untitled

social process of the nurse-patient relationship as
an economic resource was struggling to find a bal-
ance, which referred to sustaining the caring ideal
in a new reality controlled by costs.
In a study conducted by Ray and Turkel (1999),
qualitative interviews were accomplished in not-
for-profit and military sectors of the health-care
delivery system. The purpose of this research was to
continue the study of the nurse-patient relation-
ship as an economic interpersonal resource.
Findings from this study identified that the nurse-
patient relationship was both outcome and process.
Categories, which emerged during data analysis,
included relationships, caring, and costs.
In the study, a formal theory of the nurse-
patient relationship as an economic resource was
generated from the qualitative research. The formal
theory of relational caring complexity illustrated
that the caring relationship between the nurse, the
patient, and the administrator is complex and
cocreative, is both process and outcome, and is
a function of a set of economic variables and a
set of nurse-patient relational caring variables.
Economic variables are depicted as time, technical,
and organizational resources. Nurse-patient rela-
tional caring variables are caring, relationships, and
education (Turkel & Ray, 2000).

CONTINUED RESEARCH
ON ECONOMICS AND CARING

In order to measure caring as an economic resource
and to further test the theory, Ray and Turkel
(1999) developed and tested a professional and
patient questionnaire designed to measure organi-
zational caring. The Organizational Caring ques-
tionnaire is a 26-item professional and an 18-item
patient questionnaire designed from qualitative
research (Ray & Turkel, 1995, 1997, 1999) and vali-
dated and established as reliable through quantita-
tive research (Ray & Turkel, 2003). The three
subscales are caring, trust, and economics. The
questionnaire has been distributed in five different
hospitals to over 500 participants.
The qualitative data showed how critical the
partnership among nurses, patients, and adminis-
trators is to the success of an organization. Hospital
administrators have identified that nursing is key to
their economic well-being and that they must in-
vest in nursing and value the caring associated with
the practice of professional nursing.

Findings from this research in process used re-

gression analysis to determine whether or not there

was a correlation between caring within the context

of the nurse-patient relationship and patient and

economic outcomes. The research’s long-term goal

is to establish caring as an economic interpersonal

resource. The researchers’ objective was to show,

through empirical nursing research, that hospitals

with a higher organizational caring score have in-

creased patient and economic outcomes.

Economic/Political Implications

of Bureaucratic Caring

Findings from current nursing research on the eco-

nomic dimension of bureaucratic caring can be

used to guide administrative practice within

health-care organizations. As a dimension of her

research, Turkel (1997) interviewed eight top-level

hospital and corporate-level administrators to gain

an understanding of how they viewed the experi-

ences of nurses and patients in the hospital setting.

Administrators were chosen to be interviewed be-

cause they make the ultimate decision on how to al-

locate scarce human and economic resources

within the organizational setting.

Administrator participants explained the value

and importance of the nurse-patient relationship.

They discussed receiving letters from patients, scor-

ing high on surveys, and getting positive verbal

feedback from patients as indicators of caring

nurse-patient interactions. One administrator

shared the following with the researcher:

Lying in a bed like that, people feel vulnerable and are

vulnerable, and they want to know that someone is

there for them and will share with them what’s going

on. And it has to do with the caring. I hear [patients

say] that my nurse cared, she listened, and she kept

me informed. I would say that more than half of the

positive comments I receive from patients have to do

with the nurses being caring. What comes back to me

is they cared about me, they took time to talk to me,

they were kind to me.

HEALTH CARE AND

NURSING ADMINISTRATION

The results of ongoing research conducted by

Turkel and Ray (2000, 2001, 2003) showed that

administrators value caring and high-quality care.

374 SECTION IV Nursing Theory: Illustrating Processes of Development