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A descriptive study of nursing judgment in the assessment and management of cardiac pain.

Unrelieved cardiac pain in patients admitted to a coronary care unit (CCU) with a diagnosis of coronary artery disease was examined from the perspective of nursing judgment. The purpose of this study was to reveal expert clinical knowledge and judgment in this specific area of critical care practice. Using a naturalistic approach, nurses were observed and interviewed as they made judgments about cardiac pain. Qualitative data analysis identified patterns of nursing actions and thought processes. Findings indicated that clinical knowledge of the titration of drugs was used in the treatment of cardiac pain, and qualitative distinctions and sense of saliency were also important in pain assessment. Intuitive thought processes were identified in the clinical judgment of expert nurses.