The synthesis of Bureaucratic Caring Theory shows
that everything is interconnected—humanistic and
spiritual caring and the organizational system—the
whole is in the part and the part is in the whole, a
holon.
How can knowledge of caring interconnected-
ness motivate nursing to continue to embrace the
human dimension within the current economic
and technologic environment of health care? Can
higher ground be reclaimed for the twenty-first
century? Higher ground requires that we make
excellent choices. It is therefore imperative that
spiritual and ethical caring thrive in complex sys-
tems. Figure 23–2, the holographic Theory of
Bureaucratic Caring, illustrates that through spir-
itual/ethical caring as the choice point for commu-
nication in relation to the complexity of the
sociocultural system, nursing can reclaim higher
ground.
Reflections on the Theory as Holographic
Freeman (in Appell & Triloki, 1988) pointed out
that human values are a function of the capacity to
make choices and called for a paradigm giving
recognition to awareness and choice. As noted, a re-
vision toward this end is taking place in science
based on the new holographic scientific worldview.
Nursing has the capacity to make creative and
moral choices for a preferred future. Nursing
theory can focus on the capacity to continue to di-
rect the good. Nursing is being shaped by the
historical revolution going on in science, social
sciences, and theology (Harmon, 1998; Newman,
1992; Ray, 1998; Reed, 1997; Watson, 1997;
Wheatley, 1999). In these new approaches, con-
structs of consciousness and choice are central and
demonstrate that phenomena of the universe, in-
cluding society, arise from the choices that are or are
not made (Freeman cited in Appell & Triloki, 1988;
Harmon, 1998). In the social sciences, the critical
task is to comprehend the relationship between
what is given in culture (the jural order) and what is
chosen (the moral and spiritual) between destiny
and decision. In nursing, the unitary-transforma-
tive paradigm and the various theories of Newman,
Leininger, Parse, Rogers, and the holographic
Theory of Bureaucratic Caring are challenging
nursing to comprehend a similar relationship. The
unitary-transformative paradigm of nursing and
their holographic tenets are consistent with the
changing images of the new science despite the re-
ality that nursing continues to be threatened by the
business model over its long-term human interests
for facilitating health and well-being (Davidson &
Ray, 1991; Ray, 1994a, 1998; Reed, 1997; Vicenzi,
White, & Begun, 1997). The creative, intuitive, ethi-
cal, and spiritual mind is unlimited, however.
Through “authentic conscience” (Harmon, 1998)
we must find hope in our creative powers.
In the revised theoretical model, everything is
infused with spiritual/ethical caring (the center of
the model) by its integrative and relational connec-
tion to the structures of organizational life (rela-
tional self-organization). Spiritual/ethical caring is
both a part and a whole, and every part secures its
purpose and meaning from each of the parts that
can also be considered wholes. In other words,
the model shows how spiritual/ethical caring is
involved with qualitatively different processes or
systems; for example, political, economic, techno-
logical, and legal. The systems, when integrated and
presented as open and interactive, are a whole and
must operate as such by conscious choice, espe-
cially by the choice making of nursing, which al-
ways has, or should have, the interest of humanity
at heart.
The model presents a vision but it is based
on the reality of practice. The model emphasizes
a direction toward the unity of experience.
Spirituality involves creativity and choice and refers
to genuineness, vitality, and depth. It is revealed inCHAPTER 23 Marilyn Anne Ray’s Theory of Bureaucratic Caring 367SPIRITUAL-
ETHICAL
CARINGPhysical Social-CulturalEducationalEconomicPoliticalLegalTechnologicalFIGURE 23–2 The holographic Theory of Bureaucratic Caring.