This paper compares two prominent nursing theories — Jean Watson's Theory of Human Caring and Marilyn Ray's Theory of Bureaucratic Caring — with a focus on their application to acute care settings. Watson's theory calls for a fundamental transformation of nursing around a Caring Science orientation, while Ray's theory emphasizes optimizing existing institutional and bureaucratic systems to enhance patient care. Drawing on supporting research by Keesler (2007) and Eggenberger (2011), the paper argues that Ray's framework is more practically applicable for nursing leaders, particularly charge nurses, because it balances the caring mission of the profession with the economic and operational realities of healthcare institutions.
The two nursing theories espoused by Jean Watson and Marilyn Ray have different points of focus, but both address the primary purpose of nursing as a caring profession. As such, nurses, carers, and leaders all need to integrate their efforts to create a caring and comfortable environment for clients, particularly in the acute care setting. Having considered both Watson and Ray, this paper concludes that Ray's theory is the optimal choice for further study, as she provides an integrated and practical nursing framework to help leaders create the environment in which employees can fulfill their caring mission to the best of their ability.
The basic premise of Watson's theory is that nursing should function within a Caring Science orientation (Watson, 2008, p. 16). According to Watson, the fact that this has not been the focus of the nursing profession over time is the cause of many of the ailments from which not only the profession, but humanity in general, suffers. Watson therefore believes that the current nature of nursing needs to change to adhere more closely to her concept of Caring Science. There are a number of basic assumptions that promote nursing as a Caring Science, the first of which holds that it is the essence of nursing and the core of the profession, encompassing its foundation and discipline.
Watson's theories have been validated in various subsequent dissertations and research, one of which is Keesler (2007), which focuses on the need to provide hospice referrals to terminal patients. According to Keesler (2007, p. 21), Watson's Theory of Human Caring is focused on the quest to provide dignity and maintain respect for life during acute care. In this setting, providing timely hospice referrals is part of the caring process. Like Watson, Keesler appears to believe that there are significant shortcomings within the nursing profession, and in the acute care setting specifically. Hence the suggestion to apply Watson's theory to the patient's right to die with dignity — rather than while waiting for a lengthy bureaucratic referral process to conclude.
Marilyn Ray's Theory of Bureaucratic Caring takes a notably different stance. According to Ray, the bureaucratic nursing system is necessary for the optimal functioning of hospital systems and patient care (Ray, Davidson, and Turkel, 2011). Rather than calling for sweeping reform of the system itself, Ray argues that the fundamental change needed is in the relationship between the system and the people working within it.
Ray's theories have also been applied in research, specifically by Eggenberger (2011) in an examination of the role that leadership plays in optimizing the nursing profession. According to Eggenberger, it is the work of charge nurses to ensure that the nursing environment and systems are functioning at optimal ability and efficiency. There is therefore a continuous need to assess staffing according to patient volumes and acuity. While nursing is assumed to be a caring science, there is also a practical dimension of leadership in which efficiency and effectiveness must be ensured in order to guarantee the economic survival of the care facility.
"Key differences in idealism versus practicality"
"Charge nurse leadership, efficiency, and economic viability"
Because of its greater practical applicability and a tendency towards using current systems to optimize care, Ray's theory is a more viable option for further study and further possibilities. One mid-level theory that might be developed from this foundation could be derived from Eggenberger's work: to function optimally, institutions must operate under leadership that is knowledgeable about their practical and economic systems. Leaders such as charge nurses should, for example, be able to make decisions that optimize the efficiency and effectiveness of the institution — including the ability to match patient numbers with on-duty nursing staff and to handle a sudden influx of clients in an economical and timely way.
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