title: Clinical judgment and management of postoperative pain in critical care patients.
abstract: BACKGROUND
  Acute 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.
  
  
  OBJECTIVE
  This 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.
  
  
  METHODS
  Transcribed 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).
  
  
  RESULTS
  The two domains of clinical judgment found were (1) assessing the patient and (2) balancing interventions.
  
  
  CONCLUSIONS
  Many 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.
authors.affiliation: School of Nursing, University of California, San Francisco, USA.
authors.forename: D
authors.initials: D
authors.lastname: Stannard
authors.forename: K
authors.initials: K
authors.lastname: Puntillo
authors.forename: C
authors.initials: C
authors.lastname: Miaskowski
authors.forename: S
authors.initials: S
authors.lastname: Gleeson
authors.forename: K
authors.initials: K
authors.lastname: Kehrle
authors.forename: P
authors.initials: P
authors.lastname: Nye
mesh_terms: D000328:Adult; D000700:Analgesics / Q000008:administration & dosage; D003422:Critical Care; D003625:Data Collection / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D009730:Nursing Assessment; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy / Q000451:nursing*; D010865:Pilot Projects
chemical_list: D000700:Analgesics