Mary Hurley, RN; PhD Nursing Administrator, Overlook Hospital Summit, New Jersey, USA

Abstract

Job satisfaction, stress, and power were studied within the Science of Unitary Human Being as mutual-process pattern manifesting the human experience of change. Historically, the concept

of stress has not been congruent with the Rogerian view of mutual process. Stress was re-defined herein from the Rogerian perspective as "an experience of change manifested by individualism, challenge, opportunity, and consciousness raising" and operationalized with a 10-point Self-Anchoring Striving Scale. A national, randomized sample of 600 nurses resulted in a response rate of 45 percent of which 124 female nurse managers were identified for participation in the study. Data from the 124 respondents who met the study criteria were analyzed with Pearson product moment correlations and simple regressions to measure the relations among the study variables. T-tests, analyses of variance and chi-square analyses were computed to examine the study variables' associations with demographics. Power and job satisfaction were moderately related ([r.bar] = 0.40), while stress and power were weakly related ([r.bar] = 0.19). Stress was related to three of the four proposed manifestations of stress, challenge, opportunity, and consciousness raising. Three of the four dimensions of stress were inter-correlated. These findings provide partial support for the Rogerian concept that the whole is different from the sum of the parts. The correlation between job satisfaction and power reflects the theoretical rationale that managers who view themselves as participating in change should manifest power and experience job satisfaction. Further study is needed to clarify, operationalize, and test the proposed Rogerian conceptualization of stress.

Key Words: Job satisfaction, stress, power, Science of Unitary Human Beings, Rogerian Science, nurse managers, Martha Rogers

Introduction

Within the perspective of the Science of Unitary Human Beings (Rogers, 1970, 1992, 1994) people and their world are in a mutual process allowing individuals to participate in the creation of their own reality. This perspective is different from the traditional paradigm of stress that leaves individuals subject to their environments. From the Rogerian perspective, stress may be seen as a pattern manifestation of the person-environment mutual process of change. As such, it may be defined as an experience of change manifested by individualism, challenge, opportunity, and consciousness raising (Hurley, 2002). To begin to explore and validate this conceptualization of stress, the relations of stress to job satisfaction and power were examined in a random sample of nurse managers. Both job satisfaction and power are also pattern manifestations of the person-environment mutual process of change. All three variables- stress, power, and job satisfaction- can be conceived as relevant to nurses and, in particular, to nurse managers.

Stress has been labeled as one of the most debilitating and expensive phenomena in our society. Stress can affect nurses' ability and willingness to provide nursing care and can lead to job dissatisfaction, burnout, and low commitment. The cost in terms of recruitment, retention, and absenteeism of nursing personnel is high. The nurse manager is crucial to the success of the goals of the institution and often this success is a result of the manager's ability to affect staff attitudes and care. In this position, balancing the goals of the organization with the needs of staff and representing the organization to staff is both challenging and stressful.

Theoretical Rationale

According to Rogers (1970, 1992, 1994), "the concern of nursing is with [human beings] and [their] entirety, [their] wholeness" (Rogers, 1970, 3). Rogers continues, "the phenomenon central to nursing's conceptual system is the life process in [human beings]" (p. 83). The Science of Unitary Human Beings provides a framework for viewing change as the hallmark of the life process. Santos and Cox (2000) state that the science of organizational development defines "the phenomenon of change as a stressor" (p. 8). If the hallmark of the life process is change and change is considered a stressor, it is understandable why stress is considered pervasive in today's society. The traditional definitions of stress are not congruent with Rogerian science principles. For example, stress is typically viewed as something negative. Stress need not have a negative connotation, however. Not every person who experiences stress will experience illness or adverse psychological symptomatology. In fact, according to Aurelio (1993) too little stress is as bad as too much. This view suggests that traditional theoretical perspectives that view stress as negative and requiring "adaptation" may be limiting.

The human field pattern includes the beliefs, attitudes, feelings, and emotions of individuals that help them to perceive and participate in their reality. Stress is, therefore, a possible human field manifestation arising out of the human-environmental mutual process at any given relative present. That is, stress may be defined as a person's experience of change. Barrett (1983) states that life is a flow of experiences. To be alive is to experience this flow and, thus, to move and to change (Barrett, 1983, 5). From a Rogerian (Rogers, 1970, 1992, 1994) perspective, stress is a manifestation of the human experience of continual change that occurs in the mutual human field and environmental field process. Even Lazarus (2000), while rooted in stress as an adaptive process, views stress as a relational process between humans and their environments. Perceiving humans either as subject to "environmental influences" or as acting on the environment conflicts with the Rogerian concept of mutual process of people and their environments (Rogers, 1970, 85). But by recognizing the human/environmental mutual process, the stress experience can be viewed as other than an adaptive process.

Power is a concept of concern for nursing but is most often discussed in terms of power and control over someone or something. Barrett (1983) proposed a power theory that differs from the traditional view of power discussed in the literature. Barrett looked at power as a potential within people that may or may not be manifest. According to Barrett, an individual's power is realized through mutual process with the environment.

Conceptualizing power as an inherent quality is not new. However, Barrett (1983) provides a way to operationalize the concept of power as an inherent quality, allowing it to be studied in a framework that emphasizes the individual's active participation in creating change rather than the traditional view of the individual being acted upon or affected by external events. Barrett's theory conforms to a mutual process of humans and their environments as opposed to control over one's environment. Rather than being affected by events in one's life, Barrett's concept of power emphasizes active participation of the individual in creating change.

Barrett (1983) defined power as knowing participation in change. "Knowing participation is being aware of what one is choosing to do, feeling free to do it, and doing it intentionally" (p. 7). According to Barrett's conceptualization of power, a person has the ability to participate in change and "can knowingly actualize some potentials rather than others" (p. 30).

Power too has been discussed in the literature within a cause-and-effect paradigm. Barrett's (1983) theory of power is contrary to this traditional view of power. Derived from Rogers' (1970) Science of Unitary Human Beings where person and environment are in mutual process, Barrett's theory proposes that power is an inherent attribute to be manifested regardless of the context in which it is being used. Barrett describes power as an actualization of potentialities. Barrett defines power as "the capacity to knowingly participate in change characterizing the continuous patterning of the human and environmental fields" (Barrett, 1983, p. 4). Knowing participation in change has implication for how one views the worth or meaning of one's life. The field manifestations of Barrett's power which are "being aware of what one is choosing to do, feeling free to do it, and doing it intentionally" (1983, p. 7), speak to one's effectiveness in participating meaningfully in life. In Barrett's theory power is a change in participation. Whereas in other paradigms, power is often referred to as being used or exerted, in Barrett's theory power is not a tool or result of an interaction. In contrast, power is a human field manifestation that is realized through being aware and deliberately choosing an option for events arising out of the human-environmental mutual process. How individuals participate is expected to vary. Furthermore, the varied patterning of the human-environmental field related to how power is realized is unpredictable and will reflect the interpretations of a person's value system.

Job satisfaction continues to be a major focus in the nursing literature (Ruggiero, 2005; Stacciarini and Troccoli, 2004). From a Rogerian (Rogers, 1970, 1992, 1994) perspective, job satisfaction may be conceptualized as a feeling where the working individual believes there is an opportunity to experience challenge that does not exceed ability to be successful. Through deliberate choice by an individual, both the individual and environment change together and the individual experiences a feeling that in and of itself is rewarding and not necessarily dependent on the outcome of the event.

This characterization of job satisfaction is similar to the concept of optimal experience "flow" described by Csikszentmihalyi (1988). Flow experience describes an "optimal state of experience "(Csikszentmihalyi, 1988, p. 3). From studies of a wide variety of persons who pursued strenuous activities, observations were made regarding the feeling of intrinsic reward. The observation of a common experience that individuals felt was rewarding in and of itself was realized. Optimal experience maintains that the activity and the dynamics of the experience make enjoyment possible. Optimal experience requires a balance between challenge and skill with each becoming more complex over time. While the "content of the activities" can vary, the "dynamics of the experience" is believed to be stable over time (Csikszentmihalyi, 1988, p. 10). It is ultimately the individual who determines if flow will occur. Rogers (1970, 1992, 1994) also sees the evolution of life as a continuous patterning of energy fields toward greater complexification.

Literature Review

Stress

Stress continues to be a subject of interest in both the general literature and that of nurse managers (Judkins, 2004). Findings in both the theoretical and empirical literature, although not based in the Rogerian (1970, 1992, 1994) framework, lend support for conceptualizing stress as an experience of living that flows from the mutual process of the human and environmental fields, and for suggesting that stress is manifested by individualism, challenge, opportunity, and consciousness raising.

In a study of the mental and physical health of spouse caregivers, Hooker, Monahan, Shifren, and Hutchinson (1992) investigated the role of personality in the development of symptornatology. The underlying premise that personality determined the subjective appraisal of the stressor was supported ([r.bar] = .65 for neuroticism and [r.bar] = -.50 for optimism, [p.bar] <.001, two-tailed). Adler and Mathews (1994) suggest that appraisal of stress is more important than exposure to life events in deciding health outcomes. Their view suggests there is an individual component to the stress experience.

Jezierski (1993), in a qualitative study with 11 emergency department nurse managers, consistently described a perspective of challenge and an ability to make a difference (change) as themes that helped the managers with the daily stresses of their work. Thus, there is a connection with challenge, change, and stress. Stress needs to be experienced and seen as a challenge for growth and development (consciousness raising) to occur. Consciousness raising relates to a person's ability to grow and learn from an experience. Thus, while an event may be negative and stressful, the outcome promotes growth and can be seen as positive flow.

Other studies also speak to the connection of challenge and growth. McNeese-Smith (1995) in her study of nurse managers determined that managers must "challenge employees to stretch and grow" (p. 25). Frisch, [C]embeck, and Shannon, studied 21 female head nurses with all respondents agreeing that stress was sometimes positive with two using the word "challenge" (1991, p. 11). Fontaine, Manstead, and Wagner (1993), in a study of optimism, perceived control over stress, and coping, subjected coping strategies to principal axis and components analysis. The positive reinterpretation and growth items loaded as separate components indicating a difference in the two concepts. The separate loadings for these two concepts support investigation of consciousness raising as a field manifestation of stress.

When an event occurs, there is an opportunity for an options to be taken or ignored. Kerfoot (1991) states that, "basic to an optimistic outlook is the belief that there are possibilities and opportunities... in the present and the futures (p. 64). A study of "effective" nurse managers by Everson-Bates (1992) supports a view that persons who see opportunity rather than liability in reality are more successful in their endeavors.

Power

Researchers, who have studied power within the Rogerian Framework (1970, 1992, 1994), provide a foundation for the exploration of the job satisfaction, stress and power relations. Caroselli-Dervan (1991) found no significant relation between power and feminism in 89 female nurse executives suggesting that other variables such as stress may better explain the concept of power in this group of individuals. Moulton (1994) also studied nurse executives regarding empathy and power and found a significant relation in the empathy subscale personal distress and power ([r.bar] = -.14, [p.bar] < .05). Viewing a person's perception of the stress experience as either a constructive or destructive human pattern manifestation, one can hypothesize that personal distress is a stressful experience, and without awareness, one's ability to realize power is limited.

Rizzo (1990) found support for her premise that meaning in life adds to a person's life satisfaction. Meaning in life is one way individual's grow and develop. Eighty-four predominately elderly females had significant relations between power and purpose in life ([r.bar] = .51, [p.bar] < .001). Wright (1999) found a relation between trust and power ([r.bar] = .49, [p.bar] < .001) in her study of 189 adults.

Everson-Bates (1992) conducted an ethnographic analysis of the role of first-line nurse managers identified by their managers as effective in their jobs. She explored their beliefs, values, and behaviors. She also interviewed nurse executives and hospital administrators regarding their role expectations for nurse managers. The groups were in agreement regarding the process and skill components required to do the job. The essence of the role was "managing reality and managing people ... it was the process of interpreting facts as opportunities rather than liabilities" (Everson-Bates, 1992, p. 35). One common trait among the managers was the desire for power and control to make change. However, their concept of power was rooted in the traditional view of control and authority.

Job Satisfaction

Using The Index of Work Satisfaction scale, Tumulty (1992) studied 110 head nurses to test a model for role redesign and found job satisfaction to be only 4.2 (range 3.18 to 4.97) out of a possible score of 7. Wells (1990) also studied 95 nurse managers' job satisfaction as it related to organizational structure and achieved a mean score of 140.7 (range 91 to 178) out of a possible score of 190. Exactly what impacts job satisfaction remains questionable, but individualism remains a component to be investigated. For example, recent studies in concepts such as autonomy and empowerment in nurses have found that individuals may vary in their need for autonomy (Cunningham & Hyman, 1996; Song, Daly, Rudy, Douglas, & Dyer, 1997). These studies support the premise of Barrett (1983) that power also manifests differently in individuals.

Differences among nurse managers in motivation also suggest an individual component to stress and job satisfaction. Hansen, Woods, Boyle, Bott, and Taunton (1995) when comparing nurse managers to traditional business personnel, found nurse managers did not fit the mold for motivation to manage, " the degree to which a manager possess strong desire to achieve managerial role requirements" (p. 28). Motivation can be intrinsic or extrinsic. Intrinsic motivation according to Deci (1975) allows a person to feel competent and self-determining in relation to his environment and has recently been acknowledged as a component of the nursing experience (Song et al, 1997; Tovey & Adams, 1999). Intrinsic motivation may be a component in the conceptualization of job satisfaction as optimal experience "flow" (Csikszentmihalyi, 1988) used in this study.

Zavodsky and Simms (1996) support the concept that optimal experience can be actualized in the work environment. They likened the concept of optimal experience to the concept of work excitement developed by Simms and Erbin-Roesemann (Simms, Erbin-Roesemann, Darga, and Coeling, 1990). Zavodsky and Simms studied work excitement among 399 nurse executives and managers. Nurse executives were very excited ([M.bar] = 4.34, [SD.bar] = .92) and nurse managers were moderately excited ([M.bar] = 4.08, [SD.bar] = .89). Six factors emerged on factor analysis, three of which were variety of experience, pace, and personal growth and development. The researchers equated pace to change arid variety to challenge.

Methodology

A correlational design was used to investigate the relations among stress, power, and job satisfaction in female nurse managers drawn from a random, national sample of 600 nurses in a mailed survey. The return rate was 45%. Out of the returned questionnaires 135 participants met the eligibility requirements (female, working in a patient care setting, and having 24 hour accountability for unit management). Eleven of these were excluded from the study because of missing data, leaving 124 completed questionnaires for analysis.

Instruments

The Self-Anchoring Striving Scale, known as the Cantril Ladder (Cantril, 1965) was chosen to measure nurse managers' perception of their stress experience and the proposed manifestations of stress (individualism, challenge, opportunity, and consciousness raising). An individual identifies a point on the ladder (scale) that locates oneself in relation to the concept being measured. The anchoring points of the scale are the highest and lowest points of the concept being measured. Like Rogers (1970, 1992, 1994), Cantril viewed the totality of the human-environment as irreducible (Cantril & Bumstead, 1960). Cowling (1986) agrees that measures of self-report, that are experienced-based, may be more methodologically compatible with the study of variables in Science of Unitary Human Beings and serve as valid indices of the human-environmental field pattern.

Construct validity for the Cantril Ladder has been demonstrated by significant correlations to variables of concepts that should have a theoretical connection to the variable being measured (Palmore & Kivett, 1977).

Power was measured by The Knowing Participation in Change Test (PKPCT, Version 11) developed by Barrett (1983). Power was operationalized as knowing participation in change, which was derived from the Science of Unitary Human Beings (Rogers, 1970). The instrument was developed using panels of judges, a pilot study, and factor analysis resulting in four concepts each measured by 12 bipolar adjective scales. The concepts awareness, choices, freedom to act intentionally, and involvement in creating changes represent the field manifestations of power. Construct validity determined by factor analysis yielded coefficients of .56 to .70. Reliability determined by combining the variance of the factor scores ranged from .63 to .99. Each concept has a retest question the reliabilities of which ranged from .70 to .78.

The Work Quality Index (WQI) instrument designed by Whitley and Putzier (1994) was used to measure job satisfaction. The instrument is composed of 38 items which measure work environment, autonomy, work worth, relationships, role enactment, and benefits. Construct validity for the instrument was established by factor analysis and the instrument's internal consistency was demonstrated by Cronbach alpha coefficients which ranged from .72 to .94.

Analyses

Data analyses were computed using the Statistical Package for the Social Sciences Version 8.0 for Windows. The total WQI (Whitley & Putzier, 1994) and PKPCT, Version 11 (Barrett, 1983) scores were used in Pearson product moment correlations with stress and its four manifestations. Cronbach alpha coefficients were obtained to ensure the reliability of the WQI and PKPCT, Version II with this sample. The individual scores on the Cantril Ladders (Cantril, 1965) were used in the analyses. Other analyses (Pearson product moment correlations, t-tests, analyses of variance, and chi square analyses) were used as appropriate to explore the relations among the personal demographics and the study variables. Age, marital status, number of children, years in nursing and the current position, educational preparation, geographic location, size and type of institution, size of unit managed, direct care responsibility, salary, overall life satisfaction, experience and amount of stress, experience of crisis, and participation in fate were all investigated. In addition, open-ended questions were asked regarding the respondent's perception . of the experience of stress.

Findings

The sample comprised 124 respondents from 34 states, with one to 17 respondents from each state. The Midwest had the largest representation with 31.4% of respondents. The Northeast and Southeast had 29% and 24% respectively. The Southwest had 13.2%, while 2.4% came from the Northwest.

The participants ranged in age from 29 to 60 years ([M.bar] = 43.6, [SD.bar] = 7.3). Most participants were Caucasian (90.4%), married (76.7%), with one to three children (69.9%). Just over 20% had no children while just over 98% of respondents indicated a Christian religious affiliation. One-fifth of the sample held a master's degree (21.8%) and less than 50% had a bachelor's degree (41.9%) as their level of education. Most bachelor's and master's degrees were in nursing, 36.3% and 16.2%, respectively. No one in the sample reported holding a doctoral degree. Respondents reported 7 to 39 years in nursing ([M.bar] = 20.7, [SD.bar] = 7.8), with 6 months to 37 years in their current position ([M.bar] = 7.4, [SD.bar] = 6.7). Over 50% of the respondents were in their current position five years or less (52.4%), with approximately 2.4% in their current position for less than one year.

The mean annual salary was $55,800 ([SD.bar] = 11.4). Just over half of these managers (54.7%) provided direct patient care. Most respondents worked in a community hospital with fewer than 350 beds and the average size of units they were responsible for was 37 beds.

Results

Job satisfaction was not related to stress ([r.bar] = -0.11, [p.bar] = .23) or any of the four manifestations ([r.bar] = 0.02-0.13) (see Table 1). Power was positively and significantly correlated to job satisfaction, [r.bar] = .40, [p.bar] = .000. All subscales of both the power and job satisfaction instruments were significantly correlated. Three of the four manifestations of stress were intercorrelated (challenge, opportunity, and consciousness raising ([r.bar] = 0.37-0.43, [p.bar] [less than or equal to] .001). Their correlation to the measure of stress was ([r.bar] = 0.24-0.37, [p.bar] [less than or equal to].01) except for individualism which did not correlate to stress ([r.bar] = 0.13) or challenge ([r.bar] = 0.15) but did correlate to power ([r.bar] = 0.24, [p.bar] [less than or equal to]5.01)

Age, marital status, number of children, years in nursing, educational preparation, geographic location, and size and type of institution were not related to job satisfaction, stress, or power. However, married persons were more satisfied with life ([t.bar] = -1.95, [df.bar] = 121, [p.bar] = .05).

One question was whether the nurse manager had direct care responsibilities. Direct care responsibility was related to size of the unit, [[c.bar].sup.2] = 10.79, [df.bar] = 3, [p.bar] = .01 and education, [[c.bar].sup.2] = 6.29, [df.bar] = 2, [p.bar] = .04. The more beds the manager was responsible for, and the more educated she was, the less direct care responsibility she had. Nurse managers' perception of the stress experience was related to direct care responsibility, [t.bar] = 2.44, [df.bar] = 113.74, [p.bar] = .02 and years in current position, [r.bar] = .19, [p.bar] = .03. Nurses with responsibility for direct patient care and in their positions longer perceived the stress experience as defined. Nurse managers with experience in a recent crisis ([F.bar] = 5.42, [df.bar] = 1, [p.bar] = .02) and those managers who perceived themselves to have greater stress ([F.bar] = 3.22, [df.bar] = 2, [p.bar] = .04) also saw the stress experience as defined.

Salary was related to several variables. In summary, the longer the nurse manager was in the position, [r.bar] = .25, [p.bar] = .01, the more educated the nurse manager was, [F.bar] = 3.50, [df.bar] = 2, [p.bar] = .03, and the larger the institution the nurse manager worked in, [r.bar] = .23, [p.bar] = .02, the higher the nurse manager's salary.

Discussion

Overall the participants in this study were satisfied with their jobs, with 96.5% reporting a moderate or high level of satisfaction. The participants likewise reported experiencing stress, almost 98%, with 52.5% rating the experience of stress medium and 44.2% as high (See Table 2). That scores for stress and job satisfaction did not correlate is puzzling but several reasons are suggested. The instrument measuring stress may not have been sufficiently robust to explore the stress experience. Several relevant questions were not investigated as part of the study or incorporated into the construction of the stress instrument. Not explored was the kind of philosophy of stress that had been incorporated into the participants' everyday lives. Likewise, participants were not asked to describe the event they chose to reflect upon when responding to the question that anchored the stress measurement. Also not explored was the participants' perceptions of the intrinsic nature of nursing versus the everyday practice of the job when responding to the job satisfaction questions. For instance, workload was indicated as a significant source of stress yet respondents had high job satisfaction. Thus, workload did not significantly influence job satisfaction. Some researchers (Dwyer & Ganster,1991) have found the pressure of too much to do in too little time may not equate to stress. Researchers (Caspi, Bolger, & Eckenrode, 1987) have also found that persons previously exposed to major life events are less affected by daily hassles, for example, workload.

Another puzzling finding is the fact that individualism scores did not correlate to stress as a personal phenomenon, subjective in nature. The fact that individualism did not relate significantly to the experience of stress is an unexpected finding. The participants in this study who had experienced a crisis in the last six months were more inclined to perceive the stress experience as incorporating the manifestations of stress ([F.bar] = 5.42, [df.bar] = 1, [p.bar] = .02), and the crises expressed were negative life events. Some authors (Rice, 2000) suggest negative events, such as death of a loved one, may be a more universal experience rather than an individual one. Furthermore, there is an assumption in stress-asstimulus theories that there is an inherent stress in events, regardless of individual differences.

In other words, the simple fact that some major life events cannot be avoided or modified to any great extent (DeLongis, Coyne, Dakof, Folkman, & Lazarus, 1982) can distract from the individuality of the event. Life events are often seen as distal measures of stress, one reason being a life event does not address the significance of the event for the individual experiencing it (DeLongis et al., 1982). There is some support for the fact that there is a proximal and distal component to the stress process. For instance, Singh, Verbeke, and Rhoads, (1996) suggest that viewing role stress from the individual perspective versus a compositional or collective approach is not holistic in nature, and negates the contribution of the environment. They maintain that both individual and organizational variables matter when determining the effect of role stress processes.

Thus, nurse managers may not have appreciated an individual response to a major event, as much as the communal response, and so they may be more aware perhaps of what is considered a universal understanding of stress. Thus, while they could reflect upon the positive aspects of the experience (challenge, opportunity, and consciousness raising), the focus of their perception is not the individuality component of their experience.

Barrett's (1983) theory would suggest that nurse managers who were highly motivated toward actualizing and experiencing their power would express job satisfaction. This relation was demonstrated in this sample of nurse managers. As persons with an increased awareness of power, the nurse managers sought a position where that power could be manifested and this was reflected in their job satisfaction. Power contributed 16% of the variance of job satisfaction. Job satisfaction remains poorly understood. Further research on the issue is needed.

The sample of nurse managers who had direct care responsibilities, or who, were in their positions longer, or who, had experienced a recent crisis, or who, perceived themselves as having greater stress, had higher stress scores on the Cantril Ladder (Cantril, 1965). This finding may demonstrate the principle of integrality, ever present in the practice of nursing, by showing that the special nature of the relationship of patient and nurse, as well as personal experiences, may assist the growth persons realize in terms of their own awareness of the stress process and its meaning.

The equally important focus on stress and the quality of life experienced by individuals calls for innovative strategies for managing the experience of stress. It is suggested that education and training for nurse managers move beyond conceptualizing stress as negative toward fostering awareness of the stress experience as challenging and growth promoting in the work environment. Increased awareness of the mutual process of the human and environmental field may help individuals identify health-promoting ways in which to participate in the stress process.

Partial support for the concept that parts of the whole are different from the whole (Rogers, 1970, 1992, 1994) may be drawn from the lack of correlation of the individual stress manifestations and job satisfaction. All manifestations except for individualism were intercorrelated among themselves and to stress. This suggests that the parts cannot be separated from the whole or each other. The lack of significance of individualism for the stress experience remains unclear.

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Mary Hurley, RN; PhD

Nursing Administrator, Overlook Hospital

Summit, New Jersey, USA

TABLE 1
Correlation Matrix for the Major Variables and the Stress
Manifestations

                           1         2         3          4

1. Stress                  1.00     .19 *     -.11       .13
2. Power                             1.00      .40 ***   .24
3. Job Satisfaction                            1.00      .06
4. Individualism                                         1.00
5. Challenge
6. Opportunity
7. Consciousness Raising

                            5          6           7

1. Stress                  .37 ***    .31 ***     .24 **
2. Power                   .02        .13         .06
3. Job Satisfaction        .07        .02         .13
4. Individualism           .15        .34 ***     .30 ***
5. Challenge               1.00       .43 ***     .37 ***
6. Opportunity                        1.00        .41 ***
7. Consciousness Raising                          1.00

* p [less than or equal to].05, ** p [less than or equal to].01,
p [less than or equal to].001

TABLE 2
Univariate Statistics Related to Crisis, Stress, Experience,
Degree of Stress and Participation in Fate

Variable                 Frequency    Percent

Crisis
  Yes                          50       41.0
  No                           72       59.0

Experience stress
  Yes                         121       97.6
  No                            2        1.6
  Not sure                      1         .8

Degree of stress
  Low                           4        3.3
  Medium                       63       52.5
  High                         53       44.2

Deciding Fate
  Yes                         112       91.0
  No                            5        4.1
  Not sure                      6        4.9