Theory of Bureaucratic Caring Applications

Current Applications of the Theory of Bureaucratic Caring

  1. Application of the Theory of Bureaucratic Caring (BCT) within the United States Air Force Nurse Corps, and the National Capitol Region of the United States

Within the United States Air Force (USAF), Marcia A. Potter, Colonel, USAF, NC, DNP, FNP-BC, Master Clinician, Chief Primary Care Nurse, Joint Base Andrews, MD.  has initiated and applied the Theory of Bureaucratic Caring (BCT), not only, first, to facilitate with the executive team, the creation of the USAF Professional Person-Centered Caring Partnership Model (PC2P), but also, to apply the BCT to primary care. The BCT is used as a guide to frame evidence-based clinical practice and business operations in Primary Care within the National Capitol Region of the Defense Health Agency, impacting the care delivery of 450,000 Military Health System enrollees.

The PC2P Professional Person-Centered Caring Partnership Model also has formed the basis of the Triservice (Air Force, Army and Navy) professional nursing practice model developed within the Uniformed Services University of the Health Sciences to assist military healthcare. Thus, Colonel Potter’s efforts have impacted professional nursing practice for 10 million Military Health System beneficiaries worldwide.

  1. Specific Outcomes of the Application of the Theory of Bureaucratic Caring to the Military Health System Worldwide

  1. Person-Centered Partnership Models that enhances chronic care model

  2. Person-centered Caring Communication Initiative

  3. Spiritual care Embedment Project

  4. Multidisciplinary evidence-based Practice Council

  5. Patient Discharge Instructions Using Acupuncture

  6. Take Your Theorist (Dr. Marilyn A. Ray) to Lunch Education Series

  7. Creation of Simulation Projects

  8. Tri-Service Nurse Corps (Army, Navy, US Air Force) Professional Practice Model

  9. Reshaping Military Health System for Human Caring

  10. Outreach to Community Stakeholders for Health and Wellness Promotion

  11. Application of BCT to Nursing Curricula with Senior Leaders and Nursing Faculty of the Uniformed Services University of the Health Sciences

  12. Creating alliances for Multi-Dimensional Caring in Human Sciences and Business Operations

  13. Enhanced Patient Safety, Use of and Medication Adherence, Understanding of Chronic Health States

  14. Positioning of New Advanced Practice Nurses to Use BCT in Daily Clinical Practice and Leadership Roles

Specific Application of Categories (Concepts, Domains) within the Theory of Bureaucratic Caring Related to the COVID 19 Pandemic (By Colonel Marcia Potter, USAF, NC, DNP, Chief Primary Care Nurse, Adjunct Professor Uniformed Services University of the Health Sciences, Department of Defense, USA)

  1. Technology:

Use of phone, text, other social media, teleconferencing/distance learning platforms for engagement while maintaining social distance.

The impact and professional ability of nurses, physicians, respiratory therapists, EMTs, cleaning personnel, and others (all frontline workers) for understanding the COVID 19 illness, the use of ventilators, and medications to facilitate life.

  1. Education:

Provision of evidence-based and creative knowledge/advice to patients, staff, and general public after learning more about the symptoms, course and distribution of virus, mitigation, containment, treatment, and predictions of pandemic on  local, national, and global perspective levels. Application of new care approaches to COVID 19 patients, such as respiratory care and placing patients in prone position for relief and improved lung capacity. Appreciation of all education undertaken by teachers remotely.

  1. Social-cultural:

Understanding the “new” culture of COVID 19 where traditional practices, rituals, symbols have to be performed in new ways.

Redefinition of the meaning of local and global culture, community, faith, and family. Re-understanding of the culture of aging and illness.

Understanding diverse cultural ethnicities and environmental situations and their impact on health and wellbeing.

  1. Political:

Resources, authority, policy, power, and “power of caring”, and personal influence impacting engagement in human-human relationships and bonding.

Sensitivity to needs of all for the creation of new policy for all, especially, the most vulnerable. Assistance of all branches of the military to the civilian sector for application of technical help and provision of human resources for care of the sick.

  1. Economic:

Financial resources being poured into caring for people on a massive, unprecedented scale in manufacturing of life-saving technologies, scientific and medication developments, and  preservation of the economic well being of people and organizations.

Shifting of manufacturing and design to immediate financial support to individuals , families, communities, and businesses, illuminating the economic power of caring that is leveraged daily to improve health, lives, rescue and the sustaining communities. Shift of some primary care resources to tertiary care during COVID 19.

  1. Legal:

Attention to assuring the highest quality of standards for care yet relaxing some, in order to ensure that resources can be applied as broadly as possible.

New latitude given to conducting tele-health, transfer of state licensure requirements for professionals to serve in other states; use of volunteers to work in health care; enabling of governments to leverage power for the good of all.

         Physical:

In time of social distancing for the sake of life, nurses and other health care professionals, and other essential personnel are placing themselves at risk to care for the needs of the sick and to keep people well. This ultimate sacrifice cannot be overlooked or underestimated.

         Spiritual-Ethical:

At the center of every decision (related to the categories (concepts, domains)) in the BCT, the very essence of humanity, the desire to do good, to place another person’s welfare before one’s own In the deepest, most fundamental essence of being, is finding our connection to the Spiritual-the Holy. This connection compels us to rise above our fears, and self-centeredness to bring this holiness into life and action to instill, often through prayer, faith, courage, hope, love, and light to self and others.  Creating new ways of caring for the dying in isolation from family and friends (caring ways to say goodbye) by the use of the soft and compassionate voice of nurses whispering in ears, holding hands though gloved, and using social media so patients can hear or perhaps, even see their loved ones. Spiritual-ethical caring is sharing in the joys of returning patients to health through all means available; and nurses and other professionals sharing with families and friends in the sorrows and prayers of dying and death.