Objective To explore the application effect of narrative nursing based on the PERMA theory on fear and pain management during the peri-debridement period in emergency hand injury patients. Methods A total of 350 emergency hand injury patients requiring debridement admitted to the Emergency Department of Zhongshan Hospital Xiamen University from January 2024 to December 2025 were selected. They were divided into the control group and the observation group using the random number table method, with 175 cases in each group. The control group received routine nursing care during the peri-debridement period for emergency hand injuries, the observation group received narrative nursing intervention based on the PERMA theory in addition to routine nursing care. The fear visual analogue scale (VAS-F), pain visual analogue scale (VAS), Chinese version of the post-traumatic growth inventory (C-PTGI) scores, nursing satisfaction, and peri-debridement compliance were compared between the two groups before and after intervention. Results After intervention, the VAS-F score (2.04±0.76 vs. 4.15±0.92) and VAS score (2.93±0.89 vs. 3.86±1.03) in the observation group were significantly lower than those in the control group (all P＜0.05), while the C-PTGI score (36.89±4.57 vs. 28.74± 4.12) was significantly higher than that in the control group (P＜0.05). The excellent and good rate of peri-debridement compliance (94.86% vs. 81.71%) and nursing satisfaction (96.57% vs. 86.86%) in the observation group were significantly higher than those in the control group (all P＜0.05). Conclusion Narrative nursing based on the PERMA theory can effectively alleviate fear and pain during the peri-debridement period in emergency hand injury patients, promote posttraumatic growth, and improve treatment compliance and nursing satisfaction.