The Theory of Bureaucratic Caring

Ray’s Theory of
Bureaucratic Caring
Marilyn A. Ray, RN, PhD, CTN-A
Professor Emeritus
Florida Atlantic University
Boca Raton, FL 33431
Ray’s Educational Background
Diploma: St Joseph’s Hospital School of
Nursing, Hamilton, Ontario, Canada
BSN and MSN, University of Colorado
MA Anthropology, McMaster University
Flight Nurse: School of Aerospace
Medicine, Brooks Air Force Base, Texas
PhD: University of Utah/Transcultural Nsg.
Bio Ethics, Georgetown University
Space Education Program: Marshall Space
Flight Center, Huntsville, Alabama
Ray’s Practice Background
University of California: OB-GYN,
Emergency Dept and Cardiac Critical Care
University of Colorado: Critical Care-children & adults), Renal Dialysis
Gates Company: Family Centered
Occupational Health
McMaster University Health Sciences
Center: Educational Coordinator, FNP
Program, and Clinical Nurse NICU
US Air Force Reserve Nurse Corps: Flight
Nurse, Nursing Educator, Administrator,
Researcher, Consultant
Ray’s Practice Background
Transcultural nursing and caring practice
First nurse to go to Russia when opened its
space program to Aerospace Medical
Assoc. & US space engineers and
Research (quantitative and qualitative) in
complex health care systems,
public/military hospitals, private hospitals ,
different units in hospitals; diverse cultures;
study of technological & economics of
Ray’s Scholarship/Teaching
University of California SF & Univ.of
San Francisco: Undergraduate
McMaster University, Canada:
Assisted in developing & taught in the
Family Nurse Practitioner Program
University of Colorado: Graduate
Education. Philosophy of Nursing,
Caring Science, Qualitative Research
Florida Atlantic University, Christine
E. Lynn Eminent Scholar; Professor
Ray’s Scholarship/Teaching
Virginia Commonwealth University:
Yingling Visiting Scholar
Visiting Professor: Universities in
Australia and New Zealand
Certified Transcultural Nurse
Founding Member of the International
Association for Human Caring
Lectured on Transcultural Caring &
Ethics in China, Sweden, Saudi
Arabia, Canada, Australia,
Philippines, Vietnam, Japan
Ray’s Scholarship/Research
Background & Scholarship
Doctoral Dissertation, 1981: A Study of Caring
within an Institutional Culture
Theory of Bureaucratic Caring, 1981, 1984, 1989,
2001, 2004, 2010a, b, c; 2011, 2013
Mutual Intentionality: A Theory of Support for
Pregnant African American women, 1999
Technological Caring: A New Model in Critical
Care, 1987. Award for Excellence in
Caring Inquiry: The Esthetic Process in the Way of
Compassion, 1991, 2012, 2013
Theory of Relational Caring Complexity with Dr.
Marian Turkel 2013
Background & Scholarship
The ethics of care and the ethics of
cure: Synthesis in chronicity, 1988
Transcultural caring dynamics in
nursing & health care, 2010
Nursing, caring, and complexity
science: For human-environment
well-being, 2011
A study of caring within an
institutional culture: The discovery of
the Theory of Bureaucratic Caring,
Ray’s Scholarship/Research
Complex Caring Dynamics: A Unifying
Model for Nursing Inquiry, 1994, 2010,
The Ethical Theory of Existential
Authenticity: The Lived Experience of the
Art of Caring in Nursing Administration,
Transcultural caring dynamics Model, 2010
TCC Assessment of Older Adults, 2000
Phenomenological Research Method,
Caring Inquiry, 1991, 2013
Theory of Bureaucratic Caring
The theory was generated from qualitative
research involving health professionals and
patients in the hospital setting,
The theory implies that there is a dialectical
relationship (thesis, antithesis, synthesis) between
the human (person & nurse) dimension of spiritualethical caring and the structural (nursing,
environment) dimensions of the bureaucracy or
organizational culture (technological, economic,
political, legal and social ).
The Model is holographic, illuminating the holistic
nature of caring & synthesis of the humanistic
systems and technologic, economic, political, legal
Major Concepts
Spiritual-Ethical Caring
Complex Organizational Cultures: Ray’s Theory
of Bureaucratic Caring (1981, 1984, 1989, 2010, 2013)
Major Concept: Caring
Caring: a complex, transcultural, relational
process, grounded in an ethical, spiritual
context. Caring is the relationship between
charity and right action, between love as
compassion in response to human
suffering and need, and justice or fairness
in terms of what ought to be done. Caring
occurs within a culture or society, including
personal culture, hospital organizational
culture, or society and global culture (Ray,
1989; Ray in Coffman, 2006; 2010, 2013).
Major Concept: Spiritual-Ethical
Spirituality involves creativity and
choice revealed in attachment, faith,
hope, love, and community. The
ethical imperatives of caring that join
with the spiritual & relate to our moral
obligation to others. Spiritual- ethical
caring for nursing focuses on how the
facilitation of choices for the good of
others (caring, healing, well-being that
should be accomplished or can be
Major Concept: Educational
Formal and informal educational
programs, use of audiovisual media to
convey information, and other forms
of teaching and sharing information
are examples of educational factors
related to the meaning of caring.
Major Concept: Physical
Physical factors relate to the physical
state of being including biological and
mental patterns. Because the mind
and body are interrelated, each
pattern influences the other.
Major Concept: Social-Cultural
Social-Cultural factors are ethnicity
and family structures; intimacy with
friends and family; communication;
social interaction and support;
understanding interrelationships,
involvement, and structures of cultural
groups, community and society.
Major Concept: Legal
Legal factors relating to the meaning
of caring include responsibility and
accountability; rules and principles to
guide behaviors, such as policies and
procedures; informed consents; right
to privacy; malpractice and liability
issues; client, family, and professional
rights; and the practice of defensive
medicine and nursing.
Major Concept: Technological
Technological factors include nonhuman
resources, such as the use of machinery to
maintain the physiological well-being of the
patient, diagnostic tests, pharmaceutical
agents, and the knowledge and skill
needed to utilize these resources. Also
included with technology are computer
assisted practice and electronic
documentation and social media.
Major Concept: Economic
Economic factors relating to the meaning of
caring include money, budget, insurance
systems, limitations and guidelines
imposed by managed care organizations
and in general, allocation of scare
resources including to maintain the
economic viability of the organization.
Caring as an interpersonal resource (love,
communication, professional knowledge)
should be considered, as well as goods,
money and services.
Major Concept: Political
Political factors and the governance & power
structure within health care administration
influence how nursing is viewed in health care and
include patterns of communication and decisions
in the organization; role and gender stratification
among nurses, physicians, and administrators,
union activities, including negotiation and
confrontation; government and insurance
company influences; uses of power, prestige, and
privilege; and in general, competition for scarce
human and material resources.
Major Assumptions
Person/Cultural Being
Environment/Culture of Organization
Nursing is holistic, transcultural &
relational, spiritual, and ethical caring that
seeks the good of self and others in
complex community, organizational, and
bureaucratic cultures.
Dwelling with the nature of nursing reveals
that the foundation of spiritual caring is
love. Love calls forth a responsible ethical
life that enables the expression of concrete
actions of caring in the lives of nurses and
for health & healing.
A person is a spiritual and cultural
being. Persons are created by God,
the Mystery of Being, a higher power
and engages co-creatively in human
organizational and transcultural
relationships to find meaning and
Health is a pattern of meaning for
individuals, families and communities.
Beliefs and caring practices about
health & illness are central features of
culture. The social organization of
health and illness determines how
persons are recognized as sick or
well, how health or illness is
presented to health care
professionals and the way health is
interpreted by the individual.
Environment is a complex spiritual, ethical,
ecological and cultural phenomenon. This
conceptualization embodies knowledge &
conscience about the beauty of life forms &
symbolic systems or patterns of meaning.
Nursing practice in environments
embodies the elements of the social
structure and spiritual and ethical caring
patterns of meaning.
Theoretical Assertions
Caring is the essential construct and
consciousness of nursing.
The meaning of caring is love and is highly
differential depending on its context-structures (social-cultural, educational,
political, economic. physical, technological
and legal) as expressed in complex
Caring is viewed as love and bureaucratic,
given the extent to which its meaning can
be understood in relation to science & the
complex organizational structure.
Application to
Practice: Ray’s research has shown that
nurses, patients and administrators value
caring science, & the caring intentionality
that is co-created in the nurse-patient or
administrator relationship.
By creating spiritual-ethical caring
relationships, clinical nurses &
administrators can transform the workplace
into moral communities within the culture of
humanistic, social, economic, political and
legal values.
Application to
Education: The theory is useful to nursing
education because of its broad focus on caring &
complexity science /s in nursing and the
conceptualization of the health care system—used
as an organizing framework for curricula.
Universities and hospitals have incorporated Ray’s
Model of Bureaucratic Caring in the framework for
the baccalaureate nursing programs, and clinical
environments to guide nursing evolution, practice,
research, and administration.
Application to
Research: Through Ray’s extensive
experience with research, she has
developed a phenomenologicalhermeneutical approach (caring inquiry)
that continues to guide her research and
has been adopted by many researchers for
the humanistic approach, using a lens of
caring & caring science to study the human
experience in health situations.
Presenting Caring Inquiry Method August,
2013 at 32nd International Human Science
Research Conference, Aalborg, Denmark
Coffman, S. (2010/2013). Ray’s Theory of
Bureaucratic Caring. In M. Alligood (Ed.)
Nursing theorists and their work. St. Louis:
Mosby/ Elsevier.
Davidson, A., Ray, M. & Turkel, M. (2011).
Nursing, caring, and complexity science:
For human-environment well-being. NY:
Ray, M. (2010a). Transcultural caring
dynamics in nursing and health care.
Philadelphia: F. A. Davis Company.
Ray, M. & Turkel, M. (2010/in press).
Marilyn Anne Ray’s Theory of Bureaucratic
Caring in M. Smith & M. Parker (Eds.).
Nursing theories & nursing practice.
Philadelphia: F. A. Davis Company.
Ray, M. (2010b). A study of caring within
an institutional culture: The discovery of the
Theory of Bureaucratic Caring. Germany:
Lambert Academic Publishers.
Gratitude Extended to Dr. Charlotte Barry
for initiating development of PPTs
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