Intrauterine contraception insertion pain: nursing interventions to improve patient experience.
OBJECTIVE
To examine factors which contribute to the individual's experience of pain in relation to intrauterine contraception insertion and determine evidence-based nursing strategies to best assess and manage this pain.


BACKGROUND
Nurses are increasingly involved in consultations regarding intrauterine contraception. However, concerns regarding painful or difficult insertion may inhibit uptake and discourage nurses from promoting or inserting intrauterine contraception.


METHODS
Integrative review.


METHODS
Database searches of CINAHL, PubMed, Wiley Online Library and the Cochrane Collaboration for relevant literature. Eight papers met the inclusion criteria and were analysed using an integrative review process.


RESULTS
Physical causes and pharmacological interventions for insertion pain have been thoroughly investigated. Absence of previous vaginal delivery and anxiety may increase the likelihood of procedural pain. The literature fails to conclusively determine any universally effective prophylactic analgesia. Cervical anaesthesia may be beneficial in some cases and oral analgesia may relieve postprocedural pain. Distraction in the form of conversation, music or television can be effective in reducing anxiety.


CONCLUSIONS
A combination of physical, psychological and environmental factors contribute to the individual's pain experience. Nurses have the potential to make a significant impact on pain outcomes by demonstrating clinical expertise and creating a trustful environment. Giving reliable information, acknowledging the significance of anxiety and providing reassurance and distraction are effective pain reducing strategies. Research into nonpharmacological approaches is warranted, especially those which reduce anxiety.


CONCLUSIONS
Increasing uptake of long-acting reversible contraception is a public health goal. Providing effective pain management strategies to improve patient experience may encourage more nurses to recommend, or enhance their scope of practice to include, intrauterine contraception insertion.
Cripps Health Centre, University of Nottingham Health Service, Nottingham, UK.
Carmel
http://orcid.org/0000-0003-4482-491X
C
McCarthy
D005260:Female; D006801:Humans; D007434:Intrauterine Devices / Q000009:adverse effects*; D059408:Pain Management / Q000451:nursing*; D000073818:Procedural Pain / Q000451:nursing*
anxiety; contraception; intrauterine; nursing; pain