predominates in the Former Prophets (Joshua, Judges, 1–2 Samuel, and 1–2 Kings) and the Latter Prophets (Isaiah, Jeremiah, Ezekiel, and the Twelve Minor Prophets). We must bear in mind, however, that even when a given strand of moral discourse “predominates” in a given biblical book, traces of the other strands may also be found there. For example, Moses, the lawgiver of Israel, is also called a “prophet” (Deut 18:15–22); conversely, Daniel the prophet gives thanks to God that he has been granted “wisdom and power” (Dan 2:23). With respect to the New Testament, the relationship between the books and the strands is still more complex, and the interweaving of the strands even more pronounced. The Gospels, for example, sometimes feature Jesus as a lawgiver (Strand 1), sometimes as a sage (Strand 3), and sometimes as a prophet (Strand 4); and his Sermon on the Mount (Matt 5–7) quite explicitly harkens back to the Levitical Holiness Code (Strand 2). Again, the letter of James, which represents the wisdom strand in chapter 3 below, also has many features of biblical prophecy (D. Nienhuis, personal communication, July 9, 2018). It is important, therefore, not to overidentify any one strand of biblical moral discourse with any one book or group of books in the Christian Scripture.

This leads to a third clarification. Not only are multiple strands sometimes found together in a given biblical book, but the simultaneous presence of multiple strands in many biblical books, taken one by one, and in canon of sacred Scripture, taken as a whole, provides a depth and richness of ethical insight that none of the strands by itself could offer. True, the representative texts we have chosen for each strand differ markedly in literary form and even to some extent in religious outlook. Yet these differences do not reflect contradiction. On the contrary, they demonstrate the variety of ways in which the Bible, in its rich diversity-amidst-unity, seeks to shape the lives of its readers. The four strands supplement, reinforce and enrich each other, and each strand helps to correct the excesses and deficiencies to which each of the others, taken by itself, might be prone. One way to visualize this is shown in Figure 0.2, which illustrates the technique of braid-making:

Figure 0.2. Four-strand braid

Strand 1: Law

Strand 2: Holiness

Strand 3: Wisdom

Strand 4: Prophecy

We start, as shown in step 1 above, with four colored strings or strands—purple, green, red and gold. When we interweave those strands, as shown successively in steps 2 through 5, we get a braid. Now the canon of Christian Scripture is like the completed braid. If we then ask how it tries to shape the character and conduct of its readers, we discover that it does so in four somewhat different ways. Sometimes the Bible lays down laws (Strand 1). Sometimes it promotes virtuous habits or morally praiseworthy character traits (Strand 2). Sometimes it recommends sensible strategies for making decisions, solving problems and interacting with others (Strand 3). Sometimes it sharply criticizes behaviors and social institutions that cause people to forget God or oppress others (Strand 4). Different as these modes of moral instruction may seem, however, they all serve a common purpose: to increase readers’ love of God and neighbor. To grasp the Bible’s overall moral vision, therefore, we must not merely analyze its separate strands of moral discourse: we must correlate and coordinate their respective concerns and insights. We must let the Bible’s rich complexities, subtle nuances and diverse perspectives all have their say in shaping our character and conduct. In chapters 1–4, we take the four strands one by one; then, in chapter 5, we put the four strands into direct conversation with each other. We argue that people attain moral maturity when they hold the distinctive approaches of all four strands in dynamic tension, allowing each strand to have its say, and braiding them together into a strong, supple, integral whole.

Fourth, we sometimes distinguish between the ethics of conduct and the ethics of character, as shown in Table 0.2 below. Strands 1 and 4, which emphasize what people should do and how they should act, represent conduct-focused ethics. In contrast, Strands 2 and 3, which emphasize who people are as moral agents, represent character-based ethics. This distinction between conduct-focused and character-based ethics is also discernible in the Code (ANA, 2015). Thus, Provisions 1, 2, 3, 8, and 9 (which correlate with Strands 1 and 4, as shown in Table 0.1 above) stress the personal and professional conduct of nurses, whereas Provisions 4, 5, 6, and 7 (which correlate with Strands 2 and 3) focus on their moral virtues and professional skills. Yet it is important not to push the distinction between conduct-focused and character-based ethics too far. People’s behavior usually reflects their selfhood in its entirety, and their selfhood is only knowable to others (and often to themselves) by their concrete actions in the world. We may distinguish character and conduct for purposes of ethical analysis, yet we recognize that they are really aspects or dimensions of the moral life in its entirety.

Table 0.2. Conduct-Focused Ethics vs. Character-Focused Ethics
Conduct-Focused Ethics: Emphasis on laws, regulations, rules, policies, procedures or protocols	Character-Focused Ethics: Emphasis on virtues, habits, skills, disposition, motives, moral sentiments, emotional intelligence
Strand 1: Law	Strand 2: Holiness
Strand 4: Prophecy	Strand 3: Wisdom

Fifth, as previously noted, we argue in this book that ethical nursing practice involves obedience to laws, regulations and protocols; the cultivation of virtuous habits; decision-making procedures based on evidence, insight and experience; and advocacy for the rights and needs of patients, and that these differing emphases parallel the dominant themes of the four strands of biblical moral discourse, respectively. True, the Code of Ethics for Nurses with Interpretive Statements (ANA, 2015) does not explicitly invoke the Bible as a moral authority, nor does it imply that a person must be a Christian in order to practice nursing ethically. Yet the norms for the character and conduct of nurses set by the Code do correspond closely to the overall picture of godly living delineated in the four strands of biblical moral discourse, and our task is to explore these parallels. The way in which the four biblical strands and the major objectives of the corresponding provisions in the Code collectively contribute to moral maturity in Christian nurses is illustrated in Figure 0.3.

Figure 0.3. Moral maturity and the four strands

Our sixth clarification has to do with how we refer to “the nurse.” We acknowledge that the history of modern nursing has been heavily female-dominated, but the 2017 National Nursing Workforce Study (Smiley et al., 2018) reports a welcome, steady increase in the numbers of men in the nursing profession. Additionally, we acknowledge that there is now much dialogue about gender identity and the use of preferred pronouns, which may apply to some of our readers (Turner, 2014). In view of these facts, we generally speak of “nurses” in the plural. Wherever we must refer to “the nurse” in the singular, we alternate the usage of male and female pronouns, rather than constantly using awkward or ungrammatical constructions such as “he or she,” “s/he,” or “they” in a singular sense. We ask the reader to understand that such singular pronouns are intended to apply to every nurse, regardless of gender or sexual orientation.

Two Cautionary Notes

Here we must interject two cautions. First, we raise the possibility that Christian nurses might experience a conflict of conscience when reading the Code (ANA, 2015), which regards itself as the “nonnegotiable” (p. vii) ethical standard of the profession. We assume that the supreme moral authority for every Christian is the Bible and that one of the chief ways in which thoughtful Christians put their respect for the Bible’s moral authority into effect in their personal and professional lives is by using it to test the adequacy of any other proposed moral standard. As it happens, we see nothing in the Code that flatly contradicts the moral teachings of the Bible, such that Christian nurses would be obliged in conscience to disobey the former in order to remain faithful to the latter. Nevertheless, Christian nurses cannot accept the Code’s claim to be “nonnegotiable in any setting,” if that implies that its text is perfectly unambiguous throughout, that its implications for clinical practice are always self-evident, or that questions can never be raised about its adequacy and relevance to specific cases. Yet we presume that the ANA does not intend its members to regard the Code in such a “fundamentalist” fashion. For the Code itself has a long history of development, which reflects the changes that have taken place in health care and in American society generally over the past century (pp. xi–xiii; Fowler, 2015, pp. vii–ix). Nurses have been asking tough questions of their Code since they first had one, and we presume that the ANA intends them to keep doing so. In that case, the Code serves as an indispensable working norm for nursing practice, a norm that should not be violated by individual nurses in their daily work but that is always subject to constructive critique, and that can be revised as necessary through due process by the ANA. No Christian nurse should have trouble accepting that.

Second, even if Christian nurses can accept the Code (ANA, 2015) as morally binding upon their character and conduct, given that the Code itself is always revisable and that—for Christian nurses, at least—its moral authority is always subordinate to that of the Bible, there remains another problem. The ethical texts of the Bible are not always self-evident in meaning, nor is the precise manner of their application in specific cases always clear. Thus, although the moral teachings of the Bible are certainly indispensable for Christian nurses in interpreting the Code, those teachings themselves require careful theological interpretation and ethical reflection. The method we use here for interpreting our chosen biblical passages is both theological and historical-critical. A few words about these two features of our method are in order.

On the one hand, we read the Bible theologically, that is, as Christian Scripture. The church throughout the ages has regarded the Bible as God’s authoritative word for God’s faithful people, as a testimony to God’s sovereign love and redemptive power in (or “behind”) human affairs. We are not committed to any particular theory of how the human authors of the Bible derived or experienced divine “inspiration.” We do, however, affirm that the church, under the guidance of the Holy Spirit, has recognized the voice of God in (or, again, “behind”) the writings included within the Bible and regards these writings as uniquely “useful for teaching, rebuking, correcting and training in righteousness” (2 Tim 3:16). Furthermore, we are guided in our reading of the church’s sacred book by the church’s rule of faith, that is, the cluster of doctrines and religious practices deemed orthodox by the ancient ecumenical councils and held in common by the Roman Catholic Church, the Eastern Orthodox Church, and most mainline Protestant and Evangelical churches. On the other hand, we read the Bible historico-critically, that is, in light of contemporary research into the history and culture of ancient Mediterranean societies. To interpret a passage of Christian Scripture faithfully obliges us to consider the circumstances under which it was originally written and the needs, problems and worldview of the people for whom it was originally written, at least to the extent that these can be reconstructed through research into the histories, cultures, languages and literary conventions of the ancient Near East. In interpreting Scripture, we regard theological reflection and historical criticism as friendly yokefellows, not fierce adversaries, and virtually all the secondary sources we cite share that view.

The strategy for reading Scripture that we have adopted here draws heavily upon two sources. The first is The Art of Reading Scripture, coedited by biblical scholars Ellen F. Davis and Richard B. Hays (2003). Particularly useful is the book’s programmatic essay, “Nine Theses on the Interpretation of Scripture” (pp. 1–8). Our second major resource is Reading the Bible in the Strange World of Medicine, by theologian and bioethicist Allen Verhey (2003), and particularly his programmatic essay, “The Bible and Bioethics: Some Problems and a Proposal” (pp. 32–67). It must be stressed, however, that our reading of the texts we have selected to represent the four strands of biblical moral discourse is sharply focused by an objective that is not envisaged by the essays in the Davis and Hays volume and is only indirectly related to the purpose of the work by Verhey. Our objective is to show how the complex picture of Christian discipleship displayed in the Bible compares with the ethical responsibilities of professional nurses prescribed by the Code (ANA, 2015).

The Origins and Distinctiveness of this Book

As noted above, we intend this book to be used as a text for nursing ethics courses at Christian colleges and universities, and that is indeed how it came into being in the first place. The authors are faculty members at Seattle Pacific University (SPU). SPU is a church-related institution; its faculty and staff are required to be professing, practicing Christians; its curriculum and campus life are regulated by an official Statement of Faith. Undergraduates are required to take at least two, and usually three, courses in theology and Bible, and all graduate professional programs include one course (or short modules distributed over several courses) in discipline-specific theological reflection. The course from which this book originally sprang, NUR 6301 Values, Faith and Ethics, satisfies this requirement for the Master of Science in Nursing and Doctor of Nursing Practice degrees. It has been co-taught annually by Steele, a moral theologian, and either Wild or Monroe, both professors of nursing, since 2014. As our curriculum requires, and as our own consciences dictate, we teach the course from an explicitly Christian standpoint, but we neither proselytize our students nor penalize those whose religious views differ from our own. The present book, which arose from the lectures and class discussions for that course, takes the same approach. We try to show how Christian moral and religious convictions match up with the current ethical standards of the nursing profession, as stated in the Code (ANA, 2015), and we seek to highlight the spiritual and professional advantages for Christian nurses, who conscientiously apply their faith to their practice. Yet we do not claim that Christians somehow make “better nurses” than non-Christians (cf. Doornbos, Groenhout, & Hotz, 2005, 1–8). We write from a faith perspective, just as we teach. Yet we have no hidden evangelistic agenda and we intend no censure of those whose religious views differ from our own.

The origins of this book help to explain its distinctiveness. On the one hand, little if any attention is given to Christian Scripture in the standard textbooks of bioethics and nursing ethics, such as Beauchamp and Childress (2013), Jonsen, Siegler, and Winslade (2015), Grace (2018), or Fowler (2015). On the other hand, one finds few if any citations to the Code (ANA, 2015) in works that analyze medicine and nursing from a theological perspective, such as O’Brien (2018), Doornbos et al. (2005), Lysaught, Kotva, Lammers, and Verhey (2012), or Thobaben (2009). We draw gratefully upon all these important works in what follows, but we attempt something they do not, namely, to determine what light the Bible sheds on contemporary nursing practice, as normed by the Code. See the Annotated Bibliography for a brief explanation of the relationship between those works and this one.

The Uses of This Book: A Word to Educators

Here we wish to offer several suggestions for nursing educators who adopt this book for courses in nursing ethics. First, we encourage that it be used in tandem with two other books, namely, a critical, annotated edition of the Bible with the Apocrypha, and Marsha Fowler’s (2015) Guide to the Code of Ethics for Nurses with Interpretive Statements, which includes the full text of the official Code (ANA, 2015) as an appendix. Our task in this book is to identify the connections between the main themes of our chosen biblical texts and of the Code, but students will profit greatly from drilling deeper into the primary sources for themselves. Second, we recommend that this book (along with the Bible and Fowler’s Guide) be used during the first half of the course, and that other resources be used in the second half, especially those that analyze complex issues in contemporary health care or offer thought-provoking case studies in nursing ethics (e.g., Grace, 2018). Our students sometimes report that the material included in the present book seems a bit abstract until they apply it to their own practice or to hot-button issues in their field, at which point the framework provided here proves its worth. Third, we suggest that students prepare for the class session during which a given chapter in this book will be under discussion by writing out definitions of the Keywords and answering the Reading Comprehension questions provided at the end of each chapter. Fourth, we propose that in the days after a given chapter in this book has been discussed in class, the students be required to answer the Making Connections questions likewise provided at the end of each chapter. This will encourage them to apply the material covered here to their own practice even before moving to the case studies and current issues in the second half of the course. (Note: the Making Connections questions tend to work better with advanced practice nursing [APRN] students, who already have a rich fund of clinical experience under their belts, than with undergraduates, who are still mastering basic skills and concepts.) This learning activity is especially valuable if students have access to an online discussion board, where they can interact with each other’s reflections. Examples of such discussion board interactions appear in the Clinical Voices sections toward the end of each chapter.

Figure 0.4. Nursing postage stamp. This US postage stamp was issued on December 28, 1961. For details on its historic significance, see Olin (2011, December 8). We display it here as a tribute both to the students in our classes, who have contributed so much to this book, and to the book’s intended readers.

Clinical Voices

As the reader begins to discover the connections between Christian Scripture and contemporary nursing, our ultimate hope is that these will be useful in a practical sense. Ideally, the nurse is able to integrate the profession’s code of ethics with his personal values and beliefs to provide morally confident and competent patient care. Nurses from many backgrounds have found the discussions of connections described here to be useful on both personal and professional levels. They encountered a new way to wrestle with some of the difficult questions in practice. Each chapter includes some of their thoughts about integrating the strands and Code (ANA, 2015) with their individual approaches to practice. These experienced nurses—APRN students, who have deeply engaged in these discussions—have graciously given us permission to share their stories, thoughts and concerns here as a catalyst for discussions among other readers. Here are some of their initial thoughts about the framework of biblical strands connecting to professional nursing ethics:

Arely Garza: Integrating strands

Nursing is a vocation. I have always felt caring for the sick is my calling. Even when considering other career options, they always felt wrong. Jesus cared for and healed the sick outside of work days, an act prohibited on the Sabbath. This demonstrates how nursing is more than a job. Nursing is stressful and often challenging both mentally and physically. My faith and sense of calling provides motivation to continue to care for others even through difficult times. My patient, an older gentleman with cancer, had a complex treatment plan. Over the multiple times I took care of him, my use of the four strands changed. At first, I emphasized the law strand, following policies and procedures to provide the safest care while he was in a critical state; then I became his advocate, committed to involve him in his own care. He had multiple doctors who didn’t always communicate well with him. There was an instance where he and his family were frustrated with his care and confused as to what was happening. I pushed the residents to come speak to the family, which then became a care conference.

Cindy Mato: Situational connections to faith

I have never thought much about my decision-making process related to nursing interactions from a spiritual standpoint. I can honestly say that when I am caring for a difficult or angry patient, I rarely think of God or the Bible. Situations where I lean on God are often related to a critically ill patient—praying for them and asking God to grant me the skill, knowledge, and tools to help the dying patient. During further reflection, I believe my spiritual beliefs and nursing practice are intertwined when I am volunteering. I feel happy and close to God when I am participating in an activity that gives me a sense of purpose, such as volunteering. I can see how the four strands of Law, Holiness, Wisdom, and Prophecy are braided together during these times. I may be helping the oppressed (Prophecy) by using my nursing knowledge and skill (Wisdom) to do something that many others would not be willing to do (Holiness).

Inbok Wee: Holistic care and collaboration

The highlight of nursing is that we care for people with a holistic approach, not only for their physical needs but also for their emotional, mental, and social needs as a way to promote their well-being. I had a male patient admitted with malignant hypertensive urgency due to noncompliance of antihypertensive medications. There was not sufficient information about why and how long it had been since he had not taken the medications. One day after his symptoms were relieved, before treatment was completed, he wanted to go home. Once all the detailed information was given to the patient regarding his current condition, treatment, and the risks of incomplete treatment, he got upset and anxious. Later in the day, he opened up to me. He had recently divorced and lost a job, and stated he was depressed. I offered emotional support with therapeutic listening and coordinated with the provider and social worker to provide extensive support for follow-up care, charity medications, medical bills, and counseling. As a primary nurse, I promoted the patient’s rights and health with compassion and respect by providing the patient with information and assertive communication regarding his condition, treatment, and risks. By notifying care team members and collaborating with them about my patient’s emotional crisis and situation, I made a prompt decision and took accountability to provide optimal care for my patient’s health.

Being a nurse, a member of the most trusted profession (Brenan, 2017), is very hard work. It is very much heart work, too. As nurses continue to pour themselves into caring for people who are at their most vulnerable, it is our hope that the connections between ethically strong nursing care and Christian Scripture provide a resource for thinking about practice and how nurses may approach the challenges that come on a daily, if not moment-by-moment, basis.

Keywords

1.Canon

2.Holiness

3.Interpretive statement (of the ANA Code)

4.Law

5.Prophecy

6.Provision (of the ANA Code)

7.Strand (of biblical moral discourse)

8.Wisdom

Reading Comprehension

1.What is the aim of this book, and who are its intended readers?

2.How, in general terms, does the book propose to accomplish its aim?

3.What are the four strands of biblical moral discourse, and what are the specific provisions in the ANA Code, which this book will correlate with each strand?

4.Summarize the six “points of clarification” offered above.

5.Summarize the two “cautionary notes” offered above.

Making Connections

1.Nursing is now widely recognized as one of the “professions,” along with medicine, law, ordained ministry, etc. This book assumes, however, that, at least for those who self-identify as Christians, it is also a “vocation,” that is, a way of putting their faith into practice. How do you react to that assumption?

2.The ANA Code claims to be a “nonnegotiable” ethical guideline for nurses. How do you understand that claim? Have you ever been in a situation that required you to act in a way that was contrary either to the Code or to your own conscience? Explain.

3.What are your initial feelings about reading a book that relates Christian Scripture and theology to your chosen profession? Did this introduction address your concerns?

1. In the Revised Standard Version (RSV) translation of 1 Kings 1:1–4, we read of a young woman who was hired as a “nurse” for the elderly King David. But the Hebrew term used there, sākan, is better translated as “attendant,” per the New Revised Standard Version (NRSV). Her assigned duties include those of a “concubine,” although David’s impotence prevents her from exercising them. We therefore exclude this passage from the list of biblical references to “nurses,” though we mention it here in passing because older concordances sometimes cite it.

2. The Old Testament also refers several times to midwives (Hebrew: meyalledet; Greek: maia). These were women whose chief responsibility was to assist pregnant women in childbirth (Gen 35:17; 38:28; Exod 1:15–22). Those named in the Bible as midwives do not seem to have performed any other “nursing” functions, nor is midwifery listed as a function of those who are named as nurses. It is possible, of course, that some ancient women served both as nurses and as midwives, but there is no direct textual evidence to that effect.