Theory Wk13 Discussion Assignment

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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)

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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. Theory Wk13 Discussion Assignment

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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

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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)

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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

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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

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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

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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

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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

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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).

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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

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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

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Organizational Culture

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

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Types of Organizational Cultures

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

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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)

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Work of Nursing

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

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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

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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

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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

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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

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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).

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Paradigms

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

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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

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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

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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

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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

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Dimensions of Bureaucratic Caring

• Caring as humanistic
• Social
• Educational
• Ethical
• Religious/spiritual

• Caring as economic
• Political
• Economic
• Legal
• Technological

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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

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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.

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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.

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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

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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).

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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.

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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

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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

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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.

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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.

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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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Chapter 28

Dr. Troutman-Jordan’s Theory of Successful Aging

Developed by D. Gullett (2014)

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Overview of the Theory

The impetus for developing the theory of successful aging was enhanced understanding of successful aging, captured from the older adult’s perspective, and identification of foci for interventions to foster successful aging.

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Overview of the Theory (cont)

Foundation:

• Developed from a concept analysis of successful aging
• Foundations:

Roy’s Adaptation Model

Tornstam’s sociological theory of gerotranscendence

Other literature on concepts of successful aging

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Theoretical Assumptions

• Aging is a progressive process requiring from simple to increasingly complex adaptation;
• Aging may be successful or unsuccessful, depending upon where a person is along the continuum of progression from simple to more complex adaptation and the extensive use of coping processes;
• Successful aging is influenced by the aging person’s choices;
• The self is not ageless (Tornstam, 1996); and
• Aging people experience changes, which uniquely characterize their beliefs and perspectives as different from those of younger adults (Flood, 2006a). Theory Wk13 Discussion Assignment

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Definition of Theory

The theory of successful aging describes the process by which individuals use various coping mechanisms to progress toward desirable adaptation to the collective physiologic and functional changes occurring over their lifetime, while maintaining a sense of spirituality, connectedness, and meaning and purpose in life. Theory Wk13 Discussion Assignment

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Foundation of Theory

Three coping processes (the way one responds to the changing environment)

Functional Performance Mechanisms

Intrapsychic factors

Spirituality

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Constructs (within each Coping Processes)

Within each coping process there are measurable output responses- provide feedback to the person.

Cognitive

Behavioral

Affective

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Coping Processes/Output Responses

• Typical age-related declines that occur

Indicators

• Health promotion activities
• Physical health
• Physical mobility
• Annual physical exams
• Current chronic and acute disease
• Gait mobility

Functional Performance Mechanisms

Output Responses

• Each is a manifestation of the human adaptive response of functional performance mechanism

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Coping Processes/Output Responses

• Use of inherent character traits to respond to environmental stimuli

Intrapsychic Factors

Output Responses

• Creativity
• Low levels of negativity
• Personal Control

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Coping Processes/Output Responses

• The sense of connection and beliefs about a higher power the older adult has help shape his values, beliefs, and behaviors while living especially in terms of what he believes happens after death.

Spirituality

Output responses

• Spiritual perspective
• Prayer
• Religiosity

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Gerotranscendence

• Shift in metaperspective from materialistic and rationalistic to a more mature and existential one that accompanies the process of aging.
• New outlook on and understanding of life
• Broad existential changes
• Changes in one’s view of the present self & the self in retrospect
• Developmental changes (r/t existential changes and changes in self)

Associated with positive gaining and has been theorized as a precursor to successful aging

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Gerotranscendence (cont)

Three Levels of age-related change occur

Cosmic dimension-relates to the feeling of being a part of and at one with the universe

Self dimension-deals with one’s self perception

Social dimension-increase in a sense of interrelatedness to others

• Assessed using the Gerotranscendence Scale (GS) (Tornstam, 1994)

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Gerotranscendence (cont)

A reasonable and well-balanced integration of the outputs of each foundational coping process for each individual, rather than an ideal amount or combinations of features from within the foundational coping processes, must be present in order for the aging person to experience gerotranscendence. Theory Wk13 Discussion Assignment

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Measuring Successful Aging

• Successful Aging Inventory (SAI) is a 20-item questionnaire