Slide 1 :Marilyn Anne Ray
1938-Present
AKA:
SUUUUPER NURSE
Marilyn Anne RayHer Life and What Influenced Her :Marilyn Anne RayHer Life and What Influenced Her Born in Hamilton, Ontario,Canada 1938.
One of six children
At 15, father became seriously ill and nearly died
To Be or Not To Be :To Be or Not To Be It was a nurse who saved his life.
This event influenced Marilyn’s career choice.
This was only the beginning……….
Career :Career 1958 Graduated St.Joseph Hospital School of Nursing in Hamilton.
Went to UCLA working in: OB/GYN, E.R., Cardiac Critical Care for Adults and Children.
Diverse Cultures :Diverse Cultures Made many friends from diverse cultures at UCLA.
Saw importance that cultures play in the development of people’s views about nursing and the world.
1965 decided to return to college for her BSN and MSN
Influence of Madeleine Leininger :Influence of Madeleine Leininger Met Dr. Madeleine Leininger at the University of Colorado
Took special interest in nursing and anthropology; including childhood and culture, organizations and small cultures
Research involved study of a children’s hospital as a small culture.
Citizenship and Service :Citizenship and Service Mid 1960’s gains citizenship
1967 Commissioned office in USAF-Reserve-Nurse Corp
Graduated as flight nurse from School of Aerospace Medicine-Brooks AFB, Texas
Aero medical evacuation nurse during Viet Nam
More then 30 years in USAF: clinician, administrator, educator, and research
Service (continued) :Service (continued) Colonial for over 10 years
Program for educators at Marshall Space Flight Center
Charter member of the Space Flight Nursing Society.
Active duty during first Persian Gulf War at the age of 53
Received many medals, some for research and education
Research Award :Research Award In 2000, received the Federal Nursing Services Essay Award from Assoc. of Military Surgeons.
Awarded $1,000,000 in funding for a study titled “Air Force Combat Casualty Aero medical Nursing Post 9-11
$ 1,000,000
Educator :Educator UCSF
CSUSF
Worked with Dr’s Barney Glaser and Anselm Strauss (Grounded Theory)
Became interested in qualitative research from their influence
Educator (continued) :Educator (continued) Continued to study nursing as a culture
1973-1977 Returned to Hamilton, Canada and taught the FNP program integrating culture and health in the program
Masters of art in cultural anthropology and studied human relationships, decision making, conflict and the hospital as an organized culture
Many influences gradually turn into theory :Many influences gradually turn into theory Invited by Leininger to apply for first transcultural nursing doctoral program in the U.S.
At University of Utah during her doctoral program, Marilyn was in the midst of many historically significant leaders.
Doctoral dissertation related to the study of caring in the complex hospital organizational culture.
From this dissertation emerged the “Theory of Bureacratic Caring”
Doctoral Dissertation :Doctoral Dissertation 1981 Doctoral Dissertation was the study of caring in the complex hospital organizational culture.
This led to her first, original grounded Theory of Bureaucratic Caring.
More Influences :More Influences Marilyn marries Jim Droesbeke.
Rejoins faculty at University of Colorado, school of nursing.
Designed/taught qualitative nursing research.
Worked with Dr. Jean Watson (Philosophy of Human Caring).
Started the International Association of Human Caring with Watson and others.
Influences (continued) :Influences (continued) Mentored by Dr. Max van Manen from the University of Alberta in phenomenology and hermeneutic human science research methods.
Appointed by Dr. Anne Boykin (Nursing as Caring: A model for Transforming practice), Dean of the college of nursing at Florida Atlantic University
Transcultural Nursing :Transcultural Nursing 1994-1995 Held the position of Yingling Visiting Scholar Chair at Virginia Commonwealth University.
Continues interest in transcultural nursing completing a grounded research study of high risk pregnant African American women.
Transcultural Nursing (continued) :Transcultural Nursing (continued) 1998-2000 Held position of Vice President of Floridans for Healthcare.
Since 1998 a member of the Transcultural Nursing Society.
1984 awarded the Leininger Transcultural Nursing Award.
Serves on the review board for “The Journal of Transcultural Nursing”, and “Qualitative Health Research”.
Now :Now Continues focus on nurses, nurse administrators and patients in the complex hospital organizational cultures.
With Dr. Marian Turkel, has published in a number of areas.
Continues to teach at Florida Atlantic University.
Slide 19 :The Theory of Bureaucratic Caring
Analysis of the Purpose, Content, Relationships, Structure and Assumptions of the Theory :Analysis of the Purpose, Content, Relationships, Structure and Assumptions of the Theory Goal: The promotion of well-being through caring.
Purpose: Symbolize the dynamic structure of caring within a complex organization.
Content: Caring is interconnected to political, legal, economic, educational, physiological, socio-cultural and the technological surrounding structures of an organization.
Analysis :Analysis Everything infused with spiritual/ethical caring by it’s relationship to the structures of organizational life.
Interconnectedness of concepts led to “holographic” theory meaning everything is a whole in one context and a part in another; each part being in the whole and the whole being in the part.
Spiritual/ethical caring is both a part and a whole and every part secures it’s meaning from each of the parts.
Definitions :Definitions Caring: Relationship between charity and right action, love as compassion in response to suffering, and need, and justice or fairness in terms of what should be done.
Spiritual/Ethical Caring: Creativity, choice, attachment, love and community. Ethical imperatives join with spiritual relating to moral obligations to others.
Educational: Formal/informal programs, all forms of teaching/sharing information.
Physical: Physical state of being. This includes biological and mental.
Definitions (continued) :Definitions (continued) Social/Cultural: Ethnicity,family,friends, communication, social interaction/support, cultural groups, community and society.
Legal: Responsibility/accountability, rules to guide behaviors, policy/procedures, informed consent etc.
Technological: Non-human resources such as machinery, equipment, computers etc. and skills/knowledge needed to use these.
Definitions (continued) :Definitions (continued) Economic: Use of human material resources to keep up the financial viability of the organization.
Political: Power structure within the organization, decision making, union activities, government influences etc.
Relationships :Relationships All concepts
related as part of an organization
ie:
hospital, community or government.
Assumptions :Assumptions Caring is highly differential depending on it’s structure. Theory of differential nursing states that caring in nursing is influenced by the structure or culture.
Caring is bureaucratic given it’s meaning can be understood in relation to the organizational structure.
Caring is the primordial construct and consciousness of nursing.
Evaluation of the Theory; Clarity :Evaluation of the Theory; Clarity Clarity: Major structures are clearly defined and consistent with definitions used by nurses.
Arrows depict interrelationship of ethical caring with other structures.
Holograph design not seen in one dimension, but described for image.
Simplicity/Generality :Simplicity/Generality Simplicity: Simplifies dynamics of bureaucratic organizations by integrating spiritual/ethical caring with seven structures.
Generality: Philosophy looks at nature of nursing as caring. Ideas are broad. Give general ideas about how nursing profession fulfills moral obligations, and choices are guided by spiritual/ethical caring.
Accessibility/Empirical Precision :Accessibility/Empirical Precision Accessibility: Theory has been disseminated to practice settings, administrators, referenced in other books and increased awareness amongst policy makers.
Empirical Precision: Is high related to grounded theory and revisions based on research.
Scope of a Theory :Scope of a Theory Scope of Theory: This theory continues in ongoing research and scholarship and continued development.
Formal
Grand Theory
Factor Relating
Commonplaces :Commonplaces Person: Spiritual and cultural being
Health: Connected to the way people in a culture group, organizational culture, or bureaucratic system construct reality and give/find meaning.
Commonplaces :Commonplaces Environment: complex spiritual, cultural, and ethical phenomenon that symbolizes meaning.
Nursing: Holistic, relational, spiritual and ethical caring that seeks the good of self and others in complex community, organizational and bureaucratic cultures.
Importance to Nursing :Importance to Nursing Results disseminated to many practice settings, summarized in other books, taught to nurse administrators.
Transcultural communicative Caring Tool provides guidelines to help nurses understand needs in culturally dynamic health care situations.
Shown nurses, patients and administrators value the caring and can work together to transform the work environment.
Contagiousness :Contagiousness Address issues that confront nurses today within the constraint of the managed care environment.
Nurses in administrative, research and clinical roles can use the political and economic dimensions as a framework for practice.
Middle range theories have been generated.
I Like this Theory :I Like this Theory This theory is applicable in most nursing relationships.
It works well in any hospital, community/government or clinical setting.
Works well in my job in public health for the Ute Indian Tribe in rural Utah.
An example of this would be the tremendous amount of diabetes among Native Americans. There has been a sudden plethora of premature deaths in the past few months. Many evolved cultural and social norms of the tribe (bureaucracy) have perpetuated this health condition. As a nursing team, motivated by spiritual and ethical caring, we spent our morning planning interventions specifically targeting preschool age children to effect change in diet, exercise and food before they mature in the old patterns.
Conclusion :Conclusion I started out by jokingly referring to Marilyn Ray as a Suuuuuper Nurse. Truth be told, I felt exhausted after just reading her history and involvement. Marilyn Ray is a tremendous nurse and a super person. She is a Super Nurse, with a super theory about how to continue with spiritual/ethical caring in an environment that is at times oppositional.
References :References Tomey, A.M.& Alligood, M.R.(2006). Nursing theorists and their work. St. Louis, Marilyn Ray Theory of Bureaucratic Caring pp.116-139
Turkel,M., & Ray, M. Relational complexity: From grounded theory to instrument theoretical testing. Nursing Science Quarterly, 14(4), 281-287