Page 127 - alligood 8th edition_Neat

108 UNIT II Nursing Philosophies

At the National University of Colombia in Bogota, everything is a whole in one context and a part of
Colombia, Professor Olga J. Gomez and her nursing the whole in another context. Spiritual-ethical
students studied Ray’s Theory of Bureaucratic Caring, caring, the focus for communication, infuses all
focusing on the hospital nursing administration role nursing phenomena, including physical, social-
(Gomez, personal communication, April 5, 2008). As cultural, legal, technological, economic, political,
they studied the paradox between the concepts of and educational forces. The arrows reflect the
human caring and economics, the students developed dynamic nature of spiritual-ethical caring by the
a framework for phenomenological research and nurse and the forces that influence the changing
explored the perceptions of executive nurses about structure of the health care system. These forces
the relationships among human care, economics, and impact both the client/patient and the nurse.”
control of health costs. An outcome of the study was (Nevada State College, 2010, p. 2)
recognition of the importance of working together in
university and practice settings for empowerment In the health care system, the client-patient and the
and satisfaction of clients in the hospital environ- nurse come together in a dynamic transpersonal car-
ment. Finally, the Theory of Bureaucratic Caring was ing relationship (Watson, 1985). The nurse, through
adopted in 2012 by Iowa Health, Des Moines (three communication, views the person as having the capac-
hospitals) for implementation as a theory guide for ity to make choices. Through reflection on experience,
professional nursing practice at their hospitals in the nurse assesses which force has the most influence
preparation for application for Magnet Recognition on the nursing situation (Johns, 2000). The nurse
Status as centers for excellence (Turkel, 2004). draws upon empirical, ethical, and personal knowl-
edge to inform and influence the aesthetic response to
Education the patient. Through the nurse’s caring activities within
The Theory of Bureaucratic Caring is useful in nurs- the transpersonal relationship, the goal of nursing can
ing education in terms of its broad focus on caring in be achieved—the promotion of well-being through
nursing and its conceptualization of the health care caring (Nevada State College, 2010).
system. The holographic theory combines differentia- The Theory of Bureaucratic Caring is being used
tion of structures within a holistic framework. Dis- to guide curriculum development in the master’s pro-
cussion of the structures or forces within complex gram in nursing administration and in the master’s
organizations (e.g., legal, economic, social-cultural) and doctoral programs in theory courses at Florida
provides an overview of factors involved in nursing Atlantic University. Structures from the theory,
situations. Infusion of these structures with spiritual- including ethical, spiritual, economic, technological,
ethical caring emphasizes the moral imperatives and legal, political, and social, serve as a framework for
the choice making of nurses. exploration of current health care issues. Students are
When developing a new baccalaureate nursing pro- challenged to analyze the contemporary economic
gram at Nevada State College, the faculty was particu- structure of health care from the perspective of car-
larly drawn to the theory because of its description of ing. Caring within the health care delivery system is a
the dimensions relevant to nursing within a philoso- key concept in nursing courses (Turkel, 2001; Ray,
phy of caring. The conceptual framework of the new personal communication, May 2012).
nursing program combined Ray’s Theory of Bureau-
cratic Caring with theoretical ideas from Watson Research
(1985) and Johns (2000). Figure 8-3 depicts the ways From her research that resulted in the Theory of Bu-
nurses and clients interact in the health care system reaucratic Caring, Ray developed a phenomenological-
and how reflection on practice influences this process. hermeneutic approach and a caring inquiry approach
A description of the conceptual framework for the that has continued to guide her studies (Ray, 1985,
curriculum, illustrated in Figure 8-3, is as follows: 1991, 1994b, 2011). This research approach is particu-
larly significant because it is grounded in the philoso-
“. . . the holographic theory of caring recognizes phy of humanism and caring, and it encourages nurses
the interconnectedness of all things, and that to utilize phenomenological hermeneutics through the