||Caring is central to the profession of nursing, and cross-cultural caring is central to the sub-field of transcultural nursing. This study is an analysis of the meaning of caring expressions and behavior, principally those which are related to nurses within a hospital culture in the United States. Caring was investigated by primarily an inductive research approach through participant observation techniques. Comparative data of different social units (persons, roles, clinical units, and documents) formed the basis from which conceptual categories of caring (a classification system), and theoretical frames of reference were discovered. A classification system founded on 1362 caring responses of 192 participants consisting of four categories with their respective subsets was developed. They are as follows: Psychological (Cognitive and Affective); Interactional (Social and Physical); Practical (Technical and Social Organization); and Philosophical (Spiritual, Ethical, and Cultural). The Psychological category received the largest number of responses, followed by the Practical, the Interactional, and lastly, the Philosophical categories. The classification system reflected the current shift from humanistic-religious dimensions of caring to practical dimensions influenced by the relationship of caring to the bureaucratic dominant American social structures. In an analysis of caring within the hospital clinical units, data reinforced the existence of a logical connection between caring behaviors and the bureaucratic social structure. Contrasting examples of differential caring patterns emerged. A substantive theoretical frame of reference of differential caring was identified. The pattern of differential caring, coupled with the patterns discovered in the cognitive analysis were abstracted into a formal theoretical frame of reference, bureaucratized caring. The theoretical frames of reference of differentiation and bureaucratization demonstrated the complex meaning and structure of caring in a contemporary hospital culture. Ideal nursing models of caring were replaced by a bureaucratic model which produced professional conflict for the majority of nurses. The future of nursing now depends on how well the nature of bureaucratic caring is understood. To help in the development of transcultural nursing awareness and caring knowledge, a list of recommendations for research, education, and practice was suggested.