• D Stannard, K Puntillo, C Miaskowski, S Gleeson, K Kehrle, and P Nye.
• School of Nursing, University of California, San Francisco, USA.
• Am. J. Crit. Care. 1996 Nov 1;5(6):433-41.

BackgroundAcute pain is a significant problem in critical care patients. Although many barriers to successful assessment and management of pain in critical care patients have been noted, little is known about how critical care nurses make clinical judgments when assessing and managing patients' pain.ObjectiveThis qualitative analysis is part of a pilot study evaluating nurses' use of a pain assessment and intervention notation algorithm in patients in critical care areas who have limited communication abilities after abdominal or thoracic surgery.MethodTranscribed audiotapes of nurse participants' "thinking aloud" while using the pain assessment and intervention notation algorithm were analyzed by using interpretive phenomenology. The interpretive account is based on 31 tape recordings of 14 nurses caring for 41 patients (12 patients in the ICU and 29 patients in the postanesthesia care unit).FindingsThe two domains of clinical judgment found were (1) assessing the patient and (2) balancing interventions.ConclusionsMany nurses' reports showed that they accurately assessed their patients' needs for analgesics. Through testing of and learning from their patients' responses, nurses were able to give amounts of analgesics that diminished patients' postoperative pain. Additionally, nurses had to balance analgesic administration against the patients' hemodynamic and respiratory conditions, medical plan and prescriptions, and the desires of the patients and the patients' families.

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