Ray’s Theory of Bureaucratic Caring

1. Ray’s Theory of Bureaucratic Caring Marilyn A. Ray, RN, PhD, CTN-A Professor Emeritus Florida Atlantic University Boca Raton, FL 33431

2. Ray’s Educational Background • Diploma: St Joseph’s Hospital School of Nursing, Hamilton, Ontario, Canada • BSN and MSN, University of Colorado • MA Anthropology, McMaster University • Flight Nurse: School of Aerospace Medicine, Brooks Air Force Base, Texas • PhD: University of Utah/Transcultural Nsg. • Bio Ethics, Georgetown University • Space Education Program: Marshall Space Flight Center, Huntsville, Alabama

3. Ray’s Practice Background • University of California: OB-GYN, Emergency Dept and Cardiac Critical Care • University of Colorado: Critical Care-- children & adults), Renal Dialysis • Gates Company: Family Centered Occupational Health • McMaster University Health Sciences Center: Educational Coordinator, FNP Program, and Clinical Nurse NICU • US Air Force Reserve Nurse Corps: Flight Nurse, Nursing Educator, Administrator, Researcher, Consultant

4. Ray’s Practice Background • Transcultural nursing and caring practice • First nurse to go to Russia when opened its space program to Aerospace Medical Assoc. & US space engineers and physicians • Research (quantitative and qualitative) in complex health care systems, public/military hospitals, private hospitals , different units in hospitals; diverse cultures; study of technological & economics of caring

5. Ray’s Scholarship/Teaching Background • University of California SF & Univ.of San Francisco: Undergraduate Education • McMaster University, Canada: Assisted in developing & taught in the Family Nurse Practitioner Program • University of Colorado: Graduate Education. Philosophy of Nursing, Caring Science, Qualitative Research • Florida Atlantic University, Christine E. Lynn Eminent Scholar; Professor

6. Ray’s Scholarship/Teaching Background • Virginia Commonwealth University: Yingling Visiting Scholar • Visiting Professor: Universities in Australia and New Zealand • Certified Transcultural Nurse • Founding Member of the International Association for Human Caring • Lectured on Transcultural Caring & Ethics in China, Sweden, Saudi Arabia, Canada, Australia, Philippines, Vietnam, Japan

7. Ray’s Scholarship/Research Background & Scholarship • Doctoral Dissertation, 1981: A Study of Caring within an Institutional Culture • Theory of Bureaucratic Caring, 1981, 1984, 1989, 2001, 2004, 2010a, b, c; 2011, 2013 • Mutual Intentionality: A Theory of Support for Pregnant African American women, 1999 • Technological Caring: A New Model in Critical Care, 1987. Award for Excellence in Phenomenology • Caring Inquiry: The Esthetic Process in the Way of Compassion, 1991, 2012, 2013 • Theory of Relational Caring Complexity with Dr. Marian Turkel 2013

8. Background & Scholarship • Books: • The ethics of care and the ethics of cure: Synthesis in chronicity, 1988 • Transcultural caring dynamics in nursing & health care, 2010 • Nursing, caring, and complexity science: For human-environment well-being, 2011 • A study of caring within an institutional culture: The discovery of the Theory of Bureaucratic Caring, 2010

9. Ray’s Scholarship/Research Background • Complex Caring Dynamics: A Unifying Model for Nursing Inquiry, 1994, 2010, 2011 • The Ethical Theory of Existential Authenticity: The Lived Experience of the Art of Caring in Nursing Administration, 1997. • Transcultural caring dynamics Model, 2010 • TCC Assessment of Older Adults, 2000 • Phenomenological Research Method, 1983-2013 • Caring Inquiry, 1991, 2013

10. Theory of Bureaucratic Caring • The theory was generated from qualitative research involving health professionals and patients in the hospital setting, • The theory implies that there is a dialectical relationship (thesis, antithesis, synthesis) between the human (person & nurse) dimension of spiritual-ethical caring and the structural (nursing, environment) dimensions of the bureaucracy or organizational culture (technological, economic, political, legal and social ). • The Model is holographic, illuminating the holistic nature of caring & synthesis of the humanistic systems and technologic, economic, political, legal systems.

11. Major Concepts • Caring • Spiritual-Ethical Caring • Educational • Physical • Socio-cultural • Legal • Technological • Economic • Political

12. Complex Organizational Cultures: Ray’s Theory of Bureaucratic Caring (1981, 1984, 1989, 2010, 2013) Social-Cultural Physical Spiritual- Ethical Caring Educational Economic Political Technological Legal The Universal Environment

13. Major Concept: Caring • Caring: a complex, transcultural, relational process, grounded in an ethical, spiritual context. Caring is the relationship between charity and right action, between love as compassion in response to human suffering and need, and justice or fairness in terms of what ought to be done. Caring occurs within a culture or society, including personal culture, hospital organizational culture, or society and global culture (Ray, 1989; Ray in Coffman, 2006; 2010, 2013).

14. Major Concept: Spiritual-Ethical Caring • Spirituality involves creativity and choice revealed in attachment, faith, hope, love, and community. The ethical imperatives of caring that join with the spiritual & relate to our moral obligation to others. Spiritual- ethical caring for nursing focuses on how the facilitation of choices for the good of others (caring, healing, well-being that should be accomplished or can be

15. Major Concept: Educational • Formal and informal educational programs, use of audiovisual media to convey information, and other forms of teaching and sharing information are examples of educational factors related to the meaning of caring.

16. Major Concept: Physical • Physical factors relate to the physical state of being including biological and mental patterns. Because the mind and body are interrelated, each pattern influences the other.

17. Major Concept: Social-Cultural • Social-Cultural factors are ethnicity and family structures; intimacy with friends and family; communication; social interaction and support; understanding interrelationships, involvement, and structures of cultural groups, community and society.

18. Major Concept: Legal • Legal factors relating to the meaning of caring include responsibility and accountability; rules and principles to guide behaviors, such as policies and procedures; informed consents; right to privacy; malpractice and liability issues; client, family, and professional rights; and the practice of defensive medicine and nursing.

19. Major Concept: Technological • Technological factors include nonhuman resources, such as the use of machinery to maintain the physiological well-being of the patient, diagnostic tests, pharmaceutical agents, and the knowledge and skill needed to utilize these resources. Also included with technology are computer assisted practice and electronic documentation and social media.

20. Major Concept: Economic • Economic factors relating to the meaning of caring include money, budget, insurance systems, limitations and guidelines imposed by managed care organizations and in general, allocation of scare resources including to maintain the economic viability of the organization. Caring as an interpersonal resource (love, communication, professional knowledge) should be considered, as well as goods, money and services.

21. Major Concept: Political • Political factors and the governance & power structure within health care administration influence how nursing is viewed in health care and include patterns of communication and decisions in the organization; role and gender stratification among nurses, physicians, and administrators, union activities, including negotiation and confrontation; government and insurance company influences; uses of power, prestige, and privilege; and in general, competition for scarce human and material resources.

22. Major Assumptions • Nursing/Caring • Person/Cultural Being • Health • Environment/Culture of Organization

23. Nursing • Nursing is holistic, transcultural & relational, spiritual, and ethical caring that seeks the good of self and others in complex community, organizational, and bureaucratic cultures. • Dwelling with the nature of nursing reveals that the foundation of spiritual caring is love. Love calls forth a responsible ethical life that enables the expression of concrete actions of caring in the lives of nurses and for health & healing.

24. Person • A person is a spiritual and cultural being. Persons are created by God, the Mystery of Being, a higher power and engages co-creatively in human organizational and transcultural relationships to find meaning and value.

25. Health • Health is a pattern of meaning for individuals, families and communities. Beliefs and caring practices about health & illness are central features of culture. The social organization of health and illness determines how persons are recognized as sick or well, how health or illness is presented to health care professionals and the way health is interpreted by the individual.

26. Environment • Environment is a complex spiritual, ethical, ecological and cultural phenomenon. This conceptualization embodies knowledge & conscience about the beauty of life forms & symbolic systems or patterns of meaning. • Nursing practice in environments embodies the elements of the social structure and spiritual and ethical caring patterns of meaning.

27. Theoretical Assertions • Caring is the essential construct and consciousness of nursing. • The meaning of caring is love and is highly differential depending on its context--structures (social-cultural, educational, political, economic. physical, technological and legal) as expressed in complex organizations. • Caring is viewed as love and bureaucratic, given the extent to which its meaning can be understood in relation to science & the complex organizational structure.

28. Application to Practice/Education/Research • Practice: Ray’s research has shown that nurses, patients and administrators value caring science, & the caring intentionality that is co-created in the nurse-patient or administrator relationship. • By creating spiritual-ethical caring relationships, clinical nurses & administrators can transform the workplace into moral communities within the culture of humanistic, social, economic, political and legal values.

29. Application to Practice/Education/Research • Education: The theory is useful to nursing education because of its broad focus on caring & complexity science /s in nursing and the conceptualization of the health care system—used as an organizing framework for curricula. • Universities and hospitals have incorporated Ray’s Model of Bureaucratic Caring in the framework for the baccalaureate nursing programs, and clinical environments to guide nursing evolution, practice, research, and administration.

30. Application to Practice/Education/Research • Research: Through Ray’s extensive experience with research, she has developed a phenomenological-hermeneutical approach (caring inquiry) that continues to guide her research and has been adopted by many researchers for the humanistic approach, using a lens of caring & caring science to study the human experience in health situations. • Presenting Caring Inquiry Method August, 2013 at 32nd International Human Science Research Conference, Aalborg, Denmark

31. References: • Coffman, S. (2010/2013). Ray’s Theory of Bureaucratic Caring. In M. Alligood (Ed.) Nursing theorists and their work. St. Louis: Mosby/ Elsevier. • Davidson, A., Ray, M. & Turkel, M. (2011). Nursing, caring, and complexity science: For human-environment well-being. NY: Springer. • Ray, M. (2010a). Transcultural caring dynamics in nursing and health care. Philadelphia: F. A. Davis Company.

32. References/Acknowledgment: • Ray, M. & Turkel, M. (2010/in press). Marilyn Anne Ray’s Theory of Bureaucratic Caring in M. Smith & M. Parker (Eds.). Nursing theories & nursing practice. Philadelphia: F. A. Davis Company. • Ray, M. (2010b). A study of caring within an institutional culture: The discovery of the Theory of Bureaucratic Caring. Germany: Lambert Academic Publishers. • Gratitude Extended to Dr. Charlotte Barry for initiating development of PPTs