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114 UNIT II Nursing Philosophies

on the well-being of the patient, they simultane- nursing staff in partnership with the Vice President
ously created a caring-healing environment that for Nursing. Nursing administration, Clinical
contributed to the well-being of the whole—the Nurse Leaders, and staff’s actions reflected values
emotional atmosphere of the unit, the ability of and beliefs, attitudes, and behaviors about the
the Clinical Nurse Leader and staff nurses to prac- nursing care they would provide, how they would
tice caringly and competently, and the quality of use technology, and how they would deal with
care the staff were able to provide to other patients. human relationships. The ethical and spiritual
The bureaucratic nature of the hospital included choice making of the whole staff and the way they
leadership and management systems that con- communicated their values both reflected and cre-
ferred power, authority, and control to the Nurse ated a caring community in the workplace culture
Manager, the Clinical Nurse Leader, as well as of the hospital unit.

CRITICAL THINKING ACTIVITIES
Based on the case study above, consider the following Discuss the role and the value of the Clinical Nurse
questions. Leader on nursing units. What is the difference
1. What caring behaviors prompted the Nurse Manager between the Nurse Manager and the Clinical Nurse
to assign the Clinical Nurse Leader to engage in Leader in terms of caring practice in complex hospi-
direct caring for Mrs. Smith? Describe and explain tal care settings? How does a CNL fit into the Theory
the new Clinical Nurse Leader role established by of Bureaucratic Caring for implementation of a
the American Association of College of Nursing caring practice?
in 2004. 4. What interrelationships are evident between
2. What issues (ethical, spiritual, legal, social-cultural, persons in this environment, that is, how were the
economic, and physical) from the structure of the Vice President for Nursing, Nurse Manager, Clini-
Theory of Bureaucratic Caring influenced this cal Nurse Leader, staff, and patient connected in
situation? Discuss “end of life” issues in relation this situation? Compare and contrast the traditional
to the theory. nursing process with Turkel, Ray, and Kornblatt’s
3. How did the Nurse Manager balance these issues? (2012) language of caring practice within the
What considerations went into her decision making? Theory of Bureaucratic Caring.

POINTS FOR FURTHER STUDY
n Florida Atlantic University, Christine E. Lynn Col- n Ray, M. (2010). Transcultural caring dynamics in
lege of Nursing, Boca Raton, FL, at: www.fau.edu nursing and health care. Philadelphia: F. A. Davis.
n International Association for Human Caring, at: n Santa Fe Institute, Santa Fe, NM, at: www.
www.humancaring.org santafe.edu
n New England Complex Systems Institute, n Watson Caring Science Institute, at www.wcsi.org
Cambridge, MA, at: www.necsi.edu
n Plexus Institute, Allentown, NJ, at: www.
plexusinstitute.org