untitled

PART TWO:

Applications of

Marilyn Ray’s

Theory of

Bureaucratic

Caring

Marian C. Turkel

Current Context of Health-Care

Organizations

Review of the Literature: Political

and Economic Constraints of

Nursing Practice

Economic Implications of Bureau-

cratic Caring Theory: Research in

Current Atmosphere of Health-Care

Reform

Economic/Political Implications

of Bureaucratic Caring

Summary

References

Ray (1989, p. 31) warned that the “transforma-
tion of America and other health care systems to
corporate enterprises emphasizing competitive
management and economic gain seriously chal-
lenges nursing’s humanistic philosophies and theo-
ries, and nursing’s administrative and clinical
policies.” Approximately 15 years later, in the cur-
rent managed care environment, there is an intense
focus on operating costs and the bottom line, and

caring is often not valued within the organizational

culture. However, nurse researchers, nurse admin-

istrators, and nurses in practice can use the politi-

cal and/or economic dimensions of the Theory of

Bureaucratic Caring as a framework to guide prac-

tice and decision making. Use of these dimensions

of the theory integrates the constructs of politics,

economics, and caring within the health-care

organization.

The purpose of this chapter is to illuminate the

notion of political/economic caring in the current

health-care environment. Ray’s (1989) original

Theory of Bureaucratic Caring included political

and economic entities as separate and distinct

structural caring categories. The revised Theory

of Bureaucratic Caring, however, is represented

as a complex holographic theory. Given this philo-

sophical framework, the political and economic

dimensions of bureaucratic caring as portrayed

in this chapter are illuminated as interrelated

constructs.

The political and economic dimensions of bu-

reaucratic caring encompass not only health-care

reform at the national level, but also refer to the po-

litical and economic impact of these changes at the

organizational level. Through sections on the cur-

rent context of health-care organizations, review of

the literature related to the political and economic

constraints of nursing practice, economic caring

research, political and economic implications of

bureaucratic caring, and visions for the future, we

learn how the Theory of Bureaucratic Caring

applies.

Current Context of

Health-Care Organizations

In the wake of the controversial health-care reform

process that is currently being debated in the

United States, the central thesis in today’s economic

health-care milieu in both the for-profit and not-

for-profit sectors is managed care (Williams &

Torrens, 2002). Managed care is an economic con-

cept based on the premise that purchasers of care,

both public and private, are unwilling to tolerate

the substantial growth of the last several years in

health-care costs. Managed care involves managed

competition and is based on the assumption that

health-care prices will fall if hospitals and providers

are forced to compete on the basis of cost and qual-

ity, like other industries (Williams & Torrens,

CHAPTER 23 Applications of Marilyn Ray’s Theory of Bureaucratic Caring 369