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

2. 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

3. 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

4. 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

5. 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”

6. 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

7. 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

8. 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.

9. 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
German idealism
Interests were logic, aesthetics, history

10. 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

11. 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)

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

13. Theory of Bureaucratic Caring 1989

14. 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.

15. 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)

16. 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

17. 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”.

18. 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 ). 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 ). New York, N.Y.: Springer Publishing Co.

19. 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,