Marilyn A. Ray

Creating a caring practice environment through self-renewal.

The soul of nursing is seeking the good of self and others through compassionate caring. Healing and caring for oneself is vital to have the energy to compassionately care for others. Nurse leaders have the moral responsibility to facilitate self-care, renewal, and healing in the organizational culture to foster caring and trusting relationships. Nurses who have a strong sense of self and caring will provide holistic patient care grounded in caring values.

Mutual Intentionality: A Theory of Support Processes in Pregnant African American Women

The grounded theory study described in this article explored social support processes in low-income African American women during high-risk pregnancy and early parenthood. Participants included 10 pregnant African American women, 3 close support providers, and 11 health care providers. Investigators served as participant observers and conducted audiotaped interviews. The substantive theory of support that emerged from the data was labeled “mutual intentionality.” This term described the active role that both pregnant woman and support givers played in the helping process. The phrase “being there” summarized the women’s definition of support, implying that the support giver was available and willing to provide help when needed. Support was further described as “caring,”“respecting,”“sharing information” with, “knowing,”“believing in,” and “doing for” the other. For support to happen, mutuality must be established within the relationship, and both support giver and recipient intentionally aim to meet the recipient’s identified needs.

The Transformative Process for Nursing in Workforce Redevelopment

Global economic changes, managed care and insurance issues, media forces, and new career choices for women have impacted the profession of nursing. A loss of trust underscores decreased loyalty to hospital organizations and disillusionment with nursing practice. Nursing shortages have ensued. This article reports data from a grounded theory study of nursing in hospital organizations. Strategies of respecting, communicating, maintaining visibility, and engaging in participative decision making are the transformative processes leading to relational self-organization—a shared, creative response to a continuously changing and interconnected work environment. Organizations that foster ethical choices, respect, and co-creativity rather than focusing only on fiscal and material assets become the successful organizations of the future.

Relational Complexity: A Theory of the Nurse-Patient Relationship within an Economic Context

Today, nursing practice is driven by a complex system of economics, technology, and multimodal organizations. Traditional economics addresses issues and analyzes events related to the efficiency and effectiveness of goods, money, and services where maximum satisfaction related to need or want is the outcome. Economics uses facts and perceived logic, stories, and metaphors to communicate (McCloskey, 1990). The rush toward economic globalization has forced a fundamental redesign of the world’s political and economic arrangements, with the deployment of large-scale versions of economic theories, strategies, and policies benefiting corporate leaders and some governments while leaving others, such as the poor, in dire distress (Mander & Goldsmith, 1996). Economic metaphors can be pushed too far as different models of the U.S. economy have shown, resulting in “storytelling nonsense” (McCloskey, 1990) and “economic insanity” (Terry, 1995). As healthcare costs in the United States exceeded 14% of the gross national product, healthcare has not remained in isolation from economic reform (Williams & Torrens, 1999). Cost containment has had a significant impact on healthcare structures and delivery of service. While movements for compulsory health insurance with public financing in the United States have floundered, the corporatization of healthcare has flourished. Large multiunit corporations have gained a major position in the design of HMOs, and interests are determined by the rate of return on investments (Coile, 1997; Starr, 1982). Religious healthcare systems, public hospitals, and public health agencies cannot shield themselves from the impact of economic restructuring. U.S. healthcare is now dominated by corporate conglomerates in conjunction with governmentregulated Medicare and Medicaid policies. Complexity Science and Chaos Theory

Studying the human-environment phenomenon using the science of complexity

The principal argument of the present article is that a new theoretical paradigm capable of facilitating the understanding of complex phenomena is necessary to study nursings claim to its science as the science of unitary human beings, or the integrality between humans and the environment. A research study of the complex human-environment phenomenon illuminating a four-phase methodology is presented. It is argued that much can be learned by the use of the science of complexity to integrate data gleaned from different approaches to knowledge generation into a comprehensive understanding of the human being in the environment as a unified whole.

Chapter 3: Theoretical Basis for Transcultural Care

Margaret Andrews, PhD, RN, CTN, FAAN1 Jeffrey R. Backstrand, PhD2 Joyceen S. Boyle, PhD, RN, CTN, FAAN3 Josepha Campinha-Bacote, PhD, MAR, PMHCNS-BC, CTN-A, FAAN4 Ruth E. Davidhizar, DNSc, RN, APRN, BC, FAAN (deceased)5 Dawn Doutrich, PhD, RN, CNS6 Mercedes Echevarria, DNP, APN7 Joyce Newman Giger, EdD, APRN, BC, FAAN8 Jody Glittenberg, PhD, RN, FAAN, TNS9 Carol Holtz, PhD, RN10 Marianne R. Jeffreys, EdD, RN11 Janet R. Katz, PhD, RN12 Marilyn R. McFarland, PhD, RN, FNP-BC, CTN-A13 Gloria J. McNeal, PhD, MSN, ACNS-BC, FAAN14 Dula F. Pacquiao, EdD, RN, CTN15 Irena Papadopoulos, PhD, MA, RN, RM, FHEA16 Larry Purnell, PhD, RN, FAAN17 Marilyn A. Ray, PhD, MA, RN, CTN-A18 Mary C. Sobralske, PhD, RN, CTN19 Rachel Spector, PhD, RN, CTN-A, FAAN20 Marian K. Yoder, EdD, RN21 Rick Zoucha, PhD, PMHCNS-BC, CTN22

Transcultural Nursing Ethics: A Framework and Model for Transcultural Ethical Analysis

Increased awareness of cultural diversity in contemporary society and nursing mandates the need for transcultural nursing ethics. The core of this ethics assumes that all discourse and interaction is transcultural because of strengths and differences in values and beliefs of individuals and groups within global society. Transcultural ethics addresses how people ought to live when subjectively sharing a common world. This article presents a framework and model with four parts: Transcultural Caring Dynamics, Principles, Transcultural Context, and Universal Source. These incorporate the ethics of virtue, principle, values, and belief, respectively. Interactive parts of the holistic process provide the foundation for assessing and analyzing transactions to facilitate understanding and direction toward culturally based ethical decision making.

A Transtheoretical Evolution of Caring Science within Complex Systems

This article illustrates the transtheoretical evolution of caring science within complex systems from the discovery of the theory of bureaucratic caring, in 1981, to the emergence of the metatheory relational caring complexity in 2011. The theory of bureaucratic caring, derived from research, is the sentinel grounded theory in the area of caring and economics, and complex healthcare systems in general. Its tenets remain applicable to contemporary nursing practice. Other grounded theories advanced from the original theory, including struggling to find a balance, the paradox between caring and economics, relational complexity, and relational self-organization in workforce redevelopment, as well as professional and patient relational caring questionnaires are presented and discussed.

Caring as emancipatory nursing praxis: the theory of relational caring complexity.

In the culture of health care, nurses are challenged to understand their values and beliefs as humanistic within complex technical and economically driven bureaucratic systems. This article outlines the language of social justice and human rights and the advance of a Theory of Relational Caring Complexity, which offers insights into caring as emancipatory nursing praxis. Recommendations provide knowledge of the struggle to balance economics, technology, and caring. As nurses practice from a value-driven, philosophical, and ethical social justice framework, they will find “their voice” and realize the full potential that the power of caring has on patient and organizational outcomes.

Instead of Reconceptualizing the Nursing Process Let’s Re-Name It:

The discipline of nursing embraces the unitary-transformative paradigm and its theories that focus on nursing with attention to the language of humanbecoming, holism, relationship, authentic presence, caring, ethical interaction, complexity, pattern, energy, and recognition. In hospital nursing practice the medical paradigm is more prevalent and focuses on regulatory compliance, the standardization of technical language of the electronic health record, and the implementation of evidence-based practice initiatives for patient safety and quality improvement. Nursing and nursing theories are considered a moral enterprise; they involve seeking the good or caring for patients, others, and complex systems. With the continued influence of the medical paradigm, the questions for nursing are: what kind of good does nursing want to promote, and what unique contribution to patient care do nurses provide through their language, theories, and practice? A new mnemonic of Recognizing, Connecting, Partnering, and Reflecting is proposed.