Evaluation of Clinical Nursing Practice Guidelines of Extremity Injury Pain Management in Emergency Room

Main Article Content

Pornsiri Kanokkanjana
Suchira Chaiviboontham
Jiraporn Sri-on


This action research aimed to develop the clinical nursing practice guideline (CNPG) of extremity injury pain management in emergency room which developed based on evidence-based practices. It was tested for feasibility among 162 patients, 22 medical residents and 42 nurses at the University hospital, Bangkok. The instruments were divided into 3 parts; 1) screening patients 2) research instruments 3) data collection tool. Data were analyzed using descriptive statistics, One Sample T-test, and Mann Whitney U test. The results on the clinical outcomes showed that the average pain score on arrival and leaving the emergency room was significantly decrease (p<.05). It also continuously decreases of pain after pain management with this guideline on arrival and at 30, 60, 90, 120, 180, 240 minutes and leaving the emergency room. For patient’s outcome, the study showed the satisfaction with pain management was at a high level. The results of the feasibility indicated high scores for both providers’ satisfaction and collaboration with clinical nursing practice guidelines including nurses’ perception of pain management. Therefore, the clinical nursing practice guidelines of extremity injury pain management in emergency room could improve the patient outcomes and promote healthcare providers’ capability in this study. The guideline could be applied for pain management in each emergency room context. The healthcare provider should focus on continuing pain assessment and management using both pharmacological and non-pharmacological methods. The monitoring and recording of the management outcomes could help the patients receive appropriate pain management.


Download data is not yet available.

Article Details

How to Cite
Kanokkanjana, P., Chaiviboontham, S., & Sri-on, J. (2022). Evaluation of Clinical Nursing Practice Guidelines of Extremity Injury Pain Management in Emergency Room. Thai Journal of Nursing and Midwifery Practice, 9(1), 88–107. Retrieved from https://he02.tci-thaijo.org/index.php/apnj/article/view/255789
Research report


Ridderikhof ML, Schyns FJ, Schep NW, Lirk P, Hollmann MW, Gosling JC. Emergency department pain management in adult patients with traumatic injuries before and after implementation of a nurse initiated pain treatment protocol utilizing fentanyl for severe pain. JEM 2017;52: 41-25.

Alavi NM, Aboutalebi MS, Sada Z. Pain management of trauma patients in the emergency department: a study in a public hospital in Iran. Int Emerg Nurs 2017; 33:53-8.

Jahanian F, Hosseininejad SM, Ahidashti HA, Bozorgi F, Khatir IG, Montazar SH, et.al. Efficacy and safety of morphine and low dose ketamine for pain control of patients with long bone fractures: a randomized, double blind, clinical trial. BEAT 2018; 6:31-6.

Ministry of Public Health. (2018). New way of life good life starts with us. Retrieved from http://www.thaihealth.or.th.

Pierik JG, IJzerman MJ, Gaakeer MI, Berben, SA., Eenennaam, Doggen CJ. Pain management in the emergency chain: the use and effectiveness of pain management in patients with acute musculoskeletal pain. Pain Medicine 2015; 16:970–84.

Christie OO, Oluseyi AO, Olufunke. Factors associated with utilization of pain assessment tools in pain management among nurses in selected hospitals in Ekiti State. Int J Caring Sci 2018; 11:163-70.

Dibmann PD, Malignan M, Cloves PD, Parres BG, Dickerson S, Eberhardt AA. Review of the burden of trauma pain in emergency setting in Europe, Pain Therapy Journal 2018;7:179-92.

Boccio BS, Wie BA, Pasternak S, Salvador-Kelly A, Ward MF, Amore JD. The relationship between patient age and pain management of acute long bone fracture in the ED. Am J Emerg Med 2014; 32:1516-19.

Chang HL, Jung JH, Kwak YH, Kim DK, Lee JH, Jung JY, et.al. Quality improvement activity for improving pain management in acute extremity injuries in the emergency department. Clin Exp Emerg Med 2018; 5:51-9.

Pierik JG, Berben SA, Ijzerman MJ, Gaakeer MJ, Eenennaam FL, Vugt AB. A nurse-initiated pain protocol in the ED improves pain treatment in patients with acute musculoskeletal pain. Int Emerg Nurs 2016; 27:3-10.

Sepahvand M, Gholami M, Hosseinabadi R, Beiranvand, A. The use of a nurse-initiated pain protocol in the emergency department for patients with musculoskeletal injury: a pre-post intervention study. Pain Manag Nurs 2019;1-10.

Butti L, Bierti O, Lanfrit R, Bertolini R, Chittaro S, Compagni SD, et.al. Evaluation of the effectiveness and efficiency of the triage emergency department nursing protocol for the management of pain. J Pain Res 2017; 10:2479–88.

Clinical Guidance for Acute Pain Management. 1st ed. Thai association for the study of pain (TASP); 2009.

Rogers EM. Diffusion of innovations. 4th ed. New York; 2003.

Srisatitnarakun B. Research regulations in nursing science. Bangkok; 2010.

Waewwanjit D. The development and evaluation of clinical nursing practice guideline for fever management in patients with traumatic brain injury, SongklaNagarind hospital. SongklaNagarind Hospital, Prince of Songkla University; 2011. (In Thai)

Varndell, W., Fry, M., Elliott, D. Quality and impact of nurs initiated analgesia in the emergency department: A systematic review. Int Emerg Nurs 2018; 40:46–53.

Yodkolkij T. Clinical practice guideline implementation in colorectal disease patients undergoing abdominal surgery, Thai Journal of Nursing and Midwifery Practice; 2018. (In Thai)

The Royal College of Physicians of Thailand. Recommendations on “Critical Practice Guidelines”. Physician of Thailand 2001;18(6):36-47.

Pieretti S, Giannuario AD, Giovannandrea RD, Marzoli F, Piccaro G, Minosi P, etal. Gender differences in pain and its relief. Ann Ist super sanita 2016; 52:184-89.

Hatherley C, Jenning N, Cross R. Time to analgesia and pain score documentation best practice standards for the emergency department-a literature review. Aust Emerg Nurs J 2016; 19:26-36.