Stewardship in health care, in the nursing profession, and of self
The theory of stewardship incorporates concepts of environ-
mental1 and theological2 notions of practical reasoning. Within the nursing literature,3 , 4 stewardship has emerged as a topic of nurse leadership; however, there is a need to clarify the origins and meaning of the term.
Traditional definitions of stewardship
In the Book of Genesis, God appoints humanity as the steward of all creation. The Old Testament tells the story of Joseph, who is sold by his brothers into slavery and becomes Putiphar’s steward and ultimately the Pharaoh’s. From this parable, a steward is a selfless servant who manages assets and possessions without owning them, foresees future trends and creates plans and interventions.5
The parable of ‘talents’ in the New Testament describes another aspect of stewardship in which a master divides his worldly goods between his three servants. The moral portrayed in this parable is that when one is entrusted with something of value, there is an obligation to improve on it.
The Islamic institution of Hisba is responsible for organising public administrative functions within the dimensions of morality, normality and technology. The head of the Al Hisba is called the Muhtasib, who was first appointed in Medina in the 9th century. The Muhtasib in the pre-colonial Arab civilisation was responsible for the regulation of medical practice and pharmaceuticals, which incorporated equitable provision of services to the public.6
State-orientated definitions of stewardship
The broad definition of state-orientated stewardship is that the function of government is responsible for the welfare and interests of the population, especially the trust and legitimacy with which its activities are viewed by the general public.5
In 2001, the Institute of Medicine proposed six aims to improve the health care system for the 21st century.7 The recommendations were that health care should be safe, effective, patient-centred, timely, efficient and equitable. These recommendations have been assumed by both the health care community and the communities served and form the context around discussions about health care. This may lead to leadership opportunities for nursing that afford ways and a knowledge base to initiate dialogue with colleagues, including consumers and health insurers. Such opportunities allow for transformational structures, programmes and systems that meet the six recommendations of the Institute of Medicine (2001).4 It can therefore be assumed that nursing managers in all disciplines of nursing will be the chief patient and safety officers and stewards for their organisations and institutions.4
To achieve the six aims, nurse leaders will have to engage in developing, assessing and refining innovative and fresh modes of care delivery. To do this, a solid foundation in health care economics, financing and statistics will be order of the day for this aspect of stewardship.
The potential of stewardship
The potential for improving and enhancing policy outcomes is the predominant positive potential of stewardship. Another prospect of stewardship is to revive a sense of social purpose among public sectors of management, together with assisting to restore a sense of trust and legitimacy to the role of the state.5 This ‘attractiveness’ of a stewardship approach may be a realistic (and achievable) possibility to channel fresh and emerging systems of integrated care in more socially responsible ways.
Stewardship of nursing
The leadership potential of stewardship in nursing requires new models of delivery of care, and we need to address the ever-changing nature of the work of a nurse.4 With evolving new roles in the nursing profession, collaboration with nursing research colleagues will be required to develop mechanisms of evaluation and assessment which further refine evidence that supports the essential and exclusive contributions of the professional nurse in outcomes of care and prevention.4 Development and enhancement of the evidence in research call for nursi