Results of Rays research, based on bureaucratic caring theory, have been

disseminated to oractice settingss. Miller (1995) summarized the work of Ray nd

other theorists and encouraged nurse executives to examine their daily caring
skills and to use these skills in administrative practice. Nyberg studied with Ray
and acknowledged the impact of Ryas ides in her own book, A Caring Approach
in Nursing Administration (Nyberg, 1998). In her book, Nyberg urged nurse
admistrators to create a more caring and compassionate sysem, while still being
accountable for organizational management, costs, and economic forcs. Turkel
and Rays (2003) study with United states Air Force personnel resulted in
dissemination of findings and increased awareness of issues among civilian and
military policy makers.

Ray has addresed the impact of divrse culturess on the health care
system. The Transcultural Commuicative Caring Tool provides guidelines to help
nurses understand the the needs, adversity, problems, and questions of people
that arise in culturally dynamic health care situations (Ray & Turkel,2000). The
dimmensions of the tool are as follows:

1. Compassion
2. Advocacy
3. Respect
4. Interaction
5. Negotiation
6. Guidance
To assist nurses with transcutural assesment, Ray developed an instrument
for assessing older adults (Ray,2000)
Rays research has shown that nurses, patients, aand administrators value
the caring intentionality that is co-created in the nurse-patient or administrator-
nurse relationship. By creating ethical caring relationships, administrators and
staff can transform the work environment (Ray, Turkel & Marino, 2002). The
Theory of Bureaucratic Caring suggests that organizations fostering ethical
choices, respect and trust will become the successful organizations of the future.

Education
The Theory is useful to nursing education because of it broad focus on caring
in nursing and its conceptualization of the health care system. The holographic
theory combines differentiation of structures within a holisti framework
Research
From rays researct resulting in the theory of bureaucratic caring, she
develoved a phenomenological-hermeneutic approach that guides her
curret studies (ray,1985, 1991,1994b). This research methodology is
particularly significant for nurse researches,because it is grounded in the
philosophy of humanism and caring and encourages nurses to utilize
phenomenological hermeneutics thorugh the lens of caring. The evolution
of Rays research methods began with ethnography-ethnonursing,
grounded theory, and phenomenology,culminating in caring inquiry and
complex caring dynamics approaches. These approaches consist of
generation of data by inquiring into the meaning of participants life-world
and relational experiences. Interviews and narrative discourse are the
primary methods of data generation in the ethnography and
ethnonursing,grounded theory, and phenomenological approaches. In
caring inquiry the ontology of caring is a part of the approach to data
generation. Compelex caring dynamics includes not only qualitative data
generation and analysis but also complex quantitative research data
collection and analysis techniques. Through reflection, the researcher
dwells on the essential meanings of phenomena. Furtherreflection
facilitates the interpretation of the interviiew data, with the purpose of
transforming data into interpretative themes and metathemes. The goal of
the research approach is to capture the unity of meaning and synthesize
meanings into a theory or conceptual model.
Based on the Theory of Bureaucratic Caring, Ray and Turkel have
developed a program of research focusing on nursing in complex
organizations. These studies have further explored the meaning of caring
and the natur of nursing among hospital nurses, administrators, and
clients- patients. A Triservice Nursing Reseach Program grant supported
extensive research on nursing as an economic resource. Table 8-1 outline
publications that describe this ongoing program.

FURTHER DEVELOPMENT
Rays development of the Theory of Bureaucratic Caring is ongoing in her
program of research and scholarship. Her work is a synthiesis of nursing
nursing science, ethics, philosophy, complexity science, anthropology,
economics, and organizational management. Ray described her most
recent program of research sponsored by the TriService Nursing Research
Program in Nursing Science Quarterly (Turkel & Ray, 2001). It included
instrument development and psychometric