Integrating the Numeric Rating Scale into Emergency Nursing Practice: An Integrative Review

To examine the role of the numeric rating scale (NRS) in emergency department (ED) triage, evaluating its strengths, limitations, and impact on nursing workflow (including time to analgesia administration, documentation practices, and protocol adherence) and patient outcomes (including pain relief efficacy, patient satisfaction, and analgesic treatment patterns).

Integrative review following Whittemore and Knafl's (2005) framework for data synthesis and analysis, with reporting guided by PRISMA 2020 guidelines for systematic review transparency.

PubMed/MEDLINE, Scopus, CINAHL, and Cochrane Library were searched for studies published from January 2017 to October 2025.

Primary studies conducted in adult ED settings across Europe, Asia, the Middle East, and Canada that utilized NRS (alone or compared with other validated pain scales) were included. Risk of bias was assessed using Joanna Briggs Institute critical appraisal tools.

Nine studies involving 132,047 adult patients (age range: 18-96 years) met inclusion criteria. Thematic synthesis of findings across heterogeneous study designs revealed three main patterns: (1) NRS demonstrates rapid administration and high patient acceptability, with preference rates reaching 50% compared to visual analog scales and verbal descriptor scales; (2) numerical scores do not always reflect analgesic needs-17.8% of patients with mild pain (NRS 0.5-3) requested treatment, while 35% with severe pain (NRS 7-10) declined; (3) nurse-initiated protocols based on NRS were associated with 45.6%-62.5% reductions in time to analgesia, improved documentation practices (10%-56%), and higher patient satisfaction with pain management measured at discharge (>9/10), though exclusive reliance on numerical scores may overlook clinical, emotional, and behavioral indicators.

NRS remains a fundamental tool for pain assessment in EDs, but measures only pain intensity and does not constitute a holistic pain assessment. It should therefore be embedded within structured protocols and complemented by additional assessment tools to capture the multidimensional nature of pain.