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CHAPTER 8 Marilyn Anne Ray 107

Acceptance by the Nursing Community culturally dynamic health care situations (Ray &
Turkel, 2000; Ray, 2010a). The dimensions of this
Practice tool are as follows:
The Theory of Bureaucratic Caring has direct appli- 1. Compassion
cation for nursing. In the clinical setting, staff nurses 2. Advocacy
are challenged to integrate knowledge, skills, and 3. Respect
caring (Turkel, 2001). This synthesis of behaviors and 4. Interaction
knowledge reflects the holistic nature of the Theory 5. Negotiation
of Bureaucratic Caring. At the edge of chaos, con- 6. Guidance
temporary issues such as inflation of health care costs
serve as the catalyst for change within corporate Administration
health care organizations. The ethical component Ray’s research has shown that nurses, patients, and
embedded in spiritual-ethical caring (see Figure 8-2) administrators value the caring intentionality that is
addresses nurses’ moral obligations to others. Ray co-created in the nurse-patient or administrator-
(2001) emphasizes that “transformation can occur nurse relationship. By creating ethical caring relation-
even in the businesslike atmosphere of today if nurses ships, administrators and staff can transform the
reintroduce the spiritual and ethical dimensions of work environment (Ray, Turkel, & Marino, 2002; Ray,
caring. The deep values that underlie choice to do Turkel, & Cohn, 2011). The Theory of Bureaucratic
good will be felt both inside and outside organiza- Caring suggests that organizations fostering ethical
tions” (p. 429). choices, respect, and trust will become the successful
Deborah McCray-Stewart, a correction health organizations of the future.
service administrator at Telfair State Prison in Helena, Miller (1995) summarized the work of Ray and
Georgia, described how nurses in correctional health other theorists and encouraged nurse executives to
care settings integrate the Theory of Bureaucratic Car- examine their daily caring skills and to use these skills
ing into the framework of their practice (D. McCray- in administrative practice. Nyberg studied with Ray
Stewart, personal communication, April 5, 2008). and acknowledged the impact of Ray’s ideas in her
Nurses in corrections have the responsibility of car- book, A Caring Approach in Nursing Administration
ing for a complex special population. They must un- (Nyberg, 1998). Nyberg urged nurse administrators
derstand the culture, see prisoners as human beings, to create a caring and compassionate system, while
and have the ability to communicate, educate, and being accountable for organizational management,
rehabilitate in this area of health care. Their costs, and economic forces. Turkel and Ray (2003)
effectiveness results from incorporating the sociocul- conducted a study with U.S Air Force personnel that
tural, physical, educational, legal, and ethical dimen- led to increased awareness of issues between civilian
sions of caring theory into daily practice. In the eco- and military policy makers.
nomic and political areas of the correctional system, Karen O’Brien, Director of Public Health Nursing
nurses struggle with the same issues as nurses in a in Denver, Colorado, described how public health
hospital system, such as decreasing health care costs nurse consultants developed an orientation for new
while providing quality care. Economic strategies nurses by incorporating the core principles of Ray’s
include conducting health services at the facility level Theory of Bureaucratic Caring (O’Brien, personal
as opposed to transporting patients to a hospital. communication, April 12, 2008). The orientation
Radiology, laboratory, and telemedicine are curriculum includes the components of legal, tech-
introduced into the system requiring nurses to work nological, economic, and spiritual/ethical influences
in all areas. The government provides a constitution on caring for whole populations. Nurses are encour-
of care for this special population. aged to use the political and economic dimensions
Ray (2010a) has addressed the interface of di- of the theory to guide their practice. The Theory of
verse cultures within the health care system. The Bureaucratic Caring provides a framework by which
Transcultural Communicative Caring Tool provides a nurse can view the whole population and its com-
guidelines to help nurses understand the needs, ponents to understand ways they can influence
adversity, problems, and questions that arise in health outcomes.