Theory Week 13

Chapter 27

Marilyn Anne Ray’s Theory of
Bureaucratic Caring

Developed by S. Gordon (2005)

Revised by C. A. Blum (2010)

Updated by D. Gullett (2014)

On completion of this chapter, students will be able to:

Describe Ray’s Theory of Bureaucratic Caring.

Outline the development of the Theory of Bureaucratic Caring.

Discuss organizational cultures as transformational bureaucracies.

Identify and discuss characteristics of bureaucracies.

Compare and contrast the terms “formal” and “substantive” theory.

Describe what distinguishes organizations as cultures from other paradigms, such as organizations as machines.

Explain the paradox of serving a bureaucracy and serving humans using an example from clinical practice.

Compare and contrast the Theory of Bureaucratic Caring and the revised Holographic Theory of Bureaucratic Caring.

Discuss the relevance of complexity science to theory development.

Purpose of the Chapter

Discuss contemporary nursing culture
Share Dr. Ray’s theoretical views and vision of nursing
Discuss the Theory of Bureaucratic Caring
As grounded theory
As holographic theory

Generation of Bureaucratic Caring Theory

Used three research approaches
Ethnography (hospital as a culture)
Phenomenology (meaning of caring in the life world)
Grounded theory method (the structure and process of caring within the complex organization)

Theory Revisited

Ray revisited the theory and discovered the theory incorporated many concepts from the new sciences of complexity
The theory was revealed as holographic
The holographic model depicts the primacy of caring as spiritual-ethical and the other dimensions as equal, interfacing between the spiritual and ethical and the bureaucratic dimensions

The Theory of Bureaucratic Caring

Invites us to view how a new model may facilitate understanding of how nursing can be practiced in modern health care (Ray, 2006)
Is a holistic theory with a practical purpose that facilitates our understanding of nursing practice in complex contemporary health-care environments

Dr. Ray Believes

Given the nature of nursing as expanded consciousness and theory as wakefulness,
Nurses need nursing theory to stimulate thinking and critique as they function in the complex world of nursing science, research, education, and practice

Holographic Theory

Holography means that the implicate order (the whole) and explicate order (the part) are interconnected that everything is a Holon, including humans, in the sense that everything is a whole in one context and a part in another-each part being in the whole and the whole being in the part

The Theory of Bureaucratic Caring as a Holographic Theory

Holistic science (and art)

captures the idea that all systems, including health care systems, are living systems
both wholes and parts
depend on networks of relationships, information, choice and communication flow

The Theory of Bureaucratic Caring as a Holographic Theory

Furthers the vision of nursing and organizations as complex, dynamic, relational, integral, informational, and emergent—open to sets of possibilities
Synchronicity of interacting parts and the whole
Everything interconnects
We are all creative manifestations of the oneness of the environment (context), moving in relationship, and continually transforming (emerging—growing and developing) (Thoma, 2003).

The Theory of Bureaucratic Caring as a Holographic Theory

Provides a means for nurses and other professionals
to change
to realize the integral nature of the dynamic unity of the human and environment
Rather than continuing mechanistic approaches of prediction and control

Contemporary Nursing Practice

Nursing occurs in organizations that are generally bureaucratic or systematic in nature
Bureaucracies are a valuable tool
Identify
Understand
Principles that undergird coordinated and relational organizational systems

Organizational Culture

Paradigm for understanding organizations
Founded in Anthropology
Social constructions
Symbolically formed
Reproduced through interaction
Studied formally and informally

Types of Organizational Cultures

Informal
Integration of codes of ethics and conduct
Commitment
Identity
Coherence
Formal
Power and authority
Political
Legal

Work of Nursing Within the Organizational Cultures

Undervalued in terms of cost and worth
Currently evaluated in terms of patient safety and clinical nursing leadership
New interest in evaluating meaningfulness of work
Directly helping others
Creating products that help others (Cuilla, 2000)

Work of Nursing

Traditional
Directly helping others through knowledgeable caring (Watson, 2005)
Contemporary
Directly helping others
Legal context
Economic context

Call for the Reinvention of Work

Re-seeing the good of nursing
Incorporation of business principles and relational self-organization
Searching for meaning in the complexities of life and work

Organizational Cultures as Transformational Bureaucracies

Transformation of nurses toward relational self-organization and creativity
Moving from invisibility to visibility
Identifying nurses caring work as
Having value
Expression of one’s soul
Spiritual-ethical caring

Characteristics of Bureaucracies
Eisenberg & Goodall (1993)

Division of labor
Hierarchy of offices
General set of performance rules
Separation of personal from professional
Employment viewed as a career

Equal treatment of employees or standards of fairness
Protection of dismissal by tenure
Personal selection based on technical and professional qualifications

Caring as the Unifying Focus of Nursing

Caring in nursing
Brings things into being
Holistic, humane, and dynamic
Essence of nursing
Social mandate
Manifested in different and complex ways

Complexity and Nursing Theory

Complexity theory—opposing things occur at the same time (Thoma, 2003). Therefore, linear and nonlinear, and simple and complex systems exist together.
Gives rise to Chaos Theory—the notion that the concept of order exists within disorder at the system communication (Davidson & Ray, 1991).

Paradigms

Prevailing worldviews in nursing
Direct nursing theories
Enfold the care and caring ideal

Types of Paradigms

Totality (Fawcett, 1993)
Demonstrated nursing, person, society, environment, and health characterize the nature of nursing
Simultaneity (Parse, 1987)
Illuminates the human-environment integral nature of nursing
Unitary-transformative (Newman, 1992)
The view that the human being is unitary and evolving as a self-organizing field identified by pattern and interaction with the larger whole. Health is considered expanding consciousness

The Theory of Bureaucratic Caring

Has its roots in all the these paradigms by synthesis of
Caring
Organizational (bureaucratic) context
Holism
Human-environment integral relationship

Bureaucratic Caring Theory: Emergent in Grounded Theory

Originated as a Grounded Theory (Ray, 1981)
Qualitative study of caring in organizational culture
Study revealed nurses struggled with the paradox of
Serving the bureaucracy while-
Serving human beings through caring

Discovery of Bureaucratic Caring Resulted in:

Substantive Theory: Differential Caring Theory
Caring is complex
Differentiated in terms of context
Practice settings
Formal Theory: Bureaucratic Caring Theory
Synthesis of caring as humanistic and antithesis of caring as economic, political, legal, and technological

Dimensions of Bureaucratic Caring

Caring as humanistic
Social
Educational
Ethical
Religious/spiritual

Caring as economic
Political
Economic
Legal
Technological

Theory of Bureaucratic Caring as a Holographic Theory

Holographic Theory:
Interconnectedness of all things – the whole and the part are interconnected
Knowledge exists in relationship rather than the object world or subjective experience
Uncertainty is inherent in relationships because everything is in process
Nature or meaning of the whole is complex

Theory of Bureaucratic Caring as a Holographic Theory (continued)

The synthesis of caring as humanistic and caring as economic within the Theory of Bureaucratic Caring shows that everything is interconnected
The whole is in the part and the part is in the whole, a holon.
We are all creative manifestations of the oneness of the environment.

Research Demonstrates

The economic dimension of Bureaucratic Caring is dominant.
Nursing and caring are experiential and influenced by social structures.
Interactions and symbolic interactions are formed and reproduced from dominant values held within organizations.

The Theory of Bureaucratic Caring

Has been embraced by
Educators
Researchers
Nursing administrators
Clinicians
Who desire an understanding of how to preserve humanistic caring within the business or corporate culture

Relational Caring Complexity a Metatheory

Ray and Turkel (2012) continue to advance their collaborative ideas related to theory development, caring science, and the paradox between caring and economics within complex systems.
A metatheory (Ritzer, 1991) emerged from the integration of the following:
The Theory of Bureaucratic Caring (Ray, 1981, 2006)
Struggling to Find a Balance: The Paradox Between Caring and Economics (Turkel 1997, 2001)
Relational Complexity (Ray & Turkel, 2012; Turkel & Ray, 2000).

Relational Caring Complexity a Metatheory

Reveals the complexity of today’s nursing practice situation
While providing a foundation for emerging professional practice models focused on caring and healing
An innovative transdisciplinary research looking at caring and economics
Continually giving voice to the value of caring in nursing within and a part of complex organizations allows for spiritual-ethical caring to occur.

Theory of Bureaucratic Caring as a Middle-Range Theory

Relatively large scope but does not capture the full range of phenomena of a discipline
Narrower in scope than grand theories
Abstract enough to extend beyond specific data
Specific enough for testing or permitting transformational practice interventions
Fall between the concrete world of practice and grand theories

Theory of Bureaucratic Caring as a Middle-Range Theory (continued)

Bureaucratic Caring
Reflects the concrete world of practice
Responds to the caring ideal that is unique to nursing
Is both a grounded theory and a middle-range theory
May be considered a grand or holographic theory

Summary

Nursing in complex organizations has to evolve.
Caring is the primordial construct and consciousness of nursing.
Nurses are calling for expression of their own spiritual and ethical existence.
The Theory of Bureaucratic Caring as a Holographic Theory can lead the way.

References

Davidson, A., & Ray, M. (1991). Studying the human-environment phenomenon using the science of

complexity. Advances in Nursing Science, 14(2), 73–87.

Fawcett, J. (1993). From a plethora of paradigms to parsimony in worldviews. Nursing Science Quarterly, 6, 56–58.

Newman, M. (1992). Prevailing paradigms in nursing. Nursing Outlook, 40, 10–14.

Parse, R. (1987). Nursing science: Maps, paradigms, theories, and critiques. Philadelphia: W. B. Saunders.

Ray, M. (1981). A study of caring within the institutional culture. Unpublished doctoral dissertation. Salt Lake

City, UT: University of Utah.

Ray, M. (2006). Marilyn Anne Ray’s Theory of Bureaucratic Caring. In: M. Parker (Ed.), Nursing theories, nursing

practice (2nd ed.). Philadelphia: F. A. Davis.

Ray, M. & Turkel, M. (2012). A transtheoretical evolution of caring science within complex systerms. International Journal for Human Caring, 16(2), 28-49.

References

Ritzer, G., (1992 Metatheorizing: Newbury park, CA:sage.)

Thoma, H. (2003). Holistic science: All at the same time. Resurgence, 1(216), 15–17.

Turkel, M. (1997). Struggling to find a balance: A grounded theory study of the nurse-patient relationship in the changing health care environment. Unpublished doctoral dissertation, University of Miami, Florida. Microfilm #9805958.

Turkel, M. (2001). Struggling to find a balance: The paradox between caring and economics. Nursing

Administration Quarterly, 26(1), 67–82.

Turkel, M., & Ray, M. (2000). Relational complexity: A theory of the nurse-patient relationship within an

economic context. Nursing Science Quarterly, 13(4), 307–313.

Watson, J. (2005). Caring science as sacred science. Philadelphia: F. A. Davis.

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