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102 UNIT II Nursing Philosophies

world experience in the system. No one thing or per- and in other literature in 1984 and 1989. The purpose
son in a system is independent; rather, they are interde- of the dissertation research was to generate a theory
pendent. The system is holographic as the whole and of the dynamic structure of caring in a complex orga-
the part are intertwined. Thus, bureaucracy and com- nization. Methods used were grounded theory, phe-
plexity co-create and transform each other. The Theory nomenology, and ethnography to elicit the meaning
of Bureaucratic Caring is a representation of the relat- of caring to study participants.
edness of system and caring factors. The grounded theory approach is a qualitative re-
search method that uses a systematic set of procedures
to develop an inductive theory of a social process
Use of Empirical Evidence (Strauss & Corbin, 1990). The process results in the
The Theory of Bureaucratic Caring was generated evolution of substantive theory (caring data generated
from qualitative research involving health profession- from experience) and formal theory (integrated syn-
als and clients in the hospital setting. This research thesis of caring and bureaucratic structures).
focused on caring in the organizational culture and Ray studied caring in all areas of a hospital, from nurs-
first appeared in the doctoral dissertation in 1981, ing practice to materials management to administration,

MAJOR CONCEPTS & DEFINITIONS
The theoretical processes of awareness of viewing in terms of what ought to be done. Caring occurs
truth, or seeing the good of things (caring), and of within a culture or society, including personal cul-
communication are central to the theory. The dia- ture, hospital organizational culture, and societal
lectic of spiritual-ethical caring (the implicate or- and global culture (Ray, 2010a, 2010b).
der) in relation to the surrounding structures of
political, legal, economic, educational, physiologi- Spiritual-Ethical Caring
cal, social-cultural, and technological (the explicate Spirituality involves creativity and choice and is re-
order) illustrates that everything is interconnected vealed in attachment, love, and community. The
with caring and the system as a macrocosm of the ethical imperatives of caring join with the spiritual
culture. In the model (see Figure 8-2). everything is and are related to moral obligations to others. This
infused with spiritual-ethical caring (the center) by means never treating people as a means to an end
integrative and relational connection to the struc- but as beings with the capacity to make choices.
tures of organizational life. Spiritual-ethical caring Spiritual-ethical caring for nursing focuses on the
involves different political, economic, and techno- facilitation of choices for the good of others (Ray,
logical processes. 1989, 1997a, 2010a).
Holography means that everything is a whole
in one context and a part in another—with each part Educational
being in the whole and the whole being in the part Formal and informal educational programs, use of
(Talbot, 1991). Spiritual-ethical caring is both a audiovisual media to convey information, and other
part and a whole. Every part secures its meaning forms of teaching and sharing information are ex-
from each part, also seen as wholes. amples of educational factors related to the meaning
of caring (Ray, 1981a, 1989; 2010c).
Caring
Caring is defined as a complex transcultural, rela- Physical
tional process grounded in an ethical, spiritual con- Physical factors are related to the physical state of
text. Caring is the relationship between charity and being, including biological and mental patterns.
right action, between love as compassion in re- Because the mind and body are interrelated, each
sponse to suffering and need and justice or fairness pattern influences the other (Ray, 2001, 2006).