Marilyn Anne (Dee) Ray PhD, RN, CTN-A Florida Atlantic University Emeritus Professor Linda Cassidy MSN, EdM, APRN-CNS, CCNS, CCRN-CSC

Early Life Experience Born in Hamilton, Ontario, Canada Family of six children Age 15, a nurse saved her father while hospitalized for a serious illness Influenced decision to be a nurse

Education – experience Nursing Diploma (Registered Nurse), St. Joseph's Hospital School of Nursing Hamilton, Canada 1958 University of California Medical Center, Los Angeles Obstetrics and gynecology Emergency department Cardiac and critical care (adults and children) Developed interest in diverse cultures Bachelor of Science (BSN), Nursing, University of Colorado School of Nursing Denver, Colorado 1968

Education –experience Master of Science (MS), Maternal/Child Nursing, University of Colorado School of Nursing Denver, Colorado 1969 Met Dr. Madeline Leininger (first nurse anthropologist) Developed interest in anthropology Studied children’s hospital as a small culture Clinical Practice – children and adults Critical care Renal dialysis First teaching position: University of California San Francisco Dr. Barney Glaser and Dr. Anselm Strauss Grounded Theory Developed interest in qualitative research 1971 – traveled to Mexico to study anthropology and health – field work in small villages (learned of life of aboriginal people) 1972 – returned to Canada to be close to family Occupational health Neonatal Intensive care

Education – experience Master of Arts (MA), Cultural Anthropology, McMaster University Hamilton, Canada 1978 Studied: human relationships decision making Conflict Hospital as an organizational culture Doctor of Philosophy (PhD), Transcultural Nursing, University of Utah College of Nursing Salt Lake City, Utah, 1981  First transcultural doctoral program in the US Doctoral Dissertation “A Study of Caring Within An Institutional Culture”

Education – experience One of the co-founders of International Association for Human Caring (IAHC) 1978 University of Colorado 1981 Jean Watson Developed interest in phenomenology Dissertation Chair for Dr. Alice Davidson Science of Complexity Florida Atlantic University 1989 Retired 2004 Professor Emerita

Military Service Mid 1960s – US Citizen Joined USAF Reserve, Nurse Corp Graduated as flight nurse from School of Aerospace Medicine – Brooks Air Force Base, San Antonio, Tx Aeromedical evacuation nurse – served in the Vietnam war...“our job was to bring the boys home” Served in Air Force for over 30 years 1990 – First nurse to go to Soviet Union with Aerospace Medical Association 1991 – called to active duty during first Persian Gulf War Retired as Colonial

Major Influences Scholars from many disciplines: Nursing (Watson, Boykin, etc.) Anthropology (Leininger and many in program) Sociology (Glasser and Strauss) Economics Physics Philosophy (Hegel, Husserl, Weber, etc.) James (Jim) Droesbeke - inspiration, friend, soul mate, and the love of her life.

The Philosophy of Hegel Greatly influenced Ray’s Work Hegel’s dialectic (way of reasoning) – “interrelationship between thesis, antithesis, and synthesis” Thesis of being Antithesis (opposite) non-being Reconciled emerging (synthesis) into a unitive form of being Ray’s theory Implies that there is a dialectical relationship (thesis, antithesis, and synthesis)between: Thesis of Caring: Human (person and nurse dimensions of spiritual – ethical caring Antithesis of Caring: Organizational (bureaucracy) culture – technological, economic, political, legal, social Synthesized into bureaucratic theory (process is a transformation and it continues to repeat itself – continually changing, emerging and transforming) Georg Wilhelm Friedrich Hegel 1770-1831 German idealism Interests were logic, aesthetics, history

Ray’s Theory of Bureaucratic caring Originated as a grounded theory Differential caring emerged as a substantive theory Caring in organizations is complex The meaning of caring is contextual – it varies depending on department and depending upon unit within nursing Caring has different meanings depending on specific goals and values Bureaucratic caring emerged as formal theory – represents the dynamic structure of caring within the complex organization Dissertation Research (1981)involved the use of: Grounded theory methodology to generate theories Phenomenology to determining meaning of the experience Ethnography to study patterns in organizational culture Question – “What is the meaning of caring to you” Substantive theory – middle range level of abstraction. It is specific to the problem or phenomenon and links to higher, more abstract formal theory Differential Caring: Nurses

Ray’s Theories Differential Caring Bureaucratic Caring Caring varies by area or practice Nurses in ICU value technological caring Nurses in oncology value humanistic or spiritual caring Nurses value caring in terms of relationship Administrators value caring in terms of economics, legality, politics etc. Dynamic structure of caring within complex organization Continually evolving and transforming “The logical connectedness of caring to the cosmopolitan social order demonstrates that the Theory of Bureaucratic is unifying rather than alienating” (Ray, 2013)

A Study of Caring Within An Institutional Culture Marilyn Anne Ray 1981 Original Grounded Theory

Theory of Bureaucratic Caring 1989

Complex Organizational Cultures Ray’s Theory of Bureaucratic Caring Present Model: Holographic “interconnectedness of all things” Holography means that the whole (implicit order) and the parts (explicit order) are interconnected. Everything is whole in one context and part in another with each part being in the whole and the whole being in the part.

Spiritual –Ethical caring Holism and integration of body, mind, spirit Spirituality of Caring Creativity Choice Revealed in attachment, love, community Ethics of Caring Moral obligation to others Not treating people as a means to an end but rather as people who have the capacity to make choices (Turkel, 2007)

Ray’s OnGoing Work Requests from all over the world to use Bureaucratic Theory in professional practice models Ongoing developing of Theory of Bureaucratic Caring Complexity Science/Complexity Theory Transcultural nursing Technological caring Continual enhancement of nursing scholarship Mentorship of others

Marilyn (Dee) Ray Caring and love are synonymous. Inquiring about caring touches the heart and translates through the soul, the "speaking together" between the one caring and the one cared for, the shifting of consciousness from a focus on "they" or "I" to a compassionate “we”. www.marilynray.com

ReFerences Personal correspondence July 6, 2013 Coffman, S. (2010). Theory of bureaucratic caring. In Alligood, M.A. & Tomey, A.M. (Eds.), Nursing theorists and their work, (pp. 113-134). Maryland Heights, Missouri: Mosby Elsevier. Davidson, A.W., Ray, M.A. & Turkel, M.C. (2011). Nursing caring and complexity science. New York, NY.: Springer Publishing Company. Ray, M.A. (2013). The theory of bureaucratic caring for nursing practice in organizational culture. In Smith, M.C., Turkel, M.C. & Wolf, A.R., Caring in nursing classics, (pp. 309-320). New York, N.Y.: Springer Publishing Co.

References Ray, M.A. (2010/1981). A study of caring within an institutional culture. USA: LAP Lambert Academic Publishing. Turkel, M.C. (2007). Dr. Marilyn Ray’s theory of bureaucratic caring. International Journal for Human Caring, 11, 57-69.