During hospitalization, cardiac patients encounter three highly unique environments--the Emergency Room (ER), Coronary Care Unit (CCU), and Progressive Coronary Care Unit (PCCU). It appears that patients are defining these environments and drawing a meaning that is different from that of nurses.

No systematic empirical evidence exists to document how cardiac patients define each of these units. The purpose of this study was to determine to what extent patients share a common definition of the ER, CCU, and PCCU.

The study was conducted in three stages. Stage I identified categories and groups of statements that emerged when patients were admitted to the hospital with chest pain. In Stage II, the categories and statements on definition of the situation, developed by further analysis of the fieldwork data, were used to construct a questionnaire. A pilot study confirmed commonalities in patients' definition of the situation within the ER, CCU, and PCCU.

In Stage III, a revised questionnaire was used to study fifty cardiac patients' definition of the situation between and across units. An ANOVA-Repeated Measures Design tested the hypotheses generated in Stage II. Scheffe Post Hoc Test determined the significant differences between units. The results showed that patients perceived more fear in the ER than in CCU or PCCU, and more fear in CCU than PCCU. Patients perceived more distress in the ER than in CCU or PCCU; no significant difference was seen in perceived distress between CCU and PCCU. Patients perceived less help and less support from the staff in the ER than in CCU or PCCU. No significant difference was noted in perceived help and support between CCU and PCCU.

Findings support the theoretical position that commonalities exist in cardiac patients' definitions of the situation in the ER, CCU, and PCCU, that are similar within units and vary across units. Recommendations for nursing practice, nursing education, and nursing research were discussed.