Nursing, Caring, and Complexity Science: For Human ... - Axon

PROLOGUE xxxi
and ethical behavior that has an influence on what we value and how we
think and reason in work life interactions (Perrow, 1986).
Ray’s (1981a, 1984, 1989, 2006, 2010a, 2010b; Coffman, 2010; Turkel,
2001, 2006, 2007) theory of bureaucratic caring emerged from studying the
meaning of caring in a hospital’s the complex institutional culture. As a central
focus of the discipline of nursing (Newman et al., 2008; Ray, 1981a,
1981b; Watson, 1979, 1985, 2005, 2008), caring “unfolds within a participative
process formed by the informational patterns of the nurse and the
patient” (Newman et al., 2008, p. 4). Thus, the sphere of knowledge in
nursing captures views of caring, copresence, wholeness (health and wellbeing—integration
of body, mind, spirit), choice, and emergence in the
human–environment relationship.
Through her research, Ray (1981a, 1984, 1989, 2006, 2010a, 2010b;
Coffman, 2010; Ray & Turkel, 2010) also discovered how the context itself
(the bureaucracy) played a role in the meaning structure of caring, identifying
both substantive and formal theories, differential caring and a synthesis,
bureaucratic caring. The theory is holographic (Coffman, 2010; Ray, 2006,
2010a; Ray & Turkel, 2010). Caring is a whole, yet is a part of the complexity
of a hospital, and in essence, the society at large. Within the differential
caring theory, caring in the complex organization of the hospital differentiated
itself in terms of meaning by its unit context—dominant caring dimensions
related to areas of practice or units wherein professionals worked and
patients resided.
Differential caring theory also showed that different units espoused different
(dominant) caring meanings based on their organizational goals and
values, such as technological caring in intensive care units or surgical suites,
humanistic and spiritual caring in the oncology unit, and legal, economic,
and political caring in the administrative environments (Ray, 2006; Ray &
Turkel, 2010).
In this light, differential caring was organized into a hierarchical structure
(psychological, practical, interactional, philosophic) from data on the
meaning of caring (Ray, 1981a, 1984, 2010b). Here, the data revealed that
differential caring theory is an expression of beliefs and behaviors relating
to competing technological, ethical, religious, political, legal, economic,
educational, humanistic, and social factors of the organization and dominant
culture.
For its part, the formal theory of bureaucratic caring emerged by integrating
the qualitative data from interviews, participant–observations of the hospital
culture, and the interpretation of meaning of caring using an Hegelian
philosophy of thesis, antithesis, synthesis: illuminating the thesis of caring
(a meaning system) in relation to the potential antithesis of caring (the
hospital as a bureaucracy) to a synthesis, the theory of bureaucratic caring.
The theory illuminates the nature of caring as the integration of humanistic,