Acknowledgments: This research was supported by the Ethel Clark Fellowship granted to Dr. Janet L. Welch by Indiana University School of Nursing. The authors thank Gilbert Almanzo for his assistance in data collection and Drs. Joan Austin, Nancy Dayhoff, and Phyllis Dexter for their helpful comments, thoughts, and editorial assistance. Appreciation is also extended to the participating patients who generously gave their time and energy to this project. This article was presented in abstract form at ANNA's 31st National Symposium, Nashville, TN, April 2000.