relationships among women’s menopausal life-cycle stages ... · women living one-third of their...

Relationships Among Women’s MenopausalLife-cycle Stages,

Occupational Experiences & Health1

Jeannette Barsky, Chinook Health Region, LethbridgeKarran Thorpe, University of Lethbridge

KEY WORDS: MENOPAUSAL LIFE-CYCLE STAGES, OCCUPATIONAL EXPERIENCES,MENOPAUSE, WOMEN’S HEALTH

Writers in the popular and academic press indicate that women are seeking information about theirlife cycle and corresponding changes upon their life roles. The purpose of this research was to exploreand describe how women’s menopausal life-cycle stages of development relate to their health throughoccupational experiences of burnout, job involvement, and hardiness. Approximately 700 RegisteredNurses responded to the Women’s Health Occupational and Life Experiences (WHOLE) Profile.Significant findings were found between pre and post-menopausal (but not peri-menopausal) life-cycle stages and health. No significant correlations were found between menopausal life-cycle stagesand the variables of burnout, job involvement and hardiness. Significant differences were foundbetween health ailments and burnout and hardiness, between chronic illnesses and hardiness, betweenage and job involvement and hardiness, as well as number of children and job involvement. Thefindings indicated that about 40% of the participants were experiencing a high degree of burnout,43% demonstrated active job involvement, and 36% showed high hardiness.

The trends toward women in paid-work environments, the expansionof women’s roles within society, as well as the recent phenomenon ofwomen living one-third of their lives after menopause affect women’shealth (Huffman & Myers, 1999). A new wave of thinking has transpiredin the popular press as well as in the academic literature promoting aholistic, healing model of health from a life-cycle perspective (Borysenko,1996; Lauver, 2000; Northrup, 1998, 2001). This knowledge is vital tonurses, who are predominantly women themselves, for their own needsand for the needs of their patients, colleagues and the public. The purposeof this article is to describe how women’s menopausal life-cycle stages ofdevelopment relate to their health through occupational experiences (i.e.,burnout, job involvement and hardiness), presenting one segment of a

1 Jeannette Barsky acknowledges receipt of awards from the Community of Trust, Master of ScienceScholarship, and a Student Assistantship from the Faculty of Management of the University ofLethbridge, Lethbridge, Alberta. Inquiries about the paper can be directed to Jeannette Barsky,Coordinator, Cervical Health, Chinook Health Region, 306 Laval Blvd., Lethbridge, Alberta, T1K 3W5(e-mail: [email protected])

Barsky & Thorpe: MENOPAUSE, OCCUPATION & HEALTH 22

larger research project (Barsky, 1999). A conceptual model is proposed toassess potential relationships among the key variables.

A conceptual model of relationships among menopausal life-cyclestages, occupational variables and health, is offered to demonstratepotential relationships among the major variables (see Figure 1).Interactions among menopausal life-cycle stages (i.e., pre, peri and post-menopausal), and occupational variables (i.e., burnout, job involvementand hardiness), and health, not known at the outset, are the foci of thisresearch. Menopausal life-cycle stages conjure up both positive (e.g.,acceptance of natural aging processes, self-development) and negative(e.g., ailments, loss of reproductive ability) perceptions. Burnout, jobinvolvement and hardiness are recognized as significant concepts inorganizational work relevant to the effective completion of tasks althoughthey may or may not influence each other. The model acknowledges thathealth may be affected by numerous individual factors, particularly,

MENOPAUSAL LIFE-CYCLE STAGES

PRE- PERI- POST-MENOPAUSE

HEALTH CHRONIC AILMENTS ILLNESS(short-term / (long-term)long-term)

HEALTH

PRESCRIBED SURGERYMEDICATION (short-term)USE(short-term / long-term)

OCCUPATIONAL VARIABLES

BURN-OUT JOB INVOLVEMENT HARDINESS

LOW HIGH PASSIVE ACTIVE LOW HIGH

Figure 1. Conceptual Model of Relationships Among MenopausalLife-Cycle Stages, Occupational Variables, & Health.

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? ?

???

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Barsky & Thorpe: MENOPAUSE, OCCUPATION & HEALTH23

health ailments, chronic illnesses, surgery, and prescribed medication use(each of which may exert short or long-term effects on health). However,menopausal life-cycle stages and occupational variables may affect healthin indeterminate ways. The challenge is to assess the extent to whichrelationships exist among menopausal life-cycle stages and the threeoccupational variables and, hence, their effect upon health. Importantly, itis critical to assess any potential relationships inherent in this model fromwomen themselves, especially women who are actually living theexperiences. This model promotes a life-cycle perspective, whichencompasses a holistic view of women’s lives. Therefore, a radicalfeminist philosophy underpins our model taking into account thepatriarchal influences typically evident within health care institutions(Hunt, 1998).

Women’s HealthWomen’s health is becoming the focus of current research (Women’s

Health Bureau, 1999). Researchers pursue women’s health issuesregarding: life cycle (Borysenko, 1996; Sheehy, 1995), images of midlife(Bannister, 1999; Northrup, 1998; Woods & Mitchell, 1997), menopause(Hill, 1996; Kittell, Mansfield, & Voda, 1998; Li, Holm, Gulanick, &Lanuza, 2000; Northrup, 2001), medicalization of menopause (Huffman &Myers, 1999; Northrup, 1998; Prior, 1992) and hormonal replacementtherapy (Abramson, 2002; Andrist, 1998; Lee, Hanley, & Hopkins, 1999;Papaioannou et al., 1998). Other researchers explore the effects of stress(Greenglass & Burke, 2001), burnout (Hall, 2001; Maslach & Jackson, 1981;Tselebis, Moulou, & Ilias, 2001), hardiness (Kobasa , 1979; Kobasa &Maddi, 1982; Simoni & Paterson, 1997) and job involvement (Facione,1994; Salgado, 1998; White & Ruh, 1973). There is a dearth of researchdemonstrating relationships among women’s menopausal life-cyclestages, burnout, job involvement and hardiness, and subsequently, anyeffect upon health. Clarifying the knowledge gained about potentialrelationships among these key variables serves to enhance healthprofessionals in providing appropriate care to women across the lifespan.

Health is defined as a state of physical, emotional and social wellbeing,and not simply a lack of disease, according to the World HealthOrganization (1948). In this research, health is operationally definedthrough several items that address the presence of health ailments,chronic diseases, past surgeries and prescribed medication use. Manywomen balance multiple roles both inside and outside the home, all ofwhich may affect their health, either positively or negatively. For instance,women often undertake roles within the home as wife, mother, care giverand volunteer. Occupational roles, for which women receive incomes, are


operationalized through the identification of specific positions, workingfor pay and the number of hours spent in various roles. In undertakingthese roles, women reflect the general view that menopausal life-cyclestages are a natural occurrence (Abramson, 2002).

Menopausal Life-Cycle StagesIt is important to recognize that several terms are used interchangeably,

such as midlife, transition stages, patterns, developmental life stages andmenopausal life-cycle stages. For the purposes of this research,menopausal life-cycle stages refer to women’s self-reported menstrualcycle patterns (including hormonal status). Menopause is a three-stageprocess that ends a woman’s reproductive life. The first stage is pre-menopause, beginning around 40 years of age and denoting the decline ofestrogen production. In peri-menopause, the second stage, estrogen levelscontinue to decline and the consistency and regularity of the menstrualflow changes as well. Post-menopause, the third stage, follows a year andbeyond of absence of menses. Beyond these three processes, menopauseis also defined as a specific point in time when estrogen levels drop so lowthat the menses cease for one full year (Foley, Nechas & Wallis, 1995). Theyears surrounding menopause and encompassing the gradual change inovarian function constitute an entire stage of a woman’s life, lasting from6 to 13 years and also known as the climacteric (Northrup, 1998).Menopausal life-cycle stage is operationalized through several items thatrequire a subjective assessment of life stage, attitude towards menopause,the menopausal process including information about menstrual cycle andeffect of life cycle upon work. For instance, one item requested thatwomen select from seven descriptors the one that best describes theircurrent hormonal status (see Table I). Interestingly, Hoffman (1995)suggests that women, despite the natural occurrence of life-cycle stages,tend to seek invisibility, both for themselves and their menstrual cycles, tofit into a patriarchal society.

Table I: Defining Menopausal Life-Cycle Stages

Item 19. Which statement best describes your current life stageaccording to your hormonal status? Please read all 7 statements beforechecking (√) the single most appropriate response.

• Menstruating in a normal pattern without the aid of menopausalor contraceptive hormone therapy – cycle lengths of 24 to 35 daysduring the past 12 months

• Menstruating in a normal pattern with the aid of menopausal orcontraceptive hormone therapy – cycle lengths of 24 to 35 daysduring the past 12 months

• Occasional irregularity in menstruation pattern due to unknowncauses – on average cycle lengths of 24 to 35 days during the past12 months

• Irregularity or changes in menstruation pattern and flow due toaging of the ovaries – several cycle lengths of greater than 42 days(six weeks) but have menstruated within the past 12 months

• Not menstruating for the past 12 months due to aging of ovaries

• Not menstruating due to surgical removal of uterus or ovaries

• Not menstruating due to one of the following causes: pregnancy,breast feeding, medication, heavy exercise, rapid weight loss,illness, or unknown cause



Nurse researchers focus upon women’s perceptions regardingtransitional stages of menopause. For instance, from interviews with 11women (ages 40 to 53 years), Bannister (1999) relates the experientialmeaning given to midlife due to changes in defining themselves, needingaccurate information, questioning and making self-enhancing choices.These women also accept responsibility for their own well-being,physically, mentally and spiritually. In another report, 131 women in theSeattle Midlife Women’s Health Study define midlife as well as theimportant, distressing and satisfying events of this period (Woods &Mitchell, 1997). They conclude that women born between 1935 and 1955differ from earlier cohorts in “the emphasis these women placed on thecentrality of work and personal achievement in their lives” (Woods &Mitchell, Conclusion section). The complexity of managing both familyand work responsibilities throughout this midlife period supports theneed for more research in this area.

Moreover, Kittell et al. (1998) explore the transitional experiences of 61peri-menopausal women. In their research, the core variable, keeping upappearances, encompasses two important concepts: concealment andcontrol. Consistent with cultural expectations, women endeavour tocontrol physiological changes to conceal them from others, especially insocial interactions. Further, Li et al. (2000) relate peri-menopausalsymptoms to quality of life among 214 women. They conclude thatmanagement of psychosomatic, more than vasomotor, menstrual andsexual symptoms, is important to improve quality of life for these women.Despite the proliferation of research, the meaning inherent in menopausallife-cycle stages remains inconclusive regarding influences and responsesto women’s health. Also, research is inconclusive regarding therelationships among menopausal life-cycle stages and occupationalvariables (i.e., burnout, job involvement and hardiness). It wasanticipated that peri-menopausal women, more than pre and post-menopausal women, would experience various menopausal ailments,which ultimately, would affect their occupational experiences. Further, itwas anticipated that peri-menopausal women, rather than pre and post-menopausal women, who tend to be “overextended” (i.e., women withmultiple roles both inside and outside the home), will be more likely toexperience burnout and less likely to demonstrate active job involvementand high hardiness.

Occupational ExperiencesToday, health care environments tend to foster work situations that

have the potential to create excessive demands (Statistics Canada, 1999).These demands may result in adverse reactions among employees. It was


anticipated that women may experience burnout during their peri-menopausal life-cycle stages more so than at other times. However, it wasalso anticipated that women who are actively involved in theiremployment would be less likely to experience burnout. Further, it wasalso expected that women who demonstrate high hardiness would havethe capacity to cope with the challenges of their occupational settings and,therefore, would be less likely to experience burnout. These occupationalvariables were deemed important given the attention that burnoutreceives in the popular and academic literatures and the concomitanteffect that may ensue regarding job involvement and hardiness.

Burnout: Burnout, conceptualized as depersonalization, lack of personalaccomplishment and emotional exhaustion (Maslach & Jackson, 1981),often indicates a state of inability to function in one’s occupational role.Depersonalization reflects the tendency to view others as things or objectsrather than as feeling, valued persons. Lack of personal accomplishmentis the degree to which a person fails to see himself/herself as doing wellon worthwhile tasks. Emotional exhaustion refers to the feeling of beingemotionally overextended and exhausted by one’s work. In a recentstudy, Greenglass and Burke (2001) examine “the extent of stress andburnout experienced by nurses during hospital restructuring” (p. 93).Analysis of the 1,363 responses indicates that increased workload is themost significant and consistent predictor of stress for nurses duringhospital downsizing. Burnout is described as reaching epidemicproportions creating difficulties in achieving optimal health.Approximately 75% of all visits to physicians are related to anxiety andstress (Borysenko, 1996). The 1998 General Social Survey notes that one-third of Canadians are stressed out because they spend more timeworking and less time with their families and friends (Statistics Canada,1999). Chronic on-the-job stress is a pathological condition involvingnegative thought patterns that, if left unchecked, may lead to illness(Myss, 1997). In our paper chronic on-the-job stress is referred to asburnout. Changes in menopausal life-cycle stages bring forth numerousstressors (Bromberger et al., 2001; Kittell et al., 1998). Although stress andburnout are constructs that receive considerable attention amongresearchers, seldom is burnout linked with menopausal life-cycle stages.

Job Involvement: In their seminal work, White and Ruh (1973) describejob involvement as participating in the decision-making processes inone’s work. Participating in decision-making processes is possible whenindividuals perceive a strong sense of self-determinism (Amabile, Hill,Hennessey & Tighe, 1994), value their work, believe that they can make adifference and are competent in their roles. These factors contribute to“psychological empowerment [a term that] is defined as intrinsic task


motivation manifested within the individual” (Welch, Ebert & Spreitzer,2000, p. 66). Job involvement entails active copers, those individuals whoenthusiastically engage in work activities, that is, their favourable jobattitude demonstrates an identification with the organization and itsgoals. In contrast, passive copers refer to those individuals who tend to beless involved in their work. Passive copers expend sufficient effort andenergy to complete tasks without considering the notion of added value.Today, it is clear that employees strive to meet organizationalexpectations, that is, demonstrate job involvement, despite increasingdemands to do more with less (Armstrong-Stassen, Cameron, Mantler &Horsburgh, 2001). Recently, Gaudine (2000) suggests that nurses needtime to demonstrate caring for their patients as well as their colleagues.Essentially, these are what they enjoy most about and the reason why theychose the profession of nursing.

Hardiness: Hardiness reflects the individual’s response to life eventsboth personally and professionally (Kobasa, 1979). Three factors,commitment, control and challenge, measure hardiness (Kobasa &Maddi, 1982). Commitment reflects a dedication to oneself and to one’swork. A broader conceptualization of commitment is sense of purpose(Craft, 1999). Control is the extent to which an individual influences lifeevents to ensure a particular outcome. Challenge refers to life events andone’s response to those events. Individuals who are hardy cope withvarious stressors, both personal (e.g., life cycle, family) and professional(e.g., occupational roles and relationships), better than those individualswho are not hardy (Simoni & Paterson, 1997). In many ways, hardiness issynonymous with health. For instance, Sparks, Faragher and Cooper(2001) note that employee well-being was related to workplace transitionsin a constantly changing work environment. They identified fourorganizational issues: job insecurity, work hours, control at work andmanagerial style. Control at work, according to Sparks et al., resemblesthe stated elements inherent in hardiness. Various types of control (e.g.,task, pacing and scheduling) relate to the degree of commitment, controlover outcomes, and responses to challenges within the workenvironment.

METHODS

This section includes a description of the sample, instruments, pilotstudy, and data collection and analysis procedures. The University ofLethbridge Human Subject Review Committee reviewed and approvedthis research. Anonymity and confidentiality were accommodatedbecause there were no names, or other identifying information on theprofiles.


Purpose of ResearchThe purpose of this research was to explore and describe how women’s

menopausal life-cycle stages relate to occupational experiences (i.e.,burnout, job involvement, and hardiness) and, in turn, relate to health.

DesignThe research was a descriptive correlational design to explore how

women’s menopausal life-cycle stages of development and occupationalexperiences relate to health. The design was intended to identify potentialinterrelationships among the stated variables, without manipulatingwomen’s situations. Two hypotheses associated with this researchincluded:

1. There will be differences in the effect of various menopausal life-cyclestages and health experiences (e.g., health ailments, chronic illnesses,surgery and prescribed medication use). The specific directionality ofthese differences remains uncertain.

2. There will be differences in the effect of various menopausal life-cyclestages and occupational experiences (e.g., burnout, job involvement,and hardiness). The specific directionality of these differencesremains uncertain.

SampleThe population included all Registered Nurses (RNs) from a Western

Canadian province. From this population, a sample of 2,000 RNs wasselected by an external agency, independent of the provincial registry andresearchers, using a simple random selection process. Given the averageage of nurses within the work setting, it was expected that relatively equalnumbers of respondents would fall into the three menopausal stages.

InstrumentsThe eight-page Women’s Health, Occupational and Life Experiences

(WHOLE) Profile included three demographic, six health care, sevengeneral health, six menopausal life-cycle and three work profile items. Allof these items required a simple check for applicability or a dichotomousresponse. These single-item components were not designed to create acomposite scale, as is the case for many published measures in healthresearch. These items do not lend themselves to developing externalconsistency. In addition to these items, four instruments were added tothe WHOLE Profile. All of these instruments have been used widely inresearch and have achieved appropriate psychometric properties (seeTable II for reliability coefficients from the literature and the WHOLEProfile). These instruments are easily administered in a survey format.


Table II: Reliability Coefficients for Instruments, From the Literature& the WHOLE Profile

Instrument Literature WHOLE

Maslach Burnout Inventory: 0.74Depersonalization 0.79 0.77

Personal Accomplishment (Lack) 0.71 0.73Emotional Exhaustion 0.90 0.88

(Maslach & Jackson, 1981)

Job Involvement: 0.87 0.81Active (White & Ruh, 1973) 0.81Passive 0.81

Personal Views Survey: 0.79 0.80Commitment (Kobasa, 1979) 0.81

Control 0.71Challenge 0.70

Marlowe-Crowne Social 0.88 0.60Desirability Scale (Fischer & Fick, 1993)

1. Maslach Burnout Inventory (MBI, see Maslach & Jackson, 1981): TheMBI comprises the modified, 23-item version of the MBI(Golembiewski, Munzenrider & Carter, 1983). This seven-point Likertscale (one being very much UNLIKE me and seven being very muchLIKE me) was used to assess depersonalization, lack of personalaccomplishment and emotional exhaustion. Factorial, convergent,predictive and discriminant validity appears quite high (Schaufeli &Enzmann, 1998).

2. Job Involvement (White & Ruh, 1973): The job involvement scaleincludes nine items, using a five-point Likert scale. This scale uses avariety of responses such as never to always and disagree strongly toagree strongly. There are no validity measures stated by the authors.

3. Personal Views Survey (Kobasa, 1979): The Personal Views Surveymeasures three distinct components: commitment, control andchallenge. According to Ouellette (1990, 1993), this 50-iteminstrument, using a four-point response scale (zero being not at all trueand three being completely true), demonstrates construct validity.

4. Marlowe-Crowne (Crowne & Marlowe, 1960): Strahan and Gerbasi(1972) developed Form XI, a 10-item version of the Marlowe-Crowne


(1960), which was used to operationally define social desirability.Fischer and Fick (1993) report that Form XI, with a true or falseresponse, is “the scale of choice… It is a significant improvement overall of the others… it has high internal consistency and is highlycorrelated with the 33-item original scale” (p. 423).

Data Collection & AnalysisA pilot study was conducted with 25 female nursing (i.e., Post-RN) and

management undergraduates. A few minor changes were made inwording of items to enhance clarity. Their responses to the WHOLEProfile as well as criteria to assess clarity, comprehension andcomprehensiveness provided evidence of face and content validity. Forthe survey, complete package materials (i.e., cover letter; WHOLE Profile;stamped and self-addressed return envelopes) were sent to theindependent agency for distribution to the sample. Completed WHOLEProfiles were returned to the researcher. Reliability of the instrumentswithin the application of the WHOLE was measured using Cronbach’salpha. Survey data were analyzed using SPSS (2000) computer softwarefor descriptive and inferential statistics including frequencies,crosstabulations and correlations.

FINDINGS

There were a total of 692 WHOLE Profiles returned representing a34.6% response rate. All respondents were female, ranging between 22 to67 years of age (mean = 42 years). The respondents were activelyregistered within their professional association. They were working invarious positions such as staff nurse (n = 465), supervisor or coordinator(n = 52), manager (n = 41), and instructor or professor (n = 34) and officeor industrial nurses (n = 33). They worked in health care settings,including acute care and community as well as academic settings. From641 responses, 454 (65.6%) nurses indicated that they worked in urbansettings whereas 160 (23.1%) nurses worked in rural settings.

The respondents identified their menopausal stages as pre-menopausal(n = 440, 64%), peri-menopause (n = 38, 6%) and post-menopausal (n =165, 24%). Another 43 (6%) respondents were categorized as secondaryamenorrhea (i.e., not menstruating because of pregnancy, medication, orexcessive exercise). From 686 responses, 378 (55%) nurses indicated theirattitude was positive or somewhat positive and 84 (12%) nurses suggestedthat their attitude was negative or somewhat negative toward the next stageof menopause. Another 224 (32.7%) nurses stated that they did not thinkabout menopause. A few menopausal ailments were reported: heavy


menstrual cycles (n = 684: often: n = 84, 12% and always: n = 23, 3%),vaginal dryness (n = 683: often: n = 64, 9% and always: n = 20, 3%), hotflushes (n = 685: often: n = 50, 7% and always: n = 2, .3%) and night sweats(n = 688: often: n = 35, 5% and always: n = 1, .1%). Only a few respondentsadmitted that their menstrual cycle affected their approach to work (n =97, 14%) and how much they accomplished in their work (n = 90, 13%).However, more respondents indicated that their menstrual cycles did notaffect how they approached their work (n = 483, 72%) and did not affecthow much they accomplished in their work (73%).

Significant findings were found between pre and post, but not perimenopausal life-cycle stages and health. Health was measured in terms ofhealth ailments, chronic illnesses, surgeries and prescribed medicationuse. Therefore, hypothesis one was supported.

Chi square analysis indicated statistically significant findings betweenpre-menopausal life-cycle stages and chronic illnesses (21.55, p. = < .001),surgeries (94.37, p. =< .001) and prescribed medication use (22.71, p =<.001). Chi square calculations indicated statistically significant findingsbetween post-menopausal life-cycle stages and health ailments (19.84, p=<.05), chronic illnesses (25.19, p =< .001), surgeries (143.24, p =< .001)and prescribed medication use (19.98, p = < .001).

General HealthRespondents provided an assessment of their general health by

indicating the presence of various health ailments, chronic illnesses,surgical procedures and use of prescription drugs. For instance, 212 (31%)of the 687 respondents identified such chronic illnesses as asthma,emphysema, diabetes, cancer, arthritis, high blood pressure and heartproblems. The majority of the responses were in the categories of highblood pressure (n = 53, 8%), arthritis (n = 51, 7%), and asthma (n = 38, 6%).From the 690 responses, 577 (84%) nurses indicated that they hadexperienced a surgical procedure. Surgical procedures included:tonsillectomy (n = 312, 45%), appendectomy (n = 141, 20%), hysterectomy(n = 95, 14%) and cholecystectomy (n = 77, 11%). Of the 690 respondents,317 (46%) reported using prescribed medications for hormonal therapy,chronic illnesses and psychological conditions. Of the 317 respondents,101 (15%) used menopausal hormone therapy, 70 (10%) used birth controlmedications, 53 (8%) used thyroid medications, 45 (7%) used medicationsfor clinical depression, and 43 (6%) used medication for hypertension.

Burnout, Job Involvement & HardinessAs Table II presents, the reliability coefficients obtained from the

WHOLE Profile are consistent with results derived from the literature


regarding burnout (Maslach & Jackson, 1981), job involvement (White &Ruh, 1973) and hardiness (Kobasa, 1979). The data indicate a difference inthe reliability coefficient results, .60 compared to .88, obtained from therevised Marlowe-Crowne (1960) Social Desirability Scale (Fischer & Fick,1993), respectively.

Respondents obtained a total mean score of 64.9 (sd = 18.8) on themodified MBI, ranging between 23 and 161 (see Table III). Taking themean as the cut-off point, 40.2% of the respondents can be labelled asexperiencing high burnout and 53.2% can be labelled as experiencing lowburnout. The sub-scale mean scores and standard deviations for the threecomponents were: depersonalization (16.1, sd = 7.2), lack of personalaccomplishment (28.0, sd = 13.6, i.e., reflecting low personalaccomplishment) and emotional exhaustion (23.8, sd = 9.9). Further,calculations from one-way ANOVAs, statistically significant findingswere found between health ailments and low MBI (F = 9.62, df = 1, 690, p.=< .001) and high MBI (F = 10.00, df = 1, 690, p. =< .001), for those womenwho indicated they always experienced health ailments (see Table IV).

Job involvement scores indicated a total mean score of 32.4 (sd = 5.5) outof a possible 45, ranging from 9 to 45 (see Table III). Respondents wereclassified as active (n = 294, 43%) or passive (n = 377, 55%) in terms of jobinvolvement. Calculations from one-way ANOVAs indicated statisticallysignificant findings between the number of children and job involvement.For instance, the finding between number of children and passive jobinvolvement was highly significant (F = 4.64, df = 5, 531, p. =< .001) andactive job involvement was significant (F = 3.69, df = 5, 531, p. =< .05, seeTable IV). The Personal Views Survey total mean score and standarddeviation were 75.2 (sd = 9.0), ranging between 50 and 200 (see Table III).The sub-scale means and standard deviations were: commitment (39.5, sd= 5.5), control (40.1, sd = 4.9), and challenge (33.8, sd = 5.6). Calculationsfrom one-way ANOVAs indicated statistically significant findingsbetween health ailments and low and high hardiness (F = 5.24, df = 1, 538,p. =< .05). Also, statistically significant findings were found betweenchronic illnesses and low and high hardiness (F = 3.49, df = 1, 538, p. =<.05, see Table IV).

There were no statistically significant differences between menopausallife-cycle stages and burnout, job involvement and hardiness. Therefore,hypothesis two was not supported. Chi- square tests indicated nosignificant differences between the observed and expected counts amongmenopausal life-cycle stages and the burnout, job involvement andhardiness scores. However, calculations from one-way ANOVAsindicated statistically significant findings between age and jobinvolvement and hardiness (see Table IV). For instance, a significant


Tabl

e II

I: M

eans

, Sta

ndar

d D

evia

tion

s, A

lpha

Rel

iabi

liti

es &

Int

erco

rrel

atio

ns o

f th

e O

ccup

atio

nal M

easu

res

& T

heir

Res

pect

ive

Subs

cale

s*

Mea

sure

/Sub

scal

eM

Mdn

SD1

23

45

67

89

10

1.M

BI

Scor

es64

.962

.018

.8

2.To

tal j

ob in

volv

emen

t sco

re (J

I)32

.433

.05.

5-.3

7.8

1

3.Em

otio

nal E

xhau

stio

n (M

BI)

23.8

22.0

9.9

.82

-.36

.88

4.D

eper

sona

liza

tion

16.1

14.0

7.2

.58

-.31

.54

.77

5.Pe

rson

al A

ccom

plis

hmen

t (la

ck)

28.0

25.0

13.6

.54

-.22

.30

.35

.73

6.To

tal H

ardi

ness

Sco

re (H

)75

.276

.79.

0-.4

8.3

8-.4

5-.5

1 -.2

5.8

0

7.C

omm

itm

ent

39.5

41.0

5.5

-.51

.42

-.49

-.56

-.23

.90

.81

8.C

ontr

ol

40.1

41.0

4.9

-.39

.28

-.35

-.46

-.26

.84

.71

.71

9.C

hall

enge

33.8

33.0

5.6

-.29

.24

-.29

-.26

-.14

.79

.53

.43

.70

10.T

otal

Soc

ial D

esir

abil

ity

15.3

15.0

2.3

-.11

.13

.08*

-.25

-.06

.18

.19

.19

.60*

Scal

e (M

C)

* C

orre

lati

ons

are

sign

ific

ant a

t the

0.0

10 le

vel u

nles

s m

arke

d w

ith

an (*

) the

n si

gnif

ican

t at o

nly

the

0.05

0 le

vel (

2-ta

iled)

.

Cro

nbac

h A

lpha

coe

ffic

ient

s fo

r ea

ch s

ub-s

cale

/mea

sure

are

und

erlin

ed a

nd s

how

n in

the

diag

onal

.Due

to m

issi

ng v

alue

s,th

e fo

llow

ing

n=s

wer

e us

ed in

cal

cula

tion

s: JI

Bn =

671

; MBI

Bn =

646

; PH

Bn =

540

, MC

Bn =

671

.

Table IV: One-Way ANOVAs on Variables Health, Age & Number of Children by Occupational Variables

Variables Occupational F Ratio df F ProbabilityVariables

Ailments (always) Low MBI 9.62 1, 690 <.001

High MBI 10.00 1, 690 <.001

Low 5.24 1, 538 <.010Hardiness

High 5.24 1, 538 <.010Hardiness

Chronic Illnesses Low 3.49 1, 538 <.020Hardiness


Age Passive Job 9.09 4, 678 <.001Involvement

Active Job 7.71 4, 678 <.001Involvement

Low 1.01 4, 530 <.001Hardiness


Number of Children Passive Job 4.64 1, 531 <.001Involvement

Active Job 3.69 1, 531 <.003Involvement



finding was found between age and passive job involvement (F = 9.09, df= 4, 678, p. =< .001) and active job involvement (F = 7.71, df = 4, 678, p. =<.001). Also, significant findings were found between age and low and highhardiness (F = 1.01, df = 4, 530, p. =< .001). When age was analyzed bydecade, differences occurred between decade categories (see Table V). Forexample, younger women (i.e., women in their 20s) experienced less jobinvolvement (i.e., passive) compared to women in their 50s.

Table V: Post Hoc Tests Using Bonferroni for Age & Job Involvement

Age Groups Compared to Mean (years) Age Group Difference

(years)

Passive Job Involvment:

20-29 50-59 -.23*

30-39 50-59 -.30*60-69 -.34*

40-49 50-59 -.16*50-59 20-29 .23*

30-39 .30*40-49 .16*60-69 -.05*

60-69 30-39 .34*

Active Job Involvement:

20-29 50-59 .20*

30-39 50-59 .28*

40-49 50-59 .15*

50-59 20-29 -.20*30-39 -.28*40-49 -.15*

* The mean difference is significant at the .050 level.


A significant negative correlation (-.46, at the p. = 010 level) was foundbetween job involvement and burnout, indicating that a high jobinvolvement score (i.e., active) relates to a low score on the MBI (i.e., noburnout). Also, a similar significant negative correlation (-.57 at the p. =.010 level) was found between hardiness and burnout. This findingindicates that a high hardiness score (i.e., positive coping) also relates to alow score on the MBI (i.e., absence of burnout). A moderate, butsignificant, positive correlation (.38, at the p. = .010 level) was foundbetween job involvement and hardiness. This finding suggests amoderate relationship between job involvement and hardiness, such thatactive job involvement relates to positive hardiness (i.e., ability to copewell with life circumstances personally and professionally). Similarly,those respondents who receive a low score on the job involvement scalewill also obtain a low score on the hardiness scale. Therefore, these twooccupational variables tend to relate positively to one another.

The mean score and standard deviation obtained on the Marlowe-Crowne was 15.3 (sd = 2.3) out of a possible 20, ranging from 10 to 20. Thisscore reflects that respondents replied to survey items without anyinfluence to fulfill the expectations of the researchers; that is, theyresponded honestly. Calculations from one-way ANOVAs demonstratedthat respondents were not influenced by a social desirability factor,measured by the Marlowe-Crowne (1960) Scale, in answering theWHOLE Profile regarding menopausal life-cycle stages and the threeoccupational variables. However, more research is needed because theMarlowe-Crowne reliability coefficient obtained in this study was only.60.

DISCUSSION

All respondents were females due to the focus on menopausal life-cyclestages. From the results of the WHOLE Profile, the respondents appear tobe similar in age to the current population of practicing nurses. Forinstance, the respondents’ mean age of 42 years is consistent with theprovincial (43 years) and the Canadian (43 years) mean ages (CanadianNurses Association [CNA], 2000). Nurses represent an aging work force,necessitating a positive focus toward life-cycle stages. The percentage ofrespondents (n = 465, 67.2%) in staff nurse positions is similar to theCanadian population (n = 178,229, 76.7%). Other positions reflectcomparable percentages between the survey respondents and national1996 statistics: supervisor or coordinator n = 52 (7.5%) versus 13,620(5.9%); manager n = 41 (5.9%) versus 8,234 (3.6%); instructor or professorn = 34 (4.9%) versus 5,207 (2.2%), respectively (CNA).


In this study, statistically significant findings indicated a relationshipbetween pre and post-menopausal life-cycle stages and health. However,there were no significant differences between the peri-menopausal groupand health. This finding may be due to the small number in this category.Thus, hypothesis one was accepted. No data are available from CNAregarding menopausal life-cycle stages or general health of nurses ateither provincial or national levels. From a study of women’s healthissues, Wyn and Solis (2001) found that chronic conditions increaseamong women aged 45 to 64 years, consistent with the number ofrespondents with chronic diseases in this research. The number ofsurgical procedures and prescription medications noted by respondentsreflects a medical orientation towards women’s health. Today, a paradigmshift is occurring and a more holistic approach to women’s health isemerging (Borysenko, 1996; Northrup, 1998, 2001).

There were no statistically significant differences between menopausallife-cycle stages and burnout, job involvement, and hardiness. Hence, thesecond hypothesis was not supported. The lack of differences underpinsa positive orientation toward menopause. The respondents do notanticipate their work to be compromised throughout these stages. Forinstance, nurses are involved in multiple roles, both personal andprofessional, throughout menopausal life-cycle stages. Indeed, nurses arewell known for working the “double shift.” In support of this finding,Abramson (2002) reports that menopausal life-cycle stages are “ananticipated physiological event” (p. 44). Historically and currently, thebiomedical model of health perpetuates a negative connotation ofwomen’s natural life processes (Huffman & Myers, 1999).

About half of the respondents (53%) indicate a low degree of burnout.This finding is congruent with New Zealand nurses (n = 1134) whoreported a low to average degree of burnout (Hall, 2001). Given the dailydemands placed upon nurses in their work settings today, it is notsurprising that 40% of respondents demonstrate burnout. Often burnoutresults as a consequence of increased workload and changes in the workenvironment (Greenglass & Burke, 2001). Burnout translates into anegative effect upon individuals (i.e., personal, family and social life) andorganizations (i.e., decline in job performance) as noted by Salgado (1998).Menopausal life-cycle stages were not related to the experience ofburnout.

The respondents’ mean score on the job involvement scale reflects apositive orientation to their work roles. Some respondents, labelled asactive copers (43%), indicated that they perceived work challengesfavourably and sought opportunities for achievement. Otherrespondents, labelled as passive copers (55%), suggested that they were


less likely to be motivated to participate in decision-making processes.The greater number of respondents identified as passive copers mayindicate one outcome of the current constantly changing and demandinghealth care system (Armstrong-Stassen et al., 2001; Spence Laschinger,Finegan, Shamian, & Casier, 2000). This finding may also representnurses’ perceptions regarding work overload as described by Gaudine(2000) and subsequent unwillingness to engage fully in their workenvironments (Stordeur, D’hoore, & Vandenberghe, 2001; Welch et al.,2000). Menopausal life-cycle stages were not related to job involvement.

Only 36% of the respondents indicated high hardiness. This findingsuggests that the majority of the respondents compromise their healthstatus in the face of stressful events within the work setting (Kobasa,1979). The small number of respondents indicating high hardinesssuggests that they did not perceive a strong sense of purpose and anability to endure (Craft, 1999). Many practicing nurses are nearingretirement and there is a need to ensure that younger nurses aredeveloping not only expertise in nursing practice but also essentialknowledge, skills and attitudes essential to healthy living, bothpersonally and professionally. Menopausal life-cycle stages were notrelated to hardiness

The researchers recognize several limitations. This research elicitedresponses from one provincial group of RNs (i.e., those who were female,actively registered and working full or part-time in nursing) in westernCanada. The findings can be generalized to other groups only to theextent that the participants represent the characteristics inherent in othergroups. However, generalization is enhanced through simple randomselection of the sample but limited through self-selection of thoseindividuals who chose to respond to the survey. Time (i.e., a one-timesurvey without follow up) and costs (i.e., instruments, postage andsupplies) also impose restrictions upon the data collection process and,hence, generalizability of the findings.


CONCLUSION

The research reported here may indeed be the first foray into exploringrelationships among menopausal life-cycle stages as developmentalprocesses, three occupational variables and health. Pre and post-menopausal life-cycle stages correlate with health as measured in thisresearch. Menopausal life-cycle stages do not correlate with occupationalexperiences as depicted by burnout, job involvement and hardiness. Thecorrelations among the three occupational variables provide evidence thatas burnout increases job involvement and hardiness decrease. Researchsupports that women in nursing are at more risk than other occupationalgroups due, in large measure, to their multiple caring roles (see Facione,1994). An enlightened perspective of menopausal life-cycle stages fostersa holistic approach to women’s health, which serves as a viablealternative to the conventional medical model of health. If we are toaccurately reflect the meaning that women give to their personal andprofessional life experiences, we must provide opportunities to hear theirvoices throughout their menopausal life-cycle stages through rigorousresearch approaches.


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