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Nursing patients with acute chest pain: Practice

guided by the Prince Edward Island conceptual
model for nursing

Article in Nurse education in practice · May 2009

DOI: 10.1016/j.nepr.2009.03.010 · Source: PubMed

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 Nurse Education in Practice 10 (2010) 48–51

Contents lists available at ScienceDirect

Nurse Education in Practice

journal homepage: www.elsevier.com/nepr

Nursing patients with acute chest pain: Practice guided by the Prince Edward Island
conceptual model for nursing
Janelle F. Blanchard a,*, Donna A. Murnaghan b,1
a
Emergency Room Nurse, Charlottetown, Prince Edward Island, Canada
b
School of Nursing, University of Prince Edward Island, Charlottetown, Prince Edward Island, Canada

a r t i c l e i n f o s u m m a r y

Article history: Current research suggests that pain is a relatively common phenomenon with 60–90% of patients pre-
Accepted 20 March 2009 senting to emergency departments reporting pain (e.g., chest pain, trauma, extremity fractures and
migraine headache) that require treatment [Hogan, S.L., 2005. Patient satisfaction with pain management
in the emergency department. Advanced Emergency Nursing Journal 27(4), 284–294]. This article
Keywords: explores the use of conceptual theoretical empirical (C-T-E) framework to guide a senior nursing student
Conceptual model in a case study of patient with chest pain. The Middle Range Theory of Pain described by Good [Good, M.,
Pain
1998. A middle-range theory of acute pain management: use in research. Nursing Outlook 46(3), 120–
Primary health care
Middle range theory
124] and Melzack’s [Melzack, R., 1987. The short-form McGill pain questionnaire. Pain, 30, 191–197]
short form McGill pain questionnaire were applied along with the Prince Edward Island conceptual
model (PEICM) for nursing. Results indicate that the nursing student increased her ability to work in part-
nership, assess relevant and specific information, and identify a number of strategies to help the patient
achieve pain control by using a complement of pharmacological and non-pharmacological interventions.
Moreover, the C-T-E approach provided an organized and systematic theoretical approach for the nursing
student to assist a patient in pain control.
Crown Copyright Ó 2009 Published by Elsevier Ltd. All rights reserved.

Introduction holistic, systematic and evidence based model (Bryant, 2007).

Pain, a complex, multidimensional phenomenon, originates
from sensory stimuli, has obvious motivational-affective proper-
ties, demands attention, disrupts thought and behavior and results
in activity aimed to stop the pain (Melzack, 1982). More recently,
the definition of pain has been expanded to include it being subjec-
tive, multifaceted and influenced by many factors such as personal
experience and culture (Bourbonnais et al., 2003). However, in or-
der for the experience of pain to occur, it has been posited that a
stimulus must be strong enough to exceed patients’ normal pain
thresholds (Dolan, 2000).
Current research suggests that pain is a relatively common phe-
nomenon with 60–90% of patients presenting to emergency
departments reporting pain (e.g., chest pain, trauma, extremity
fractures and migraine headache) that require treatment (Hogan,
2005). Although common, pain and its accompanying symptomol-
ogy are complex in nature. For example, chest pain can present as
myocardial infarction, angina, pericarditis, or anxiety. Accordingly,
pain assessment and management should be approached using a
* Corresponding author. Tel.: +1 902 368 1004.
E-mail addresses: janelleblanchard@hotmail.com (J.F. Blanchard), dmurnaghan@
upei.ca (D.A. Murnaghan).
1
Tel.: +1 902 566 0749; fax: +1 902 566 6486.
Key physiological pain assessment factors include: location, type,
intensity and duration as well as assessment of environmental, so-
cial and cultural aspects of pain (Bird, 2005).
As the research on pain has expanded, best practice standards
have been established which suggest that both pharmaceutical
and non-pharmaceutical measures should be used to control pa-
tients’ pain symptoms (Gatlin and Schulmeister, 2007). In hospital
settings, however, the use of traditional pharmaceutical measures
are more common than non-pharmaceutical measures (e.g., pa-
tient repositioning, thermal measures, massage therapy, aroma-
therapy, and meditation).
Nursing students are challenged with the responsibility of help-
ing to relieve patients’ pain. As part of this process, students re-
quire pain assessment tools that address patients’ personal
experiences and environmental and social factors (e.g., culture,
anxiety) that may impact this experience. While nursing students
may develop a basic understanding of what constitutes pain (any-
thing the patient says it is) in their training, students may feel ill
equipped when it comes to implementing pain specific interven-
tions. A better understanding of the assessment models designed
to help guide nurses in decision making as it relates to pain symp-
tomatology would assist students in identifying appropriate inter-
ventions and implementing best practice guidelines for pain
management.

1471-5953/$ - see front matter Crown Copyright Ó 2009 Published by Elsevier Ltd. All rights reserved.
doi:10.1016/j.nepr.2009.03.010
 J.F. Blanchard, D.A. Murnaghan / Nurse Education in Practice 10 (2010) 48–51
Conceptual theoretical empirical (C-T-E) system, developed by
Fawcett (2005), is one example of a framework that may help
guide nursing students in their management of pain. C-T-E is made
up of three key components: (a) a conceptual model to guide prac-
tice; (b) a middle range theory (MRT) to address the area of con-
cern; and (c) an empirical indicator to collect specific data
(Fawcett, 2005). The benefits of using C-T-E systems include re-
duced staff turnover, more rapid movement from novice to expert
nurse, increased patient and family satisfaction, increased nursing
job satisfaction, and considerable cost savings (Fawcett, 2005). This
article uses a case study approach to apply the C-T-E system in a
training environment. By exploring how a nursing student was
able to translate C-T-E theory into practice, this article will demon-
strate the efficacy of C-T-E training for pain management cases.
For the purpose of this case study, the Middle Range Theory of
Pain: A Balance between analgesia and side effects was used in
conjunction with the Prince Edward Island conceptual model (PEI-
CM) of nursing. Mr. Wood (fictitious name), a 55 year old male pre-
senting with chest pain in an emergency care setting was the focus
case study for this article. Data pertaining to Mr. Wood’s care and
condition were collected using the short-form McGill pain ques-
tionnaire (SF-MPQ).
Conceptual theoretical empirical system based nursing practice
The C-T-E system can provide direction for nursing practice
based on knowledge that is specific to the discipline. This frame-
work guides nursing students in the identification of important
data, the establishment of relationships between data, and the
selection of appropriate clinical interventions (Fawcett, 2005).
Raudonis and Acton (1997) suggest that the use of C-T-E system
helps nursing students to better understand data and therefore
guide appropriate interventions, to practice in a more purposeful
and systemic manner resulting in better patient outcomes.
The Prince Edward Island conceptual model for nursing
PEICM for nursing: A nursing perspective of primary health care
(Munro et al., 2000) is a reciprocal interaction worldview model in
which human beings are viewed holistically. This model is congru-
ent with the international move towards primary health care
(PHC). While other nursing models have incorporated PHC as a
component of their respective frameworks, (i.e. Orem’s self deficit
model) it appears that the PEICM is the only conceptual model of
nursing with PHC as its underlying framework.
In the PEICM, person can be an individual, group or community;
health is defined as a dynamic process which incorporates both
wellness and illness and is influenced by several factors called
the determinants of health; the environment incorporates both
internal and external environment and is affected by a combina-
tion of the determinants of health (Advisory Committee of Popula-
tion Health, 1994). The PEICM discusses the five principles of PHC
(accessibility, public participation, wellness promotion and illness
prevention, intersectoral collaboration, appropriate technology)
that guide nursing care. The goal of nursing is to work in partner-
ship with the patient to promote wellness and prevent illness
(Munro et al., 2000).
Nurse–patient partnership, one of the major concepts in the
PEICM, extends our understanding of the principle of public partic-
ipation (Munro et al., 2000). Partnership is the sharing of power be-
tween a health care professional and a patient (Courtney et al.,
1996). The patient has the right and the duty to individually and
collectively participate in their own health care. Three main con-
cepts of partnership include: (a) the structure of relationship; (b)
power sharing; and (c) negotiation. The nature of the relationship
49
in the partnership model is that the professional actively facilitates
the partner’s participation in the relationship. There is an ongoing
process of negotiation of goals, roles and responsibilities, and each
person in the relationship respects individual and cultural differ-
ences (Courtney et al., 1996). Power sharing is the sharing of power
between partners. Strickland and Strickland (1996) propose that
instead of health care providers giving up power, passive patients
should be encouraged to actively participate in their health care
plan. Engaging patients in the delivery of health care is essential
for active negotiation of treatment options. Using power sharing
and negotiation, patients and health care providers are able to cre-
ate mutually agreed upon treatment plans to help best meet the
patient’s individual needs.
Partnership in training
In a training environment, effective partnership requires the
nursing student to move from the expert role in order to become
a partner with the patient, play an equal role and establish goals
together (Courtney et al., 1996) thereby enhancing patient empow-
erment (Gallant et al., 2002). Antecedents of partnership (Gallant
et al., 2002) include: (a) partners must value each other as a worth-
while human being with unique needs, regardless of socioeco-
nomic class; (b) partners must value cooperative and share
responsibilities, power and accountability; (c) partners must be
open and respectful towards what each member brings to a part-
nership; (d) the nursing student must believe in the patient’s capa-
bilities, and be willing to step down from the status associated
with being a nursing student; and (e) the nursing student must be-
lieve in the patient’s empowerment and encourage the patient’s
active participation in their health care plan and decision making.
The middle range theory of pain: a balance between analgesic and side
effects
MRT’s can assist practice by providing an understanding of a pa-
tient’s behavior, suggesting interventions, and discussing possible
explanations for the degree of effectiveness of the interventions
(Peterson and Bredow, 2004). Since it appears no middle range the-
ory has been published from the PEICM, Good’s MRT of pain (The
theory of balance between analgesic and side effects) is congruent
with the philosophical underpinnings of the PEICM and therefore,
was used for this case. This theory was developed from acute pain
management guidelines published by the Agency for Health Care
Policy and Research (Acute Pain Management Guideline Panel,
1992). Good’s MRT of pain suggests that in order to achieve a balance
of analgesia and medication side effects for patients experiencing
acute pain nursing students need to administer potent pain medica-
tion and provide non-pharmacologic interventions (Good, 1998).
Three propositions guide this theory: (1) multimodal interventions
(administering potent medication along with pharmacologic or
non-pharmacologic interventions); (2) attentive care (regular pain
assessment and side effect assessment); and (3) patient participa-
tion (goal setting and patient teaching) (Good, 1998). These three
elements are congruent with the PEICM because they both value
and believe in patient participation, partnership, holistic approach,
and recognize the determinants of health using a PHC lens.
Empirical indicator
Empirical indicators are tools or protocols to record observa-
tions, guide and evaluate nursing practice. It is a method to collect
data which can be an actual instrument, experimental condition, or
clinical procedure and should be congruent with a conceptual
model and middle range theory (Fawcett, 2005). The SF-MPQ cho-
sen as the empirical indicator for this case is an extension of the
50 J.F. Blanchard, D.A. Murnaghan / Nurse Education in Practice 10 (2010) 48–51
McGill Pain Questionnaire (MPQ) developed by Ronald Melzack in
1975. The SF-MPQ, [which focuses on pain description and offers a
methodological approach to assess the sensory, affective and eval-
uative components of pain] was developed to provide a brief pain
assessment that takes approximately 2 min to complete.
Several studies have shown that the SF-MPQ is a valid, objective
and reliable instrument. Currently, it is one of the most widely
used assessment tools for measuring pain (Sloman et al., 2005;
Chang et al., 2006; Kahl and Cleland, 2005). The cronbach coeffi-
cient alpha for the SF-MPQ is 0.81 (Karp et al., 2006). The SF-
MPQ has been shown to have high correlations with the original
version (MPQ), with correlation coefficients varying from 0.67 to
0.90 (Melzack, 1987). SF-MPQ consists of 15 pain descriptors (11
sensory and 4 affective), present pain intensity (PPI), and a visual
analogue scale (VAS) (Mystakidoum et al., 2002; Melzack, 1975;
Turk and Melzack, 2001).
SF-MPQ was chosen because it is complementary to the con-
structs of the PEICM and Good’s MRT of pain. Further, the SF-
MPQ is well suited for an emergency unit given that it is compre-
hensive, quick and easy to administer, easily understood by pa-
tients, simple to score, and most importantly the tool has the
ability to measure the sensory and affective components of pain
(Bondestam et al., 1987). Previous empirical use of the SF-MPQ
(MacDonald and Weiskopf, 2001; Ronnevig et al., 2003) demon-
strated that when interviewing patients the majority used words
or synonyms of the sensory and affective word descriptors in-
cluded in the SF-MPQ.
Case application
This case study describes the application of the C-T-E frame-
work by a senior nursing student in an undergraduate nursing pro-
gram and explores the nursing student’s experience of working
with the C-T-E in the pain management care of a patient presenting
with chest pain to the emergency department. Mr. Wood, a 55 year
old male was admitted to the Emergency Department complaining
of chest pain. During his admission, the philosophy and principles
of primary health described in the PEICM (Munro et al., 2000) were
used to guide the nursing student’s approach to care. In accordance
with the C-T-E system, Mr. Wood was viewed as a biopsychosocial
spiritual person who had many factors (determinants of health)
which impacted his perception of pain. The principles of PHC were
used as a lens to consider all aspects of Mr. Wood’s situation.
Partnership was a key component to guiding pain control for
Mr. Wood. The five antecedents of partnership theory (Gallant
et al., 2002) provided a systematic approach when assessing Mr.
Wood. Partnership was used in caring for Mr. Wood in a number
of ways. The nursing student encouraged Mr. Wood to participate
in his own care and agreed to play an equal role in the relationship.
The nursing student used language the patient could understand
when explaining the SF-MPQ and procedures being done. The pa-
tient willingly agreed to complete the SF-MPQ and the results of
the data gathered were used by Mr. Wood and the nursing student
to identify his degree of pain. Mr. Wood played an active role in
describing his pain by using the SF-MPQ and the nursing student
provided for confidentiality and demonstrated empathy by recog-
nizing his concerns. The nursing student assessed Mr. Wood’s con-
dition frequently and intervened appropriately when necessary
which led to Mr. Wood developing trust in the nursing student.
The student reviewed with him and his wife the chest pain proto-
col. If Mr. Wood’s acuity of illness was more serious (i.e. decreased
responsiveness) and could not be active in his care the nursing stu-
dent would have provided care based on pain assessment data and
using standard pain management protocols while keeping Mr.
Wood and his family informed of the treatment plan.
Using the SF-MPQ, Mr. Wood chose appropriate descriptive
words that matched his pain level and rated his pain an 8/10 on
the pain scale section of the tool. The nursing student considered
the three propositions of the pain control theory (multimodal
interventions, attentive care and patient participation) when
reviewing the results of the SF-MPQ. The student’s experience with
C-T-E helped her to understand the importance of communicating
with Mr. Wood about his care. By discussing the importance of all
the treatments and procedures and how Mr. Wood could help the
nursing student in the intervention process a rapport underscored
by partnership was created.
By having Mr. Wood engage in developing an understanding of
his pain, the nursing student was able to help him complete the SF-
MPQ. As a result of the alliance established between the nursing
student and Mr. Wood, he was able to take an active role in imple-
menting non-pharmocological interventions and seemed to re-
spond in a more insightful manner to the institution’s chest pain
protocol. Taken together, these intervention measures resulted in
Mr. Wood’s empowerment. Throughout his care, he was receptive
to receiving the treatment suggested and stated that he felt in-
cluded in his care by completing the SF-MPQ.
In this case, best practice standards for pain management were
achieved. The nursing student worked collaboratively with Mr.
Wood by providing non-pharmacological measures (e.g., assessing
vital signs every 15 min, assisting Mr. Wood to a comfortable posi-
tion in the stretcher, providing him with a warm blanket and giv-
ing reassurance and supportive care to him and his wife).
Additionally, the physician on call ordered pharmacological inter-
ventions included in the institution chest pain protocol (i.e. elec-
trocardiogram, oxygen, nitroglycerine, morphine).
Mr. Wood repeated the SF-MPQ 30 min after initiation of treat-
ment and rated his pain as a 3/10 on the pain scale. The posttest
results show that Mr. Wood’s pain diminished suggesting that
appropriate interventions were effective. These interventions were
derived from the proper use of partnership, identifying and apply-
ing the propositions of the pain control theory and using the SF-
MPQ as the assessment tool. The results of the SF-MPQ were dis-
cussed with Mr. Wood and he validated that he felt understood
by the nursing student.
Discussion
Four important lessons were identified from using the (C-T-E)
system in this case study. First, the two way partnership allowed
the nursing student to work collaboratively with Mr. Wood to en-
hance his care, while implementing the standardized chest pain
protocol to address his pain. What made this type of health service
delivery different from the usual care was the focus on informed
theory on pain management. In this case, the nursing student used
her knowledge of a MRT and an empirical assessment tool to work
in partnership with the patient. Using this approach enabled the
student to teach Mr. Wood to use and report changes in his pain
assessment and encouraged him to communicate his need for pain
control measures. By using this system the nursing student was
able to clearly move forward with Mr. Wood in achieving pain
control.
The second lesson learned is that the SF-MPQ tool provided Mr.
Wood with a number of ways to describe his pain (i.e. descriptive
words, numbers and visual analog scale) resulting in comprehen-
sive, relevant and specific information. Scoring the SF-MPQ gave
the nursing student direction and assisted in deciding appropriate
interventions.
The third lesson was that using the C-T-E system fits well into
the clinical setting. Prior to using this system the nursing student
found herself not fully understanding her patient’s situation and
 J.F. Blanchard, D.A. Murnaghan / Nurse Education in Practice 10 (2010) 48–51
degree of pain and often found herself providing only pharmaco-
logical interventions for pain control. Had the nursing student
not acquired the theoretical knowledge of C-T-E and had the
opportunity to apply this in a practice setting, she may not have
been able to gather comprehensive pain assessment data. Failure
to obtain such information could have resulted in nursing care that
would be considered inadequate.
Fourth lesson is the need for continuity in knowledge, tools, and
resources to implement a coordinated C-T-E approach in nursing
practice. Currently, there is no literature that examines the PEICM
and the middle range of pain in caring for a patient with chest pain.
Current assessment tools for practice are not designed to follow
the PEICM and therefore it would be important to adopt appropri-
ate tools for the setting. Further, patient care could become disor-
ganized and the result may be nursing care that appears disjointed
if the C-T-E approach is not consistently used.
Challenges and opportunities to using the C-T-E approach in nursing
practice
Some challenges to using a C-T-E system might include adop-
tion of a theoretical approach that uses terminology that is not of-
ten clear because of the complexity of the underlying theoretical
postulates of the disciplines from where the theory has been
derived.
The majority of the literature on C-T-E is written by and for
graduate and post doctoral level practice. The complexity of the
language may be the reason why there is minimal use of nursing
models and theories in practice. For example, the term empirical
indicator is simply another word for protocols, scripts and data
assessment tools that are based on theory that can be used by
nurses to collect relevant information.
This nursing student believes that if nursing models and theo-
ries are not a key component of a nursing unit mission statement,
new graduate nursing students will be reluctant to use their
knowledge in nursing theory and therefore opt to use more tradi-
tional and entrenched nursing care within their new work environ-
ment. Training must be provided to nurses currently working in
the field. New graduates who have this enhanced knowledge could
play a valuable role in such training, resulting in an enhance sense
of value to the practice.
One might suggest that this inclusive and knowledge based ap-
proach to patient care is no different than what has been done by
nurses for years. What is different is the C-T-E-approach challenges
nurses to reflect on nursing knowledge or borrow from other disci-
pline theories that are congruent with nursing practice to provide
evidence informed nursing care. By being explicit the nurse is then
challenged to adopt a continuity of care approach, provide clear
protocols for practice through patient care plans, nursing assess-
ment tools and documentation of care.
Conclusion
Using the C-T-E system, this nursing student was able to con-
sciously look at how theory can be used explicitly in practice and
identify possible challenges to implementing nursing theory in pa-
tient care. The C-T-E system allowed this nurse to use knowledge
from the discipline to guide her approach to Mr. Wood. She used
a valid assessment tool to collect specific pain related data and
then linked the findings from that assessment to guide the nursing
actions for Mr. Wood. By using congruent theory, this nursing stu-
dent understood the rationale behind her practice and allowed her
51
to practice in the broader scope of her nursing practice. In the fu-
ture, if nursing students use the C-T-E process they might be better
able to fully assess patient’s pain in a systematic way that leads to
more comprehensive nursing action. This nursing student believes
that nursing models can strengthen the quality of nursing care pro-
vided to the patient by working in partnership, focusing on the pri-
ority health concern, and evaluating interventions.
References
Acute Pain Management Guideline Panel, 1992. Journal of Pain and Symptom
Management 7(4), 214–228.
Advisory Committee on Population Health, 1994. Strategies for population health:
investing in the health of Canadians. Minister of Supply and Services Canada,
Ottawa.
Bird, J., 2005. Assessing pain in older people. Nursing Standard 16 (19), 45–54.
Bondestam, E., Hovgren, E., Hovgren, K., Gaston Johansson, F., Jern, S., Herlitz, J.,
Holmberg, S., 1987. Pain assessment by patients and nursing students in the
early phase of acute myocardial infarction. Journal of Advanced Nursing 12 (6),
677–682.
Bourbonnais, F.F., Perreault, A., Bouvettte, M., 2003. Introduction of pain and
symptoms assessment tool in the clinical setting: lessons learned. Journal of
Nursing Management 12 (3), 194–200.
Bryant, H., 2007. Pain: a multifaceted phenomenon. Emergency Nurse 14 (10), 6–10.
Chang, M., Chen, C., Huang, K., 2006. A comparison of massage effects on labor pain
using the McGill pain questionnaire. Journal of Nursing Research 14 (3), 190–
197.
Courtney, R., Ballard, E., Fauver, S., Gariota, M., Holland, L., 1996. The partnership
model: working with individuals, families, and communities toward a new
vision of health. Public Health Nursing 13 (3), 177–186.
Dolan, B., 2000. Pain management. In: Dolan, B., Holt, L. (Eds.), Accident and
Emergency Theory into Practice. Bailliere Tindal, London.
Fawcett, J., 2005. Contemporary Nursing Knowledge: Analysis of Evaluation of
Nursing Models and Theories, third ed. F.A. Davis Company, Philadelphia, PA.
Gallant, M.H., Beaulieu, M.C., Carnevale, F.A., 2002. Partnership: an analysis of the
concept within the nursing student–patient relationship. Journal of Advanced
Nursing 40 (2), 149–157.
Gatlin, C.G., Schulmeister, L., 2007. When medication is not enough:
nonpharmacologic management of pain. Clinical Journal of Oncology Nursing
11 (5), 699–704.
Good, M., 1998. A middle-range theory of acute pain management: use in research.
Nursing Outlook 46 (3), 120–124.
Hogan, S.L., 2005. Patient satisfaction with pain management in the emergency
department. Advanced Emergency Nursing Journal 27 (4), 284–294.
Kahl, C., Cleland, J.A., 2005. Visual analogue scale, numeric pain rating scale and the
McGill pain questionnaire: an overview of psychometric properties. Physical
Therapy Reviews 10 (2), 123–128.
Karp, J., Reynolds, C., Butters, M., Dew, M., Mazumdar, S., Begley, A., Lenze, E.,
Weiner, D., 2006. The relationship between pain and mental flexibility in older
adult pain clinic patients. Pain Medicine 7 (5), 444–452.
MacDonald, D.D., Weiskopf, C.S., 2001. Adult patients’ postoperative pain
descriptors and responses to the short-form McGill pain questionnaire.
Clinical Nursing Research 10 (4), 442–452.
Melzack, R., 1975. The McGill pain questionnaire: major properties and scoring
methods. Pain 1 (3), 277–279.
Melzack, R., 1982. Recent concepts of pain. Journal of Medicine 13 (3), 147–160.
Melzack, R., 1987. The short-form McGill pain questionnaire. Pain 30, 191–197.
Munro, M., Gallant, M., MacKinnon, M., Dell, G., Herbert, R., MacNutt, G., McCarthy,
M.J., Murnaghan, D., Robertson, K., 2000. The Prince Edward Island conceptual
model of nursing: a nursing perspective of primary health care. Canadian
Journal of Nursing Research 32 (1), 39–55.
Mystakidoum, K., Parpa, E., Tsilika, E., Kalaidopoulou, O., Georgaki, S., Galanos, A.,
Vlahos, L., 2002. Greek McGill pain questionnaire: validation and utility in
cancer patients. Journal of Pain and Symptom Management 24 (4), 379–387.
Peterson, S., Bredow, T., 2004. Middle Range Theories: Application to Nursing
Practice. Lippincott Williams & Wilkins, Philadelphia, PA.
Raudonis, B.M., Acton, G.L., 1997. Theory-based nursing practice. Journal of
Advanced Nursing 26, 138–145.
Ronnevig, M., Bjorsvik, E., Gullestad, L., Forfang, K., 2003. A descriptive study of early
nonspecific chest pain after PTCA: important area for the acute health care
personnel. Heart and Lung 32 (4), 241–249.
Sloman, S., Rosen, G., Rom, M., Shir, Y., 2005. Nursing students’ assessment of pain in
surgical patients. Journal of Advanced Nursing 52 (2), 125–132.
Strickland, W.J., Strickland, D.L., 1996. Partnership building with special
populations. Family Community Health 19, 21–34.
Turk, D.C., Melzack, R. (Eds.), 2001. Handbook of Pain Assessment, second ed. The
Guilford Press, New York.