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Dr. Marilyn Ray's Theory of Bureaucratic Caring
Transcript of Dr. Marilyn Ray's Theory of Bureaucratic Caring
Clip from the movie John Q
Dr. Marilyn Ray
It was a typical Saturday night at the hospital when Michael was assigned as my patient. I reviewed his chart and discovered that he had an enlarged heart and was in need of an immediate heart transplant. I remember the scared look on his face when I entered his room. Michael was terrified and his parents were undergoing the most stressful moment of their lives. I was told by the charge nurse that Michael's prognosis was not positive because his family did not have the necessary resources to finance his transplant, and his father's new insurance plan would not cover the procedure. Even though I could not provide monetary help, I did everything I could to keep Michael comfortable and to not lose his innocent childish spirit.
Marilyn Ray was born in Ontario Canada and has a intense educational and professional career. Her professional career began as she received her diploma from St.Joseph Hospital. She furthered her education in Denver Colorado at UC, receiving her BSN and MSN in Maternal-Child Nursing. She achieved another Master's degree in Anthropology from McMaster University in her hometown of Hamilton, Canada. She earned her highest degree from the University of Utah; a PhD in Transcultural Nursing. In the midst of completing her education, she practiced in the following areas of health care: adult intensive care, neonatal intensive care, pediatrics, OBGYN, ER, and flight nursing. In addition, she served with the US Air Force for 30 years before retiring as a Colonel in 1999. Among her numerous awards, she was the recipient of the Federal Nursing Services Research Award for her work on economics and nursing.
Before retiring from FAU Christine E. Lynn College of Nursing as a professor in 2004, she also taught at the UCSF, University of San Francisco, University of Colorado, and McMaster University. She maintains a connection with the university as a Professor Emerita. She is one of the founders of the National Caring Research Conference, now known as International Association for Human Caring (IAHC). This organization awards $1,000 a year for one international nursing student.
Through compassion and justice nursing strives towards excellence in the activities of caring in the dynamic complex cultural contexts of relationships, organizations, and communities
A person is a spiritual and cultural being who engages cocreatively in human organizational and transcultural relationships to find meaning and value. Persons are created by god.
Health is not simply the consequence of a physical state of being. Health is intimately connected to the way people (including nurses) in a cultural group, an organizational culture, or a bureaucratic system construct the reality of health and find meaning.
Environment is a complex spiritual, ethical, ecological, and cultural phenomenon. This conceptualization of environment embodies knowledge and conscience about the beauty of life forms and symbolic (representational) systems or patterns of knowing. Nursing practice in environments embodies the elements of the social structure and spiritual and ethical caring patterns of meaning.
Ways of Knowing
Nurse recognizes that a super hero toy might boost Mikey's spirit
Personal curiosity of the mom of what medications the nurse is giving Mikey
Remembered Mikey likes ice chips and that they make him feel better
Lasix-diuretic for fluid retention
Dopamine for BP
Digoxin for heart failure
Analgesics for pain
Intensive care unit machinery
Competency via administering medications correctly
Showed respect, empathy and dignitiy for both Mikey and his mom
Essence of Caring
A call for individualized recognition in the midst of corporate needs
Responses would vary by area of practice. For instance, caring behaviors slightly differ between the oncology unit and intensive care unit. In terms of the nursing situation, the response required is for individualized care to Mikey despite the corporate need for money to pay for his care.
A call for partnership among nurses, physicians, patients and administrators essential for running a successful hospital organization
Administrators should recognize the nurse-patient caring relationship as having an intangible value and they should consider that a return on investment.
The goal of the system is to decrease the lenght of stay and increase staff ratios; therefore,
nurses need to establish trust and initiate
a relationship during their first encounter with a patient. Nurses need to focus on being, knowing, and doing all at once and being there from a patient perspective.
Nurses need to become proactive and began to use theory-based practice to take action on their future.
Current research has showed that the preservation of the nurse-patient relationship and humanistic caring was continuing to grow despite the heavy emphasis by administrators and insurance companies on cost control. Further research should be done to monitor the nurse-patient relationship and humanistic caring.
The nurse explained to the mother the reason behind each medicine that he was giving to Mikey
He presented himself as a calm individual that was aware of the critical situation of Mikey and he was managing it
He spoke to Mikey and let him know what he was about to feel as the effect of one of the medications. He used words that were at the child’s level of understanding
He was able to connect with Mikey by giving him one of his favorite toys. He also showed Mikey’s mother that he cared as the toy event brought emotional satisfaction for Mikey
ow that you know your patients like yourself
nbearable pain will go away
espect them, listen and smile
peak the truth and look into their eyes
ven if you know that tears will rise
reat them with love and give them your best
nly they know, what it is like to be on that “bed”
ecause at the end of the day
xcellent care should be what they get
Concepts of Theory
a complex, transcultural, relational process, grounded in ethical, spiritual context. Caring occurs within a culture/society, including personal culture, societal culture, global culture, and in this case, hospital organizational culture. Caring becomes the relationship between love as compassion in response to needs and suffering, between charity and right action, and justice or fairness in terms of what should be done.
relates to holism and the integration of mind, body and spirit. Spirituality involves the creativity and choice. It is revealed in attachment, love and community. Ethically speaking, to care for someone means to never treat a person as means to an end, but as beings with the capacity to make choices and thus be autonomous. SE caring for nurses focuses on how the facilitation of choices for the good of others can and should be accomplished.
Different forms of teaching and sharing information related to the meaning of caring, such as, formal and informal educational programs, and use of audiovisual media to convey information.
Physical state of being (biological and mental), since the body and mind are inter-connected, each influences the other.
ethnicity and family structures, communication, social interaction and support, intimacy with friends and family, the understanding of interrelationships, personal involvement, and intimacy, structures of cultural groups, community and society.
responsibility and accountability; rules and ethics that guide behaviors (hospital policy and procedures); informed consent; client, family and professional rights; rights to privacy (HIPAA); malpractice and liability issues; practice of defensive medicine and nursing
non-human resources, such as machinery (to maintain physiological well-being of patient), pharmaceutical agents, diagnostic testing, and the overall knowledge and skill to utilize these resources. Computer-assisted practice and documentation are also technological aspects of nursing
money, budgets, insurance, limitations, and guidelines imposed by managed care organizations. In addition to goods, money, and services, nursing should be considered as an interpersonal resource as well.
these kinds of factors and the power structure within healthcare administration influence the way nursing is viewed in healthcare and includes patterns of communication and decision-making in the organization; role and gender stratification among nurses and other healthcare professionals; union activities- negotiation and confrontation; government and insurance company influences; use of power presage and privileges can be competition for scare human and material resources.
Ray, M. A. (1989). The theory of bureaucratic caring for nursing practice in the organizational culture. Nursing Administration Quarterly, 13(2), 31-42.
Turkel, M. C. (2007). Dr. marilyn ray's theory of bureaucratic caring. International Journal for Human Caring, 11(4), 57-70.