working for the good of the whole is imperative.
Running away from the chaos of hospitals or mis-
understanding the meaning of work life cannot be-
come the norm. Wherever nurses go, they will be
haunted by bureaucracies, some functional, many
problematic. What, then, is the deeper reality of
nursing practice? The following is a presentation of
theoretical views that relate to bureaucratic caring
theory, culminating in a vision for understanding
the deeper significance of nursing life.
SUBSTANTIVE AND FORMAL THEORY
Glaser and Strauss (1967; Glaser, 1978; Strauss &
Corbin, 1998) were the first social scientists to pre-
sent the perspective of social theory, both substan-
tive and formal, discovered from inductive research
processes. Substantive and formal theories emerge
from in-depth qualitative studies of social cultural
processes—action and interaction associated with
the social world. The researcher considers evidence
about how one event affects another and explains
the things observed and recorded by developing
theoretical relationships about the data. Theoretical
sampling (Glaser, 1978) refines, elaborates, and ex-
hausts conceptual categories so that an actual inte-
gration of descriptors and categories can facilitate
the discovery of substantive theory. The discovery
of a basic social process is the foundation for sub-
stantive theory. The formal theory is generated
from both the inductive process, based on substan-
tive knowledge/theory, and deductive approaches,
which draw upon cumulative knowledge from the
social world to examine the initial propositions ad-
vanced. A formal theory reflects the structure of
both processes.
The Theory of Bureaucratic Caring integrated
knowledge from data that is associated with re-
searching the meaning and action of caring in the
institutional culture of a hospital, which resulted
in a substantive theory of differential caring. Narra-
tive responses to the meaning of caring reported by
different health-care professionals and patients
produced varied beliefs and values, ranging from
humanistic definitions, such as empathy, love, and
ethical and religious delineations, to technological,
legal, political, and economic descriptions. The for-
mal theory evolved as a result of using the Hegelian
dialectical process of examining and connecting
codetermining polar opposites of the humanistic
dimensions as the thesis of caring in relation to the
dimensions of economics, politics, law, and tech-
nology of the bureaucracy as the antithesis of car-
ing. The process was synthesized into a dialectical,
formal Theory of Bureaucratic Caring. The laws of
the dialectic—codetermination of polar opposites,
negation of each of the separate codetermining op-
posites, and synthesis of conceptualizations toward
transformation and change—demonstrated that
the understanding of institutional caring as a
whole, or the Theory of Bureaucratic Caring, is
simply a representation of its integral nature in
contemporary organizational culture. The theory
shows that caring reached its completeness through
the process of its own relevance in practice (Ray,
1981, 1989).MIDDLE-RANGE THEORY
Middle-range theory deals with a relatively broad
scope of phenomena but does not cover the full
range of phenomena of a discipline, as do grand
theories that encompass the fullest range or the
most global phenomena in the discipline (Chinn &
Kramer, 1995). As such, middle-range theories are
generally considered narrower in scope than grand
theories, and to some extent narrower than formal
theory within the grounded theory tradition. There
is a paradox in caring as middle-range theory.
Caring in nursing, for example, may be considered
by some intellectuals in the discipline as hav-
ing a narrow scope or a foundation for a middle-
range theory. However, others who have adopted
Newman’s (1992) paradigmatic view regarding
the focus of the discipline of nursing as caring
in the human health experience or who have seri-
ously studied caring, may see it as a broad enough
concept to capture the nature of nursing.
Is the Theory of Bureaucratic Caring a middle-
range theory as well as a grounded theory? Middle-
range theories are abstract enough to extend
beyond data generated in a specific space, place,
and time, but specific enough to allow for testing
the theory in different arenas or permitting inter-
ventions for practice to transform nursing practice
(Moody, 1990). The initial dialectical theory
showed that “living caring in organizational life”
with the meaning and symbols in an institu-
tional culture reflects the culture of the macro
or dominant culture. The meaning of “caring” in
the organization showed that meaning was con-
stituted within a larger pattern of significance.CHAPTER 23 Marilyn Anne Ray’s Theory of Bureaucratic Caring 365