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112 UNIT II Nursing Philosophies

Most terms did not change from the 1989 article to the holistic nature of concepts and relationships. As
2001 and 2006 publications; however, some concepts nurses in all areas of practice study these new concep-
combined or separated as Ray’s development of the the- tualizations, they may be led to question the cause-
ory evolved (Ray, 2010a; Ray & Turkel, 2010). Therefore, and-effect stance of older linear ideas. Therefore, the
for this chapter, currently used terms were clarified with Theory of Bureaucratic Caring has the potential to
the theorist. Furthermore, the formal definitions of the change the paradigm or way of thinking of practicing
terms spiritual-ethical caring, social-cultural, physical, nurses.
and technological, as they relate to the theory, are pub-
lished for the first time in this chapter. Accessibility
The diagram presented in Figure 8-2 enhances Because the Theory of Bureaucratic Caring is generated
clarity. The interrelationship of spiritual-ethical car- using grounded theory and has undergone continued
ing with the other structures and the openness of the revisions based largely on research, empirical precision
system are depicted by the organization of concepts is high with concepts grounded in observable reality.
and the dynamic arrows. Ray’s description of the The theory corresponds directly to the research data
theory (2001, pp. 428-429; assists the reader in imag- that are summarized in published reports (Ray, 1981a,
ing the theory relationships as holographic. 1981b, 1984, 1987, 1989, 1997b, 1998).
Ray, Turkel, and Marino use this theory in a pro-
Simplicity gram of research into the nurse-patient relationship
Ray’s theory simplifies the dynamics of complex bu- as an economic resource (Ray, 1998; Ray, Turkel, &
reaucratic organizations. From numerous descrip- Marino, 2002; Turkel, 2003; Turkel & Ray, 2000, 2001,
tions of the inductive grounded theory study, Ray 2003). These studies provide guidance for nursing
derived the integrative concept of spiritual-ethical practice and enhance nurses’ understanding of the
caring and the seven interrelated concepts of physical, dynamics of health care organizations. Ray (2001)
social-cultural, legal, technological, economic, political, proposes that bureaucratic caring culminates “in a
and educational structures. Given the complexity of vision for understanding the deeper reality of nursing
bureaucratic organizations, the number of concepts is life” (p. 426).
minimal.
Importance
Generality The issues that confront nurses today include eco-
The Theory of Bureaucratic Caring is a philosophy that nomic constraints in the managed care environment
addresses the nature of nursing as caring. Alligood and the effects of these constraints (e.g., staffing ra-
(2010) notes, “Nursing philosophy sets forth the mean- tios) on the nurse-patient relationship. These are the
ing of nursing phenomena through analysis, reasoning, very issues that the Theory of Bureaucratic Caring
and logical argument” (p. 69). Ray’s theory addresses addresses. Nurses in administrative, research, and
questions such as “What is the nature of caring in nurs- clinical roles can use the political and economic di-
ing?” and “What is the nature of nursing practice as mensions of the theory as a framework to inform
caring?” Philosophies are broad and provide direction their practice. This theory is relevant to the contem-
for the discipline (Alligood, 2010, p. 69). The Theory of porary work world of nurses.
Bureaucratic Caring proposes that nurses are choice Ray and Turkel have generated middle-range theo-
makers guided by spiritual-ethical caring, in relation to ries through their program of research based on the
legal, economic, technological, and other structures. Theory of Bureaucratic Caring. Ray uncovered the
The Theory of Bureaucratic Caring provides a Theory of Existential Authenticity (1997b) as the unity
unique view of health care organizations and how of meaning for nurse-administrator caring art, and Sor-
nursing phenomena interrelate as wholes and parts of bello adapted it more recently (2008). Nurse adminis-
the system. Concepts are derived logically with in- trators described an ethic of living, caring for the good
ductive research. Ray’s analysis incorporates ideas of their staff nurses and for the good of the organiza-
from complexity science. The conceptualization of the tion. Relational (Caring) Complexity focuses on the
health care system as holographic emphasizes the nurse-patient relationship within an economic context