title: Cardiac pain or panic disorder? Managing uncertainty in the emergency department.
abstract: Emergency department admissions for chest pain might be related to a psychological problem, such as panic. Panic disorder adversely affects the person's lifestyle, general health, and psychological well-being. Panic disorder is difficult to recognize, so nursing assessment and management of these clients is important. This paper presents research findings from a New Zealand study that explored emergency nurses' differentiation of non-cardiac chest pain from panic disorder and raised significant issues in the nursing assessment and management of such clients. The data were gathered from focus group interviews and were analyzed thematically. Three themes, prioritizing time, managing uncertainty and ambiguity, and the life-threatening lens, were identified. The findings confirm that a panic disorder is not always diagnosed when biomedical assessment is used in isolation from a psychosocial assessment. Emergency nurses are pivotal in reversing the cycle of repeat presenters with non-cardiac chest pain. Recommendations for assessing and managing this complex condition are presented.
authors.affiliation: School of Nursing, University of Auckland, Auckland, New Zealand. h.hamer@auckland.ac.nz
authors.forename: Helen P
authors.initials: HP
authors.lastname: Hamer
authors.forename: Antoinette M
authors.initials: AM
authors.lastname: McCallin
mesh_terms: D000328:Adult; D000787:Angina Pectoris / Q000175:diagnosis*; D001291:Attitude of Health Personnel; D002637:Chest Pain / Q000175:diagnosis / Q000209:etiology; D003937:Diagnosis, Differential; D016529:Emergency Nursing / Q000379:methods*; D005260:Female; D017144:Focus Groups; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods / Q000451:nursing; D008487:Medical History Taking / Q000379:methods; D008875:Middle Aged; D009520:New Zealand; D024802:Nurse's Role / Q000523:psychology; D009730:Nursing Assessment / Q000379:methods*; D015404:Nursing Methodology Research; D009741:Nursing Staff, Hospital / Q000193:education / Q000523:psychology*; D016584:Panic Disorder / Q000175:diagnosis*; D036301:Qualitative Research; D012308:Risk Management; D011795:Surveys and Questionnaires; D017748:Time Management; D014218:Triage; D035501:Uncertainty