Date of Conferral



Doctor of Nursing Practice (DNP)




Sue Bell


The clinical practice problem addressed was pain control in emergency department (ED) patients. The purpose of this project was to establish situations when inhaled nitrous oxide (N2O) could be used to manage pain in the ED. Specifically, a systematic review provided answers to questions related to appropriate uses of N2O in acute pain management, the effectiveness of inhaled N2O in managing acute pain, and the benefits of and barriers to N2O use in the ED. The middle range nursing theory of acute pain management published by the Agency for Health Care Policy and Research served as the theoretical support for the project. A systematic literature review using the PRISMA checklist yielded 5 studies that were incorporated into the synthesis of evidence. Inhaled N2O was found to be safe and effective for managing pain in some ED patients and in women undergoing labor. N2O can be used in pediatric and adult patients for minor procedural pain relief and pain associated with burns and cancer. N2O was associated with improved outcomes and increased patient and family satisfaction. However, extensive adoption was hindered by the scarcity of the delivery equipment, untrained medical staff, and the increasing use of N2O as a recreational drug with addictive properties. Although integrating the use of inhaled N2O to mitigate pain may improve patient outcomes, more research is indicated before the widespread use of the drug can be encouraged. The findings were communicated to the ED staff for consideration of the limited adoption of N2O in the ED. The use of this alternative evidence-based and effective pain control agent may result in positive social change by lessening acute or procedural pain experienced by patients in specific ED situations.

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