Copyright © 2015. F.A. Davis CompanyChapter 28Dr. Tro.docx

Copyright © 2015. F.A. Davis Company
Chapter 28
Dr. Troutman-Jordan’s Theory of Successful Aging
Developed by D. Gullett (2014)
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Overview of the Theory
The impetus for developing the theory of successful aging was
enhanced understanding of successful aging, captured from the
older adult’s perspective, and identification of foci for
interventions to foster successful aging.
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Overview of the Theory (cont)
Foundation:Developed from a concept analysis of successful
agingFoundations:
Roy’s Adaptation Model
Tornstam’s sociological theory of gerotranscendence

Other literature on concepts of successful aging
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Theoretical AssumptionsAging is a progressive process
requiring from simple to increasingly complex adaptation;
Aging may be successful or unsuccessful, depending upon
where a person is along the continuum of progression from
simple to more complex adaptation and the extensive use of
coping processes; Successful aging is influenced by the aging
person’s choices; The self is not ageless (Tornstam, 1996); and
Aging people experience changes, which uniquely characterize
their beliefs and perspectives as different from those of younger
adults (Flood, 2006a).
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Definition of Theory
The theory of successful aging describes the process by which
individuals use various coping mechanisms to progress toward
desirable adaptation to the collective physiologic and functional
changes occurring over their lifetime, while maintaining a sense
of spirituality, connectedness, and meaning and purpose in life.
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Foundation of Theory
Three coping processes (the way one responds to the changing
environment)
Functional Performance Mechanisms
Intrapsychic factors
Spirituality
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Constructs (within each Coping Processes)
Within each coping process there are measurable output
responses- provide feedback to the person.
Cognitive
Behavioral
Affective
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Coping Processes/Output Responses Typical age-related
declines that occur
IndicatorsHealth promotion activitiesPhysical healthPhysical
mobilityAnnual physical examsCurrent chronic and acute
disease Gait mobility
Functional Performance Mechanisms

Output ResponsesEach is a manifestation of the human adaptive
response of functional performance mechanism
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Coping Processes/Output Responses
Use of inherent character traits to respond to environmental
stimuli
Intrapsychic Factors
Output ResponsesCreativityLow levels of negativityPersonal
Control
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Coping Processes/Output ResponsesThe sense of connection and
beliefs about a higher power the older adult has help shape his
values, beliefs, and behaviors while living especially in terms
of what he believes happens after death.
Spirituality
Output responsesSpiritual perspectivePrayerReligiosity
*

GerotranscendenceShift in metaperspective from materialistic
and rationalistic to a more mature and existential one that
accompanies the process of aging. New outlook on and
understanding of lifeBroad existential changesChanges in one’s
view of the present self & the self in retrospectDevelopmental
changes (r/t existential changes and changes in self)
Associated with positive gaining and has been theorized as a
precursor to successful aging
*
Gerotranscendence (cont)
Three Levels of age-related change occur
Cosmic dimension-relates to the feeling of being a part of and at
one with the universe
Self dimension-deals with one’s self perception
Social dimension-increase in a sense of interrelatedness to
othersAssessed using the Gerotranscendence Scale (GS)
(Tornstam, 1994)
*
Gerotranscendence (cont)
A reasonable and well-balanced integration of the outputs of
each foundational coping process for each individual, rather

than an ideal amount or combinations of features from within
the foundational coping processes, must be present in order for
the aging person to experience gerotranscendence.
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Measuring Successful AgingSuccessful Aging Inventory (SAI)
is a 20-item questionnaire
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ANGEL-MAN SYNDROME
Independent Power Point Presentation:
Guidelines for Success
The purpose of this activity is to promote dissemination of
research in the field of nursing and discuss the nurse’s role in
care of complex patients. Students should research an area of
nursing practice focusing on genetic platforms, future trends
and nursing role (patient advocate for health and wellbeing,
educate, collaborate with medical team to provide support,
provide support and advice to patients etc.) . Students will craft
an individual Power Point presentation to be delivered via
lecture to the class. Introduction, discussion of pertinent
information on basis of genetic consideration as well as the
nurse’s role ending in a conclusionary discussion encompassing
future trends and nursing role by week 13 lecture. A question
and answer section will complete the lecture. APA formatting is
expected and a minimum of 3 nursing journal references are
required, not more than 3 years.
Chapter 27

Marilyn Anne Ray’s Theory of
Bureaucratic Caring
Developed by S. Gordon (2005)
Revised by C. A. Blum (2010)
Updated by D. Gullett (2014)
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On completion of this chapter, students will be able to:
Describe Ray’s Theory of Bureaucratic Caring.
Outline the development of the Theory of Bureaucratic Caring.
Discuss organizational cultures as transformational
bureaucracies.
Identify and discuss characteristics of bureaucracies.
Compare and contrast the terms “formal” and “substantive”
theory.
Describe what distinguishes organizations as cultures from
other paradigms, such as organizations as machines.
Explain the paradox of serving a bureaucracy and serving
humans using an example from clinical practice.
Compare and contrast the Theory of Bureaucratic Caring and
the revised Holographic Theory of Bureaucratic Caring.
Discuss the relevance of complexity science to theory
development.
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Purpose of the ChapterDiscuss contemporary nursing
cultureShare Dr. Ray’s theoretical views and vision of
nursingDiscuss the Theory of Bureaucratic CaringAs grounded
theoryAs holographic theory
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Generation of Bureaucratic Caring TheoryUsed three research
approachesEthnography (hospital as a culture)Phenomenology
(meaning of caring in the life world)Grounded theory method
(the structure and process of caring within the complex
organization)
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Theory RevisitedRay revisited the theory and discovered the
theory incorporated many concepts from the new sciences of
complexityThe theory was revealed as holographicThe
holographic model depicts the primacy of caring as spiritual-
ethical and the other dimensions as equal, interfacing between
the spiritual and ethical and the bureaucratic dimensions
*

The Theory of Bureaucratic CaringInvites us to view how a new
model may facilitate understanding of how nursing can be
practiced in modern health care (Ray, 2006)Is a holistic theory
with a practical purpose that facilitates our understanding of
nursing practice in complex contemporary health-care
environments
*
Dr. Ray BelievesGiven the nature of nursing as expanded
consciousness and theory as wakefulness, Nurses need nursing
theory to stimulate thinking and critique as they function in the
complex world of nursing science, research, education, and
practice
*
Holographic TheoryHolography means that the implicate order
(the whole) and explicate order (the part) are interconnected
that everything is a Holon, including humans, in the sense that
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
*

The Theory of Bureaucratic Caring as a Holographic Theory
Holistic science (and art) captures the idea that all systems,
including health care systems, are living systemsboth wholes
and partsdepend on networks of relationships, information,
choice and communication flow
*
Furthers the vision of nursing and organizations as complex,
dynamic, relational, integral, informational, and emergent—
open to sets of possibilitiesSynchronicity of interacting parts
and the wholeEverything interconnectsWe are all creative
manifestations of the oneness of the environment (context),
moving in relationship, and continually transforming
(emerging—growing and developing) (Thoma, 2003).
*
Provides a means for nurses and other professionals to
changeto realize the integral nature of the dynamic unity of the
human and environmentRather than continuing mechanistic
approaches of prediction and control

*
Contemporary Nursing PracticeNursing occurs in organizations
that are generally bureaucratic or systematic in
natureBureaucracies are a valuable tool
IdentifyUnderstandPrinciples that undergird coordinated
and relational organizational systems
*
Organizational CultureParadigm for understanding
organizationsFounded in AnthropologySocial
constructionsSymbolically formedReproduced through
interactionStudied formally and informally
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Types of Organizational CulturesInformalIntegration of codes
of ethics and conductCommitment IdentityCoherence
FormalPower and authorityPoliticalLegal
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Work of Nursing Within the Organizational
CulturesUndervalued in terms of cost and worthCurrently
evaluated in terms of patient safety and clinical nursing
leadershipNew interest in evaluating meaningfulness of
workDirectly helping othersCreating products that help others
(Cuilla, 2000)
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Work of NursingTraditionalDirectly helping others through
knowledgeable caring (Watson, 2005)ContemporaryDirectly
helping othersLegal contextEconomic context
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Call for the Reinvention of WorkRe-seeing the good of
nursingIncorporation of business principles and relational self-
organization Searching for meaning in the complexities of life
and work
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Organizational Cultures as Transformational
BureaucraciesTransformation of nurses toward relational self-
organization and creativity Moving from invisibility to
visibility Identifying nurses caring work as Having value
Expression of one’s soulSpiritual-ethical caring
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Characteristics of Bureaucracies
Eisenberg & Goodall (1993)Division of laborHierarchy of
officesGeneral set of performance rulesSeparation of personal
from professionalEmployment viewed as a careerEqual
treatment of employees or standards of fairnessProtection of
dismissal by tenurePersonal selection based on technical and
professional qualifications
*
Caring as the Unifying Focus of NursingCaring in
nursingBrings things into beingHolistic, humane, and
dynamicEssence of nursingSocial mandateManifested in
different and complex ways

*
Complexity and Nursing TheoryComplexity theory—opposing
things occur at the same time (Thoma, 2003). Therefore, linear
and nonlinear, and simple and complex systems exist
together.Gives rise to Chaos Theory—the notion that the
concept of order exists within disorder at the system
communication (Davidson & Ray, 1991).
*
Paradigms Prevailing worldviews in nursingDirect nursing
theoriesEnfold the care and caring ideal
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Types of ParadigmsTotality (Fawcett, 1993)Demonstrated
nursing, person, society, environment, and health characterize
the nature of nursingSimultaneity (Parse, 1987)Illuminates the
human-environment integral nature of nursingUnitary-
transformative (Newman, 1992)The view that the human being
is unitary and evolving as a self-organizing field identified by
pattern and interaction with the larger whole. Health is
considered expanding consciousness

*
The Theory of Bureaucratic Caring
Has its roots in all the these paradigms by synthesis
ofCaringOrganizational (bureaucratic) contextHolismHuman-
environment integral relationship
*
Bureaucratic Caring Theory: Emergent in Grounded
TheoryOriginated as a Grounded Theory (Ray, 1981)Qualitative
study of caring in organizational cultureStudy revealed nurses
struggled with the paradox ofServing the bureaucracy while-
Serving human beings through caring
*
Discovery of Bureaucratic Caring Resulted in: Substantive
Theory: Differential Caring TheoryCaring is
complexDifferentiated in terms of contextPractice
settingsFormal Theory: Bureaucratic Caring TheorySynthesis of
caring as humanistic and antithesis of caring as economic,
political, legal, and technological

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Dimensions of Bureaucratic Caring Caring as
humanisticSocialEducationalEthicalReligious/spiritualCaring as
economicPoliticalEconomic LegalTechnological
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Theory of Bureaucratic Caring as a Holographic
TheoryHolographic Theory:Interconnectedness of all things –
the whole and the part are interconnectedKnowledge exists in
relationship rather than the object world or subjective
experienceUncertainty is inherent in relationships because
everything is in processNature or meaning of the whole is
complex
*
Theory of Bureaucratic Caring as a Holographic Theory
(continued)The synthesis of caring as humanistic and caring as
economic within the Theory of Bureaucratic Caring shows that
everything is interconnected The whole is in the part and the
part is in the whole, a holon.We are all creative manifestations
of the oneness of the environment.

*
Research DemonstratesThe economic dimension of Bureaucratic
Caring is dominant.Nursing and caring are experiential and
influenced by social structures.Interactions and symbolic
interactions are formed and reproduced from dominant values
held within organizations.
*
The Theory of Bureaucratic CaringHas been embraced by
EducatorsResearchersNursing administratorsCliniciansWho
desire an understanding of how to preserve humanistic caring
within the business or corporate culture
*
Relational Caring Complexity a MetatheoryRay and Turkel
(2012) continue to advance their collaborative ideas related to
theory development, caring science, and the paradox between
caring and economics within complex systems. A metatheory
(Ritzer, 1991) emerged from the integration of the following:
The Theory of Bureaucratic Caring (Ray, 1981, 2006)Struggling

to Find a Balance: The Paradox Between Caring and Economics
(Turkel 1997, 2001)Relational Complexity (Ray & Turkel,
2012; Turkel & Ray, 2000).
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Relational Caring Complexity a MetatheoryReveals the
complexity of today’s nursing practice situation While
providing a foundation for emerging professional practice
models focused on caring and healingAn innovative
transdisciplinary research looking at caring and
economicsContinually giving voice to the value of caring in
nursing within and a part of complex organizations allows for
spiritual-ethical caring to occur.
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Theory of Bureaucratic Caring as a Middle-Range
TheoryRelatively large scope but does not capture the full range
of phenomena of a disciplineNarrower in scope than grand
theoriesAbstract enough to extend beyond specific dataSpecific
enough for testing or permitting transformational practice
interventionsFall between the concrete world of practice and
grand theories
*

Theory of Bureaucratic Caring as a Middle-Range Theory
(continued)Bureaucratic CaringReflects the concrete world of
practiceResponds to the caring ideal that is unique to nursingIs
both a grounded theory and a middle-range theoryMay be
considered a grand or holographic theory
*
SummaryNursing in complex organizations has to evolve.Caring
is the primordial construct and consciousness of nursing.Nurses
are calling for expression of their own spiritual and ethical
existence.The Theory of Bureaucratic Caring as a Holographic
Theory can lead the way.
*
References
Davidson, A., & Ray, M. (1991). Studying the human-
environment phenomenon using the science of
complexity. Advances in Nursing Science, 14(2), 73–87.
Fawcett, J. (1993). From a plethora of paradigms to parsimony
in worldviews. Nursing Science Quarterly, 6, 56–58.
Newman, M. (1992). Prevailing paradigms in nursing. Nursing
Outlook, 40, 10–14.
Parse, R. (1987). Nursing science: Maps, paradigms, theories,

and critiques. Philadelphia: W. B. Saunders.
Ray, M. (1981). A study of caring within the institutional
culture. Unpublished doctoral dissertation. Salt Lake
City, UT: University of Utah.
Ray, M. (2006). Marilyn Anne Ray’s Theory of Bureaucratic
Caring. In: M. Parker (Ed.), Nursing theories, nursing
practice (2nd ed.). Philadelphia: F. A. Davis.
Ray, M. & Turkel, M. (2012). A transtheoretical evolution of
caring science within complex systerms. International Journal
for Human Caring, 16(2), 28-49.
*
References
Ritzer, G., (1992 Metatheorizing: Newbury park, CA:sage.)
Thoma, H. (2003). Holistic science: All at the same time.
Resurgence, 1(216), 15–17.
Turkel, M. (1997). Struggling to find a balance: A grounded
theory study of the nurse-patient relationship in the changing
health care environment. Unpublished doctoral dissertation,
University of Miami, Florida. Microfilm #9805958.
Turkel, M. (2001). Struggling to find a balance: The paradox
between caring and economics. Nursing
Administration Quarterly, 26(1), 67–82.
Turkel, M., & Ray, M. (2000). Relational complexity: A theory
of the nurse-patient relationship within an
economic context. Nursing Science Quarterly, 13(4), 307–
313.
Watson, J. (2005). Caring science as sacred science.
Philadelphia: F. A. Davis.

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