Running head: THERAPEUTIC NURSING INTERVENTIONS 1

Therapeutic Nursing Interventions in the Emergency Department

Ellen Gilliam

Old Dominion University

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Introduction

The Emergency Room where I work in is a Level II trauma center located in an urban

area consisting of 42 beds. I work as a Patient Care Assistant and see numerous patients who

come in with excruciating pain first hand. Pain is highly subjective and is manifested in various

states in patients who seek care in the Emergency Department. Patients may be angry, crying,

pacing, or shaking due to pain. I chose this subject to investigate because the majority of the

patients I work with are seeking treatment due to acute pain. I have experienced a patient

walking in crying because of their abdominal pain. I’ve had to obtain vitals on a patient who was

screaming and shaking because she was experiencing intense flank pain, and a patient who felt

like they were going to pass out due to a painful fracture of their wrist. Pain is a common

symptom of patients coming into the Emergency Department that nurses can positively impact

by carrying out therapeutic nursing interventions.

Current Practice

In “Effective Pain Management and Improvements in Patients’ Outcomes and

Satisfaction,” Diane Glowacki stated that a huge barrier to effective pain management is a lack

of proficient pain assessments. She also stated that a thorough pain assessment and shared goal

setting are critical to efficient pain management and positive outcomes. Formal mechanisms

currently in place at the Emergency Department include assessing the patient’s pain to include

severity, location, and duration in triage, applying heat or ice if applicable, providing a quiet

environment, administering prescribed analgesics, and completing ordered tests to find the cause

of the pain if it is not obvious.

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In a randomized clinical trial conducted by Chang, Bijur, and Esses, they tested the effect

of a single dose of oral opioid and nonopioid analgesics in acute extremity pain in the

Emergency Department (2017). Of 416 patients randomized, 411 were analyzed with a mean

NRS pain score of 8.7. Within 2 hours, the mean NRS pain score decreased by 43 in the

ibuprofen and acetaminophen group, 4.4 in the oxycodone and acetaminophen group, 3.5 in the

hydrocodone and acetaminophen group, and by 3.9 in the codeine and acetaminophen group

(Chang et al, 2017). Although none of the analgesics completely diminished the patient’s pain,

they did decrease it. Administering pain medications is an efficient nursing intervention to

reduce pain in the patient’s seeking treatment in the Emergency Department.

It is important to obtain frequent vital signs in all patients seeking treatment in the

Emergency Department, especially those experiencing pain. When patients experience acute

pain, their vital signs will be elevated (Trakalo, Horowitz, & McCulloch, 2015). In an

observational descriptive study testing the validity of vital signs being an appropriate indicator of

pain, positive correlation coefficients were found between heart rate, respiratory rate, and

patient’s pain intensity (Erden, Demir, Ugras, Arslan, and Arslan, 2018). When obtaining vital

signs on a patient experiencing pain, it is essential for the nurse to pay attention to the patient’s

heart rate, respiratory rate, and pain intensity in the Emergency Department.

The nurses I work with do an amazing job at implementing these formal mechanisms.

However, the only discrepancy I observe are patients being placed in the waiting room for an

extended period of time, preventing them from being in a quiet environment or receiving

analgesics. Nurses cannot medicate patients in the waiting room because a physician must see

them first and request an order, resulting in patients sitting in the waiting room in pain if there is

a wait.
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Nursing Interventions

Nursing interventions are actions and actual treatments that nurses carry out to help the

patient reach their optimal function and set goals. Three nursing interventions that could be

implemented for pain management in the Emergency Department that are not currently in

practice include music therapy, guided imagery, and acupuncture.

Music therapy is the therapeutic use of music to reduce anxiety and negative

physiological and psychological experiences. A longitudinal matched case-control study design

was used to decipher effects of music therapy on patients in the Emergency Department. Using

music therapy services did not result in significantly different patient ED satisfaction scores;

however, patients’ self-reported scores for stress and pain decreased significantly following

music therapy (Mandel, Davis, Secic, 2019). Music therapy also proves to be impactful in

managing pain during invasive medical procedures that can be performed in the Emergency

Department (Mandel et al., 2019).

A pilot study was conducted to test the feasibility of a guided imagery stress and pain

reduction intervention protocol in adults suffering from sickle cell disease (SCD). Patients with

SCD were split into two groups: a control group and a guided imagery group. The guided

imagery group viewed a 12-minute guided imagery video and the control group was instructed to

record their sickle cell experience on the tablet for 12 minutes. Findings from this study were

consistent with the hypothesis that guided imagery intervention can be used to reduce current

stress and pain, as well as to control pain in emergency department while waiting to be evaluated

for further pain management (Ezenwa, 2016).

Acupuncture is an integral part of traditional Chinese medicine, it stimulates anatomical

points on the body using very thin, metallic needles. There has been evidence that acupuncture
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can help treat back pain and pain associated with osteoarthritis (Trakalo et al., 2015). A pilot

feasibility study was conducted on patients with lower back pain in an Emergency Department,

these patients were separated into two groups. One group received standard care and the second

group received standard care plus battlefield acupuncture. Battlefield acupuncture is a simple

acupuncture protocol the military designed providing immediate relief of acute pain through the

application of 5 pre-specified points on the ear (Fox, Danesh, Murakami, Gestal, Harper-Brooks,

Jalloh, Linton, Ortiz, Tapia, Manini, 2016). Lower back pain in patients who received standard

card plus battlefield acupuncture was significantly improved compared to patients who received

standard care only (Fox et al., 2016). These studies proved battlefield acupuncture was a feasible

alternative therapy to standard therapy for lower back pain in the Emergency Department.

Pain is a major factor in patients’ seeking treatment in the Emergency Department. It can

range from chest pain, to back pain, to fractures and sore throats. A nurse has many roles and

opportunities to decrease the patient’s intensity of pain through therapeutic nursing interventions

such as performing a full pain assessment, obtaining vital signs, and administering prescribed

analgesics. However, research shows that implementing alternative therapeutic nursing

interventions such as music therapy, guided imagery, and acupuncture may add to the efficiency

and timely relief of pain patient’s experience when seeking care in the Emergency Department.
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Reference List

Chang, A.K., Bijur, P.E., Esses D., Barnaby, D.P., Baer, J. (2017). Effect of a single dose of oral

opioid and nonopioid analgesics on acute extremity pain in the emergency department: A

randomized clinical trial. JAMA.318(17), 1661–1667. doi:10.1001/jama.2017.16190.

Erden, S., Demir, N., Ugras, G.A., Arslan, U., Arslan, S. (2018). Vital signs: Valid indicators

to assess pain in intensive care unit patients? An observational, descriptive study. Nurs

Health Sci. 20, 502–508. https://doi-org.proxy.lib.odu.edu/10.1111/nhs.12543

Ezenwa, Miriam O. (2016). Guided imagery intervention for stress and pain in adults with sickle

cell disease. Retrieved from: https://sigma.nursingrepository.org/handle/10755/601790

Glowacki, D (2015). Effective pain management and improvements in patients’ outcomes and

satisfaction. Critical Care Nurse 35, 33-41. Retrieved from:

https://www.aacn.org/docs/cemedia/C1533.pdf

Susan E Mandel, Beth A Davis, Michelle Secic. (2019). Patient satisfaction and benefits of

music therapy services to manage stress and pain in the hospital emergency

department, Journal of Music Therapy, 56(2), 149–173, https://doi-

org.proxy.lib.odu.edu/10.1093/jmt/thz001

Fox L.M., Danesh, H., Gesetal, C., Harper-Brooks, A., Jalloh, Y.K., Linton, E., Ortiz, V., Tapia,

B., Manina, A.F. (2016). 207 randomized trial of acupuncture versus standard therapy to

treat low back pain in the emergency department, Annals of Emergency Medicine, 68(4).

https://doi.org/10.1016/j.annemergmed.2016.08.221.

Trakalo, K. Horowitz, L. & McCulloch, A. (Eds.). (2015). Nursing: A concept-based approach

to learning (2nd ed., Vol. 1). Boston, MA: Pearson Education.

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