The health care environment has undergone some fundamental changes over the past three decades, especially regarding the patient care. However, amidst all these complexities, it is possible to focus on decisions that guarantee the well-being of the organization at the expense of patient. This paper interrogates Marilyn Ray’s theory of Bureaucratic Caring delineating the effectiveness of its application in nursing practice and proves that this theory is extremely useful as it promotes the adoption of human perspective in corporate policy and helps improve the patients’ life quality and benefit-finding.
To begin with, the Theory of Bureaucratic Caring posits that since healthcare, healthcare systems, and practice of nursing in complex organizations are constantly changing, it is essential for nurses, involved in the practice environment, to be grounded not only in the political, legal, technological, educational, physical, and economic dimensions of caring, but also in the spiritual-ethical dimension (Ray, 1989). According to Ray, given today’s healthcare environment, nurses need to interrogate the meaning of care and examine how it is related to and influenced by organizational culture. In such a way, they will be able to define the ways through which patient care is expressed through the hospital organization (Smith & Parker, 2015; Masters, 2015). Thus, the Theory of Bureaucratic Caring is a framework that introduces a human perspective through considering the spiritual-ethical dimensions of caring in the contemporary hospitals as complex organizations.
The way I understand it, the Ray’s theory fosters the patient input integration in decision-making and organizational culture. I think the theory means that nurses ought to consider this input. From the way it has been framed, the theory is meant to consolidate the different goals of hospital organizations, spanning the legal, technological, financial, and educational circles into a cohesive whole that promotes the well-being of both the hospitals and patients. In my opinion, the Theory of Bureaucratic Caring provides the most practical framework for retaining the focus on the patients. If well appropriated, it can empower nurses and the other healthcare practitioners to humanize their patients through considering their spiritual-ethical needs and negating the urge to conceptualize them as the units in a production line. Thus, the theory provides an institutionalized mechanism through which patient input can be leveraged to improve the care quality and enable the patients to experience benefit-finding.
A good example of its application is the scenario with Jacob Jones. He is a 54-year-old man who was diagnosed with a liver cancer. He has been undergoing chemotherapy for the past two years, but the analgesic level of pain is increasingly becoming excruciating, and Jacob is willing to die instead of living with it. He puts in for a request to his doctor to perform an assisted euthanasia to relieve him of suffering. Since the patient is terminally ill and is experiencing unbearable pain, the doctor considers the request. He calls the family members, briefs them on the Jacob’s decision, and asks the patient if there are any other things they may do for him. Since Mr. Jones is deeply religious, he asks for a priest to pray for him before his death, and the nurses comply.
As it can be observed from this scenario, the physicians and nurses do everything they can to ensure that the patient experiences benefit-finding, attaining comfort and ultimate peace in death. They not only consider the legal and political implications of their actions, but also will of the patient to fulfill his spiritual demands. If the health care professionals were ignorant of this theory and patient needs, they would have persisted in treating Mr. Jones against his will, and they would not have also considered the spiritual nourishment he had requested.
In conclusion, it is evident that the Theory of Bureaucratic Caring is of significant importance to nursing practice. It is connected with a fact that in the complex healthcare organizations it is very easy to lose focus on the other aspects of caring and neglect the patient caring dimension. The theory is also useful in reminding nurses and policy formulators of healthcare organizations that the patient should be at the center of their decision-making. Thus, considering the ethical and spiritual needs of the patients is central to implementing an integrative care approach that optimizes benefits of humankind.
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