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CHAPTER 8 Marilyn Anne Ray 105

Thus, through compassion and justice, nursing strives
toward excellence in the activities of caring through
the dynamics of complex cultural contexts of relation-
Physical Social- ships, organizations, and communities (Ray, 2010a;
cultural
Davidson, Ray, & Turkel, 2011).
Person
Educational
Legal A person is a spiritual and cultural being. Persons are
Spiritual- created by God, the Mystery of Being, and they
ethical
caring engage co-creatively in human organizational and
transcultural relationships to find meaning and value
Political Technological (M. Ray, personal communication, May 25, 2004).

Health
Economic
Health provides a pattern of meaning for individuals,
families, and communities. In all human societies,
beliefs and caring practices about illness and health
are central features of culture. Health is not simply
FIGURE 8-2 The Holographic Theory of Bureaucratic
Caring. (From Parker, M. E. [2006]. Nursing theories and nursing the consequence of a physical state of being. People
practice [3rd ed.]. Philadelphia: F. A. Davis. Graphics redrawn construct their reality of health in terms of biology;
from originals by J. Castle and B. Jensen, Nevada State College, mental patterns; characteristics of their image of the
Henderson, NV.) body, mind, and soul; ethnicity and family structures;
structures of society and community (political, eco-
nomic, legal, and technological); and experiences
The initial theory was examined using the philoso- of caring that give meaning to lives in complex ways.
phy of Hegel. The theory was revisited in 2001 after The social organization of health and illness in society
continuing research, and examination in light of the (the health care system) determines the way that peo-
science of complexity and chaos theory, resulting ple are recognized as sick or well. It determines how
in the holographic Theory of Bureaucratic Caring health professionals and individuals view health and
(see Figure 8-2). illness. Health is related to the way people in a cultural
group or organizational culture or bureaucratic system
Major Assumptions construct reality and give or find meaning (Helman,
1997; Ray, 2010a).
Nursing
Nursing is holistic, relational, spiritual, and ethical car- Environment
ing that seeks the good of self and others in complex Environment is a complex spiritual, ethical, ecologi-
community, organizational, and bureaucratic cultures. cal, and cultural phenomenon. This conceptualization
Dwelling with the nature of caring reveals that love is of environment embodies knowledge and conscience
the foundation of spiritual caring. Through knowledge about the beauty of life forms and symbolic (repre-
of the inner mystery of the inspirational life within, sentational) systems or patterns of meaning. These
love calls forth a responsible ethical life that enables the patterns are transmitted historically and are pre-
expression of concrete actions of caring in the lives served or changed through caring values, attitudes,
of nurses. As such, caring is cultural and social. Trans- and communication. Functional forms identified
cultural caring encompasses beliefs and values of com- in the social structure or bureaucracy (e.g., political,
passion or love and justice or fairness, which has legal, technological, and economic) play a role in
significance in the social realm, where relationships are facilitating understanding of the meaning of caring,
formed and transformed. Transcultural caring serves cooperation, and conflict in human cultural groups
as a unique lens through which human choices are and complex organizational environments. Nursing
seen, and understanding in health and healing emerges. practice in environments embodies the elements of