Only the priority problem shall be addressed in the second level assessment here (although the nurse would need to assess all the maladaptive behaviours in a similar way). Under normal circumstances, the patient would be involved in the decision making process about whether this behaviour was adaptive or maladaptive. However, the patient has already inferred that this is a problem for which he needs intervention by presenting himself in the A&E department. The nurse must now decide what are the stimuli causing the problem. The focal stimulus is the lack of blood supply to the myocardium. This is the stimulus which would be initially selected for management as it is the primary cause of the problem (Fawcett 1990 ; Gerrish 1989). The contextual stimuli may have been a flight of stairs that Mr Davis climbed just before the pain started or anxiety related to a family problem. A residual stimulus may be that he has had this kind of pain before and he knows that there is an end to it. This will actually help him to adapt more quickly.